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EXAMINING THE U.S. PUBLIC HEALTH RESPONSE 

TO THE EBOLA OUTBREAK 

HEARING 

BEFORE THE

SUBCOMMITTEE ON OVERSIGHT AND 

INVESTIGATIONS 

OF THE

COMMITTEE ON ENERGY AND 

COMMERCE 

HOUSE OF REPRESENTATIVES 

ONE HUNDRED THIRTEENTH CONGRESS 

SECOND SESSION 

OCTOBER 16, 2014 

Serial No. 113–179 

( 

Printed for the use of the Committee on Energy and Commerce 

energycommerce.house.gov 

COMMITTEE ON ENERGY AND COMMERCE 

FRED UPTON, Michigan 

Chairman 

RALPH M. HALL, Texas 

JOE BARTON, Texas 

Chairman Emeritus 

ED WHITFIELD, Kentucky 

JOHN SHIMKUS, Illinois 

JOSEPH R. PITTS, Pennsylvania 

GREG WALDEN, Oregon 

LEE TERRY, Nebraska 

MIKE ROGERS, Michigan 

TIM MURPHY, Pennsylvania 

MICHAEL C. BURGESS, Texas 

MARSHA BLACKBURN, Tennessee 

Vice Chairman 

PHIL GINGREY, Georgia 

STEVE SCALISE, Louisiana 

ROBERT E. LATTA, Ohio 

CATHY MCMORRIS RODGERS, Washington 

GREGG HARPER, Mississippi 

LEONARD LANCE, New Jersey 

BILL CASSIDY, Louisiana 

BRETT GUTHRIE, Kentucky 

PETE OLSON, Texas 

DAVID B. MCKINLEY, West Virginia 

CORY GARDNER, Colorado 

MIKE POMPEO, Kansas 

ADAM KINZINGER, Illinois 

H. MORGAN GRIFFITH, Virginia 

GUS M. BILIRAKIS, Florida 

BILL JOHNSON, Ohio 

BILLY LONG, Missouri 

RENEE L. ELLMERS, North Carolina 

HENRY A. WAXMAN, California 

Ranking Member 

JOHN D. DINGELL, Michigan 

FRANK PALLONE, JR., New Jersey 

BOBBY L. RUSH, Illinois 

ANNA G. ESHOO, California 

ELIOT L. ENGEL, New York 

GENE GREEN, Texas 

DIANA DEGETTE, Colorado 

LOIS CAPPS, California 

MICHAEL F. DOYLE, Pennsylvania 

JANICE D. SCHAKOWSKY, Illinois 

JIM MATHESON, Utah 

G.K. BUTTERFIELD, North Carolina 

JOHN BARROW, Georgia 

DORIS O. MATSUI, California 

DONNA M. CHRISTENSEN, Virgin Islands 

KATHY CASTOR, Florida 

JOHN P. SARBANES, Maryland 

JERRY MCNERNEY, California 

BRUCE L. BRALEY, Iowa 

PETER WELCH, Vermont 

BEN RAY LUJAN, New Mexico 

PAUL TONKO, New York 

JOHN A. YARMUTH, Kentucky 

SUBCOMMITTEE ON OVERSIGHT AND INVESTIGATIONS

TIM MURPHY, Pennsylvania 

Chairman 

MICHAEL C. BURGESS, Texas 

Vice Chairman 

MARSHA BLACKBURN, Tennessee 

PHIL GINGREY, Georgia 

STEVE SCALISE, Louisiana 

GREGG HARPER, Mississippi 

PETE OLSON, Texas 

CORY GARDNER, Colorado 

H. MORGAN GRIFFITH, Virginia 

BILL JOHNSON, Ohio 

BILLY LONG, Missouri 

RENEE L. ELLMERS, North Carolina 

JOE BARTON, Texas 

FRED UPTON, Michigan (ex officio) 

DIANA DEGETTE, Colorado 

Ranking Member 

BRUCE L. BRALEY, Iowa 

BEN RAY LUJAN, New Mexico 

JANICE D. SCHAKOWSKY, Illinois 

G.K. BUTTERFIELD, North Carolina 

KATHY CASTOR, Florida 

PETER WELCH, Vermont 

PAUL TONKO, New York 

JOHN A. YARMUTH, Kentucky 

GENE GREEN, Texas 

JOHN D. DINGELL, Michigan (ex officio) 

HENRY A. WAXMAN, California (ex officio) 

(II) 

(III) 

C O N T E N T S 

Page 

Hon. Tim Murphy, a Representative in Congress from the Commonwealth 

of Pennsylvania, opening statement ................................................................... 2 

Prepared statement .......................................................................................... 3 

Hon. Diana DeGette, a Representative in Congress from the State of Colorado, opening statement ...................................................................................... 5 

Hon. Bruce L. Braley, a Representative in Congress from the State of Iowa, 

opening statement ................................................................................................ 6 

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

Hon. Fred Upton, a Representative in Congress from the State of Michigan, 

opening statement ................................................................................................ 7 

Prepared statement .......................................................................................... 8 

Hon. Michael C. Burgess, a Representative in Congress from the State of 

Texas, opening statement .................................................................................... 9 

Prepared statement .......................................................................................... 10 

Hon. Marsha Blackburn, a Representative in Congress from the State of 

Tennessee, opening statement ............................................................................ 10 

Hon. Henry A. Waxman, a Representative in Congress from the State of 

California, opening statement ............................................................................. 11 

Hon. Frank Pallone, Jr., a Representative in Congress from the State of 

New Jersey, prepared statement ........................................................................ 148 

Hon. Gene Green, a Representative in Congress from the State of Texas, 

prepared statement .............................................................................................. 150 

WITNESSES

Thomas R. Frieden, Director, Centers for Disease Control and Prevention ....... 13 

Prepared statement .......................................................................................... 16 

Answers to submitted questions ...................................................................... 163 

Anthony S. Fauci, Director, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Department of Health and Human 

Services ................................................................................................................. 29 

Prepared statement .......................................................................................... 31 

Answers to submitted questions ...................................................................... 195 

Robin A. Robinson, Deputy Assistant Secretary and Director, Biomedical Advanced Research and Development Authority, Office of the Assistant Secretary for Preparedness and Response, Department of Health and Human 

Services ................................................................................................................. 43 

Prepared statement .......................................................................................... 45 

Answers to submitted questions ...................................................................... 207 

Luciana Borio, Assistant Commissioner for Counterterrorism Policy and Director, Office of Counterterrorism and Emerging Threats, Food and Drug 

Administration, Department of Health and Human Services .......................... 56 

Prepared statement .......................................................................................... 58 

Answers to submitted questions ...................................................................... 214 

John P. Wagner, Acting Assistant Commissioner, Office of Field Operations, 

U.S. Customs and Border Protection, Department of Homeland Security ...... 66 

Prepared statement .......................................................................................... 68 

Answers to submitted questions ...................................................................... 217 

Daniel Varga, Chief Clinical Officer and Senior Executive Vice President, 

Texas Health Resources ....................................................................................... 72 

Prepared statement .......................................................................................... 75 

Answers to submitted questions ...................................................................... 228 

Page

IV 

SUBMITTED MATERIAL

Photo chart, ‘‘Levels of protective gear,’’ New York Times, submitted by Ms. 

DeGette ................................................................................................................. 84 

Report of October 15, 2014, ‘‘Safe Management of Patients with Ebola Virus 

Disease (EVD) in U.S. Hospitals,’’ Frequently Asked Questions, Centers 

for Disease Control and Prevention, submitted by Ms. DeGette ..................... 87 

Health Advisory of August 1, 2014, ‘‘Guidelines for Evaluation of U.S. Patients Suspected of Having Ebola Virus Disease,’’ Centers for Disease Control and Prevention, submitted by Ms. DeGette ................................................ 91 

Health Advisory of July 28, 2014, ‘‘Ebola Virus Disease Confirmed in a 

Traveler to Nigeria, Two U.S. Healthcare Workers in Liberia,’’ Centers 

for Disease Control and Prevention, submitted by Ms. DeGette ..................... 94 

Letter of October 16, 2014, from Randi Weingarten, President, American 

Federation of Teachers, to Mr. Upton and Mr. Waxman, submitted by 

Ms. Schakowsky ................................................................................................... 105 

Article, ‘‘Diary,’’ by Paul Farmer, London Review of Books, October 23, 2014 

issue, submitted by Ms. Schakowsky ................................................................. 108 

Letter of October 16, 2014, from Delegate Robert G. Marshall, House of 

Delegates, Commonwealth of Virginia, et al., to Terry McAuliffe, Governor, 

Commonwealth of Virginia, submitted by Mr. Griffith ..................................... 124 

Report of October 2014, ‘‘Will America’s Fragmented Public Health System 

Meet the Ebola Challenge?,’’ Scholars Strategy Network, submitted by Mr. 

Yarmuth ................................................................................................................ 129 

Map, ‘‘Top Passenger Flows: Number of passengers (weekly),’’ submitted by 

Ms. DeGette .......................................................................................................... 143 

Report of August 2014, ‘‘DHS Has Not Effectively Managed Pandemic Personal Protective Equipment and Antiviral Medical Countermeasures,’’ Office of Inspector General, Department of Homeland Security, 1 submitted 

by Mr. Burgess 

Photo showing personal protective equipment, Dallas Morning News, submitted by Mr. Burgess ......................................................................................... 146 

Subcommittee memorandum .................................................................................. 152 

1The report has been retained in committee files and also is available at 

http://docs.house.gov/meetings/IF/IF02/20141016/102718/HHRG-113- 

IF02-20141016-SD010.pdf. 

(1) 

EXAMINING THE U.S. PUBLIC HEALTH 

RESPONSE TO THE EBOLA OUTBREAK 

THURSDAY, OCTOBER 16, 2014 

HOUSE OF REPRESENTATIVES, 

SUBCOMMITTEE ON OVERSIGHT AND INVESTIGATIONS, 

COMMITTEE ON ENERGY AND COMMERCE, 

Washington, DC. 

The subcommittee met, pursuant to call, at 12:02 p.m., in room 

2123 of the Rayburn House Office Building, Hon. Tim Murphy 

(chairman of the subcommittee) presiding. 

Members present: Representatives Murphy, Burgess, Blackburn, 

Gingrey, Scalise, Gardner, Griffith, Johnson, Long, Ellmers, Upton 

(ex officio), DeGette, Braley, Schakowsky, Castor, Welch, Yarmuth, 

Green, and Waxman (ex officio). 

Also present: Representatives Matheson, Sarbanes, Harris, and 

Meadows. 

Staff present: Gary Andres, Staff Director; Charlotte Baker, Deputy Communications Director; Sean Bonyun, Communications Director; Leighton Brown, Press Assistant; Rebecca Card, Staff Assistant; Karen Christian, General Counsel; Noelle Clemente, Press 

Secretary; Marty Dannenfelser, Senior Advisor, Health Policy and 

Coalitions; Brenda Destro, Professional Staff Member, Health; 

Andy Duberstein, Deputy Press Secretary; Brad Grantz, Policy Coordinator, Oversight and Investigations; Sydne Harwick, Legislative Clerk; Brittany Havens, Legislative Clerk; Sean Hayes, Deputy 

Chief Counsel, Oversight and Investigations; Kirby Howard, Legislative Clerk; Charles Ingebretson, Chief Counsel, Oversight and Investigations; Emily Newman, Counsel, Oversight and Investigations; Krista Rosenthall, Counsel to Chairman Emeritus; Macey 

Sevcik, Press Assistant; Alan Slobodin, Deputy Chief Counsel, 

Oversight and Investigations; Sam Spector, Counsel, Oversight and 

Investigations; Jean Woodrow, Director of Information Technology; 

Ziky Ababiya, Democratic Staff Assistant; Peter Bodner, Democratic Counsel; Brian Cohen, Democratic Staff Director, Oversight 

and Investigations, and Senior Policy Advisor; Lisa Goldman, 

Democratic Counsel; Elizabeth Letter, Democratic Professional 

Staff Member; Karen Lightfoot, Democratic Communications Director and Senior Policy Advisor, and Nick Richter, Democratic Staff 

Assistant. 

Mr. MURPHY. Good afternoon. I convene this hearing of the Subcommittee on Oversight and Investigations, Committee on Energy 

and Commerce. 

Ms. DEGETTE. Mr. Chairman, I can’t see the witnesses. 

2 

Mr. MURPHY. We will need to make sure that the media is— 

when the witnesses speak that we are clear of the center section. 

OPENING STATEMENT OF HON. TIM MURPHY, A REPRESENTATIVE IN CONGRESS FROM THE COMMONWEALTH OF PENNSYLVANIA 

Today, the world is fighting the worst Ebola epidemic in history. 

CDC and our public health system are in the middle of a fire. Job 

one is to put it out completely, and we will not stop until we do. 

We must be clear-eyed and singular in purpose to protect public 

health, and to ensure not one additional case is contracted here in 

the United States. We in Congress stand ready to serve as a strong 

and solid partner in solving this crisis because there is no greater 

responsibility for the U.S. Government than to protect and defend 

the safety of the American people. 

The stakes of this battle couldn’t be any higher. The number of 

Ebola cases in western Africa is doubling about every 3 weeks. The 

math still favors the virus, even with the recent surge in global response. 

With no vaccine or cure, we are facing down a disease for which 

there is no room for error. We cannot afford to look back at this 

point in history and say we should have done more. 

Errors in judgment have been made, to be sure, and it is our immediate responsibility today to learn from those errors, correct 

them rapidly, and move forward effectively as one team, one fight. 

Let us candidly review where we stand. When the latest Ebola 

outbreak in West Africa was confirmed months ago, authorities 

thought it would be similar to the 1976 outbreaks and quickly contained. That turned out to be wrong. By underestimating both the 

severity of the danger and overstating the ability of our healthcare 

system to handle Ebola cases, mistakes have been made. What was 

adequate practice for the past has proven to fall short for the 

present. 

The trust and credibility of the administration and Government 

are waning as the American public loses confidence each day with 

demonstrated failures of the current strategy, but that trust must 

be restored, but will only be restored with honest and thorough action. 

We have been told: ‘‘virtually any hospital in the country that 

can do isolation can do isolation for Ebola.’’ The events in Dallas 

have proven otherwise. Current policies and protocols for surveillance, containment, and response were not sufficient. False assumptions create real mistakes, sometimes deadly mistakes. 

We must understand what went wrong so we can get a firm handle on this crisis: Why was the CDC slow to deploy a rapid response team at Texas Health Presbyterian Hospital? Why weren’t 

protocols to protect healthcare and hospital workers rapidly communicated? What training have healthcare workers received? 

And there are things about Ebola we don’t know. How long does 

the virus live on surfaces or on certain substances? How do 

healthcare workers wearing full protective gear still get infected? 

Can it be transmitted from a person who does not yet have a high 

fever? Both CDC and NIH tell us that Ebola patients are only contagious when having a fever. However, the largest study of the curVerDate Mar 15 2010 13:31 Sep 09, 2015 Jkt 037690 PO 00000 Frm 00006 Fmt 6633 Sfmt 6633 F:\113THCONGRESS\113179EBOLAMORESCANS090815\113179EBOLAPENDING WAY
3 

rent Ebola outbreak found that nearly 13 percent of confirmed 

cases in West Africa did not have associated fever. 

Now, I respect the CDC as the gold standard for public health, 

but the need for strong congressional oversight and partnership remains paramount. I want to understand why CDC and the White 

House changed course in 2010 on proposals first introduced in 2005 

that would have strengthened the Federal quarantine authority. 

We are here to work through and fix these problems. 

I restate my ongoing concern that administration officials still 

refuse to consider any travel restrictions for the more than 1,000 

travelers entering the United States each week from Ebola hot 

zones. 

A month ago, the President told us someone with Ebola reaching 

our shores was unlikely and that ‘‘we have taken the necessary 

precautions’’ to ‘‘increase screening at airports so that someone 

with the virus does not get on a plane for the United States.’’ 

Screening and self-reporting at airports have been a demonstrated failure, yet the administration continues to advance a 

contradictory position for this failed policy that frankly doesn’t 

make sense to me, especially if priority one is to contain the spread 

of Ebola and protect public health. 

It troubles me even more when public health policies are based 

upon a stated concern over cutting commercial ties with fledgling 

democracies rather than protecting public health in the United 

States. This should not be presented as an all-or-none choice. We 

can and will create the means to transport whatever supplies and 

goods are needed in Africa to win this deadly battle. We do not 

have to leave the door open to all travel to and from hot zones in 

western Africa while Ebola is an unwelcome and dangerous stowaway on these flights. I am confident we can develop a reasoned 

and successful strategy to meet these needs. 

The current airline passenger screening at five U.S. airports 

through temperature taking and self-reporting is troubling. Both 

CDC and NIH tell us that Ebola patients are only contagious when 

having a fever, but we know this may not be totally accurate. 

A determined, infected traveler can evade the screening by masking the fever with ibuprofen or avoiding the five airports. Further, 

it is nearly impossible to perform contact tracing of all people on 

multiple international flights across the globe. 

So let me be clear to all the Federal agencies responding to the 

outbreak. If resources or authorization is needed to stop Ebola in 

its tracks, tell us in Congress. I pledge, and I believe this committee joins me in pledging, that we will do everything in our 

power to work with you to keep the American people safe from the 

Ebola outbreak in West Africa. 

[The prepared statement of Mr. Murphy follows:] 

PREPARED STATEMENT OF HON. TIM MURPHY

Today, the world is fighting the worst Ebola epidemic in history. CDC and our 

public health system are in the middle of a fire. Job One is to put it out completely. 

We will not stop until we do. 

We must be clear-eyed and singular in purpose to protect public health, and ensure not one additional case is contracted here in the U.S. We in Congress stand 

ready to serve as a strong and solid partner in solving this crisis. There is no greatVerDate Mar 15 2010 13:31 Sep 09, 2015 Jkt 037690 PO 00000 Frm 00007 Fmt 6633 Sfmt 6633 F:\113THCONGRESS\113179EBOLAMORESCANS090815\113179EBOLAPENDING WAY
4 

er responsibility for the U.S. Government than to protect and defend the safety of 

the American people. 

The stakes in this battle couldn’t be any higher. The number of Ebola cases in 

West Africa is doubling about every three weeks. The math still favors the virus, 

even with the recent surge in global response. 

With no vaccine or cure, we are facing down a disease for which there is no room 

for error. We cannot afford to look back at this point in history and say we could 

have done more. 

Errors in judgment have been made, and it is our immediate responsibility today 

to learn from those errors, correct them rapidly and move forward effectively as one 

team—one fight. 

Let us candidly review where we stand. 

When the latest Ebola outbreak in West Africa was confirmed months ago, authorities thought it would be similar to the 1976 outbreaks and quickly contained. 

That turned out to be wrong. 

By underestimating both the severity of the danger and overstating the ability of 

our healthcare system to handle Ebola cases, mistakes have been made. What was 

adequate practice for the past has proved to fall short for the present. 

The trust and credibility of the administration and Government are waning as the 

American public loses confidence each day with demonstrated failures of the current 

strategy. That trust must be restored, but will only be restored with honest and 

thorough action. 

We have been told: ‘‘virtually any hospital in the country that can do isolation can 

do isolation for Ebola.’’ The events in Dallas have proven otherwise. 

Current policies and protocols for surveillance, containment and response were 

not sufficient. We’ve learned frontline hospital workers were not fully trained in 

these procedures, do not have proper equipment, do not know how to properly put 

on and remove safety gear, so we still have alot more work to do because educating, 

training and assisting our public health workforce on the frontlines across the country must be a priority. 

We cannot be lulled into a false sense of security. We know we have the best 

healthcare system in the world, but this committee well knows from our previous 

hearings with other Federal agencies and notably General Motors, what happens 

when assumptions are made that foster complacency. False assumptions create true 

mistakes. Sometimes, deadly mistakes. 

At the same time we must understand what went wrong so we can get a firm 

handle on this crisis: Why was the CDC slow to deploy a rapid response team at 

Texas Health Presbyterian Hospital? Why weren’t protocols to protect healthcare 

and hospital workers rapidly communicated? What training have healthcare workers received? 

There are things about Ebola we don’t know. How long does the virus live on surfaces or on certain substances? How do healthcare workers wearing full protective 

gear get infected? Can it be transmitted from a person who does not yet have a high 

fever? 

Both CDC and NIH tell us that Ebola patients are only contagious when having 

a fever. However, the largest study of the current Ebola outbreak found that nearly 

13% of confirmed cases in West Africa did not have associated fever. With many 

lives at risk, we should investigate the findings, and take proper action. 

I respect the CDC as a gold standard for public health, but the need for strong 

congressional oversight and partnership remains paramount given the CDC hasn’t 

had a stellar year. There have been high profile mishaps such as transfers of live 

anthrax, some anthrax held in Ziploc bags, and mistaken shipments of a deadly 

strain of Avian flu unknown to CDC leadership for weeks. I also want to understand 

why CDC and the White House changed course on in 2010 on proposals first introduced in 2005 that would have strengthened Federal quarantine authority. We are 

here to work through and fix these problems. I restate my ongoing concern that administration officials still refuse to consider any travel restrictions for the more than 

1,000 travelers a week entering the U.S. from Ebola hot zones. 

A month ago, the President told us someone with Ebola reaching our shores was 

‘‘unlikely’’ and that ‘‘we’ve been taking the necessary precautions’’ to ‘‘increase 

screening at airports so that someone with the virus doesn’t get on a plane for the 

United States.’’ 

Screening and self-reporting at airports have been a demonstrated failure, yet the 

administration continues to advance a contradictory reason for this failed policy that 

frankly doesn’t make sense, especially if ‘‘priority one’’ is to contain the spread of 

Ebola and protect public health. 

It troubles me even more when public health policies are based upon a stated concern over ‘‘cutting commercial ties with fledgling democracies’’ rather than proVerDate Mar 15 2010 13:31 Sep 09, 2015 Jkt 037690 PO 00000 Frm 00008 Fmt 6633 Sfmt 6633 F:\113THCONGRESS\113179EBOLAMORESCANS090815\113179EBOLAPENDING WAY
5 

tecting public health in the United States. This should not be presented as an allor-none choice. We can and will create the means to transport whatever supplies, 

and goods are needed in Africa to win this deadly battle. We do not have to leave 

the door open to all travel to and from hot zones in western Africa while Ebola is 

an unwelcome and dangerous stowaway on these flights. I am confident we can develop a reasoned and successful strategy to meet these needs. 

We will have a rational, informed discussion about using commercial travel restrictions—the same ones being employed by British Airways, Air France, and more 

than a dozen nations—to protect Americans while at the same time ensuring aid 

and eradication efforts continue in West Africa. 

The current airline passenger screening at five U.S. airports through temperature 

taking and self-reporting is troubling. Both CDC and NIH tell us that Ebola patients are only contagious when having a fever. The largest study of the current 

Ebola outbreak found that nearly 13% of confirmed cases in West Africa did not 

have associated fever. With many lives at risk, we should investigate the findings, 

and take proper action. 

A determined, infected traveler can evade the screening by masking the fever 

with ibuprofen or avoiding the five airports. 

Further, it is nearly impossible to perform contact tracing of all people on multiple international flights across the globe, when contact tracing and treatment just 

within the United States will strain public health resources. 

The only way we can dispel the fear and hysteria surrounding Ebola is with clear, 

honest answers teamed with swift, effective action. This situation demands leadership from the top and by that I mean the White House. The ‘lead from behind’ strategy is recipe for disaster when trying to stop the transmission of Ebola. The legislative and executive branches of this Government are one team, and we will fight this 

together. We stand ready to meet with the administration at anytime and anywhere 

in this cause to help everyone. 

So let me be clear. To all the Federal agencies responding to the outbreak: If resources or authorization is needed to stop Ebola in its tracks, speak up—tell Congress. I pledge to will do everything in my power to work with you to keep the 

American people safe from the Ebola outbreak in West Africa. 

Mr. MURPHY. I now recognize the ranking member of the subcommittee, Ms. DeGette. 

OPENING STATEMENT OF HON. DIANA DEGETTE, A REPRESENTATIVE IN CONGRESS FROM THE STATE OF COLORADO 

Ms. DEGETTE. Thank you, Mr. Chairman. 

On Monday, the Director General of the World Health Organization called the Ebola outbreak ‘‘the most severe, acute health emergency seen in modern times.’’ She warned that the epidemic 

‘‘threatens the very survival of societies and governments in West 

Africa.’’ 

This WHO assessment is no exaggeration. CDC predicts that up 

to 1.4 million West Africans could be infected with Ebola. Many 

more will die from treatable illnesses due to the collapse of these 

countries’ public health infrastructures. This is a humanitarian crisis, and we have a moral imperative to help in West Africa. But 

ending the West Africa outbreak is also a U.S. national security 

imperative because doing so is the best way to keep Ebola out of 

the United States. 

I was alarmed like all of us were when Thomas Duncan flew to 

the United States while harboring Ebola, and even more disturbed 

to learn of his discharge from the Texas Presbyterian ER with a 

fever after reporting that he had traveled from Liberia. Even 

worse, we learned this week that two nurses treating Mr. Duncan, 

Nina Pham and Amber Vinson, have contracted Ebola. I know, Mr. 

Chairman, we all join in sending these women and their families 

our prayers. 

6 

These new cases raise serious questions. The Washington Post 

wrote yesterday that Texas Presbyterian ‘‘had to learn on the fly 

how to control the deadly virus’’ and that the hospital was ‘‘not 

fully prepared for Ebola.’’ We need to find out why this hospital 

was unprepared and if others are too, and we need to make sure 

that the CDC is filling these readiness gaps. We should be concerned about the appearance of Ebola in the United States and the 

transmission to two health care workers, but we should not panic. 

We know how to stop Ebola outbreaks by isolating patients and 

tracing and monitoring contacts. The U.S. health care system can 

prevent isolated cases from becoming broader outbreaks, and that 

is why I am glad Dr. Frieden is here with us and Dr. Varga will 

be with us by video, because it would be an understatement to say 

that the response to the first U.S.-based patient with Ebola has 

been mismanaged, causing risk to scores of additional people. I 

know both of these gentlemen will be transparent and forthright in 

helping me to understand how we can improve our response when 

yet another person, and it will inevitably happen, shows up at the 

emergency room with these kind of symptoms. 

I appreciate the steps taken by CDC and Customs to begin airport screenings. These steps are appropriate, and as some call for 

cutting off all travel, as the chairman said, this won’t be reasonable 

to be able to stop anybody with Ebola from coming into the United 

States, and we don’t want to take steps that would endanger Americans by interfering with efforts to halt the outbreak in Africa. 

You know, there is no such thing as fortress America when it 

comes to infectious diseases, and the best way to stop Ebola is 

going to be to stop this virus in Africa. Experts from Doctors Without Borders have told us that a quarantine on travel would have 

‘‘catastrophic impacts on West Africa.’’ Also, earlier this week the 

Director of NIH, Dr. Francis Collins, said had we adequately funded his agency for over a decade, we would already have an Ebola 

vaccine. His words are a reminder that key public health agencies 

have faced stagnant funding for several years, hampering our ability to respond to this crisis. 

Mr. Chairman, 6 weeks ago when I first sent you a letter to ask 

for this hearing, the scope of the problem in West Africa was beginning to come into focus. Now the situation is dire. Let us work together to make sure that we stop it as quickly as we can. 

With that, I yield the balance of my time to the gentleman from 

Iowa, Mr. Braley. 

OPENING STATEMENT OF HON. BRUCE L. BRALEY, A 

REPRESENTATIVE IN CONGRESS FROM THE STATE OF IOWA 

Mr. BRALEY. Thank you. 

Our duty today is to make sure the administration is doing everything possible to prevent the spread of Ebola within the United 

States. Our number one priority in combating this disease must be 

the protection of Americans, and we have to figure out the best 

way to do that. 

My heart goes out to all those suffering from this horrible epidemic, and I am very proud of the hard work done by American 

troops, doctors, nurses, and other volunteers to combat this disease. 

7 

Congress must come together, put aside partisan differences and 

help stop this outbreak. 

Today I hope to hear what steps the administration is taking to 

prevent the spread of Ebola and respond to the outbreak. I am 

greatly concerned, as Congresswoman DeGette has expressed, that 

the administration did not act fast enough in responding in Texas. 

We need to look at all the options available to keep our families 

safe and move quickly and responsibly to make any necessary 

changes at airports. 

[The prepared statement of Mr. Braley follows:] 

PREPARED STATEMENT OF HON. BRUCE L. BRALEY

Thank you. Today, we must make sure the administration is doing everything 

possible to prevent the spread of Ebola within the United States. Our number one 

priority in combating this disease must be the protection of Americans. 

My heart goes out to those suffering from this epidemic, and I’m very proud of 

the hard work done by American troops, doctors, nurses, and volunteers to combat 

the disease. Congress must come together, put aside partisan differences, and help 

stop this outbreak. 

Today, I hope to hear what steps the administration is taking to prevent the 

spread of Ebola and respond to the outbreak. I’m greatly concerned that the administration did not act fast enough. The administration needs to look at all options 

available to keep our families safe, and they need to move quickly and responsibly 

to make any necessary changes at our airports and hospitals that would prevent 

this disease from spreading further. And I’m going to ask specific questions on their 

plans for that. 

One of the most important allies we have is a company in Ames, Iowa, called 

NewLink Genetics, with 120 employees working around the clock. NewLink has an 

Ebola vaccine that could help stop this disease, and they are currently trying to secure a contract with HHS to expand their manufacturing, so I hope to hear how 

HHS is moving forward as quickly as possible. 

Thank you to the witnesses for being here today, and I look forward to a thoughtful and productive conversation. 

Mr. MURPHY. The gentleman’s time is expired. I now recognize 

the chairman of the full committee, Mr. Upton, for 5 minutes. 

OPENING STATEMENT OF HON. FRED UPTON, A REPRESENTATIVE IN CONGRESS FROM THE STATE OF MICHIGAN 

Mr. UPTON. Well, thank you. 

Let me first begin by thanking our witnesses and all of the Members, Republicans and Democrats, for being here today. 

You know, it is unusual to convene a hearing in DC during a district work period, but on this issue, there is no time to wait. I was 

likewise glad to see the President get off the campaign trail yesterday to finally focus on the crisis. 

People are scared. We need all hands on deck. We need a strategy, and we need to protect the American people, first and foremost. It is not a drill. People’s lives are at stake, and the response 

so far has been unacceptable. 

As chairman of this committee, I want to assure the witnesses 

that we stand ready to support you in any way to keep Americans 

safe, but we are going to hold your feet to the fire on getting the 

job done, and getting it done right. 

Both the United States and the global health community have so 

far failed to put in place an effective strategy fast enough to combat the current outbreak. The CDC admitted more could have been 

done in Texas. Two health care workers have become infected with 

8 

Ebola even as nurses and other medical personnel suggest that protocols are being developed on the fly. And none of us can understand how a nurse who treated an Ebola-infected patient, and who 

herself had developed a fever, was permitted to board a commercial 

airline and fly across the country. 

It is no wonder the public’s confidence is shaken. Over a month 

ago, before Ebola reached our shores, we wrote to Health and 

Human Services Secretary Burwell seeking details for the preparedness and response plan here at home and abroad, and it is 

clear whatever plan was in place was insufficient, but I believe 

that we can and must do better now. 

We need a plan to treat those who are sick, to train health care 

workers to safely provide care, and to stop the spread of this disease here at home and at its source in Africa. This includes travel 

restrictions or bans from that region beginning today. Surely we 

can find other ways to get the aid workers and supplies in to these 

countries. From terrorist watch lists to quarantines, there are tools 

used to manage air travel to assure public safety. Why not here? 

We can no longer be reacting to each day’s crisis. We need to be 

aggressive and finally get ahead of this terrible outbreak. 

The American people also want to know about our troops and 

medical personnel who are courageously headed to Africa to treat 

the sick. How will they be protected? We want to know that health 

care workers here in America have the training and resources necessary to safely combat that threat as well. 

So it is not just the responsibility of the United States. The global health community bears the charge to finally get ahead of the 

threat, develop a clear strategy, train all those who are involved in 

combating this disease, and eradicate this threat. 

We have all heard the grave warnings that this will get worse 

before it gets better. People are scared. It is our responsibility to 

ensure that the Government is doing whatever it can to keep the 

public safe. 

Diana DeGette and I have partnered together on the 21st Century Cures initiative to help improve the research and speed the 

approval of life-saving medicines and treatments, and while much 

attention has been paid to how this effort can help with diseases 

like cancer and diabetes, these same reforms can also help in the 

development of treatments for deadly infections like Ebola. We are 

all partners in this effort to save lives. 

[The prepared statement of Mr. Upton follows:] 

PREPARED STATEMENT OF HON. FRED UPTON

Let me begin by thanking our witnesses and all of the Members, Republicans and 

Democrats, for being here today. It’s unusual to convene a hearing in Washington 

during a district work period, but on this issue, there’s no time to wait. I was likewise glad to see President Obama get off the campaign trail to finally focus on this 

crisis. 

People are scared. We need all hands on deck. We need a strategy. We need to 

protect the American people, first and foremost. This is not a drill—a fact that the 

doctors and nurses working on the front lines understand. People’s lives are at 

stake, and the response so far has been unacceptable. 

As chairman of this committee, I want to assure the witnesses that we stand 

ready to support you in any way to keep Americans safe, but we are going to hold 

your feet to the fire on getting the job done, and getting it done right. Both the 

9 

United States and the global health community have so far failed to put in place 

an effective strategy fast enough to combat the current outbreak. 

Just the other day, the CDC admitted more could have been done in Texas. Two 

health care workers have become infected with Ebola even as nurses and other medical personnel suggest that protocols are being ‘‘developed on the fly.’’ And none of 

us can understand how a nurse who treated an Ebola-infected patient, and who herself had developed a fever, was permitted to board a commercial airline and fly 

across the country. 

It’s no wonder the public’s confidence is shaken. Over a month ago, before Ebola 

reached our shores, we wrote to Health and Human Services Secretary Sylvia 

Burwell seeking details for the preparedness and response plan here at home and 

abroad. It’s clear whatever plan was in place was insufficient, but I believe we can 

and must do better now. 

We need a plan to treat those who are sick, to train health workers to safely provide care, and to stop the spread of this disease here at home and at its source in 

Africa. This includes travel restrictions from that region beginning today. Surely we 

can find other ways to get the aid workers and supplies in to these countries. From 

terrorist watch lists to quarantines, there are tools used to manage air travel to assure public safety. Why not here? We can no longer be reacting to each day’s crisis. 

We need to be aggressive and finally get ahead of this outbreak. 

The American people also want to know that our troops and medical personnel 

who are courageously headed to Africa to treat the sick will be protected. We want 

to know that health care workers here in America have the training and resources 

necessary to safely combat this threat. 

This is not just the responsibility of the United States. The global health community bears the charge to finally get ahead of this threat, develop a clear strategy, 

train all those who are involved in combating this disease, and eradicate this threat. 

We have all heard the grave warnings that this will get worse before it gets better, and folks are scared. It is our responsibility to ensure that the Government is 

doing whatever it takes to keep the public safe. Diana DeGette and I have 

partnered together on the 21st Century Cures initiative to help improve the research and speed the approval of life-saving medicines and treatments, and while 

much attention has been paid to how this effort can help with diseases like cancer 

and diabetes, these same reforms can also help in the development of treatments 

for deadly infections like Ebola. We are all partners in this effort to save lives. 

Mr. UPTON. I yield the balance of my time to Dr. Burgess. 

OPENING STATEMENT OF HON. MICHAEL C. BURGESS, A 

REPRESENTATIVE IN CONGRESS FROM THE STATE OF TEXAS 

Mr. BURGESS. Thank you, Mr. Chairman, and my thanks to the 

panel for being here today, and I think everyone here agrees, we 

must fix this. 

America’s response to the Evola Virus Disease outbreak is not a 

political issue, it is a public health crisis and a very dire one at 

that. 

The frightening truth is that we cannot guarantee the safety of 

our health care workers on the front lines. It has been known for 

some time that health care workers have an outsized risk in western Africa. They have a 56 percent mortality rate of those health 

care workers who catch this disease. Two nurses have contracted 

Ebola in the United States, and indeed, we have to learn from the 

current situation in Texas and use any information we can gather 

to better help prepare hospitals and protect our health care workers on the front line. We are here today because we need answers 

to these questions. 

This past August, the Inspector General of the Department of 

Homeland Security issued a report on personal protective equipment and antiviral countermeasures. They found that, and I am 

quoting here, ‘‘The Department of Homeland Security did not adequately conduct a needs assessment prior to purchasing pandemic 

10 

preparedness supplies and then did not effectively manage its 

stockpile of personal protective equipment and antiviral medical 

countermeasures.’’ This just illustrates how unprepared we are. We 

have to get this right. 

[The prepared statement of Mr. Burgess follows:] 

PREPARED STATEMENT OF HON. MICHAEL C. BURGESS

America’s response to the Evola virus disease is not a political issue. This is a 

public health crisis and a dire one at that. The frightening truth is that we cannot 

guarantee the safety of our health care workers on the front lines of response. 

In West Africa, there have been 416 healthcare workers who have contracted 

Ebola. 233 of them have died. That is a 56% mortality rate. 

As of today, two health care workers contracted Ebola in the United States. According to the CDC, they were exposed to the virus before Mr. Duncan, Patient Zero, 

was diagnosed. In turn, the focus must now be on preparedness for hospitals around 

the country. 

Indeed, we must learn from the current situation at Texas Presbyterian and use 

any information we can gather to help better prepare other hospitals around the 

country. 

We are here today because we need answers to our questions about both the 

CDC’s and the administration’s flawed responses. While I believe the CDC had protocols in place, it seems to me there was a breakdown in the communication between the CDC and hospitals around the country. 

This past August, the Inspector General at the Department of Homeland Security 

issued a report on personal protective equipment and antiviral medical countermeasures. 

They found that, and I quote, ‘‘The Department of Homeland Security did not adequately conduct a needs assessment prior to purchasing pandemic preparedness 

supplies and then did not effectively manage its stockpile of pandemic PPE and 

antiviral medical countermeasures.’’ This illustrates just how unprepared we may 

still be. 

Drugs companies are stating that they will have basic information on the efficacy 

of their drugs and vaccines by the end of the year. The end of the year is too late. 

We have been actively funding research on vaccinations and drug treatments for 

over a decade, but now the time to perform is now. When will these protocols be 

expedited? 

Relevant agencies have the statutory authority to quarantine and isolate individuals who are infected with or carrying an infectious communicable disease. 

Secretary Burwell has this authority which is enumerated in the Public Health 

Service Act. When will this authority be used? 

Numerous laws have been passed in the past decade to better prepare us for an 

outbreak of infectious illness, to increase coordination, and to fast- track drug development. The Assistant Secretary for Preparedness and Response, Dr. Lurie, has 

been notably absent. 

I have a long-standing relationship with Texas Presbyterian. This crisis is in my 

back yard. I want to make sure we are doing everything in our power to stop Ebola. 

Mr. BURGESS I would like to yield the balance of my time to Ms. 

Blackburn from Tennessee. 

OPENING STATEMENT OF HON. MARSHA BLACKBURN, A REPRESENTATIVE IN CONGRESS FROM THE STATE OF TENNESSEE 

Mrs. BLACKBURN. Thank you, Dr. Burgess, and yes, indeed, welcome to all of our witnesses. 

Everyone has mentioned we are here to work with you to protect 

Americans, and that includes the caregivers, and by that I mean 

the men and women working on the front lines, the Screaming Eagles of the 101st from Fort Campbell. 

I will yield back my time and have further questions later. 

Thank you. 

11 

Mr. MURPHY. The gentlelady yields back and time is expired. I 

would now like to introduce the witnesses—I am sorry. No, first I 

go to Mr. Waxman. I apologize. 

OPENING STATEMENT OF HON. HENRY A. WAXMAN, A REPRESENTATIVE IN CONGRESS FROM THE STATE OF CALIFORNIA 

Mr. WAXMAN. Thank you, Mr. Chairman. I am pleased to have 

this opportunity to make an opening statement before we hear 

from the witnesses. 

I think we have to put all of this in perspective and not panic. 

Everybody said not to panic, and then they made statements like 

‘‘We are going to get tough. We are going to do something about 

it.’’ Well, what do we need to do? 

First of all, we have got a problem in Africa, and this is a serious 

outbreak that could spiral beyond our control. On Tuesday, the 

World Health Organization estimated that soon there could be up 

to 10,000 new Ebola cases each week in West Africa, and CDC has 

warned that the outbreak could infect as many as 1.4 million people by the end of January. So this is a humanitarian crisis in Africa, and we have a responsibility to help because if we don’t help 

there, that outbreak is going to continue to spiral out to other 

places, and sealing people off in Africa is not going to keep them 

from traveling. They will travel to Brussels, as one of the people 

did, and then into the United States. 

We can stop the epidemic from spreading in Africa or in the 

United States if we isolate the patient and monitor the contacts of 

that patient, and if we do that, we can stop it there and we can 

stop it here. 

So in Africa, we need to know: Are we moving fast enough, do 

responders have adequate resources, are we effectively coordinating 

our response with other countries in international organizations? 

But here, people are scared, and we shouldn’t make them even 

more frightened. Put this in perspective. We have had three recent 

cases of Ebola in this country: Thomas Duncan, who entered the 

United States while harboring Ebola and who flew through Brussels to get here; Nina Pham and Amber Vinson, the nurses who became ill while caring for Mr. Duncan. We should be concerned 

about these cases, and we need to act urgently, but we need not 

to panic. What we have to do is learn what we need to do, what 

mistakes we have made and not repeat them. We want to find out 

what happened at Texas Health Presbyterian Hospital, how CDC, 

State and local health officials and hospitals can improve procedures moving forward. 

We should also use this as a wakeup call to ensure the adequacy 

of our own public health and preparedness safety net. We need to 

be prepared before a crisis hits, not scrambling to respond after the 

crisis. 

In the past decade, the ability to fund research and public health 

programs has declined here in the United States. Since 2006, 

CDC’s budget adjusted for inflation has dropped by 12 percent. 

Funding for the Public Health Emergency Preparedness Cooperative Agreement, which supports State and local health department 

preparedness activities, has been cut from $1 billion in its first 

12 

year of funding in 2002 to $612 million in 2014. All of these were 

also subject to the sequestration, and those who allowed that sequestration to happen by closing the Government have to answer 

to the American people as well. 

We need to commit adequate funding to public health infrastructure. We need to hold public health systems accountable to standards of preparedness. Based on what we know, it appears that 

Texas Presbyterian would have not met those standards, though in 

fairness, I suspect that many hospitals all over the country would 

also have struggled to respond. This is a problem we have to solve. 

Mr. Chairman, before I run out of time, I want to acknowledge 

the health care workers and volunteers, those treating Ebola victims in the United States and those who have traveled to West Africa to help during this outbreak. It is dangerous work that they 

are doing. They are putting themselves in danger to save lives. 

They deserve our thanks and our praise. 

I also want to thank all of our witnesses. You have my confidence, and I appreciate you joining us today to provide answers 

about how to stop the current Ebola outbreak in Africa and how 

to improve our public health systems to avoid the next crisis. 

I am ending my career at the end of this year, but I have been 

through so many hearings where, when there is a crisis, we have 

Congressmen sit and point fingers. Well, let us point fingers at all 

of those responsible. We have our share of responsibility by not 

funding the infrastructure. In Africa, they have no infrastructure. 

We have to help them develop it to deal with this crisis, but we 

shouldn’t leave ourselves vulnerable by these irrational budget 

cuts. 

Mr. MURPHY. The gentleman’s time is expired. Thank you. 

I would now like to introduce the witnesses on the panel for today’s hearing. Dr. Thomas R. Frieden is the Director of the Centers 

for Disease Control and Prevention. Dr. Anthony Fauci is the Director of the National Institute of Allergy and Infectious Diseases 

within the National Institutes of Health. Dr. Robin Robinson is the 

Director of Biomedical Advanced Research and Development Authority within the Office of the Assistant Secretary for Preparedness and Response at the United States Department of Health and 

Human Services. Dr. Luciana Borio is the Assistant Commissioner 

for Counterterrorism Policy at the U.S. Food and Drug Administration. Mr. John P. Wagner is the Acting Assistant Commissioner of 

the Office of Field Operations within U.S. Customs and Border Protection at the U.S. Department of Homeland Security. And joining 

us today on videoconference from Texas will be Dr. Daniel Varga, 

who is the Chief Clinical Officer and Senior Vice President at 

Texas Health Resources. 

I will now swear in the witnesses. You are all aware that the 

committee is holding an investigative hearing, and when doing so 

has had the practice of taking testimony under oath. Do any of you 

object to taking testimony under oath? None of the witnesses say 

so, and Dr. Varga? 

Mr. VARGA. No. 

Mr. MURPHY. Thank you. The Chair then advises you that under 

the rules of the House and the rules of the committee, you are entitled to be advised by counsel. Do any you desire to be advised by 

13 

counsel during your testimony today? Thank you. Everyone answers no. In that case, would you all please rise and raise your 

right hand and I will swear you in. 

[Witnesses sworn.] 

Mr. MURPHY. You are now under oath and subject to the penalties set forth in Title XVIII, section 1001 of the United States 

Code. We will call upon you each to give a 5-minute opening summary of your written statement. 

Dr. Frieden, you are recognized for 5 minutes. 

STATEMENTS OF THOMAS R. FRIEDEN, DIRECTOR, CENTERS 

FOR DISEASE CONTROL AND PREVENTION; ANTHONY S. 

FAUCI, DIRECTOR, NATIONAL INSTITUTE OF ALLERGY AND 

INFECTIOUS DISEASES, NATIONAL INSTITUTES OF HEALTH, 

DEPARTMENT OF HEALTH AND HUMAN SERVICES; ROBIN A. 

ROBINSON, DEPUTY ASSISTANT SECRETARY AND DIRECTOR, 

BIOMEDICAL ADVANCED RESEARCH AND DEVELOPMENT 

AUTHORITY, OFFICE OF THE ASSISTANT SECRETARY FOR 

PREPAREDNESS AND RESPONSE, DEPARTMENT OF HEALTH 

AND HUMAN SERVICES; LUCIANA BORIO, ASSISTANT COMMISSIONER FOR COUNTERTERRORISM POLICY AND DIRECTOR, OFFICE OF COUNTERTERRORISM AND EMERGING 

THREATS, FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES; JOHN P. WAGNER, 

ACTING ASSISTANT COMMISSIONER, OFFICE OF FIELD OPERATIONS, U.S. CUSTOMS AND BORDER PROTECTION, DEPARTMENT OF HOMELAND SECURITY; AND DANIEL VARGA, 

CHIEF CLINICAL OFFICER AND SENIOR EXECUTIVE VICE 

PRESIDENT, TEXAS HEALTH RESOURCES 

STATEMENT OF THOMAS R. FRIEDEN 

Mr. FRIEDEN. Thank you very much, Chairman Murphy, Ranking 

Member DeGette, Chairman Upton, and Ranking Member Waxman. I very much appreciate the opportunity to come before you to 

discuss the Ebola epidemic and our response to it to protect Americans. 

My name is Dr. Tom Frieden. I am trained as a physician. I am 

trained in internal medicine, in infectious diseases. I completed the 

CDC Epidemic Intelligence Service training, and I have worked in 

the control of diseases, communicable diseases and others, since 

1990. 

Ebola spreads only by direct contact with a patient who is sick 

with the disease or has died from it, or with their body fluids. 

Ebola is not new, although it is new to the United States. We know 

how to control Ebola, even in this period. Even in Lagos, Nigeria, 

we have been able to contain the outbreak. We do that by triedand-true measures of finding the patients promptly, isolating them 

effectively, identifying their contacts, ensuring that if any contact 

becomes ill, they are rapidly identified, isolated, and their contacts 

are identified. 

But there are no shortcuts in the control of Ebola, and it is not 

easy to control it. To protect the United States, we have to stop it 

at the source. 

There is a lot of fear of Ebola, and I will tell you as the Director 

of CDC, one of the things I fear about Ebola is that it could spread 

14 

more widely in Africa. If this were to happen, it could become a 

threat to our health system and the health care we give for a long 

time to come. 

Our top priority, our focus is to work 24/7 to protect Americans. 

That is our mission. We protect Americans from threats, and in the 

case of Ebola, we do that by a system at multiple levels. In addition to our efforts to control the disease at the source, we have 

helped each of the affected countries establish exit screening so 

that every person leaving has their temperature taken. In a twomonth period of August and September, we identified 74 people 

with fever. None of them entered the airport or boarded the plane. 

As far as we know, none of them were diagnosed with Ebola, but 

that was one level of safety. 

Recently, we have added another level of screening people on arrival to the United States. That identifies anyone with fever here, 

and we have worked very closely with the Department of Homeland Security and Customs and Border Protection to implement 

that program, and I would be happy to provide further details of 

it later. 

We have also increased awareness among physicians throughout 

the United States to think Ebola in anyone who has fever and/or 

other symptoms of infection and who has been to West Africa in 

the previous 21 days. We have established laboratory services 

throughout the country so that not all laboratory tests have to 

come to the specialized laboratory at CDC. In fact, one of those laboratories in Austin, Texas, identified the first case here. 

We also have fielded calls from concerned doctors and public 

health officials throughout the country. We found more than 300 

calls and only one patient, Mr. Duncan, had Ebola, but that is one 

too many, and we are open to ideas for what we can do to keep 

Americans as safe as possible as long as the outbreak is continuing. 

We also have established emergency response teams from CDC 

that will go within hours to any hospital that has an Ebola case 

to help them provide effective care safety. 

[Slide.] 

There is a lot of understandable concern about the cases in Dallas. I have one slide, if we can show it, of the contact tracing activities there, and I think we provided copies for the members. The 

two core activities in Dallas are to ensure that there is effective infection control and to trace contacts. Here you see a timeline of exactly what has happened in the identification of contacts. We have 

followed each of the contacts. When any become ill or if any become 

ill, we immediately isolate them so that we can break the chain of 

transmission. That is how you stop Ebola. I can go through the details when you wish. 

We also are working to ensure that there is effective infection 

control there, and I can go through the details of that. 

In sum, CDC works 24/7 to protect Americans. There are no 

shortcuts. Everyone has to do their part. There are more than 

5,000 hospitals in this country. There are more than 2,500 health 

departments at the local level. We are there to support. We are 

there with world-class expertise, and we are there to respond to 

threats so that we can help protect Americans, and we are always 

open to new ideas. We are always open to data because our bottom 

15 

line is using the most accurate data and information to inform our 

actions and protect health. 

Thank you. 

[The prepared statement of Mr. Frieden follows:] 

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Mr. MURPHY. Thank you, Dr. Frieden. I now recognize Dr. Fauci 

for a 5-minute summary of your statement. 

STATEMENT OF ANTHONY S. FAUCI 

Mr. FAUCI. Thank you, Chairman Murphy, Ranking Member 

DeGette, Chairman Upton, and Ranking Member Waxman. You 

have just heard about the public health aspects of Evola Virus Disease from Dr. Frieden. I appreciate the opportunity to speak with 

you this morning for a few minutes on the role of the National Institute of Allergy and Infectious Diseases in research addressing 

Evola Virus Disease. 

Of note is that our activities actually started with the tragic 

events of 9/11/2001, which were followed closely by the anthrax attacks, which many of the members remember, against the Congress 

of the United States and the press. It was in that environment that 

a multifaceted approach towards bioterrorism was actually mounted by the Federal Government, one of which was the research endeavor to develop countermeasures. We soon became very aware 

that naturally occurring outbreaks of disease are just as much of 

a terror to the American and world public as a deliberate bioterror 

event. 

[Slide.] 

You see on this slide a number of what we call Category A pathogens from anthrax to botulism, plague, smallpox, and tularemia, 

but look at the last bullet, the viral hemorrhagic fevers including 

Ebola, Marburg, Lassa and others. The viral hemorrhagic fevers 

are particularly difficult because they have a high degree of 

lethality and a high infectivity upon contact with body fluids. Therapy is mainly supportive without specific interventions, and we do 

not have a vaccine. 

And so what is the role of the National Institutes of Health—if 

we could advance the slide—in the research endeavor? 

[Slide.] 

As you can see on this slide, we do basic and clinical research, 

and importantly, we supply resources for researchers in industry 

and academia to advance product development. The end game of 

what we do are diagnostics, therapeutics, and vaccines. I am sorry. 

Could we get the slide back on, the last slide? 

This is a multi-institutional endeavor. As you can see on this 

slide, the NIH is responsible for fundamental basic research and 

early concept development, something that we did relatively alone 

because of the lack of interest on the part of industrial partners in 

making interventions. We partnered with BARDA, who you will 

hear from shortly with Dr. Robin Robinson, and then we partnered 

with industry, as I will tell you in a moment, ultimately in collaboration with the FDA to get the approval of products. Next slide. 

[Slide.] 

You have heard a lot about therapeutic interventions. I would 

just like to spend a moment talking to you about a few of them. 

First, it is important to realize that they are all experimental. 

None of them has proven to be effective. So when you hear about 

giving a drug that has a positive effect, we do not know at this 

point, A, is it a positive effect, or B, is it causing harm? And that 

30 

is the reason why we need to study these carefully at the same 

time we rapidly make them available to the people who need them. 

The first one on the list is ZMapp. You have heard of it. That 

was given to Dr. Brantley and Nancy Writebol. It looks very good 

in animal models. It still needs to be proven in humans. There are 

others such as the BioCryst product, which is a nucleoside analog. 

You have heard about the Tekmira drug, which was developed with 

support from the Department of Defense, which is also being used, 

and others that you will hear about such as Brincidofovir and 

Favapiravir. These are just a few of those that will be going into 

clinical trials and that are actually being used in an experimental 

way with compassionate use with approval from the FDA in certain 

individuals. 

[Slide.] 

Let me turn to this slide here, which is an important one, regarding a vaccine. We have been working on an Ebola vaccine for a 

number of years. We did the original studies shown in an animal 

model to be quite favorable. We are now right at the point where 

we are in Phase I trials that some of you may have heard of, started at the NIH on September 2nd. Testing of a second vaccine was 

started just a couple of days ago by the U.S. military in collaboration with the NIH. When we finish those Phase I trials, namely 

asking is it safe and does it induce a response that you would predict would be protective, it is important to make sure it is safe. If 

those parameters are met, we will advance to a much larger trial 

in larger numbers of individuals to determine if it is actually effective as well as not having a paradoxical negative deleterious effect. 

The reason we think this is important is that if we do not control 

the epidemic with pure public health measures, it is entirely conceivable that we may need a vaccine, and it is important to prove 

that it is safe and effective. 

I would like to close by making an announcement to this committee because I am sure you will hear about it soon in the press. 

This evening, tonight, we will be admitting to the special clinical 

studies unit, at the National Institutes of Health, Nina Pham, otherwise known as Nurse Number One. She will be coming to the National Institutes of Health, where we will be supplying her with 

state-of-the-art care in our high-level containment facilities. 

Thank you very much, Mr. Chairman. 

[The prepared statement of Mr. Fauci follows:] 

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Mr. MURPHY. Thank you, Doctor. I now recognize Dr. Robinson 

for 5 minutes for a summary of your statement. 

STATEMENT OF ROBIN A. ROBINSON 

Mr. ROBINSON. Good afternoon, Chairman Murphy, Chairman 

Upton, Ranking Members DeGette and Waxman, and other distinguished members of the subcommittee. Thank you for the opportunity to speak with you today about our efforts by the Government on Ebola. 

I am Dr. Robin Robinson, a former vaccine developer in industry, 

and for the last 10 years a public servant working on pandemic 

preparedness and many other biothreats. 

BARDA was created by the Pandemic and All-Hazards Preparedness Act in 2006. It 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 in responding to emerging threats 

like the H1N1 pandemic in 2009 and the avian influenza H7N9 

outbreak in China last year. 

Today, we are immersed in responding to Ebola, which is simultaneously a biothreat with a material threat determination issued 

by the Department of Homeland Security and an emerging infectious disease. 

As you have said and my colleagues have said, when it comes to 

Ebola as a biothreat and emerging infectious disease, the best way 

to protect our country is to address the current epidemic in Africa, 

the worst on record. 

BARDA works with its Federal partners to transition the medical 

countermeasures from early development, as Dr. Fauci said, into 

advanced 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 been FDA approved in the last 2 years, and 

today we are transitioning several promising and maturing Ebola 

vaccines and therapeutic candidates from early development, under 

NIH and DoD support, into advanced development and ensuring 

that commercial-scale manufacturing capacity for these product 

candidates is available as soon as possible. 

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, FDA and our industry partners 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, improved framework for 

medical countermeasures development has been afforded to Federal 

and industry partners, and last year we made five new vaccine candidates in record time for the H7N9 outbreaks in China. Currently, 

we are working with a wider array of partners including both small 

44 

and large pharmaceutical companies, Canada, the U.K., western 

African countries, the World Health Organization, and others to 

make and evaluate the safety and efficacy of these Ebola product 

candidates. 

BARDA has established a medical countermeasure infrastructure 

to assist product developers on a daily basis to respond immediately in a public health emergency. We are using a number of our 

core service assistance programs. There is the Nonclinical Studies 

Network, our Centers for Innovation and Advanced Development 

and Manufacturing, and our Fill Finish Manufacturing Network to 

make these products available as soon as possible. Additionally, 

our staff are onsite at the manufacturer, people in plant, to provide 

technical assistance and oversight to expedite product availability. 

Additionally, we are working with CDC and others across the 

Federal Government and internationally with our modeling efforts 

to look at the Ebola outbreak as it becomes epidemic and also what 

possible impacts and interventions may occur. 

BARDA supports large-scale production of medical countermeasures and response measure for public health emergencies like 

the H1N1 pandemic and H7N9 outbreaks. Today we are assisting 

Ebola vaccine and therapeutic manufacturers with scaled-up production. Specifically, we are supporting the development and manufacturing of ZMapp monoclonal antibody therapy for clinical studies at one manufacturer, expanding overall manufacturing capacity 

of ZMapp by enlisting the help of other tobacco plant-based manufacturers, and working on alternative Ebola monoclonal antibody 

candidates to expand production capacity. Pending the outcome of 

ongoing animal challenge studies, BARDA is prepared to support 

advanced development of additional promising therapeutic candidates that Dr. Fauci talked about to treat Ebola patients. 

On the vaccine front, BARDA is working with industry partners 

to scale up manufacturing of three promising Ebola vaccine candidates, one of which we will make an announcement today, from 

pilot scale to commercial scale for clinical studies in Africa next 

year. In addition to BARDA’s efforts in the Ebola response, ASPR 

is supporting a number of other response activities including supporting health care system preparedness, developing policies and 

guidance on patient movement, repatriation, standards of care and 

clinical guidance, supporting the logistical aspect of deploying U.S. 

public health service officers to West Africa, and ongoing coordination and communication with national and international communities responding to the threat. 

Finally, we face significant challenges, as has been discussed, in 

the coming weeks and months with the Ebola epidemic continuing 

and as these medical countermeasures are manufactured and evaluated, but bottom line is that my colleagues here and our industry 

partners will use all of our collective capabilities here and abroad 

to address today’s Ebola epidemic and to be better prepared for future Ebola outbreaks and bioterrorism events going forward. 

I want to thank the committee and subcommittee for your generous and continued support over the past decade and the opportunity to testify. Thank you. 

[The prepared statement of Mr. Robinson follows:] 

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Mr. MURPHY. Thank you, Dr. Robinson. Dr. Borio, you are recognized for 5 minutes. 

STATEMENT OF LUCIANA BORIO 

Ms. BORIO. Thank you. Good afternoon, Chairman Murphy, 

Ranking Member—— 

Mr. MURPHY. If you could just please pull the microphone as 

close to you as possible. Thank you. 

Ms. BORIO. Good afternoon, Chairman Murphy, Ranking Member 

DeGette and members of the subcommittee. Thank you for the opportunity to appear before you today to discuss FDA’s actions to respond to the Ebola epidemic, a tragic global event. My colleagues 

and I at the FDA are determined to do all we can to help end it 

as quickly as possible. 

The desire and need for safe and effective vaccines and treatments is overwhelming. FDA is taking extraordinary steps to be 

proactive and flexible. We are leveraging our authorities and working diligently to expedite the development and manufacturing 

availability of safe and effective medical products for Ebola. We are 

providing FDA’s unique scientific and regulatory advice to companies to guide their submissions. We are reviewing data as it is received. These actions help advance the development of investigation of products as quickly as possible, and for example, in the case 

of the two vaccines that Dr. Fauci mentioned, FDA took only a few 

days to review the applications and to allow the studies to proceed. 

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

and GlaxoSmithKline began Phase I clinical testing on September 

2nd and the vaccine candidate being developed by NewLink Genetics began similar clinical testing on October 13th. We are also 

partnering with the U.S. Government agencies that support medical product development including NIAID, BARDA, and the Department of Defense. 

Because of FDA’s longstanding collaboration with the DoD, FDA 

was able to authorize the use of the Ebola diagnostic test under our 

emergency use authorization within 24 hours of request. We authorized the use of two additional diagnostics tests developed by 

the CDC and these tests of course are essential for an effective 

public health response. 

In addition, we are supporting the World Health Organization. 

Our scientists are providing technical advice to the WHO as it 

works to assess the role of convalescent plasma in treating patients 

with Ebola. 

I recently participated in a consultation focused on Ebola vaccines in Geneva, which included dozens of experts from around the 

world as well as from affected and neighboring countries in West 

Africa. Participants agreed that promising investigational vaccines 

must be evaluated in scientifically valid clinical trials and in a 

most urgent manner. The FDA is working closely with our Government colleagues and the vaccine developers to support this goal. 

It is important to note, though, that while we all want access to 

immediate therapies to cure or prevent Ebola, the scientific fact is 

that these investigational products are in the earliest stages of development. There is tremendous hope that some of these products 

will help patients but it is also possible some may hurt patients 

57 

and others may have little or no effect. Therefore, access to investigational products should be through clinical trials when possible. 

They allow us to learn about product safety and efficacy, and they 

can provide an equitable means for access. 

FDA is working with our NIH colleagues to develop a flexible 

and innovative clinical trial protocol to allow companies and clinicians to evaluate multiple investigational Ebola products under a 

common protocol. The goal is to ensure accrual of interpretable 

data and generate actionable results in the most expeditious manner. It is important for the global community to know the risks and 

benefits of these products as soon as possible. 

Until such trials are established, we will continue to enable access to these products when available and requested by clinicians. 

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

assess that the expected benefits outweigh the potential risks for 

the patient. 

I can tell you that every Ebola patient in the United States has 

been treated with at least one investigational product. Because 

Ebola is such a serious and often rapidly fatal disease, FDA has 

approved such requests within a matter of a few hours and oftentimes in less than one hour. 

There are more than 250 FDA staff involved in this response, 

and without exception, everyone has been proactive, thoughtful, 

and adaptive to the complex range of issues that have emerged. We 

are fully committed to sustaining our deep engagement and aggressive activities to support the robust response to the Ebola epidemic. 

Thank you, and I will take your questions later. 

[The prepared statement of Ms. Borio follows:] 

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Mr. MURPHY. Thank you, Dr. Borio. Mr. Wagner, you are recognized for 5 minutes. 

STATEMENT OF JOHN P. WAGNER 

Mr. WAGNER. Thank you, Chairman Murphy, Ranking Member 

DeGette and distinguished members of the subcommittee for the 

opportunity to discuss the efforts of U.S. Customs and Border Protection in deterring the spread of Ebola by means of international 

travel. 

Each day, about 1 million travelers arrive in the United States. 

About 280,000 of them arrive at our international airports. CBP is 

responsible for securing our Nation’s borders while facilitating the 

flow of legitimate international travel and trade that is so vital to 

our Nation’s economy. 

Within this broad responsibility, our priority mission remains to 

prevent terrorists and terrorist weapons from entering the United 

States. However, we also play an important role in limiting the introduction, transmission and spread of serious communicable diseases from foreign countries. We have had this role for over 100 

years, and in coordination with the CDC, we have had modern protocols in place for well over a decade that have guided response to 

a variety of significant health threats. 

CBP officers at all ports of entry assess each traveler for overt 

signs of illness. In response to the recent Ebola virus outbreak in 

West Africa, CBP in close collaboration with CDC is working to ensure that frontline officers are provided the information, training, 

and equipment needed to identify and respond to international 

travelers who may pose a threat to public health. 

All CBP officers are provided guidance and training on identifying and addressing travelers with any potential illness including 

communicable diseases such as the Ebola virus. CBP officer training includes CDC public health training, which teaches officers to 

identify through visual observation and questioning the overt 

symptoms and characteristics of ill travelers. CBP also provides 

operational training and guidance on how to respond to travelers 

with potential illness including referring individuals who display 

signs of illness to CDC quarantine officers for secondary screening 

as well as training on assisting CDC with implementation of its 

isolation and quarantine protocols. 

Additionally, CBP provides training for its frontline personnel by 

covering key elements of CBP’s Bloodborne Pathogens Exposure 

Control Plan, protections from exposure, use of personal protective 

equipment, other preventive measures and procedures to follow in 

a potential exposure incident. We are committed to ensuring our 

field personnel have the most accurate, updated information regarding this virus since the outbreak began. CBP field personnel 

have been provided a steady stream of guidance starting with initial information on the current outbreak at the beginning of April 

this year with numerous and regular updates since then. 

Information sharing is critical, and CBP continues to engage 

with health and medical authorities. Since January of 2011, CDC’s 

Division of Global Migration and Quarantine has stationed a liaison officer at our national targeting center to provide subject-matVerDate Mar 15 2010 13:31 Sep 09, 2015 Jkt 037690 PO 00000 Frm 00070 Fmt 6633 Sfmt 6633 F:\113THCONGRESS\113179EBOLAMORESCANS090815\113179EBOLAPENDING WAY
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ter expertise and facilitate requests for information between the 

two organizations. 

Starting October 1st this year, CBP began providing Ebola information notices to travelers entering the United States from Guinea, Liberia and Sierra Leone. This tearsheet provides the traveler 

information and instructions should he or she have a concern of 

possible infection. 

In addition to visually screening all passengers for overt signs of 

illness, starting October 11th CBP and CDC began enhanced 

screening of travelers from the three affected countries entering at 

JFK Airport, and today we expanded these enhanced efforts at Dulles, Chicago O’Hare, Atlanta, and Newark. Approximately 94 percent of travelers from the affected countries enter the United 

States through these five airports. In coordination with CDC, these 

targeted travelers are asked to complete a CDC questionnaire, provide contact information, and have their temperature checked. 

Based on these enhanced screening efforts, CDC quarantine officers 

will make a public health assessment. 

Since the additional measures went into effect at JFK, CBP has 

conducted enhanced screening on 155 travelers who were identified 

in advance as being known to have traveled through one of these 

three affected countries. An additional 13 travelers were identified 

by CBP officers as needing additional screening during the course 

of our standard interview process that is applied at all ports of 

entry. A total of eight of these travelers have been sent to tertiary 

screening by CDC, and it is important to note that so far all passengers were examined and released. 

While CBP officers receive training in illness recognition and response, if they identify an individual believed to be ill, CBP will 

isolate the traveler from the public in a designated area and contact the local CDC quarantine officer along with local public health 

authorities to help with further medical assessment. CBP officers 

are trained to employ universal precautions, an infection control 

approach developed by CDC when they encounter individuals with 

overt symptoms of illness or contaminated items in examinations 

of baggage and cargo. When necessary, CBP personnel will take the 

appropriate safety measures based on the level of potential exposure. These procedures designed to minimize risk to our officers 

and the public have been used collaboratively by both agencies on 

a number of occasions with positive results. CBP will continue to 

monitor the Ebola outbreak, provide timely information and guidance to our field personnel, work closely with our interagency partners to develop or adopt measures as needed to deter the spread 

of Ebola in the United States. 

So thank you for the opportunity to testify today and the attention you are giving to this very important issue. I will be happy to 

answer any of your questions. 

[The prepared statement of Mr. Wagner follows:] 

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Mr. MURPHY. Thank you. Now we are going to recognize Dr. 

Daniel Varga, Chief Clinical Officer joining us from Texas on videoconference. Dr. Varga. 

STATEMENT OF DANIEL VARGA 

Mr. VARGA. Good afternoon, Chairman Murphy, Vice Chair Burgess, Ranking Member DeGette and members of the committee. My 

name is Dr. Daniel Varga. I am the Chief Clinical Officer and Senior Executive Vice President for Texas Health Resources. I am 

board certified in internal medicine and have more than 24 years 

of combined experience in patient practice, medical education, and 

health care administration. 

I am truly sorry that I could not be with you in person today, 

and I deeply appreciate the committee’s understanding of our situation and how important it is for me to be here in Dallas during this 

very challenging and sensitive time. 

Texas Health Presbyterian Hospital Dallas is one of 13 wholly 

owned acute-care hospitals in the Texas Health Resources System. 

We are an 898-bed hospital treating some of the most complicated 

cases in north Texas. Texas Health Dallas is recognized as a magnet designated facility for excellence in nursing services by the 

American Nurses Credentialing Center, the Nation’s leading nursing credentialing program. 

Texas Health Resources is one of the largest faith-based centers 

not-for-profit health systems in the United States and the largest 

in north Texas in terms of patients served. Our mission is to improve the health of the people in the communities we serve, and 

we care for all patients regardless of their ability to pay. We serve 

diverse communities, and as such, as provide one standard of care 

for all regardless of race or country of origin. 

As the first hospital in the country to both diagnose and treat a 

patient with Ebola, we are committed to using our experience to 

help other hospitals and health care providers protect the public 

health against this insidious virus. It is hard for me to put into 

words how we felt when our patient Thomas Eric Duncan lost his 

struggle with Ebola on October 8th. It was devastating to the 

nurses, doctors, and team who tried so hard to save his life, and 

we keep his family in our thoughts and prayers. 

Unfortunately, in our initial treatment of Mr. Duncan, despite 

our best intentions and a highly skilled medical team, we made 

mistakes. We did not correctly diagnose his symptoms as those of 

Ebola, and we are deeply sorry. Also, in our effort to communicate 

to the public quickly and transparently, we inadvertently provided 

some information that was inaccurate and had to be corrected. No 

doubt, that was unsettling to a community that was already concerned and confused, and we have learned from that experience as 

well. 

Last weekend, Nurse Nina Pham, a member of our hospital family who courageously cared for Mr. Duncan, was also diagnosed 

with Ebola. Our team is doing everything possible to help her win 

that fight, and on Tuesday her condition was upgraded to good, and 

as Dr. Fauci mentioned earlier, Nina’s care continues to evolve. I 

can tell you that the prayers of the entire Texas Health system are 

with her. Yesterday, as has been noted, we identified a second careVerDate Mar 15 2010 13:31 Sep 09, 2015 Jkt 037690 PO 00000 Frm 00076 Fmt 6633 Sfmt 6633 F:\113THCONGRESS\113179EBOLAMORESCANS090815\113179EBOLAPENDING WAY
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giver with Ebola, and I can also tell you that our thoughts and 

prayers remain with Amber as well. 

A lot is being said about what may or may not have occurred to 

cause Nina and Amber to contract Ebola. We know that they are 

both extremely skilled nurses and were using full protective measures under the CDC protocols, so we don’t yet know precisely how 

or when they were infected. But it is clear there was an exposure 

somewhere, sometime, and we are poring over records and observations and doing all we can to find the answers. 

You have asked about the sequence of events with regard to our 

preparedness for Ebola and our treatment of Mr. Duncan. Key 

events from our preparation timeline are attached to our submitted 

statement, but here is a brief overview. As the Ebola epidemic in 

Africa worsened over the summer, Texas Health hospitals and facilities began educating our physicians, nurses, and other staff on 

the symptoms and risk factors associated with the virus. On July 

28, an Infection Prevention Nurse Specialist at Texas Health received the first Centers for Disease Control and Prevention Health 

Advisory about Evola virus disease and began sharing it with other 

Texas Health personnel. The Healthcare Advisory encouraged all 

healthcare providers in the U.S. to consider EVD in the diagnosis 

of febrile illness—in other words, a fever—in persons who had recently traveled to affected countries. The CDC advisory was also 

sent to all directors of our emergency departments and signage was 

also posted in the EDs. 

On August 1, Texas Health leaders, including all regional and 

hospital leaders and the ED leaders across our system, received an 

email directing that all hospitals have a hospital epidemiologic 

emergency policy in place to address how to care for patients with 

Ebola-like symptoms. The email also drew attention to the fact that 

our electronic health record documentation in emergency departments included a question about travel history to be completed on 

every patient. Attachments to the e-mail included a draft THR epidemiologic emergencies policy that specifically addressed EVD, 

CDC-based poster to be posted in the ED, and the CDC advisory 

from 7/28. 

The August 1 CDC Guidelines and Evaluation of U.S. Patients 

Suspected of Having Evola Virus Disease was distributed to staff, 

including physicians, nurses, and other frontline caregivers on August 1st and August 4th. 

Over the last 2 months, the Dallas County Health and Human 

Services Department communicated with us frequently as plans 

and preparatory work were put in place for a possible case of 

Ebola. We have also provided the August 27, 2014 Dallas County 

Health Department algorithm and screening questionnaire. 

At 10:30 p.m. on September 25th, Mr. Duncan presented to the 

Texas Health Presbyterian Dallas Emergency Department with a 

fever of 100.1, abdominal pain, dizziness, nausea, and headache, 

symptoms that could be associated with many other illnesses. He 

was examined and underwent numerous tests over a period of 4 

hours. During his time in the ED, his temperature spiked to 103 

degrees Fahrenheit but later dropped to 101.2. He was discharged 

early on the morning of September 26th, and we have provided a 

74 

timeline on the notable events of Mr. Duncan’s initial emergency 

department visit. 

On September 28th, Mr. Duncan was transported to the hospital 

by ambulance. Once he arrived at the hospital, he met several of 

the criteria of the Ebola algorithm. At that time, the CDC was notified. The hospital followed all CDC and Texas Department of State 

Health Services recommendations in an effort to ensure the safety 

of all patients, hospital staff, volunteers, nurses, physicians, and 

visitors. Protective equipment included water-impermeable gowns, 

surgical masks, eye protection and gloves. Since the patient was 

having diarrhea, shoe covers were added shortly thereafter. 

We notified the Dallas County Health and Human Services Department, and their infectious disease specialists arrived on the 

site shortly thereafter. On September 30th, lab testing confirmed—— 

Mr. MURPHY. Doctor, could you—— 

Mr. VARGA [continuing]. The first case of the Evola Virus Disease 

diagnosed in the United States at Texas Health Dallas. Later that 

same day, CDC officials were notified, and they arrived on our 

campus October 1st. Physicians—— 

Mr. MURPHY. Doctor, one moment, please. 

Mr. VARGA [continuing]. Nurses—— 

Mr. MURPHY. Could you hold one moment, please? I know we are 

going way over time, and we do want to hear these details, but 

could you wrap it up? Because a lot of members want to ask you 

questions as well on some of these details, sir. 

Mr. VARGA. OK. 

Mr. MURPHY. Thank you. 

Mr. VARGA. In conclusion, I would like to underscore that we 

have taken all the steps possible to maximize the safety of our 

workers, patients and community, and we will continue to make 

changes as new learnings emerge. Moreover, we are determined to 

be an agent for change across the U.S. healthcare system by helping our peers benefit from our experience. 

Texas Health Resources is an organization with a long history of 

excellence. Our mission and our ministry will continue, and we will 

emerge from these trying times stronger than ever. 

Thank you for the opportunity to testify, and I’ll obviously be 

glad to answer any questions from the committee. 

[The prepared statement of Mr. Varga follows:] 

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Mr. MURPHY. Thank you. We will be recognizing each person on 

this committee for 5 minutes of questions. We will keep a strict 

time on this as well. 

Let me start off here with Dr. Frieden. A second nurse infected 

with Ebola took a flight to Cleveland after she registered a fever. 

We have a report that says she contacted the CDC and was told 

she could fly. Did she in fact call the CDC and ask for guidance 

on boarding a commercial flight as far as you know? 

Mr. FRIEDEN. My understanding is that she did contact CDC and 

we discussed with her her report of symptoms as well as other 

evaluation. 

Mr. MURPHY. Were you part of that conversation? 

Mr. FRIEDEN. No, I was not. 

Mr. MURPHY. Was there a pre-plan suggesting limiting her contacts with other persons? 

Mr. FRIEDEN. The protocol for movement and monitoring of people potentially exposed to Ebola identifies as high risk someone 

who did not wear appropriate personal protective equipment during 

the time they cared for a patient with Ebola. On—— 

Mr. MURPHY. Well, let me you ask this. What specifically did she 

tell you? We know Mr. Duncan’s medical team was was not under 

the same observation and travel restrictions as people he came into 

contact with, so what specifically did she tell you her symptoms 

were or what was happening? 

Mr. FRIEDEN. I have not seen the transcript of the conversation. 

My understanding is that she reported no symptoms to us. 

Mr. MURPHY. All right. Let me ask another question here quickly. With regard to the new patient being transferred to NIH, will 

people who come into contact with her be under any travel restrictions? Dr. Fauci, perhaps you know that? I know—— 

Mr. FAUCI. Well, according to the guidelines, the people who will 

be coming into contact with her will be physicians, nurses, and others who will be in personal protective equipment, and therefore 

they are not restricted. 

Mr. MURPHY. Why is she being transferred to NIH and away 

from Texas? 

Mr. FAUCI. To give the state-of-the-art care in a containment facility of highly trained individuals who are capable of taking care 

of her. 

Mr. MURPHY. Has her condition deteriorated or improved? 

Mr. FAUCI. No, it has not. I have not seen the patient yet. I will 

when she gets here. But at this point, from the report that we are 

getting from our colleagues in Dallas, it is that her condition is stable and she seems to be doing reasonably well. But I have to verify 

that myself when my team goes over. 

Mr. MURPHY. And if other people come to Dallas or somewhere 

else, will they also be transferred to NIH? 

Mr. FAUCI. We have a limited capacity of beds, of being able to 

do this type of high-level care and containment. Our total right 

now is two beds. She will occupy one of them. 

Mr. MURPHY. Thank you. 

Dr. Frieden, when we spoke on the phone the other day, you remained opposed to travel restrictions because, in your words, you 

said ‘‘cutting commercial ties would hurt these fledgling democVerDate Mar 15 2010 13:31 Sep 09, 2015 Jkt 037690 PO 00000 Frm 00084 Fmt 6633 Sfmt 6633 F:\113THCONGRESS\113179EBOLAMORESCANS090815\113179EBOLAPENDING WAY
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racies.’’ Now, is this the opinion of CDC? Is this your opinion or 

does someone also advise you, someone within the administration, 

any other agencies? Where did this opinion come from that that is 

of high importance? 

Mr. FRIEDEN. My sole concern is to protect Americans. We can 

do that by continuing to take the steps we are taking here as well 

as—— 

Mr. MURPHY. Did someone advise you on that? Did someone outside of yourself, somebody else advise you that that is the position, 

we need to protect fledgling democracies? 

Mr. FRIEDEN. My recollection of that conversation is that that 

discussion was in the context of our ability to stop the epidemic at 

the source. 

Mr. MURPHY. But we can get supplies and medical personnel into 

the Ebola hot zones and so stopping planes—and I have heard you 

say this on multiple occasions, that we have 1,000-plus persons per 

week coming into the United States from hot zones. Am I correct 

on that? Coming from those areas? 

Mr. FRIEDEN. There are approximately 100 to 150 per day. 

Mr. MURPHY. OK. Now, the Duncan case has seriously impacted 

Dallas and northern Ohio but what I don’t understand, if the administration insists on bringing Ebola cases into the United States, 

clearly you have determined how many Ebola infection cases the 

U.S. public can handle. I mean, NIH can handle two of these beds. 

Do you know that number overall in this country, how many we 

can handle? 

Mr. FRIEDEN. Our goal is for no patients with Ebola—— 

Mr. MURPHY. I understand, but as long as we don’t restrict travel 

and we are not quarantining people and we are not limiting their 

travel, we still have a risk, and so these issues of surveillance and 

containment I don’t understand, and this is the question the American public is asking: why are we still allowing folks to come over 

here and why once they are over here is there no quarantine. 

Mr. FRIEDEN. Our fundamental mission is to protect Americans. 

Right now, we are able to track everyone who comes in. 

Mr. MURPHY. But you are not stopping them from being around 

other people, Doctor. I understand that, and I have respect for you, 

but my concern is the American public, and even so, they are not 

limited from travel, they are not quarantined for 21 days because 

they could still show up with symptoms, they could still bypass all 

the questions that Mr. Wagner referred to and the thermometers, 

and this is what happened with the nurse who went to Cleveland. 

So I am concerned here. Is this going to be a maintained position 

of the administration that there will be no travel restrictions? 

Mr. FRIEDEN. We will consider any options to better protect 

Americans. 

Mr. MURPHY. Thank you. I now give 5 minutes to Ms. DeGette. 

Ms. DEGETTE. Thank you, Mr. Chairman. 

Dr. Frieden, I have got some questions for you and Dr. Varga for 

you, and I would appreciate yes or no answers because I have a lot 

to move through and only a short amount of time. 

Dr. Frieden, in the spring of 2014, Ebola began spreading 

through West Africa, causing increasing concern within the international public health community, correct? 

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Mr. FRIEDEN. Correct. 

Ms. DEGETTE. Ebola has an incubation period of about 21 days 

and is not contagious until the person with the virus begins to be 

symptomatic beginning often with a fever, correct? 

Mr. FRIEDEN. Between 2 and 21 days, yes. 

Ms. DEGETTE. Ebola is transmitted through contact with a patient’s bodily fluids including vomit, blood, feces, and saliva, and 

the virus concentrates more heavily as the patient becomes sicker, 

presenting increasingly greater risk to those who may be in contact 

with them, correct? 

Mr. FRIEDEN. Correct. 

Ms. DEGETTE. Now, the CDC has developed guidance for hospitals to follow if patients present with symptoms consistent with 

Ebola, and it distributed them to hospitals around the country in 

the summer of 2014, correct? 

Mr. FRIEDEN. Correct. 

Ms. DEGETTE. Now, Dr. Varga, can you hear me? 

Mr. VARGA. Yes, ma’am. 

Ms. DEGETTE. Your hospital received the first CDC Health Advisory about Ebola on July 28th, and this advisory was given to the 

directors of your emergency departments and signage was posted 

in your emergency room. Is that right? 

Mr. VARGA. Yes, ma’am. 

Ms. DEGETTE. Now, was this information given to your emergency room personnel and was there any actual person-to-person 

training at Texas Presbyterian for the staff at that time? Yes or no. 

Mr. VARGA. Was given to the emergency department. 

Ms. DEGETTE. Was there actual training? 

Mr. VARGA. No. 

Ms. DEGETTE. On August 1st, your hospital received an email 

from the CDC specifying how to care for Ebola patients and advising intake personnel to ask a question about travel history from 

West Africa. Is that right? 

Mr. VARGA. That is correct. 

Ms. DEGETTE. Now, on September 25th, almost 2 months after 

the first advisory received by the hospital, Thomas Eric Duncan 

showed up at Texas Presbyterian with a fever that spiked up to 

103 and he told the personnel that he had come from Liberia. Despite this, the hospital sent him home. Is that right? 

Mr. VARGA. That is not completely correct. 

Ms. DEGETTE. Well, they did send him home, right? 

Mr. VARGA. That is correct. 

Ms. DEGETTE. Now, 3 days later, on September 28th, he took a 

severe turn for the worse and was brought back by ambulance. The 

hospital staff, nurses, and everybody else wore protective equipment. Is that right? 

Mr. VARGA. That is correct. 

Ms. DEGETTE. And then eventually shoe covers were put on, too. 

Do you know how long that took them to put the shoe covers on? 

Mr. VARGA. I don’t. 

Ms. DEGETTE. Now, because Ebola is highly contagious when the 

patient is symptomatic, the protective gear has to shield them from 

any contact with bodily fluids. Is that right, Dr. Frieden? 

Mr. FRIEDEN. Correct. 

83 

Ms. DEGETTE. Now, I have a slide I would like to put up, and 

I got it from the New York Times today. It is the photo of the people in the various protective gear. So the first one on the left shows 

what they are supposed to wear when they are not having contact 

with the bodily fluids. The second one shows what they are supposed to have with the bodily fluids. So I want to ask you, Dr. 

Varga, is what they were wearing at first before the Ebola was diagnosed, that first set of protective gear? 

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Mr. VARGA. I am sorry. I can’t see the picture right now. 

Ms. DEGETTE. OK. I was told you would be able to. 

Dr. Frieden, what should they have been wearing of that protective gear before the Ebola was diagnosed? 

Mr. FRIEDEN. I can’t make out the details, but the recommendations vary as to the risk including whether the patient is having 

diarrhea or vomiting and may expose health care workers to—— 

Ms. DEGETTE. Well, this guy, he had diarrhea and vomiting. So, 

in your testimony, people should have been completed covered. Is 

that right? 

Mr. FRIEDEN. I would have to look at the exact details to know 

what the answer to that question would be. 

Ms. DEGETTE. So you don’t know whether they should have been 

completely covered if the patient had diarrhea and vomiting and he 

had come from West Africa? 

Mr. FRIEDEN. If the patient had diarrhea or vomiting, then additional covering is recommended under the CDC recommendations, 

yes. 

Ms. DEGETTE. Now, my other question that I want to ask—and 

I am going to have to get—Dr. Varga, I am going to have to get 

your testimony since you can’t see my chart. 

Now, subsequently, a number of people, health care workers, 

were put into this group, this protective work. Is that right, Dr. 

Frieden? People who were being monitored. 

Mr. FRIEDEN. So health care—— 

Ms. DEGETTE. And on October 10th, Nina Pham presented with 

a fever, and she was admitted to the hospital. Is that right? 

Mr. FRIEDEN. Yes. 

Ms. DEGETTE. And then on October 13th, Amber Vinson, who 

was self-monitoring, she presented with a fever and she was told 

by your agency she could board the plane. Is that right? I just have 

one more question. 

Mr. FRIEDEN. That is my understanding. 

Ms. DEGETTE. Now, your—— 

Mr. FRIEDEN. I need to correct that. 

Ms. DEGETTE. OK. 

Mr. FRIEDEN. I have not reviewed exactly what was said but she 

did contact our agency and she did board the plane. 

Ms. DEGETTE. And she says she was told to board the plane. 

Now—— 

Mr. FRIEDEN. That may well be correct. 

Ms. DEGETTE. Now, your August 22nd protocols say people who 

are being monitored should not travel by commercial conveyances, 

don’t they? 

Mr. MURPHY. Time is expired. You can answer the question. 

Ms. DEGETTE. That is what they say. 

Mr. FRIEDEN. People who are in what is called controlled movement should not board commercial airlines. 

Ms. DEGETTE. Right, and that is people who have close contact 

with these patients, right? That is what your guidelines say. 

Mr. FRIEDEN. The guidelines say that health care workers with 

appropriate personal protective equipment don’t need to be, but 

people without appropriate personal protective equipment do need 

to travel by controlled transportation. 

86 

Mr. MURPHY. The gentlelady’s time is expired. We do need to—— 

Ms. DEGETTE. Mr. Chairman, I just ask for the record the interim guidance dated October 22nd, the interim guidance dated August 1st, and the CDC Health Advisory dated July 28th be included 

in the record. 

Mr. MURPHY. Without objection, we will include it in the record. 

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Mr. MURPHY. And Dr. Frieden, I need you and also the doctor in 

Texas to get back to this committee as a follow-up to her question 

because your comment you just made to us was that if she was 

wearing appropriate protective gear, she is OK to travel; if she was 

not, she should not have traveled. And you just told us we don’t 

know. We need to find that out. It is an important question. 

I now recognize the chairman of the committee, Mr. Upton, for 

5 minutes. 

Mr. UPTON. Thank you again, Mr. Chairman. 

I think most Americans realize that, if you are exposed, you have 

21 days. If you go beyond 21 days, you are at virtually no risk of 

Ebola if you go that far. But it is conceivable then that after 14 

or 15 days, you in fact can still get Ebola. Is that correct? 

Mr. FRIEDEN. Yes. 

Mr. UPTON. So I want to go back to the restricting of travel, particularly by non-U.S. citizens, these 150 folks a day into the United 

States from West Africa. So the conditions as you talked about exit 

screening, all folks from there are exit screened, so it is perfectly 

conceivable that someone even after 14 days can exit screen, they 

are OK, no fever, and in fact, get to their destination, perhaps in 

the United States, and have the worst. Is that right? 

Mr. FRIEDEN. Yes. 

Mr. UPTON. So if our fundamental job is to protect the American 

public, the administration, as I understand it, because I have 

looked at the legal language, the President does have the legal authority to impose a travel ban because of health reasons, including 

Ebola. Is that not correct? 

Mr. FRIEDEN. I don’t have the legal expertise to answer that 

question. 

Mr. UPTON. I saw language earlier today—we can share that 

with you—but he does, from what we understand, not only an Executive Order that former President Bush issued when he was 

President but also legal standing as well. So if you have the authority, and it is my understanding again that a number of African 

countries around West Africa, around particularly these three nations, in fact have imposed a travel ban from those three countries 

into their country. Is that not true? 

Mr. FRIEDEN. I don’t know the details of the restrictions. There 

are some restrictions. 

Mr. UPTON. It is my understanding that they said no and including even Jamaica, as I read in the press earlier this week, has 

issued a travel ban from folks coming from West Africa. Are you 

aware of that? 

Mr. FRIEDEN. I don’t know the details of what other countries 

have done. I know some of the details, and some of them have been 

in flux. 

Mr. UPTON. Well, I guess the question that I have is, if other 

countries are doing the same, and as you said, the fundamental job 

of the United States now is to protect American citizens, why cannot we move to a similar ban for folks who may or may not have 

a fever, knowing in fact that the exposure rate, 14 days or 15 days, 

is well within the 21 days and in fact knowing 150 folks coming 

a day, not 100 percent, it is 94 percent in terms for screening from 

97 

U.S. airports, it seems to me that this is not a failsafe system that 

has been put into place at this point. 

Mr. FRIEDEN. Mr. Chairman, may I give a full answer? 

Mr. UPTON. I look forward to it. 

Mr. FRIEDEN. Right now we know who is coming in. If we try to 

eliminate travel, the possibility that some will travel overland, will 

come from other places and we don’t know that they are coming in 

will mean that we won’t be able to do multiple things. We won’t 

be able to check them for fever when they leave—— 

Mr. UPTON. If I can interrupt you just for a second, do we not 

have a record of where they have been before, i.e., a passport or 

travel status as they travel from one country to another? 

Mr. FRIEDEN. Borders can be porous—may I finish? 

Mr. UPTON. Go ahead. 

Mr. FRIEDEN. Especially in this part of the world. We won’t be 

able to check them for fever when they leave. We won’t be able to 

check them for fever when they arrive. We won’t be able, as we do 

currently, to take a detailed history to see if they were exposed 

when they arrive. When they arrive, we wouldn’t be able to impose 

quarantine as we now can if they have high-risk contact. We 

wouldn’t be able to obtain detailed locating information, which we 

do now, including not only name and date of birth but email addresses, cell phone numbers, address, addresses of friends so that 

we can identify and locate them. We wouldn’t be able to provide all 

of that information as we do now to State and local health departments so that they can monitor them under supervision. We 

wouldn’t be able to impose controlled release, conditional release on 

them or active monitoring if they are exposed or to in other 

ways—— 

Mr. UPTON. My time is expired. I know I have a swift gavel over 

here to my left. But I just don’t understand. If we have a system 

in place that requires any airline passenger coming in overseas 

with a date of birth to make sure they are not on the anti-terrorist 

list that we can’t look at one’s travel history and say, ‘‘No, you are 

not coming here, not until this situation’’—you are right, it needs 

to be solved in Africa, but until it is, we should not be allowing 

these folks in, period. 

Mr. MURPHY. The gentleman’s time is expired. I recognize Mr. 

Waxman for 5 minutes. 

Mr. WAXMAN. Thank you, Mr. Chairman. 

Dr. Frieden, you have a difficult job. In fact, all of your colleagues who are involved from the different agencies have a difficult job because this is a fast-moving issue, and you are trying to 

explain things to people and educate them with limited information 

and partial authority. In fact, the CDC can’t even do anything in 

a State. They have to be invited in by the State. You can’t tell the 

States to follow your guidelines. You can give them guidelines. So 

you are dealing with a fast-moving situation and you have to strike 

a balance about informing the public on the one hand and keeping 

it from panicking on the other. So let us go to basics. 

If people are frightened about getting Ebola, what assurances 

can we give them that this is not going to be a widespread epidemic in the United States, as you have said on numerous occasions? 

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Mr. FRIEDEN. The concern for Ebola is first and foremost among 

those caring for people with Ebola. That is why we are so concerned about infection control anywhere patients with Ebola are 

being cared for. Second, in the health care system as a whole, to 

think about travel because someone who has a fever or other signs 

of infection needs to be asked where have you been in the past 21 

days, and if they have been in West Africa, immediately isolated, 

assessed and cared for. 

Mr. WAXMAN. So we have to make sure that we monitor health 

care workers because they are exposed to people who have Ebola. 

The questions have been raised, well, what about all these people 

coming in from Africa from the countries where the Ebola epidemic 

is taking place, and you have been asked why don’t we just restrict 

the travel either directly or indirectly from anybody coming in from 

those countries. 

I would like to put up on the screen a map to show the passenger 

flows from those countries. That map shows that if you—I will hold 

it up here. If you are looking at those particular countries in Africa, 

they can go to any country in Europe. They can go to Turkey, 

Egypt, Saudi Arabia. They can go to China and India. They can go 

to other countries in Africa and then from those other countries 

come to the United States. So I suppose we can set up a whole bureaucratic apparatus to be sure that somebody didn’t really travel 

from Nigeria or Cameroon or Senegal or Guinea or Sierra Leone to 

be sure they didn’t really get here from any of those countries. 

That could be our emphasis, but it seems to me what you are saying is that we want to monitor people before they leave those countries to see whether they have this infection, and we want to monitor them when they come into these countries to see whether they 

have this infection. Is that what you are proposing to do? 

Mr. FRIEDEN. That is what we are actually doing. We are able 

to screen on entry. We are able to get detailed locating information. 

We are able to determine the risk level. If people were to come in 

by, for example, going overland to another country and then entering without our knowing that they were from these three countries, 

we would actually lose that information. Currently we have detailed locating information. We are taking detailed histories and we 

are sharing information with State and local health departments so 

that they can do the follow-up they decide to do. 

Mr. WAXMAN. Dr. Fauci, do you agree with Dr. Frieden on this 

point? 

Mr. FAUCI. I do. 

Mr. WAXMAN. You wouldn’t put a travel ban in. It sounds like, 

you know, we always seal off our borders, don’t let those people 

come in. Now, that is usually a reference to the immigration matter, not public health particularly, or it might be a tangential issue, 

but we know certain countries where the epidemic is originating. 

Why not stop them from coming in? 

Mr. FAUCI. Well, I believe that Dr. Frieden and yourself just articulated it very clearly. It is certainly understandable how someone might come to a conclusion that the best approach would be 

to just seal off the border from those countries, but now we know 

what we are dealing with. If you have the possibility of doing all 

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of those lines that you showed, that is a big web of things that we 

don’t know what we are dealing with. 

Mr. WAXMAN. So what we know is this epidemic can spread if 

there is contact with body fluids from somebody who is showing the 

symptoms of Ebola or someone who has been exposed to that individual. If we had a travel ban, wouldn’t we just force these people 

to hide their origin and wouldn’t we also not know where they are 

coming from if they are going out of their way to hide it? A ban 

or quarantine would hinder efforts to fight the epidemic in West 

Africa, and the worse the epidemic becomes in West Africa, the 

greater it is going to be a problem all over the world including the 

United States. 

Mr. MURPHY. The gentleman’s time is expired. 

Mr. WAXMAN. Is that your position? Dr. Fauci, is that your position? 

Mr. FAUCI. Yes. 

Mr. MURPHY. The gentleman’s time is expired. Now we recognize 

the vice chair of the full committee for 5 minutes. 

Mrs. BLACKBURN. Thank you, Mr. Chairman. 

Dr. Frieden, I want to be sure I heard you right. You just said 

to Chairman Upton that we cannot have flight restrictions because 

of a porous border, so do we need to worry about having an unsecure southern and northern border? Is that a big part of this problem? 

Mr. FRIEDEN. I was referring to the border of the three countries 

in Africa, Liberia—— 

Mrs. BLACKBURN. You are referring to that border, not our porous border? 

Mr. FRIEDEN [continuing]. Guinea and Sierra Leone. 

Mrs. BLACKBURN. Mr. Wagner, would it help you all, the Border 

Patrol, if we secured the southern border and eliminated illegal 

entry? 

Mr. WAGNER. Well, travelers coming across the southern border, 

like the northern border, we are going to, you know, query their 

information in our database. We are going to ask them their travel 

history, where they are coming from, how they arrived in the country they are coming from—— 

Mrs. BLACKBURN. Yes or no is sufficient. I need to move on. 

Dr. Frieden, I want to come back to you. I would remind you that 

a week before last when I was at the CDC, and I thank you for 

letting me come down to follow up with you all on some of our committee work, that I recommended a quarantine in the affected region and hold people there, and I still think that that is something 

that we should consider. Quarantining people for 21 days before 

they leave that region, it helps every country. 

I want to go back to an issue that you and I talked about at the 

CDC and a subsequent phone call, and that is the medical waste, 

and you assured me that standard protocols were being followed for 

disposal of this waste, and we know that 20, 25 years ago, hospitals 

could incinerate their waste. EPA regulations now prohibit that, 

and the waste has to be trucked, and they outsource the care of 

this medical waste and it results in that going to central processing 

centers. So let me ask you this. Is Ebola waste as contagious as a 

patient with Ebola? 

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Mr. FRIEDEN. Ebola waste or waste from Ebola patients can be 

readily decontaminated. The virus itself is not particularly hardy. 

It is killed by bleach, by autoclaving, by a variety of chemicals. 

Mrs. BLACKBURN. OK. Is Ebola medical waste more dangerous 

than other medical waste? 

Mr. FRIEDEN. The severity of Ebola infection is higher, so you 

want to be certain when you are getting rid of it that you handle 

it effectively. 

Mrs. BLACKBURN. OK. Is the CDC assessing the capabilities of 

hospitals to manage the medical waste of Ebola patients and does 

the CDC allow offsite disposal of Ebola medical waste? 

Mr. FRIEDEN. My understanding is to the latter question, yes, we 

worked very closely with both the Department of Transportation as 

well as the commercial waste management companies to ensure 

that capability. 

Mrs. BLACKBURN. So we have an added danger in having to truck 

this waste and move it to facilities. Are the employees of the processing centers being trained in how to dispose of Ebola waste? 

Mr. FRIEDEN. We have detailed guidelines for the disposal of 

medical waste from care of Ebola patients. 

Mrs. BLACKBURN. All right. You and I talked a little bit about my 

troops from Fort Campbell that are going to be over there, and I 

have some questions from some of my constituents. Are the American troops going to come in contact with any Ebola patients or 

with those exposed to Ebola or included in any of these controlled 

movement groups? 

Mr. FRIEDEN. As I understand it from the Department of Defense, their plans do not include any care for patients with Ebola 

or any direct contact with patients with Ebola. That said, we would 

always be careful in country because there is the possibility of coming in contact with someone with symptoms and being exposed to 

their body fluids, and that is why the Department of Defense is 

being extremely careful to avoid that possibility. 

Mrs. BLACKBURN. We are still going to rely on self-reporting? 

Mr. FRIEDEN. No. We are taking temperatures at many locations 

within the country. We are having hand-washing stations—— 

Ms. BLACKBURN. So you are moving away from self-reporting? 

Because originally it was—you said our structure was built on selfreporting when I visited with you earlier, and I found a quote from 

you from December 2011 at the George Comstock lecture in TB research, and I am quoting you: ‘‘Hippocrates was right: patients lie. 

About a third of patients don’t take medication as prescribed and 

a third don’t take them at all. You can either delude yourself and 

think that patients are taking their medications or not. In TB control, it is a simple model. If we see people take their meds, we believe they took their meds.’’ 

Now, Dr. Frieden, relying on self-reporting and making certain 

that people tell us the truth before they leave and then we catch 

the fever at the right time if they have a temperature. We have got 

to do better than this. We can do better than this. We are here to 

work with you and we expect a better outcome. I yield back. 

Mr. MURPHY. The gentlelady’s time is expired. I now recognize 

Mr. Braley for 5 minutes. 

Mr. BRALEY. I would like to thank the panel for joining us today. 

101 

Dr. Frieden, I was happy to hear you say we will consider any 

options to protect Americans. I think that is the purpose of everyone here in this room today. But I do want to ask you about Texas. 

Are you familiar with the concept of sentinel-event reporting? 

Mr. FRIEDEN. Yes. 

Mr. BRALEY. Has CDC done a root-cause analysis of what happened at Texas Presbyterian and come up with an action plan on 

what we learned from that incident? We have the detailed hospital 

checklist for Ebola preparedness, which we have heard about here 

today. Have there been any recommendations on changing, modifying, or updating this in light of what happened at Texas Presbyterian? 

Mr. FRIEDEN. We have a team of more than 20 of some of the 

world’s top disease detectives in Texas now. We were there. We left 

the first day the patient was diagnosed. We identified three areas 

of particular focus. The first is the prompt diagnosis of anyone who 

has fever or other symptoms of infection and a travel history to 

West Africa, and Dr. Varga spoke about that issue. The second is 

contact tracing, and the graphic that I provided earlier outlines 

what we are doing there very intensively. The State of Texas and 

the country are doing a terrific job along with our staff making 

sure that every single contact of the first patient, Mr. Duncan, is 

monitored, their temperature taken by an outreach worker every 

day for 21 days. They are most of the way through that risk period. 

So of the 48, none have developed symptoms, none have developed 

fever. We are now looking at the contacts, health care workers who 

may have had contact as the two individuals who became infected 

did, and our thoughts are with them, and we are delighted that 

NIH is supporting the hospital in Texas and also that Emory University is doing that as well, and the third area is after identification and contact tracing is effective isolation, and we are looking 

very closely at what might possibly have happened to result in 

these two exposures. 

Mr. BRALEY. And I assume if there are any new recommendations based upon that analysis, this protocol that was sent out will 

be updated and redistributed? 

Mr. FRIEDEN. We always look at the data to see what we can do 

to better protect Americans. 

Mr. BRALEY. Thank you. 

Dr. Fauci, you were kind enough to share with us this graphic, 

and in it you mentioned a company in Ames, Iowa, called NewLink, 

which is working on one of the vaccines that just went into Phase 

I clinical trials this week, correct? 

Mr. FAUCI. That is correct. 

Mr. BRALEY. And I had an opportunity to talk to two of their employees yesterday, and I know that they are working around the 

clock trying to help come up with a vaccine that will meet the protocol and the standards for scalability that I think everyone is looking for. The WHO, the Department of Defense, HHS, and the public health agency in Canada have called this vaccine one of the 

most advanced in the world, and they have requested contracts 

with HHS to expand the manufacturing, to add a third site for 

manufacturing, to complete the scientific studies required to scale 

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vide newly manufactured vaccines that are equivalent to the original vaccines, and they have also identified companies to work as 

subcontractors. 

Dr. Robinson, can you tell us what HHS is doing to make sure 

that those contracts are moving forward as quickly as possible? 

Mr. ROBINSON. Thank you, sir. We have reviewed their proposal. 

It looks very favorable, and we will be in the next several weeks 

finalizing the negotiations with them. Prior to that, we actually 

have been helping them with their submissions to the FDA and 

providing assistance onsite and also at the manufacturing sites and 

working with them to expand their production with other companies including a very large company here in the United States. 

Mr. FAUCI. And also, Mr. Braley, the HHS is also involved in the 

other end of it because the trials that were started were not only 

in collaboration with the Department of Defense but we admitted 

our first VSV patient at our clinical center in Bethesda for a Phase 

I trial. So it is not only in the testing but also in the ultimate production. 

Mr. BRALEY. And it is my understanding, Dr. Fauci and Dr. Robinson, that the ultimate goal is to also expand this clinical testing 

into some of the affected regions in Africa as well once we have an 

understanding of some of the concerns that were identified earlier 

in your testimonies. 

Mr. FAUCI. That is quite correct. In fact, when I was saying that 

after we get through Phase I on the trial, I was talking about both 

vaccines, the GlaxoSmithKline and the NewLink both. If they are 

safe and induce the response we feel is appropriate, we will expand 

both of them into larger trials in West Africa. 

Mr. BRALEY. And then Mr. Wagner, a question for you. We have 

heard a lot today about the issue of travel restrictions. Can you 

sort of walk us through the strengths and weaknesses of that approach from your standpoint in border security? 

Mr. WAGNER. Well—— 

Mr. MURPHY. The gentleman’s time is expired so if you could give 

a quick answer? 

Mr. WAGNER. So we have the ability to use the data that the airlines give us to be able to see where travel is originating from. 

There are instances where travelers may go to different locations. 

We might not see that, but through our questioning and our review 

of their passport, we can identify that they have been to these affected regions or if they come through one of the borders. If they 

fly to Canada or Mexico it is more difficult for us to do it but the 

possibility is there, but the possibility is also greater that we would 

miss one, so I do agree with what the experts, you know, say. It 

is easier to manage it and control it when we know where people 

are coming from voluntarily and not intentionally trying to deceive 

us. 

Mr. MURPHY. The gentleman’s time is expired. The word is ‘‘voluntary.’’ 

I now recognize Dr. Burgess for 5 minutes. 

Mr. BURGESS. Thank you, Mr. Chairman, and I would like to 

stay with what Chairman Upton was talking about on the travel 

restriction. 

103 

The Secretary of Health and Human Services under the Public 

Health Service Act has the authority to issue a travel restriction. 

Under the pandemic plan that was adopted in 2005, the President 

has the ability to issue a travel restriction. Two thousand five was 

geared toward the pandemic avian influenza but it was amended 

in July of this year to include the hemorrhagic fevers. So I believe 

that authority very clearly exists. Now, the question is why the Executive Branch and why the agency will not exercise that authority. Mr. Chairman, I think perhaps this committee should consider 

forwarding to the full House a request that we have a vote on travel restriction because people are asking us to do that, and I think 

they are exactly correct to make that request. 

Dr. Frieden, the first nurse who was infected over the weekend 

is now being transferred away from Presbyterian, and yet her condition has been serially reported in the news media as she is stable 

and she has been improving, so is the reason that she is having 

to be removed because the personnel are no longer willing to stay 

at Presbyterian to take care of her? 

Mr. FRIEDEN. Texas Presbyterian is really dealing with a difficult 

situation. They are working very hard. Because of the events of the 

past week, they are now dealing with at least 50 health care workers who may potentially have been exposed. The management of 

those individuals, making sure that if any of them develop any 

symptoms whatsoever, even the slightest, they come in immediately to be assessed so that if they develop Ebola, we hope no 

more will, but we know that is a possibility since two individuals 

did become infected, others may. That makes it quite challenging 

to operate a hospital, and we felt it would be more prudent to focus 

on caring for any patients who come in, health care workers or others who might come in with symptoms. 

Mr. BURGESS. I don’t disagree, and you and I have talked about 

this, and I am fully in favor of individuals who have been diagnosed that they do be taken care of in centers. Dr. Fauci, you know 

that if somebody wants to do research on the Ebola, they can’t just 

go to a regular university setting and do that. They must go to one 

of the laboratories where they have the capability of protecting the 

personnel who are not only doing the experiments but other personnel surrounding in the lab. Is it possible to get—I had a picture 

from the Dallas Morning News which had the CDC-recommended 

personal protective equipment. I think we have it there, and this 

not only shows the personal protective equipment, but it also details the order in which it should be put on and removed. I would 

know that shoe covers are not included in this graphic but you do 

see a fair amount of exposed skin around the eyes and the forehead 

and of course the neck. Now, Dr. Frieden, this is going to be hard 

to see, but this is your picture in western Africa, and as you can 

see, there is head-to-toe covering and goggles, and I believe if I understand the circumstances correctly, you were just about to be 

dosed with a near-toxic dose of chlorine. Is that not correct? 

Mr. FRIEDEN. Yes. 

Mr. BURGESS. Well, and that is why you can’t have skin exposed, 

because it is impossible to do the disinfection, if you will, after taking care of an Ebola patient or being in an Ebola ward. It is impossible to do the disinfection if there is skin exposed because exposed 

104 

skin would be killed by the chlorine and that would not be good 

for the person delivering the care. 

I mentioned this in my opening statement. I am so concerned. 

We know the numbers in western Africa are going up on Ebola. We 

know the case rate is going to increase. We know that 10 percent 

of those cases are health care workers, and we know that 56 percent of those health care workers in western Africa will succumb 

to the illness so that is a pretty dire warning for anyone who is 

involved in delivering health care. Dr. Robinson, let me ask you. 

What kind of stockpile of this personal protective equipment do you 

have available to the health care workers who are on the front 

line? And bear in mind, no travel restrictions so a new patient 

could come in tonight and go to any hospital in this country and 

present themselves. Are you going to be able to quickly deliver a 

stockpile of personal protective equipment like this? 

Mr. ROBINSON. So we know from talking to the manufacturers, 

there are no shortages right now and that they are willing to deliver within 24 hours or less. 

Mr. BURGESS. Let me just task this question, Dr. Frieden. You 

know, what did you think the first patient was going to look like 

when you knew you were going to have a patient zero at some 

point or that it was a possibility. We had the gentleman who died 

in Nigeria at the end of July who could have gotten on a plane to 

Minneapolis. What did you think that was going to look like? What 

was patient zero going to look like? And now you have seen what 

it really looks like—— 

Mr. MURPHY. The gentleman’s time is expired. 

Mr. BURGESS [continuing]. What is the matchup there? 

Mr. MURPHY. You can go ahead and answer quickly. Thank you, 

Doctor. 

Mr. FRIEDEN. Our goal has been to get hospitals ready. The specific type of personal protective equipment to be used is not simple, 

and there is no single right answer, but there is a balance between 

protective equipment that is more familiar or less familiar, that is 

more flexible and less flexible, that can be decontaminated more 

easily or less easily, so the use of different types of protective 

equipment is something that obviously we are looking at very intensively now in Dallas in conjunction with the health care workers 

there. 

Mr. MURPHY. Thank you. I now recognize Ms. Schakowsky for 5 

minutes. 

Ms. SCHAKOWSKY. Thank you, Mr. Chairman. 

I have so many questions. I just want to begin, though, by thanking the health care professionals that are on the front line, and I 

would like to ask unanimous consent to put into the record, Mr. 

Chairman, a letter from Randi Weingarten from the American Federation of Teachers, which represents many nurses into the record. 

I would also like unanimous consent to put in the record the diary 

of Paul Farmer from Partners in Health, who has among other 

things said the fact is that weak health systems are to blame for 

Ebola’s rapid spread in West Africa, and we know that West Africa 

has 24 percent of global disease burden, 3 percent of world health 

workforce, one doctor in Liberia for 90,000 people. 

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Ms. SCHAKOWSKY. So I would like to focus on what we are going 

to do to help that infrastructure, but in my limited time I want to 

focus on our infrastructure here. 

We have a vast infrastructure—hospitals, community health centers, I want to point out too where people may present themselves, 

nurses, nurses’ aides, no one better than the United States, but do 

we have the ability to train and equip, as we talk about in military 

terms in Syria, and do we have the ability really to train and 

equip? 

Let me just put a couple things on the table. In terms of the 

nurses, I still don’t feel like we have a good answer of why nurse 

one and nurse two contracted Ebola. Is it because there was a problem with not following the protocols or is there something wrong 

with the protocols? And how are we going to ensure that even if 

we have the best protocols in the world that everybody knows how 

to use them? 

Congresswoman DeGette showed the various protective gear that 

our nurses are supposed to have, and yet 2 days apparently went 

by when they were not wearing shoe covers, that their necks were 

not covered, that skin in fact, as Dr. Burgess was talking about, 

was in fact exposed, even as we knew that he had Ebola. 

So how are we going to make sure despite how we are going to 

check at the airports—I am from Chicago. I talked to our health 

director today. I know what we are doing. But there is still the 

chance that someone could present anywhere. So how come the 

nurses in Dallas weren’t protected and how are we going to make 

sure that everybody can be? 

Mr. FRIEDEN. So first just to clarify one thing, those first couple 

of days, the 28th, 29th, 30th, were before his diagnosis was known 

so he had suspected Ebola. The test was being drawn and assessed 

but he had not yet been diagnosed with Ebola, and in our team’s 

review—— 

Ms. SCHAKOWSKY. Is that—excuse me one second. Congresswoman, were you saying otherwise? Can I yield? 

Ms. DEGETTE. If the gentlelady will yield, but he presented with 

Ebola symptoms. He had been to the emergency room just a couple 

of days earlier saying he had been from Africa, and I believe the 

CDC protocols that were given to the Dallas hospital said that people should be wearing that protective covering even before the official diagnosis. I would certainly hope—thank you for yielding, Ms. 

Schakowsky. 

Dr. Frieden, I would certainly hope that here going forward if a 

patient shows up saying he is from Africa and he is vomiting and 

he has diarrhea, that you wouldn’t say, ‘‘Well, we don’t have the 

lab results in yet,’’ you would start treating that person like they 

had Ebola. 

Mr. FRIEDEN. Absolutely. I just wanted to clarify that those first 

couple of days, the 28th and 29th, he was being isolated for Ebola. 

The diagnosis was confirmed on the 30th. On the 30th we sent a 

team there—— 

Ms. SCHAKOWSKY. OK. 

Mr. FRIEDEN. And when we looked at the—to answer your question—of those first couple of days, there was some variability in the 

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use of personal protective equipment. The hospital was certainly 

trying to implement CDC protocol—— 

Ms. SCHAKOWSKY. I know, but going forward, how are we going 

to assure that just trying, you know, how are we going to educate 

people, nurses? The nurses are saying across the country that they 

have not been involved and that they are not trained properly or 

have the equipment. 

Mr. FRIEDEN. Three phases. First, think Ebola in anyone with 

travel history and symptoms. Second, any time a patient is suspected, isolate them, contact us, and we will talk you through how 

to provide care while we get the test done, and if it is confirmed, 

we will be there within hours with a CDC Ebola Response Team. 

Ms. SCHAKOWSKY. OK. My time is expired. 

Mr. MURPHY. Just in response to that, when did you come up 

with that plan that you just stated to Ms. Schakowsky, the plan 

in terms of training for nurses? When was that decided? 

Mr. FRIEDEN. We look at our preparedness continuously so 

awareness has been something that we have been promoting in extensive ways since the outbreak—— 

Mr. MURPHY. I mean, she was asking specifically for those 

nurses. When was the plan put in place for the Texas hospitals and 

says you need to follow this protocol from this point on? 

Mr. FRIEDEN. The day the diagnosis was confirmed, we sent a 

team to Texas. 

Mr. MURPHY. Thank you. Dr. Gingrey is recognized for 5 minutes. 

Mr. GINGREY. Well, first of all, I want to thank, of course, Chairman Murphy for calling the subcommittee back to Washington to 

hold today’s hearing on our collective response to the ongoing Ebola 

outbreak and commend my colleagues on both sides of the aisle, 

your near-unanimous attendance to this hearing. 

Since my time is very limited, of course, I would like to get directly to my questions, and this is kind of a follow-on maybe to 

what Ms. Schakowsky was asking, and I don’t think we ever got 

around to an answer on that, and I am going to direct the question 

to Dr. Frieden and to Dr. Varga, maybe first to Dr. Varga. 

As we know from new reports yesterday, there has been a second 

health care worker who has contracted Ebola, Ms. Amber Vinson. 

Now that she is receiving isolated treatment at Emory University 

containment unit in Atlanta, we must examine the protocol breakdowns that resulted in the contraction of Ebola by these two nurses 

who were directly in contact treating Thomas Duncan. 

Dr. Varga, in your written testimony you say that the first nurse, 

Ms. Pham, to contract Ebola was using full protective measures 

under the CDC protocol while treating Mr. Duncan. Has your organization in Texas identified where the specific breaches in protocol 

were that resulted in her infection or, alternatively, the inadequacies of the protocol? Dr. Varga, that question is for you. 

Mr. VARGA. Thank you, sir. We are investigating currently the 

source of this obvious exposure and contraction of the illness. We 

have confirmed that Nina through her care with Mr. Duncan was 

wearing protective patient equipment through the whole period of 

time. As Dr. Frieden already mentioned, with the diagnosis of the 

Ebola confirmed, the level of personal protective equipment was 

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elevated to the full hazmat style. We don’t know at this particular 

juncture what the source or the cause of the exposure that caused 

Nina to contract the disease was. 

Mr. GINGREY. Dr. Varga, I am going to interrupt you just for a 

second because of limitation of time. I want to now go to Dr. 

Frieden. 

Dr. Frieden, as Dr. Varga just stated, health care personnel were 

following CDC protocols while treating Mr. Duncan, which include 

the use of so-called PPE, personal protective equipment. Do the 

CDC guidelines, your guidelines, on the use of PPE mirror current 

international standards that by the way are being adhered to, 

those international standards, in West Africa in those three countries, Sierra Leone, Guinea, and Liberia? 

Mr. FRIEDEN. The international standards are something that 

evolve and change. We use different PPE in different settings. 

There is no single right answer, and this is something we are looking at very closely. Our current guidelines are consistent with recommendations from the World Health Organization. That is my understanding. 

Mr. GINGREY. I would think that there would need to be, Dr. 

Frieden, and I commend you for the job that you are doing and I 

know these are tough times for all of us, but I think some consistency is what we need, and that brings me to my next question and 

my last question, and again, it is to you, Dr. Frieden. 

This issue of elevated temperature, is it 100.4, is it 101.5, is it 

99.6? I think there is some great confusion because initially when 

people were screening, Mr. Wagner, at the airports in West Africa, 

the temperature threshold was 101.5, and then I think now the 

screenings that we are doing at these five major airports including 

Hartsfield International in Atlanta, it is now 100.4. When Mr. 

Duncan came for the first time to the Texas Presbyterian Hospital, 

his temperature was, what, 100.1, and within 24 hours, of course, 

it was 103. So when mom and dad are out there when their child 

has a temperature and this fall is flu season and they are going 

to the doctor, they are going to demand being checked for Ebola. 

Give us some guidelines on what is elevated temperature and when 

should parents be concerned? 

Mr. FRIEDEN. Well, first, parents should not be concerned about 

Ebola unless you are living in West Africa or the child has had exposure to Ebola, and right now the only people who have had exposure to Ebola in the United States are people who either are providing care for Ebola patients or the contacts of the three Ebola patients, and I outlined those in this sheet. For our screening criteria, 

we are always going to try to have an additional margin of safety 

and so we look at that, and we would rather check more people and 

assess, so we are going to always have that extra margin of safety 

for our screening. 

Mr. GINGREY. Thank you, and I yield back. 

Mr. MURPHY. I now recognize Ms. Castor for 5 minutes. 

Ms. CASTOR. Thank you all for tackling this important public 

health issue of the Ebola virus, and I want to thank the experts 

at the Centers for Disease Control and the NIH and medical professionals across the country, especially those at Emory University 

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Health Care who have been proactive in containing and treating 

the virus. 

I agree with President Obama and all of you. We have to be as 

aggressive as possible in preventing any transmission of the disease within the United States and boosting containment in West 

Africa. 

But I also think we need to pause here. This is a wakeup call 

for America that we cannot allow NIH funding to stagnate any 

longer. Earlier this year in the Budget Committee, I offered an 

amendment to the Republican budget to restore the cuts to NIH, 

the budget cuts that have been inflicted over the past 2 years and 

repair the damage of the Government shutdown of last year. Unfortunately, it did not pass on a party-line vote. We will only save 

lives if we can robustly fund medical research in America and keep 

America as the world leader. 

So I would like to turn to some of that research that is going on 

now because it is going to be research that will be our longer-term 

response to Ebola. It will be the vaccines to prevent the disease 

and the drugs to treat it. So I want to walk through a basic point 

here, that the development of vaccines and treatments for Ebola is 

different from the development of many other drugs. There is not 

a large private market for Ebola drugs, so the development requires leadership of our country, and NIH, as Dr. Fauci has testified, has been working on a vaccine for many years, and he reported today they have now moved into some Phase I clinical trials. 

Dr. Fauci, can you explain to us why Government support is so 

important for developing Ebola vaccines and treatments? 

Mr. FAUCI. Well, when you have a product that you want to develop, there is not a great incentive on the part of the pharmaceutical companies because it is a disease whose characteristics are 

not a large market. We had the experience when you are dealing 

with emerging and reemerging diseases, be it influenza or be it a 

rare disease that could either be used deliberately in bioterror or 

a rare disease like Ebola, that if you look prior to the current epidemic, there were 24 outbreaks since 1976. The total number of 

people in those outbreaks was less than 3,000. It was about 2,500. 

So we were struggling for years to get pharmaceutical partners 

ourselves who were doing the fundamental basic and clinical research, and then we did get some pharmaceutical partners like we 

have now with GlaxoSmithKline and the NewLink Corporation, 

which is the reason why we are now moving along. So that is one 

of the reasons why we have BARDA, so I showed that slide, Ms. 

Castor, with the NIH and the researchers at this end, and then you 

have to push the envelope further to the product to de-risk it on 

the part of the companies. Companies don’t like to take risks when 

they don’t have a—— 

Ms. CASTOR. So can you quantify a timeline for an Ebola vaccine 

to be on the market? Is it feasible for any vaccines to be approved 

in time to assist in the current outbreak? 

Mr. FAUCI. Well, your question has a couple of assumptions. The 

first is that the vaccine is safe and it works. The second is going 

to be, how long is this outbreak going to last at this level. If you 

look at the kinetics and the dynamics of the epidemic, it looks very 

serious. Our response to it—when I say ‘‘our,’’ I mean the global 

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response—has not kept up with the rate of expansion. If that keeps 

up as the CDC has projected, we may need a vaccine to actually 

be an important part of the control of the epidemic itself as opposed to what the original purpose of it was, to protect health care 

workers alone, but now if you have a raging epidemic—and to be 

quite honest with you, Ms. Castor, I cannot predict when that will 

be. 

If you have a lot of rate of infection, a vaccine trial takes a much 

shorter time to give you the answer. If it slows down, it is a much 

longer time. If you have a lot more people in your vaccine trial, it 

takes less time. If we have trouble logistically, which we might, of 

getting people into the trial, it might take longer. So I would like 

to give you a firm answer but we can’t right now. 

Ms. CASTOR. In addition to the vaccines, part of controlling the 

virus is early diagnosis and treatment. I know there are some diagnostic tests that are being developed. Can you speak to the prospects of improved diagnostics that can assist in this outbreak? 

Mr. FAUCI. Right. Well, there are a couple of us, and when I say 

‘‘us’’ I mean agencies that are working on diagnostics. Dr. Frieden’s 

group at the CDC has actually played a major role in leadership. 

We have several grants and contracts out to try and get earlier and 

more sensitive diagnostics. 

Ms. CASTOR. Thank you. 

Mr. MURPHY. Thank you. I now recognize Mr. Gardner for 5 minutes. 

Mr. GARDNER. Thank you, Mr. Chairman, and I thank the witnesses for joining us today and the work that you are undertaking. 

Dr. Frieden, I want to clarify something that you had said earlier. I believe you mentioned that there are approximately 100 to 

150 people a day coming into the United States from the affected 

areas? 

Mr. FRIEDEN. That is my understanding, yes. 

Mr. GARDNER. And to Mr. Wagner, you had mentioned that we 

are screening 94 percent of those people? 

Mr. WAGNER. As of today with the expansion to the four additional locations. That covers about 94 percent. 

Mr. GARDNER. OK. So of the 100 to 150, 94 percent are being covered. That means that somewhere between 2,000 and 3,000 people 

a year are coming into this country without being screened from 

the affected areas? 

Mr. WAGNER. Well, they would undergo a different form of 

screening. We are still going to identify that they have been to one 

of those three affected regions, and we are still going to ask them 

questions about their itinerary. We are going to be alert to any 

overt signs of illness and coordinate with CDC and public health 

if they are sick, and we are also going to give them a fact sheet 

about Ebola, about the symptoms, what to watch for, and most importantly, who to contact—— 

Mr. GARDNER. Would we be checking their temperature? 

Mr. WAGNER. We will not be checking their temperatures or having them fill out a contact sheet about—— 

Mr. GARDNER. So there are 2,000 to 3,000 people entering this 

country a year without checking their temperature, without having 

the contact sheet that 94 percent of those affected people—— 

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Mr. WAGNER. They are going to arrive at hundreds of different 

airports throughout the United States. 

Mr. GARDNER. OK. I want to talk a little bit more about the travel restrictions. 

Dr. Frieden, how many non-U.S. military flights, commercial 

flights, are currently going into the affected countries? 

Mr. FRIEDEN. I don’t have the exact numbers. 

Mr. GARDNER. Does anyone on the panel know how many commercial flights are going into these areas? Mr. Wagner, you don’t 

know? 

Mr. WAGNER. From the United States or from anywhere? 

Mr. GARDNER. From the United States into those areas. 

Mr. WAGNER. There are no direct flights, commercial flights, 

from those three affected areas to the United States. 

Mr. GARDNER. And into the area, into West Africa. 

Mr. WAGNER. There are flights into West Africa. 

Mr. GARDNER. How many? 

Mr. WAGNER. That I don’t have offhand. 

Mr. GARDNER. Anybody on the panel know how many? How 

many coming back into the United States? 

Mr. WAGNER. There are no commercial flights coming directly 

into the United States from those three areas. 

Mr. GARDNER. And what about Europe? 

Mr. WAGNER. There are hundreds of flights a day coming from 

there. 

Mr. GARDNER. OK. So people traveling from West Africa to Europe to here? 

Mr. WAGNER. That is generally how they would get here. 

Mr. GARDNER. And 94 percent screening. How many flights are 

required daily, every other day, or weekly to get the supplies and 

personnel to the affected areas? 

Mr. FRIEDEN. The quantity of supplies is quite large. I would 

have to get back to you in terms of the numbers. But there are 

huge quantities needed, but it is not just supplies. It is also personnel who need to move back and forth. 

Mr. GARDNER. Well, if you could get back to me with that number, I would appreciate it. 

Now, Dr. Frieden, are you aware if Nigeria has a travel ban from 

the countries affected with the outbreak right now? 

Mr. FRIEDEN. I believe that is not the case. 

Mr. GARDNER. They do not? OK. 

Dr. Frieden, one of the issues that has been brought up regularly 

to me back in the district when I go home, what should I tell my 

local hospital and local doctors that they need to do to address 

Ebola? 

Mr. FRIEDEN. The single most important thing they need to do 

is to make sure that if anyone comes in with fever or other symptoms of infection, they need to ask where they have been for the 

past 21 days and whether they have been in West Africa. 

Mr. GARDNER. And the training that a small local district hospital would receive, is that the same kind that a major metropolitan hospital would receive? 

Mr. FRIEDEN. There are a variety of forms of training. We support hospitals. Hospitals are regulated by States, not by CDC. 

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Mr. GARDNER. Dr. Frieden, what do we need to do? We are entering the flu season now, as somebody else on the panel had mentioned. What do we need to do to make sure that people understand that there could be similar conditions, similar circumstances 

so that we don’t have a situation where people are indeed panicked? 

Mr. FRIEDEN. The key issue, it is, as you point out, getting into 

flu season. By all means, get a flu shot. And for health care workers, any time someone comes in with a fever or other signs of infection, take a travel history. That is really important. 

Mr. GARDNER. Dr. Frieden, I just want to go back to what I said 

at the beginning. You mentioned that we can’t have a travel ban 

because you are afraid of the impact that it would have but you 

don’t know how much personnel, equipment, and flights are currently in use. 

Mr. FRIEDEN. My point earlier on was that, if passengers are not 

allowed to come directly, there is a high likelihood that they will 

find another way to get here and we won’t be able to track them 

as we currently can. 

Mr. GARDNER. But we are talking about supplies, equipment, and 

personnel, how many? How many flights? How many personnel? 

How much equipment? 

Mr. FRIEDEN. The point I made earlier was if we are not able to 

track people coming directly, we will lose that ability to monitor 

them for fever, to collect their locating information, to share that 

with local public health authorities and to isolate them if they are 

ill. 

Mr. GARDNER. Mr. Chairman, I yield back. 

Mr. MURPHY. The gentleman’s time is expired. Thank you. I now 

recognize Mr. Welch for 5 minutes. 

Mr. WELCH. Thank you. 

I want to follow up on some of Mr. Gardner’s questions. First of 

all, I want to understand this. There has been one person that 

came to the United States and then he infected two health care 

workers in Dallas, correct? 

Mr. FRIEDEN. At this point, none of the 48 contacts he had before 

getting isolated have developed symptoms and they are mostly well 

past the maximum incubation period, although not completely out 

of the woods. 

Mr. WELCH. All right. And for everybody on the panel, it is Code 

Red. We have had two instances of infection here in the United 

States, but this is such a highly contagious disease that we are on 

full alert, correct? 

Mr. FRIEDEN. It is a very severe disease. It is not nearly as contagious as some other diseases, but any infection in a health care 

worker is unacceptable. 

Mr. WELCH. That is right, and there is an enormous, enormous 

amount of public concern and apprehension about this so we appreciate the full-on efforts that you are making. There has been some 

lessons learned from what happened in Dallas. The hospital has 

been forthcoming about mistakes that were made, and now what 

you are telling us is that there has been information provided to 

all our hospitals in the country about what protocols to follow, correct? 

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Mr. FRIEDEN. Correct. 

Mr. WELCH. Now, just on a practical level, is it feasible that all 

our hospitals are going to be in a position to provide state-of-theart treatment or does it really as a practical matter make sense for 

hospitals to contact you when they have a potential infection for 

you to come and then for us to have centers to which that individual who is infected can be treated? 

Mr. FRIEDEN. Every hospital needs to be able to think it may be 

Ebola, diagnose it, to call us as they do—we have had hundreds of 

calls—and then we will send a team to determine what is best for 

that hospital and that patient. 

Mr. WELCH. And then what we have also heard—Ms. 

Schakowsky asked this question—this is absolutely a public health 

infrastructure issue where it gets out of hand, correct? 

Mr. FRIEDEN. Public health measures can control Ebola. 

Mr. WELCH. Right. And they have had effective measures in Nigeria where they have been able to contain it but they have no 

public health infrastructure in these three countries where the epidemic is now getting some headway, correct? 

Mr. FRIEDEN. Exactly. 

Mr. WELCH. And then in the United States, of course, we are fortunate to have a pretty good infrastructure but we do have to have 

an answer, I think, to this question that is being asked about travel. That is a concern that people have because it is seen as a quote, 

easy answer, and I just want to understand what the debate is 

within the medical community. For a lot of us sitting up here, we 

are hearing from our constituents. It sounds like something that 

we can do and that will eliminate any possibility of an infection 

coming here, but that may be a psychological answer but not necessarily an effective medical answer. 

All of us have been asking you to give your explanation, and anyone else can come in, as to why from a medical standpoint you 

have concluded that a total travel ban is inappropriate and not effective. 

Mr. FRIEDEN. First off, many of the people coming to the United 

States from West Africa are American citizens, American passport 

holders, so that is one issue just to be aware of, but—— 

Mr. WELCH. All right. And then by the way, I don’t have much 

time, but our health care workers, even if there some risk of infection, if we are going to encourage people to go and do the important 

work including our military personnel, we have got to take them 

back and make sure we can treat them if in fact they do get the 

illness, correct? 

Mr. FRIEDEN. People travel, and people will be coming in. 

Mr. WELCH. And as I understand it, you say there is basically 

a tradeoff. If you have a full-on ban, there is going to be ways 

around it and then you are going to lose the benefit of being able 

to track folks who may be infected and then that could lead to a 

greater incidence of outbreak, so it is a tradeoff. Is that essentially 

what is going on? 

Mr. FRIEDEN. We are open to any possibility that will increase 

the safety of Americans. 

Mr. WELCH. Right. So are there some midpoints that in terms of 

travel restrictions as opposed to a travel ban that may make sense 

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to you in coordination with your colleagues, particularly Mr. Wagner? 

Mr. FRIEDEN. We would look at any proposal that would improve 

the safety of Americans. 

Mr. WELCH. All right. This isn’t about funding so I am not going 

to ask you because I think we would know what your answers 

would be, but I just want to share my concern that was expressed 

by Ms. Castor. 

Mr. Chairman, we may want to have a hearing at some point 

about what is the funding requirements to make certain that the 

infrastructure this country needs to be in place before something 

happens is robust, it is strong, we have got people who are trained, 

they are ready to do the job and they have everything that they 

need. So that is not today’s hearing but I think it is a question that 

we should address because with 20 percent across-the-board funding at NIH, I find that to be a reckless decision with 12 percent 

at CDC. I think that is definitely the wrong direction. I think this 

Congress has to revisit our priorities on making certain that we 

have the public health infrastructure to be prepared to protect the 

American people. 

Mr. MURPHY. If I could just say, we are planning a second hearing, and in preparation for that we will also ask if NIH does have 

the flexibility now to transfer funds as well as HHS. 

I now recognize Mr. Griffith for 5 minutes. 

Mr. GRIFFITH. Thank you, Mr. Chairman. 

I believe we should have reasonable travel restrictions. Dr. 

Frieden, in answering a question of my colleague from Colorado, 

Mr. Gardner, you indicated that Nigeria didn’t have any restrictions, and that is accurate, but I have in my possession, and I 

would ask that it be submitted to the committee for the record, a 

letter from delegate Robert G. Marshall of Manassas, Virginia, to 

Governor Terry McAuliffe, Governor of the Commonwealth, and in 

that he cites the International SOS, a prominent medical and travel security services company with more than 700 locations in 76 

countries, reports that African countries have imposed total air, 

land, and water travel bans by persons from countries where Ebola 

is present. The countries include Kenya, Cape Verde, Cameroon, 

Mauritius, South Sudan, Namibia, Gambia, Gabon, Cote d’Ivoire, 

Rwanda, Senegal, Chad and Kenya. South African development 

community members, 14 countries, only allow highly restricted 

entry from Ebola-affected regions with monitoring for 21 days and 

travel to public gatherings discouraged. 

[The information follows:] 

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Mr. GRIFFITH. I find that interesting, Dr. Frieden, because some 

of those countries have had previous outbreaks of Ebola themselves. Wouldn’t you agree that some of those countries have had 

to face Ebola before? 

Mr. FRIEDEN. I would have to check the list carefully to know, 

but I will take your word for it. 

Mr. GRIFFITH. All right. I will tell you that this is a concern to 

a lot of our constituents and to mine as well, and I was checking 

my Facebook page recently when I saw that a Facebook friend of 

mine, a father from Virginia, asked for prayers for his daughter because she lives in the apartment complex with the first nurse, 

Nurse number one, as I think somebody referred to earlier, and 

was very concerned, and while I think I know the answer, I would 

like to get your answer so that I can reassure this father and that 

is, his question is, if I count to 21 days and my daughter is not infected, at that point can I exhale and breathe a sigh of relief? 

Mr. FRIEDEN. Not only can he do that but he can do that now 

because the first nurse only exposed one person, one contact, and 

that was only in the very early stages of her illness, so at most, 

one person from the community was exposed. 

Mr. GRIFFITH. And I appreciate that. He also asked a second 

question. He said there is some suggestion coming out of Dallas 

that the patient’s dog may be infected and may have infected other 

dogs through actual contact or by feces. Can the virus be transmitted by dogs? And I will tell you that I did some homework on 

this because I thought it was an interesting question and found a 

CDC publication from March of 2005 that did a study on dogs in 

Africa in the affected areas and a study in France as a control 

group, and they found that while dogs show antibodies for Ebola, 

they are asymptomatic, but the study went further to say that 

there is really a lot of questions about how Ebola is transmitted, 

and in some instances, Gabon in 1996 and 2004, Republican of 

Congo likewise in 2004 and the Sudan, that there is a question 

mark as to whether or not, or how that Ebola outbreak occurred. 

It wasn’t in the normal or standard ways. It wasn’t human to 

human. And this report indicates that dogs might be—might be— 

I don’t want to scare folks—might be suspect. 

I guess my question to you is, isn’t it true that we really don’t 

know a whole lot about the various outbreaks of Ebola and so when 

we are trying to assure the American people just like previously we 

didn’t think it would come to this country and then we thought if 

it did get to this country, we wouldn’t have any problems controlling it. Now we have got all kinds of people being monitored. Isn’t 

it true there are still a lot of questions about how Ebola is spread? 

Mr. FRIEDEN. Although we are still learning a lot about Ebola 

and every other organism that we study and that we control, we 

have a lot of information about Ebola. We have a good sense of how 

it is controlled, and we have looked at the issue of exposure to animals. We know that in parts of Africa, consumption of forest-living 

animals can be a cause. We don’t know of any documented transmission from dogs to humans, but that is why the authorities with 

our agreement have quarantined a dog, and we are helping them 

to assess that situation. 

128 

Mr. GRIFFITH. And it is also true that while we have no evidence 

of transmission from human to dogs, we really don’t know if there 

can be. We have what we call in the law—I used to be a lawyer— 

you have a lack of evidence as opposed to negative evidence. We 

don’t have clear evidence that you can’t transmit it either. And 

what is interesting is, that raised the question for me about, OK, 

we have got no restrictions on travel of human beings, how about 

the dogs? I called Customs. They said, well, our experts are there, 

and then after pushing them a little bit, they said that is USDA. 

We call USDA, and Dr. Frieden, they said that would be CDC. 

So I understand all your reasons, and while I don’t agree with 

completely, I understand the concerns about humanitarianism, et 

cetera, but don’t you think we ought to at least restrict travel of 

dogs? 

Mr. FRIEDEN. We will follow up in terms of what is possible and 

indicated. 

Mr. MURPHY. I now recognize Mr. Yarmuth for 5 minutes. 

Mr. YARMUTH. Thank you, Mr. Chairman, and before I begin my 

questioning, I would like to submit for the record an article titled 

‘‘Will America’s fragmented public health system meet the Ebola 

challenge?’’ by Mark Rothstein, who is the Director of the Institute 

of Bioethics at the University of Louisville Medical School. I would 

like to submit that for the record. Thank you. 

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Mr. YARMUTH. I would like to thank the panel for their testimony 

and answering the questions, and this has been a very enlightening 

hearing. I also want to acknowledge at the beginning that the Kentucky Air National Guard, which is based in my district, is in Senegal right now providing the infrastructure for the 101st in their 

efforts, so I want to acknowledge their participation in this effort. 

At the risk of displaying my ignorance, we apparently know that 

you cannot detect the Ebola until the same time it becomes symptomatic when it becomes contagious. Is there any other kind of test 

that would indicate whether anything is going on in the body? I 

know that sometimes my doctor will say, well, you have got an elevated white blood cell count, something is going on there, and may 

not know exactly what it is. Is that true of the Ebola or would that 

not indicate that something is going on? 

Mr. FRIEDEN. At this point we don’t have a test that would identify it before someone has symptoms. In fact, the test only turns 

positive when they are sick, and the test is for the virus itself and 

that is why—that is another reason besides the patterns of disease 

that we are confident that it doesn’t spread. We can’t even find tiny 

amounts of it in people’s bodies until they get sick. 

Mr. YARMUTH. Is there any research being done as to a possible 

test, earlier test for this? 

Mr. FRIEDEN. There is a lot of research being done to try to understand and diagnose and treat and prevent better. 

Mr. YARMUTH. Good. I am a media person by background. That 

is where I spent most of my career, so I am very sensitive to how 

the media treat situations like this, and certainly the media can be 

a very important part of providing public information about a potential threat to public safety as this is. But they can also go overboard, as we know, and I am curious because I see every day comments in the media about the spread of Ebola and outbreaks of 

Ebola, and while yes, technically it has spread from one person to 

two health care workers, I know that the public may hear that very 

differently and perceive there to be a much broader and widespread 

incident of Ebola in the country, and I see things like, for instance, 

in the Washington Post today the picture of the woman at Dulles 

Airport who looks like she is mummified because of her concern of 

contracting Ebola, and I know that now one survey showed 98 percent of the American people are aware of the Ebola situation and 

not even 50 percent know there is an election coming up in 3 

weeks. So the media has certainly let the public know that there 

is something going on. 

My question to you is, has the media coverage so far been helpful 

or harmful in your efforts to have the public have an appropriate 

concern and awareness of what the situation is? 

Mr. FRIEDEN. Well, anytime health care workers become infected 

and ill in this country, it is unacceptable, and our thoughts are 

with the two infected health care workers in hoping for their recovery. So it is certainly understandable that there is intense media 

interest. It is new to the United States. It is a scary disease, had 

a movie made about it, and it is important to have that attention 

so that we as a society pay attention, and doctors in hospitals and 

community health clinics, and primary care practices think of the 

possibility of Ebola that we generate the societal will and resources 

132 

to both protect Americans and stop it at the source because it has 

got to be stopped at the source to make us completely safe. 

Some of the coverage, I think many would agree, may exaggerate 

the potential risks or may confuse people about the risks. There 

really is a lot we know about Ebola. CDC has an entire branch, entire group of professionals who spend their careers working on 

Ebola and other similar infections. They go out and stop outbreaks 

all the time. We have stopped every outbreak of Ebola until the 

current one in West Africa. There is zero doubt in my mind that 

barring a mutation which changes it, which we don’t think is likely, there will not be a large outbreak in the United States. So I 

think we welcome the attention. It would be important at times to 

put it in perspective. 

Mr. YARMUTH. I appreciate that. I agree totally. 

One final question in the last 30 seconds. Is there any additional 

authority that CDC would find more helpful in conducting or meeting the responsibilities? I know most of yours is guidance and information, but is there any specific authority that Congress could 

grant you that would make it easier for you to do your job? 

Mr. FRIEDEN. We are looking at a variety of things, emergency 

procurement, for example, to see in conjunction with the administration whether there are some changes that might allow us to respond more quickly and effectively. 

Mr. YARMUTH. Thank you. I yield back 

Mr. MURPHY. I recognize Mr. Johnson for 5 minutes. 

Mr. JOHNSON. Thank you, Mr. Chairman, and Dr. Frieden, thank 

you for being here. I thank all of you on the panel for being here 

today. 

You know, this is not about politics, it is not about international 

diplomacy. It is about public health and protecting the public safety 

of the American people particularly our health care workers, who 

if I understood correctly, you have acknowledged are some of the 

high-risk folks to be exposed. 

You know, one of my main concerns, Dr. Frieden, is that we don’t 

know what we don’t know. Throughout testimony and questioning 

today, I have heard you say multiple times ‘‘I don’t know the details of this, I don’t know the details of that,’’ and I think what the 

American people are wanting is some assurance that somebody 

does know the details. 

So let me ask you a question. Do we know yet how the two 

health care workers in Dallas contracted the virus? Was it a breakdown in the protocol? Was it a breakdown in the training of the 

protocol? Do we know whether or not the protocol works? 

Mr. FRIEDEN. The investigation is ongoing. We have identified 

some possible causes. We are not waiting for the investigation to 

be completed—— 

Mr. JOHNSON. So we don’t know? 

Mr. FRIEDEN. We are immediately—— 

Mr. JOHNSON. OK. 

Mr. FRIEDEN [continuing]. Going to take safety measures. 

Mr. JOHNSON. I get that. We don’t know. You know, the people 

in Ohio are concerned, especially now that we know that one of 

those health care workers traveled through Ohio, even spent some 

133 

time in Akron with family members. I applaud Governor Kasich’s 

immediate actions to try to address the situation. 

You know, in my experience as a military war planner, 26 1⁄2

years in the military, and I know we have got military engaged in 

this process overseas, we don’t wait until the bullets start flying to 

figure out whether our war plan is going to work. 

Dr. Frieden, when did the CDC find out that there was an outbreak of Ebola in West Africa? 

Mr. FRIEDEN. Late March. 

Mr. JOHNSON. Late March. One of the things that we do in the 

military is that we conduct what is called operational readiness inspections. We give real-world scenarios in controlled environments, 

no notice so that those who are going to be responsible for executing a war plan know what to do when the first shot is fired, no 

panic, no second guessing; they know what to do. Has the plan to 

address an Ebola outbreak ever been tested by the CDC in a realworld environment? 

Mr. FRIEDEN. Not only has the plan been tested but outbreak 

control has been done multiple times in parts of Africa. What had 

not been done is in this part of Africa which had never seen—— 

Mr. JOHNSON. No, I am talking about here in America. 

Mr. FRIEDEN. In America also we do a series of preparedness 

plans, for example—— 

Mr. JOHNSON. Do you know of any hospitals in eastern and 

southeastern Ohio that have participated in any kind of real-world 

scenario of an Ebola outbreak? 

Mr. FRIEDEN. I can’t speak to that specific example, no. 

Mr. JOHNSON. OK. Let me go a little bit further. You mentioned 

earlier that 150 per day roughly are coming in from West Africa. 

I think Mr. Wagner indicated 94 percent screening. Let me give 

you a scenario. Let us say a person comes in to the country from 

West Africa, and let us assume that everything in the screening 

process works right. They are maybe in day 14 of having been exposed to Ebola in West Africa. They show up here in America with 

no symptoms. They go through the screening process, and so they 

go on about wherever they go—Akron, Cleveland, Cincinnati, Los 

Angeles, wherever. Day 17 or 18 they start getting ill and they 

start seeing a spike in their temperature. If they walk into any 

emergency room in Appalachia Ohio and start throwing up, having 

symptoms, does your plan identify that and does your plan tell that 

hospital emergency room what to do in that scenario? They don’t 

know that person came from Liberia or any other place. 

Mr. FRIEDEN. We have detailed checklists and algorithms that 

we have distributed widely, provided repeated training and information so that health care providers throughout the country have 

a detailed checklist of what to do step by step by step to determine 

whether the person has Ebola, if they do, to call for help and we 

will be there. 

Mr. JOHNSON. Mr. Chairman, I yield back. 

Mr. MURPHY. Thank you. Mr. Green is next in line, but we are 

looking for him, so Mr. Matheson is next for 5 minutes. 

Mr. MATHESON. Well, thank you, Mr. Chairman. I have a number of questions. I will try to move through them quickly. 

134 

Dr. Frieden, as was mentioned by a couple people in their opening statements, it strikes me that controlling the outbreak in West 

Africa is really one of the real key issues to keeping Americans 

safe. There are reports that indicate we may still be losing some 

ground in Liberia, so I guess I would ask the question, what would 

enhance the international community’s ability to gain control of the 

situation in West Africa in terms of actions and resources? 

Mr. FRIEDEN. The fight against Ebola in West Africa is challenging. The health systems are weak. What we are finding is that 

it is moving quickly and there is a real risk it will spread to other 

parts of Africa. Therefore, the key ingredient to progress there is 

speed. Because the outbreak is increasing so quickly, the quicker 

we surge in a response, the quicker we blunt the number of cases 

and the risk to other parts of the world including the United States 

decreases. 

Mr. MATHESON. And are you resource-constrained in that context? 

Mr. FRIEDEN. Congress has provided money or approval or agreement to use money for the Department of Defense. USAID has resources going in. At CDC, we received through an anomaly $30 

million for the first 11 weeks of this fiscal year, which we appreciate. 

Mr. MATHESON. Let me ask you, you have a number—CDC has 

an unprecedented number of people in the field right now in West 

Africa and in Texas. How many people do you have deployed doing 

airport screenings? 

Mr. FRIEDEN. I would have to get back to you with the exact 

number. We are working both to oversee the screenings in West Africa and make sure they are done correctly and to screen individuals here, collect information on them and transfer that information—— 

Mr. MATHESON. I need you to get that number and also find out 

if those resources are best used there or elsewhere with your limited number of people. That would be interesting to hear. 

Following up on Mr. Yarmuth’s questioning, is there a development of a more rapid test to determine if someone has Ebola than 

what we use today? 

Mr. FRIEDEN. A more rapid test would be very helpful. The U.S. 

Navy has a pilot test in development. We are currently testing that 

in parts of West Africa. It is simpler, quicker and would be very 

helpful, even if it isn’t quite as sensitive in West Africa, but we are 

working with a number of commercial manufacturers also on a 

more rapid test than there is currently. 

Mr. MATHESON. It seems to me that when it comes to infection 

control and prevention and hospital epidemiology standards, I 

think they vary widely from hospital to hospital in this country. 

What legislative or regulatory actions could strengthen these systems? I mean, how can we reduce this variability among hospitals 

in our country? 

Mr. FRIEDEN. Infection control in our hospitals generally is a 

challenge and something that CDC works hard with hospitals and 

State health departments and State governments to improve. Hospitals are regulated by the States within which they operate, and 

the issue of what could be done to improve infection control is comVerDate Mar 15 2010 13:31 Sep 09, 2015 Jkt 037690 PO 00000 Frm 00138 Fmt 6633 Sfmt 6633 F:\113THCONGRESS\113179EBOLAMORESCANS090815\113179EBOLAPENDING WAY
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plex. CDC has a large hospital infection prevention program, and 

there we support regional efforts to share lessons and figure out 

new ways to do things better to prevent infection, and that kind 

of center-of-excellence model is a very important one. 

Mr. MATHESON. But you are suggesting that while you can provide the information and the expertise and the guidance, the actual 

implementation and responsibility is still a State function more 

than a Federal function. Do you think we should be looking at that 

issue? 

Mr. FRIEDEN. In the United States, we have a federalist system. 

The CDC provides information and input. There are roughly 5,000 

hospitals in the country. We are not a regulatory agency. 

Mr. MATHESON. Right. One other line of question. There is no 

good news about Ebola, but at least it is not transmitted as an airborne entity. It is clear that we don’t want to underestimate its 

ability to be transmitted, and while the focus is on Ebola and rightly so for this hearing, there are other airborne transmissible pathogens that ought to be of great concern to everyone including this 

Congress that exist around the globe today, MERS being one of 

them. Is this experience we have had with Ebola, how do we learn 

from it to make sure we are prepared for other human-to-humantransmissible pandemics that may be a higher rate of transmission 

than Ebola? 

Mr. FRIEDEN. I think there are two major lessons, first, to prevent it at the source. If we had had the basic public health system 

in place in these three countries a year ago to find it, stop it, and 

prevent it, it would be over already, and second, within our country, to continue to support hospital preparedness, community preparedness and fundamentally the public health measures to find, 

stop and prevent health threats. 

Mr. MATHESON. OK. Thanks, Mr. Chairman. 

Mr. UPTON [presiding]. Mr. Long is recognized for 5 minutes. 

Mr. LONG. Thank you, Mr. Chairman, and today we have referred to—people on the panel, people up here have referred to 

Nurse One and Nurse Two, and these are two young women that 

have dedicated their lives to helping other people, sick people, and 

to refer them as Nurse One and Nurse Two just doesn’t set well 

with me. It is kind of reminiscent of Dr. Seuss Thing One and 

Thing Two. These are not things. So for the record, I would like 

to state that the first nurse to contract Ebola was Nina Pham, and 

the second nurse was Amber Joy Vinson. These are young women 

with families. I know one in particular has a fiance ́. And so I think 

that it would serve as well to remember that these are human 

beings that have dedicated—young women that have dedicated 

their lives to helping other people, and for them and nurses everywhere and their families, I would just like to open with that. 

Dr. Frieden, you said in your testimony earlier that only by direct contact can you contract Ebola. Do you stand by that statement? 

Mr. FRIEDEN. Direct contact with someone who is ill or died from 

Ebola or their body fluids. 

Mr. LONG. And it is not airborne, Congressman Matheson just 

said, and you agreed it is not an airborne—cannot be contracted 

airborne. 

136 

Mr. FRIEDEN. Ebola spreads person to person, not by the airborne route, so it is not like—— 

Mr. LONG. Do you need personal contact? 

Mr. FRIEDEN. Yes. 

Mr. LONG. If you need personal contact with bodily fluids, why 

is there an airliner in the Denver Airport right now that Frontier 

Airlines has scrubbed four times? Aren’t they wasting money? Why 

can’t they get that back into service? If you have to have bodily 

contact, close contact, why scrub that airliner? 

Mr. FRIEDEN. I understand that people are very concerned about 

Ebola. It is a scary disease. I can’t comment—— 

Mr. LONG. So it is just for public perception? I mean, they really 

don’t need to be doing that, right? 

Mr. FRIEDEN. We have detailed guidelines along with the EPA 

for how to clean airliners. 

Mr. LONG. Do you need a fever to be contagious? 

Mr. FRIEDEN. You need to be sick. Generally the first symptom 

of illness is fever. 

Mr. LONG. So do you need a fever to be contagious? 

Mr. FRIEDEN. Late in the disease when people are deathly ill, 

they may not have fever but they would be likely be unable to walk 

at that point. 

Mr. LONG. This 21-day period that you need to show symptoms 

within 21 days from exposure, during that period could you be contagious the third day of that point? 

Mr. FRIEDEN. Only if you were sick, only if you had symptoms. 

Mr. LONG. OK. And the incubation period is anywhere from zero 

to 21 days? 

Mr. FRIEDEN. Two to 21 days, generally within the first 10 days 

or so. 

Mr. LONG. You said here today that there are 100 to 150 people 

a day coming from West Africa into the United States. You are opposed to travel restrictions, which the constituents in the 7th District in Missouri are very much in favor of travel restrictions. I predict you are going to put on or the President is going to put on 

travel restrictions. I don’t know if it is going to be today or tomorrow or 2 weeks or a month from now but I think that they are coming and I think sooner rather than later. If there are 150 a day, 

and you rationalize, well, we don’t really need to worry about that 

because they could get across borders, they could go by land and 

then get here. With that 100 to 150 a day, don’t you think that 

number might be reduced to five or ten a day if we did put on travel restrictions? 

Mr. FRIEDEN. I can’t comment on what numbers would—— 

Mr. LONG. If someone had to make an effort other than going out 

to their local airport and jumping on a plane, if they really had to 

try to get here, don’t you think that number would dramatically 

drop? 

Mr. FRIEDEN. I know that people do come back, and right now 

we are able to screen them, collect their information—— 

Mr. LONG. What if they don’t come back? A lot of people come 

in this country and we lose track of them. They don’t come back. 

What happens then? My point is, if you have got 150 a day coming 

in or you have five coming in a day, I and my constituents would 

137 

rather have five a day coming in, and this thing of checking for 

temperatures like it is going to help is kind of like scrubbing a 

plane that doesn’t need to be scrubbed. 

But I would like to recommend the folks reading this copy of 

Bloomberg Business Week ‘‘Ebola is coming, coming to America. 

The United States had a chance to stop the virus in its tracks but 

it missed.’’ That issue came out before Mr. Duncan came to this 

country and before he was diagnosed with Ebola. There is some 

good reading in there that I would recommend. 

I would also recommend to you if you want to Google a hospital 

from hell, it is swamped by Ebola in the New York Times just a 

few days ago, hospital from hell, if you get a chance to read that. 

I think that everyone would be in favor of the travel restrictions 

we have talked about here today, and today OSHA, Occupational 

Safety and Health Administration, just today said that Customs 

and Border Patrol immigration enforcement agents are at risk of 

coming into contact with Ebola. 

Mr. Wagner, are we prepared for that? Are your agents, are they 

protected to the fullest extent what they need? 

Mr. WAGNER. We—— 

Mr. LONG. This just came out today. 

Mr. WAGNER. We issue them personal protective gear and we 

train them on how to wear it and what circumstances to wear it, 

but they encounter all different kinds of travelers with a whole 

host of different potential communicable diseases. So you know, we 

are aware and we do train to recognize signs of overt illness and 

we have the protocols with health professionals to get those travelers into that care and to protect our employees. 

Mr. LONG. To me, they fall in the same category of the nurses. 

They are there to save us and help people and protect people in 

this country, so God bless, and I will yield back. 

Mr. UPTON. The gentleman’s time has expired. The gentlelady 

from North Carolina, Mrs. Ellmers. 

Mrs. ELLMERS. Thank you so much, Mr. Chairman, and I have 

a number of questions. 

I would like to start with Dr. Varga in regard to the two nurses 

that were exposed. My understanding is, one of the nurses, the 

first nurse, Ms. Pham, was exposed in the emergency room. Is that 

correct? 

Mr. VARGA. I am sorry. Could you repeat the question, please? 

Mrs. ELLMERS. The first nurse was exposed in the emergency 

room. Is that correct? 

Mr. VARGA. No, that would not be correct. Nina was one of our 

ICU nurses and came in contact with Mr. Duncan when Mr. Duncan was transferred from the emergency department up to the ED. 

Mrs. ELLMERS. So that was sometime from September 28th to 

the 30th. Is that correct? 

Mr. VARGA. That is correct. 

Mrs. ELLMERS. OK. And then the second nurse, Ms. Vinson, was 

she also an ICU nurse? 

Mr. VARGA. That is correct. 

Mrs. ELLMERS. OK. So they were exposed after the point that we 

would have already started recognizing that Ebola was being questioned. Is that correct? 

138 

Mr. VARGA. No, that is not correct. The nurses in the MICU from 

the time they had first contact with Mr. Duncan were in personal 

protective equipment according to the CDC guidelines. Nina cared 

for Mr. Duncan—— 

Mrs. ELLMERS. OK. Dr. Varga, I am going to stop you right 

there. So they were already using universal precautions but also 

were using some of the more isolation? And just answer yes or no. 

Mr. VARGA. Yes. 

Mrs. ELLMERS. OK. To that, I would like to move on to Dr. 

Frieden. On October 6th, I sent a letter to the CDC, to CBP, and 

HHS calling for travel restrictions. So there is no question I believe 

travel restrictions need to be put in place, and now after having 

this subcommittee hearing, I believe even more strongly that we 

need them, and I just want to back up to a couple questions for 

Dr. Frieden and Dr. Fauci. Are there multiple strains of Ebola? 

Mr. FRIEDEN. There are five different subspecies. This outbreak 

is one particular subspecies, Ebola Zaire, and all of the strains that 

we have seen have been closely related. 

Mrs. ELLMERS. OK. So we know that it is isolated to one particular strain? 

Mr. FRIEDEN. Yes. 

Mrs. ELLMERS. Now, you had mentioned, and I believe the quote 

was, ‘‘unless it mutates, there will not be an outbreak here in the 

United States.’’ Is that correct? 

Mr. FRIEDEN. There will not be a large outbreak here barring a 

mutation. 

Mrs. ELLMERS. Well, the question I have is, when the nurses 

were using the protective gear then, how is this that this has happened? It tells me that something is changing here, and are we currently looking into this situation right now? 

Mr. FRIEDEN. We are absolutely looking for other mutations or 

changes. What we have seen is a very little change in the virus. 

We don’t think it is spreading by any different way. 

Mrs. ELLMERS. And you have already said a couple of times that 

you don’t believe that this is airborne, and yet I know how nurses 

are. I was one for 21 years before coming to Congress. You are protecting yourself. You are protecting your patient. You are protecting your family. They followed precautions, I am sure, and now 

we are having this conversation, and I am very concerned about 

that. 

Mr. FRIEDEN. We are confident that this is not airborne transmission. These nurses were working very hard. They were working 

with a patient who was very ill, who was having lots of vomiting, 

lots of diarrhea. There was a lot of infectious material, and the investigation is ongoing but we immediately implemented a series of 

measures to increase the level of safety. 

Mrs. ELLMERS. OK. I am going to move on. 

Dr. Borio, in the discussion of fast tracking a test for Ebola, 

where is the FDA on that? Is there a fast-track process right now 

that you know of? 

Ms. BORIO. For diagnostic tests? 

Mrs. ELLMERS. Yes. 

Ms. BORIO. So there are three diagnostic tests that are authorized for use under our EUA authorities, and we have also taken 

139 

some practice steps by contacting manufacturers, commercial manufacturers, who we know have potential interest in technologies to 

be brought to bear here, and we reached out to a handful who 

might be interested in working with us. 

Mrs. ELLMERS. OK. So you are in the process of looking towards 

a fast-track process? 

Ms. BORIO. Yes. We would expedite every such test. 

Mrs. ELLMERS. Great. Thank you. 

And then Dr. Frieden, lastly, I am speaking on behalf of my constituents and every American in this country. I just don’t believe 

that it is acceptable that the quote that you had given us, ‘‘we 

won’t be able to track them,’’ is the reasoning for why we should 

not implement travel restrictions. I do believe we can, and Mr. 

Wagner, as far as our Customs and Border Patrol, do you believe 

that there is a way that we can implement tracking? 

Mr. WAGNER. Tracking? 

Mrs. ELLMERS. Tracking of individuals if we do not allow them 

to come—— 

Mr. WAGNER. Yes, we have ways to determine a person’s 

itinerary and travel history through the questioning or review of 

the passport. It is easier when they are coming on a direct ticket 

from those places—— 

Ms. ELLMERS. True, but as you pointed out, they are coming 

from—— 

Mr. MURPHY. The gentlelady’s time is expired. 

Mrs. ELLMERS. Thank you, Mr. Chairman. I thank you for indulging my overtime here. 

Mr. MURPHY. I now recognize Mr. Scalise for 5 minutes. 

Mr. SCALISE. Thank you, Mr. Chairman. I appreciate you holding 

this hearing, and I want to thank all of the panelists for coming 

and participating, and I have talked to a number of health care 

professionals as well as many constituents and listened to the 

panel as well. I want to join with Chairman Upton in urging the 

President to immediately institute a travel ban until such time 

that they can firmly and scientifically prove that Americans are 

safe from having more Ebola patients coming into the United 

States, and Dr. Frieden, you expressed disagreement with that. 

Have you all had any conversations within the White House about 

a travel ban and whether or not the President has the authority, 

because many of us have said the President does have the authority to do it today. 

Mr. FRIEDEN. From the point of view of CDC, we are willing to 

consider anything that will reduce risk of—— 

Mr. SCALISE. But have you considered that and have you ruled 

it out or have you not considered it at all? Have you had conversations with the White House about a travel ban? That is a yes or 

no question. Have you had conversations with the White House 

about a travel ban? 

Mr. FRIEDEN. We discussed many aspects—— 

Mr. SCALISE. How about a travel ban? Have you had that conversation—— 

Mr. FRIEDEN. We have had discussions on the issue of travel to 

and from West Africa. 

Mr. SCALISE. And have you all ruled it out? 

140 

Mr. FRIEDEN. I can’t speak for the White House. I can tell you 

that—— 

Mr. SCALISE. You can speak for the CDC. If you were in those 

conversations, maybe they had their own conversations without you 

but if you were involved in conversations with the White House 

about a travel ban, did they rule it out? Are they still considering 

it? 

Mr. FRIEDEN. From the CDC’s perspective, we will consider anything that will better protect—— 

Mr. SCALISE. So are you going to answer the question about your 

conversations with the White House? Is the White House considering a travel ban? 

Mr. FRIEDEN. I can’t speak for the White House. 

Mr. SCALISE. Do you know if they have ruled out a travel ban? 

Mr. FRIEDEN. I can’t speak for the White House. 

Mr. SCALISE. Have you had conversations with them about it? 

Mr. FRIEDEN. We have discussed the issue of travel. 

Mr. SCALISE. All right. I would urge you at a minimum, if you 

have ruled out a travel ban, if you don’t think it is the right way 

to go, there are a lot of people that would disagree with you. At 

a minimum, you ought to look at least immediately suspending 

visas to non-U.S. nationals seeking to travel into the United States 

from Sierra Leone, Liberia, and Guinea. Have you all considered 

that or discussed it or ruled it out? 

Mr. FRIEDEN. At CDC, our authority is to quarantine individuals 

who require isolation. 

Mr. SCALISE. But earlier you said you don’t think there should 

be a travel ban. What about at least looking at suspending visas 

to non-U.S. citizens? Have you looked at that? 

Mr. FRIEDEN. CDC doesn’t issue visas. 

Mr. SCALISE. But you can make a recommendation to the White 

House that it would be in the best interest of the American people 

to have that kind of suspension issue, can’t you? Are you not aware 

of that? 

Mr. FRIEDEN. We would certainly consider anything that will reduce risk to Americans. 

Mr. SCALISE. Let me ask you this. Do you have a high level of 

confidence that our U.S. troops that are over there right now—I 

have got estimates that are around 350 U.S. troops are already in 

those three affected countries. Up to 3,000 troops are going to be 

sent over by President Obama. Do you have a high level of confidence that those U.S. troops are protected with all the protocols 

in place so that they will not contract Ebola? 

Mr. FRIEDEN. We have worked very closely with DoD on their 

protocols and—— 

Mr. SCALISE. So do you have a high level of confidence that they 

are protected? 

Mr. FRIEDEN. I would not say that there is zero risk. They are 

in those countries but they are not participating in high-risk activities that—— 

Mr. SCALISE. Are you consulting with DoD? Who establishes the 

protocols in that case? Is the CDC involved in that? 

Mr. FRIEDEN. They are following the CDC’s protocols but they 

follow their own—— 

141 

Mr. SCALISE. Let me ask you about the protocols because I have 

read reports that some people with some of the other organizations 

that have been over there for a while—you have got the group Samaritan’s Purse, a gentleman by the name of Sean Kaufman, who 

is involved with some of the doctors that have been over there that 

have gotten infected. They have been working for decades in some 

cases. He said that he warned your agency that the guidelines that 

you had on Ebola were lax and his response was, ‘‘They kind of 

blew me off,’’ meaning your agency blew him off when he was 

warning you that your protocols were lax. Are you aware of that? 

Mr. FRIEDEN. I saw that quotation. We take all suggestions—— 

Mr. SCALISE. Have you identified who blew him off in your agency? 

Mr. FRIEDEN. I don’t know that that occurred. 

Mr. SCALISE. Well, I would hope that you would go and find out 

because there is a real concern. You know, one of the biggest concerns I get from the hospitals in my district that I have talked to, 

and I have talked to a number of hospital officials, medical officials, professionals in my district. They are concerned that they 

haven’t had consistent protocols. There has been at least four just 

in the last few weeks where the protocols keep changing. Now, 

with the nurse, the first nurse that was infected, I believe you personally said that the protocols were breached originally. Have you 

backed away from that? 

Mr. FRIEDEN. We are looking at what might—— 

Mr. SCALISE. You said the protocols were breached. Were the protocols breached with the first nurse that was infected? Yes or no. 

Mr. FRIEDEN. Our review of the records suggests that in the first 

few days of—— 

Mr. SCALISE. If you didn’t know for a fact, you shouldn’t have 

said it. 

Mr. MURPHY. The gentleman’s time is expired. 

Mr. SCALISE. Do you withdraw that statement, or do you still 

stand by the statement that protocols were breached by the first 

nurse? 

Mr. FRIEDEN. There was a definite exposure that resulted—— 

Mr. SCALISE. Were protocols breached, yes or no? 

Mr. MURPHY. The gentleman’s time is expired. 

Mr. SCALISE. Yield back. 

Mr. MURPHY. Thank you. 

It is the tradition of this committee that the ranking member 

and the chairman have a final 2-minute wrap-up. Ms. DeGette, 2 

minutes. 

Ms. DEGETTE. Dr. Frieden, would it be fair to say that it looks 

like the first nurse, Ms. Pham, was exposed in the first couple of 

days before the diagnosis came in? 

Mr. FRIEDEN. That is our leading hypothesis at this point. 

Ms. DEGETTE. Thank you. 

Now, Dr. Varga, we have still got you, I hope. 

Mr. VARGA. Yes, I am here. 

Ms. DEGETTE. Have you now seen my chart from the New York 

Times about the protective gear? 

Mr. VARGA. Yes, ma’am. 

142 

Ms. DEGETTE. Do you know which of these types of protective 

gear Ms. Pham and the other health care workers were wearing 

during those first 2 days? 

Mr. VARGA. Ms. Pham would have been wearing or Nina would 

have been wearing the second garb. The folks in the ED most likely 

would have been wearing the first picture. 

Ms. DEGETTE. OK. Thank you. So it is your testimony you don’t 

really know how Ms. Pham was—well, either one of these wonderful nurses were exposed. Is that correct? 

Mr. VARGA. That is correct. 

Ms. DEGETTE. OK. I just want to say one last thing. I think that 

we have had a lot of discussion today about a lot of issues, and my 

takeaway is this—and Dr. Frieden, I am going to make a statement 

and I would ask you to comment on it. It seems to me that, aside 

from trying to stop this Ebola in Africa, the thing we can do here 

is, number one, we can give better training to the people in our 

emergency rooms and our first responders, not just send them out 

emails or bulletins. Number two, we can have more robust protective gear at an early stage if somebody looks like they might have 

a risk for Ebola, and number three, I think it might be really useful to put CDC on the ground much earlier. Here, they didn’t come 

into this Dallas hospital until after the diagnosis. So there were 2 

days when people were moving in and out of Mr. Duncan’s room, 

and we don’t know exactly what happened. Dr. Frieden, could you 

comment very briefly on that? 

Mr. FRIEDEN. I will agree completely on the training. We are 

looking very carefully at the personal protective equipment issue. 

We consult immediately every time, and there have been more 

than 300 consultations for hospitals that have thought they might 

have a patient with Ebola. Only Mr. Duncan was confirmed to have 

Ebola. 

We can’t be everywhere. Everyone has to do their part but we 

will do everything we can to support the front lines. 

Ms. DEGETTE. And Mr. Chairman, I would ask for both this protective gear chart and also our map of the flights to be included 

in the record, and I would also ask—— 

Mr. MURPHY. Without objection. 

[The map follows:] 

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Ms. DEGETTE. I would also ask all of our witnesses if they would 

continue to keep this committee updated as to changes in procedures or developments that are made as we go along, and I would 

ask unanimous consent to put in the other members’ opening statements in the record. 

Mr. GRIFFITH. Mr. Chairman, I had previously asked for unanimous consent for the letter that I quoted from. 

Mr. MURPHY. Yes, that was granted. 

Mr. GRIFFITH. I don’t think we ever agreed on it but—— 

Mr. MURPHY. It is so ordered. 

Mr. GRIFFITH. Thank you. 

Mr. MURPHY. I now recognize myself for a final 2 minutes. 

So having listened to all your testimony, a couple of things that 

stand out for me. One, I appreciate Dr. Daniel Varga’s statement 

of honesty that we made mistakes. I didn’t hear that from any of 

you, and that troubles me. Because what has happened here, is 

your protocol depends on everyone being honest 100 percent of the 

time. I am not a medical expert. I study behavior as a psychologist. 

People are not honest 100 percent of the time. 

Secondly, it relies on tools for taking temperatures, which have 

their own reliability and validity issues, a 1 in 21 chance during 

those 21 days it may register something, and a person can mask 

it with some analgesics, so that is not helpful. 

We also have to recognize human behavior, that protocols may 

not be followed. That is why you have a failsafe system of basically 

a buddy watching you put on your garb, watch you take it off, making sure you use other things, and I think the example of how this 

failed was, there is an assumption in the travel—Dr. Frieden, you 

said CDC granted her travel with the assumption that she used all 

the right protective gear but we have looked at this, and you are 

not aware of what she wore and it does not appear she wore the 

proper ones. So to this extent, these are my recommendations 

based on what we have heard in this hearing. 

I believe we need an immediate ban on commercial non-essential 

travel from Guinea, Liberia, and Sierra Leone until we have an accurate and thorough screening process and we treat this disease. 

Number two, a mandatory quarantine order for any American who 

was treated an Ebola patient or has traveled to and returned from 

the Ebola hot zone countries. This includes a prohibition of domestic travel because of an assumption, and without this assumption 

of what they wore was donned and removed properly. Number 

three, immediate training and thorough training for U.S. health 

care hospital workers to include a review of personal protective 

equipment used in the treatment of possible Ebola-infected patients, their wear and removal. Number four, identify and designate specific medical centers equipped and trained to treat potential Ebola patients and expansion of those as soon as possible. 

Number five, identify gaps in statutory language that may prevent 

CDC and any other Federal agency including BARDA, FDA, and 

NIH from taking more aggressive and immediate action to protect 

public health from Ebola including letting us know of any abilities 

now to transfer funds immediately or any other action Congress 

needs to do to facilitate your needs. Number six, accelerate directives on development and deployment of clinical trials for all promVerDate Mar 15 2010 13:31 Sep 09, 2015 Jkt 037690 PO 00000 Frm 00148 Fmt 6633 Sfmt 6633 F:\113THCONGRESS\113179EBOLAMORESCANS090815\113179EBOLAPENDING WAY
145 

1The information has been retained in committee files and also is available at http:// 

docs.house.gov/meetings/IF/IF02/20141016/102718/HHRG-113-IF02-20141016-SD010.pdf. 

ising Ebola vaccines, investigational drugs, and diagnostic tests. 

Number seven, acquisition of additional airplanes and vehicles capable of transporting American medical and military personnel who 

may have contracted Ebola in Africa to return to the United States 

beyond the current capacity of two. Number eight, additional contact tracing and testing resources for public health agencies, and 

number nine, to provide information to Congress regarding any resources needed to assist health interventions, aggressive health 

interventions in Africa so we can stop Ebola there. 

I appreciate all the members coming back today for this hearing, 

and I particularly appreciate the testimony of the panel. I ask 

unanimous consent that the members’ written opening statements 

be introduced into the record. Without objection, the documents 

will be entered into the record. 

Mr. BURGESS. Yes, I have a document to enter into the record, 

the Office of Inspector General, Department of Homeland Security, 

and then the photograph that I demonstrated earlier today. 

Mr. MURPHY. So ordered. That will be included in the record. 1

[The photograph follows:] 

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147 

Again, I thank all the witnesses and members—— 

Ms. SCHAKOWSKY. Mr. Chairman. 

Mr. MURPHY [continuing]. Who have participated in the hearing. 

Ms. SCHAKOWSKY. Mr. Chairman, I just want an acknowledgement that the things I wanted included in the record—— 

Mr. MURPHY. Yes, those are included, as well. 

Ms. SCHAKOWSKY. Thank you. 

Mr. MURPHY. We will also have a hearing in November. We will 

follow up. We will notify members of the participants in that and 

when that will be. 

I ask all members to submit questions for the record and ask 

that the witnesses please agree to respond promptly to the questions, and with that, this hearing adjourned. 

[Whereupon, at 2:55 p.m., the subcommittee was adjourned.] 

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