 We almost met in India. You were dead. Good morning, everyone. I'm Steve Morrison from CSIS. And thanks for joining us for this session on expanded US engagement to combat Ebola in West Africa. I'll say a few words of introduction around the session and the speakers that we have here momentarily. We're going to run a quick video that CSIS prepared, just a two or three minute video to tee this up. So Paul, if you could do that, please. Ebola is a modern day plague tearing through Liberia, Sierra Leone, and Guinea. Thousands dead, thousands more sick, untold numbers of people at risk as the virus spreads at an exponential pace in countries with exceptionally weak health systems and poor leadership. Ebola threatens to enter neighboring West African states. Through international air travel, it has reached our shores, Senegal, Nigeria, and Spain. More may follow. India and China are also vulnerable, among others. Ebola leaked to Dallas when a Liberian man flew there in September, became ill, and later died. Two nurses who treated Thomas Eric Duncan caught the virus. Luckily, each recovered. The drama in Dallas sparked fear and exposed readiness problems in US medical facilities. It ignited controversy over what controls there should be over health workers and others exposed to Ebola here or while serving in West Africa. Debate intensified when an American doctor who treated Ebola patients returned to his New York City home from Guinea and became sick after circulating through the city. US leadership is an essential element in fighting this complicated two front war. At the source in West Africa, the fight is to break the chain of transmission and stabilize countries at risk of collapse. The US military is deploying up to 4,000 soldiers to Liberia to expedite the construction of treatment facilities. It is the first ever US military mission to battle an epidemic. US military and civilian expenditures over the next six months will exceed $1 billion. A multilateral region-wide effort is essential to bring the epidemic under control, save lives, and eliminate the export of cases. That means flooding the zone with doctors, nurses, and supplies and establishing community-level care. It means establishing a viable UN operation that can lead into the future. At home, the fight is to protect US citizens and ensure their safety, contain fear and panic without impeding the flow of essential American health workers into and out of West Africa. As we have seen, these two fronts can collide, leading to blunt confrontations between states and the White House, between governors and federal public health officials. As we head deeper into this uncertain two front war, many questions loom large. Will it be possible to successfully isolate the sick, contain the spread, change burial practices, end the chain of transmission, and reduce the epidemic? Will it be possible to reach a coherent consensus on how best to protect Americans and advance our health objectives in West Africa? Well, thank you. Special thanks to Beverly Kirk, Johnny Harris, and Paul Friends for putting that piece together. I think what that conveys is just how impressive the US mobilization has been in this period, both at home and in West Africa. We're gonna focus predominantly today on the West Africa. This is a bold and ambitious set of commitments. It's getting bigger, as we'll hear today, and any discussion around the request that's put forward. It's something that has brought forward a very strong security rationale for why we're doing this, as well as the ethical and humanitarian imperatives that drive US actions. And it's something that's tested the full spectrum of US capacities. It's tested the resolve and whether we can integrate across these institutions. And so we're really thrilled to be able to bring together the four individuals who are here today with us. We're gonna hear from them in sequence, and then we'll open the floor for a discussion with you. We'll hear first from Dr. Tom Frieden, Director of CDC, with a predominant focus on the big picture and on the public health interventions and the health security lens through which this crisis is now seen and understood and acted upon. He's been in this role at CDC for over five and a half years, has been into fatiguel and has brought to the fight on Ebola, his previous experiences, fighting MDR-TV in New York City in the 90s, fighting to be in India, leading the New York Health Commissioner's Office for seven years in New York City and undertaking a number of innovative steps there. The health security lens was getting defined as a new feature of US foreign policy well before the Ebola crisis broke, largely through Tom Frieden's efforts. And we'll see that lens debated out later this afternoon in the Senate appropriations discussion around the $6.2 billion request, which is really sort of the biggest, most powerful expression of how the health security lens has come to be a new feature of US global health. After we've heard from Tom, we'll hear from Jeremy Konendike, who's the head of the USAID's Office of Foreign Disaster Assistance. He comes also very much rugged and battle tested in working in difficult environments. While at Mercy Corps, he worked on field humanitarian and emergency operations in Kosovo, Guinea, Southern Sudan, Uganda, among other places, heading up the humanitarian post-conflict work there, and has done a sterling job at USAID. And of course, USAID plays a leading role on the ground and leading the ground game and is critical on the broader development agenda as well as the emergency operations and has gotten involved in stimulating through its grand challenges some of the work on trying to improve protective gear and other things. After, Jeremy, we'll hear from Ambassador Don Lou, who's the deputy in the Special Envoy's Office created by Secretary Kerry and led by Ambassador Nancy Powell. Don, most importantly for this purpose, he was a Peace Corps volunteer in the late 80s in Sierra Leone. And after that point, he has gone on to a very distinguished career within the Foreign Service and served in either the DCM or Charger role in multiple places in the South Caucasus and Central Asia, in South Asia and is slated to go out as our Ambassador to Albania soon, we hope. And our last speaker rounding things out is Ann Witkowski, who is a veteran of CSIS, who was with us for nine years. Leading a number of programs, the embassy project on the embassies of the future, the review of Goldwater Nichols and a number of other projects that she led while she was here prior to that. She was at the NSC for the entire duration of the Clinton administration heading up defense policy in arms control matters. She comes here as a Deputy Assistant Secretary within the Department of Defense with the key policy oversight and support to the US military operations in West Africa. Prior to that, she was at the Department of State for four years as a Deputy Coordinator on Homeland Security and Multilateral Affairs in the Counterterrorism Bureau at State. So thank you all for being with us today. Tom, you wanna kick things off? Sure, and Steve, thanks so much for bringing us together and thanks to CSIS also. It's great to be here with Don Jeremy and Ann. Jeremy and I traveled together in Liberia not too long ago. It's remarkable how fast things change in the field in West Africa. And today is an important day for the response. It's the first day of hearings on the emergency funding request. And that request is quite crucial to our ability to protect Americans. And I'll talk about the three different aspects of the battle and the three different aspects of the request which not coincidentally are the same. The first is stopping the epidemic at the source in West Africa. And as you may have read in the media, there are some signs of a decrease in cases in some parts of West Africa. And that's encouraging. And I wouldn't want anyone to take any message from that other than it's a proof of principle that Ebola spreads in well-defined ways and it's stopped in well-defined ways. The problem is that the challenge is so large, so extensive, and moving so quickly that it tests all of our systems. We have the success story of Nigeria. Nigeria had a single traveler arrive. That traveler had Ebola, was sick on the plane, was carried off the plane to a hospital, resulted ultimately in a cluster of 19 additional cases. That cluster was stopped. And it was stopped through rapid public health action. We put 10 of CDC's top disease detectives on the ground within 48 hours. We repurposed 40 of the Nigerian doctors we had trained to stop polio to the response. We drew on both the PEPFAR infrastructure and the polio infrastructure. The Nigerians put an emergency operation center first in Lagos and then in Port Harcourt. The Nigerian government and the Lagos government really stepped up. They identified 899 contacts. They did 19,000 home visits. One contact slipped out and went to another city, Port Harcourt, and caused another cluster there. But after intensive follow-up, the outbreak was stopped. And from that one importation, Nigeria is now Ebola-free. That's an example of what can and should happen. But we have lots of places where there aren't the resources. There isn't the timely responsiveness. And it's not happening. You may have seen indications that some of the Ebola treatment units in Liberia now are not fully occupied. And that's a good sign. That's a sign that they're being built. That's a sign that they're being used. And that's a sign that in some locations we've seen progress. I do want to show two slides just to put things in perspective in terms of where we are now. In case there's any concept that we're out of the woods, because we are nowhere near out of the woods. The first slide shows cases by month in West Africa over the past few months. And what you see is a steadily increasing number. So while the number in Liberia appears to have possibly decreased somewhat in the past few weeks, that is just an indication of the need to intensify the efforts throughout the country. And in Liberia, we're seeing virtually one new cluster per day, often in very remote areas of the country. We're traveling there by helicopter, by hike. And in each of those clusters, we need to march to a response similar to the one I described in Lagos, Nigeria, where we identify all of the contacts, trace them for 21 days, establish isolation facilities, work with the community to increase understanding of the disease, and ultimately turn off the two things that are driving this epidemic everywhere it's spreading, unsafe care and unsafe burials. The next slide just gives a sense of where we are compared to all of the history of Ebola. In October alone, there were more cases of Ebola in West Africa than in all of recorded Ebola history combined. So we have a long way to go. Slides off, please. In fact, over the weekend, we heard from Mali, where we've seen now first an importation, as we call it, of a two-year-old child who had Ebola. And more than 100 contacts were followed. None of them became ill. And just as the last contacts were leaving the monitoring period, a religious leader died, most likely from Ebola. He was cared for in different places within Mali. At least one of his family members got Ebola and died from it. And we now have a very complex investigation. We already have eight CDC staff on the ground. We actually had CDC staff on the ground before the first case helping Mali to prepare for a first case. But the response there is going to need to be very intensive. We have probable cases among people who worked in the burial process, among health care workers who cared for the individual. And there will be hundreds of contacts who need to be followed and traced in multiple different parts of Mali. So we have a long window. We can turn the slides off, please. What we're seeing in Liberia is an expansion geographically to different parts of the country. What we're seeing in Sierra Leone is a steadily increasing number of cases in a steadily increasing number of places, despite the fact in Sierra Leone that in some of the poorest regions, which were previously the epicenter, we're seeing progress and progress from those same two things, safer care, safer burial. In Guinea, we've seen a waxy and waning of cases and in recent weeks a big increase of cases, especially in the poorest region but also elsewhere in the country. And Guinea is really a warning of what can happen anytime we let down our guard because cases can come roaring back. This is the largest global response in CDC history. We have today 170 staff on the ground in West Africa. We're working throughout the region to prepare countries to respond, to strengthen laboratory systems to better understand the epidemic, to help with contact tracing and organization of the emergency management functions, to work very closely with USAID in the dark process in marshaling more assistance from the US government but also from national communities. And what we've seen within Liberia and Sierra Leone is communities increasingly taking the lead in saying we want the tools to stop this in our community and that's what USAID, ourselves, DOD, State Department and others are facilitating and helping. Moving from the situation in West Africa to the situation in the US, this is truly a national security priority. We will not get to zero risk in the US until there are no epidemics, till there are no outbreaks in Africa. So our health is inextricably linked with the health of people in West Africa. And I think the last few months have made that very clear. At CDC, we're committed to making decisions and providing advice based on the best available data. When the first case of Ebola was diagnosed in the US, we had very little data about what would happen in terms of Ebola in the US. We did have decades of experience in Africa and we had a good understanding of the biology of the virus. But the US healthcare system struggles. It struggles to deal with infections. It struggles to deal with the challenges of a diverse patient population. It struggles to deal with staffing levels and shortages. And one of the things that we have adjusted is our ability to provide extra margins of safety so that the risk of infection of healthcare workers is kept to an absolute minimum. We've also understood that there are, at any one time, several thousand people in this country who have returned within the last 21 days from West Africa. In any one moment, any one of them could develop a fever. In fact, more than 60 have been tested for Ebola over the past few months. Two were positive, Dr. Spencer and Eric Duncan. Their care and their outcomes couldn't have been more different. And as we get more information, we continue to do things to strengthen the response in the US and globally, and we'll continue to do that going forward. For example, we provide rapid Ebola preparedness teams or response teams or rep teams to go out to hospitals that are preparing for a possible Ebola case. In fact, the rep team of CDC was already at Bellevue Hospital before Dr. Spencer happened to go there. Dr. Spencer knew to call a number and be safely transported to Bellevue where they were waiting and ready for him. They took all precautions and will track to ensure that if anyone who cared for him becomes ill, they're rapidly assessed. But ultimately, for every step of this outbreak, we understand what is the way to make care safer and burial safer? Because those two things are what is going to turn this around. But we need to do that with a speed, scale, and extent that we've never worked in before in public health. And that's why the US-based response is also very important. So we can ensure that in this country, we're doing whatever we can to minimize risk. The third area, as Steve mentioned, is global health security. Ebola is a very sharp reminder that we are all connected, that the health security of any part of the world may affect us here, that any blind spot, any weak link, may be the next Ebola or the next SARS, which cost the world $40 billion in just a few months, or the next HIV. We can't predict where it will come from or what it will be, but we are certain that there will be continued emerging health threats. And we're certain that unless we urgently, as an emergency, strengthen the ability to find threats when they emerge, respond to them promptly and prevent them wherever possible, not only will other countries be more vulnerable, but we will be more vulnerable to harms from emerging infectious diseases. This is just one example of a harm that we need to mitigate, of a disease that we need to control, but with rapid and comprehensive action, we can push Ebola back, we can stop the chains of transmission. The amount of effort it's going to take is really enormous to give you just one example of that. Over the past four decades, CDC has helped to investigate about an outbreak or cluster of Ebola every year or two in Africa. And until this West Africa outbreak, we had helped stop every one of them. Over the past few weeks in Liberia, we've been responding to approximately one new cluster or outbreak, often in very remote, difficult to reach areas every day. And that level of response is something that we need to build the capacity for urgently. And that's what the funding request is about. That's what 170 of CDC's top staff are doing seven days a week in West Africa. That's what over 800 CDC staff are doing 24-7 at the CDC today and until this outbreak is over and until we build stronger systems so that the next outbreak will be found earlier, stopped earlier and won't become this type of a global crisis. Thank you. Jeremy, tell us a bit about the AID ground game. Yes, thank you. So Tom's done a fantastic job of laying out the scope of the challenge that we face. AID has mobilized for this response, the largest whole of agency response and the largest whole government, coordinating the largest whole government response that we've seen for any disaster since Haiti. And we are on track to have a larger response to this than we had to the Haiti earthquake. So that, I think, gives a bit of a frame for how substantial an effort, how substantial it costs this is going to require to control this outbreak. And that's only in three countries. If it spreads further, which we hope it will not, to other neighbors and Maui is now a real concern, we'll go even bigger. So this is an absolutely enormous effort. And it is one that AID is treating and approaching both as a public health emergency, but also as a disaster response, very intentionally as a disaster response. Because it is a disaster both in terms of the impact that the disease itself is having directly on the individuals and communities affected by it, but it is also having a whole range of second order impacts on the economies and health systems food security and livelihoods of individuals and communities in these countries. And so we are looking at it through those lenses and approaching it through those lenses. And that's a fairly unique way to work. We haven't really worked this way in the past because we haven't had a challenge like this in the past. And so very early on, what triggered AIDs, heavy involvement in my office's direct involvement was the issuance of disaster decorations by the ambassadors in these countries in the region saying this has gone well beyond a normal situation and we need disaster response capabilities and we need greater public health support. And so we in CDC then, CDC already had teams on the ground. They amp those up significantly in partnership with AID. AID deployed a dark team to the three countries. That's our disaster assistance response team. So that is our very flexible, adaptable model for how we respond to disasters and what we put on the ground. Anytime there's a disaster, this time with a twist because it has been a joint effort with CDC and CDC personnel, sit on the dark teams in all three countries and work directly with AID staff because this is an area where we are experts at mobilizing, we are experts at coordinating, we are experts at getting into a difficult situation and getting things done. We're not experts in epidemiology. We're not, we have some public health people that nothing like what CDC has. So this is really a response where a massive, a massive whole government effort that really pulls the capacities from all the parts of the US government, as you can see here on the stage, into the fight. And AID's role in that is both to coordinate that overall effort and to manage our own interventions in support of the response. So we are working with our interagency partners to orient DOD's effort, to orient other efforts in support of and under the technical and medical guidance of CDC. How do we fight this? What do we have to do? And leading the execution of that. And as Tom said, the basics of how you fight this are known. It's good public health interventions. It's good isolation, good treatment. That's not any different than any past outbreak. What is different in this outbreak is scale. And every previous, just to put, and Tom's slide I think contains this very powerfully, to put this in perspective, every previous outbreak had basically been modest size, rural, one maybe two ETU treatment units and good public health interventions were sufficient to contain those. And they never reached major cities. I lived in Uganda for several years in my career. There were several outbreaks of Ebola and Marburg while I lived there. And they were all contained very rapidly through that approach. So we know that approach works. What is different here is it has reached the major cities and it has spread like wildfire. And we had no precedent. We had no model. We had no roadmap for what do you do in that kind of a situation or what tools. We knew the ingredients, but we had to figure out the recipe. And what we have seen now that we have several months of ground truth is it has reinforced fundamentally the basics that go into that, but it has also taught us. So we knew, for example, that isolation would be high impact. And that has been the core element of treatment and isolation. It's been the core element of every past response. What we didn't know was the impact that burials would have on their own because generally you'd have burials linked to isolation. Isolation, building an ETU, sourcing the staff, training up the staff, that's a long process. It can take several months. So we knew that would take some time. We wouldn't be able to bring that online at scale rapidly. So as we launched those interventions, we also launched things like, say, burial teams. And what we've seen is that those have actually had an enormous impact very quickly in Liberia where they had gone to scale. We're optimistic, well, that's too strong. I say we are cautiously hopeful that as similar interventions come online in Sierra Leone, that we will see some similar impact in Sierra Leone, although Sierra Leone, as the slide showed, is still in quite a bad state. And in Guinea, which is traditionally the strongest of the three countries, which is not to say it's got strong systems, but at least it is not barely a decade removed from the Civil War, we haven't seen it get as bad. I think that highlights another important factor in this, which is that this is a disease. If cholera is a disease that preys on poor water and sanitation infrastructure and practices, this is a disease that preys on poor health systems and weak governments. And that is conversely why countries like Nigeria and Senegal have had more success in controlling it because they have more strength with which to do so. But so our role has been to lead the execution of these activities under the strategy that the president laid out. And the flexibility and adaptability that we have applied and continuously applied is absolutely crucial because, as Tom said, we didn't know how the disease would behave when it hit new environment. And this is a very new environment. We're now learning a lot and we're finding our response accordingly. But it's also been reinforcing the fundamentals here. The fundamentals of the strategy, the fundamentals of good public health response are what's needed and we're seeing real impact where those have come into play. At an increasingly national level in Liberia, but even at a localized level in different areas throughout the region that were once hotspots and have been able to tamp down the spread through application of some of these good public health interventions. The dark team's role, in addition to running those, is to help to coordinate the interagency players. So we work closely with DOD on the construction of ETUs, the training that DOD is doing. I will go through all chapter and verse because they will do that. But all the different important capabilities that they're bringing to the fight, we engage closely with the embassy to support the embassy's ability to manage this and then we really talked about what we do with CDC. So that's, in broad strokes, what we're doing on the ground. We're also doing some things back here because this is a new challenge and we need some new tools with which to fight it. One of the big challenges, for example, is personal protective equipment. This is, the current designs are not well-suited to a place where you're working in 100 degrees in high humidity. And that has been a major rate limiter for the ability of staff to provide care in any team setting because you need to cycle out, and Tom can attest to this because he's actually been in the stuff. You need to cycle out of that after about 45 minutes or an hour or you'll pass out. And you hear people talk about their boots being full of sweat after an hour because it is so difficult to be in this PPE. So we're looking, we've launched a grand challenge in collaboration with the White House to improve PPE quality, improve wearability, improve safety. If you could improve PPE quality, if you could make it wearable for two or three hours in a stretch rather than an hour in a stretch, for example, you would massively reduce the amount of it that we need to use and you would significantly improve the quality of care that people could provide in this facility. So we're also looking at innovations like that through the grand challenge. We're also trying to improve data. Data has been a big challenge throughout this both because we suspect there are cases we're not seeing and the information systems in these countries are very poor and the disease is moving so rapidly but that then makes it hard to fight because you need to know how many beds do we actually need? Where do we need to send the burial teams? Where do we need to send? Where do we route the PPE? So improving real-time data is a critical factor as well and we've brought over the former federal government CTO from the White House who's now working with AID on improving some of those pieces. I wanted to say one last word here about the absolute heroism of health workers who are responding there and I think this is increasingly well known for those of you who watched the 60 Minutes piece the other night on the National Medical Corps which is a USAID partner in Liberia. There were very, very powerful interviews with some of the staff who they've brought over to work on the response. There are hundreds of staff doing that and we'll need hundreds more and it's very, very important that those people be supported, not stigmatized, treated like the heroes that they are because they really are going over risking their lives in extremely difficult conditions in order to fight on behalf of a national security priority of the United States and I think we need to absolutely ensure that they are treated with all their respect and support and admiration and do them, give them that. Thank you, Jeremy. We've had in the panel just previous we had the International Committee of the Red Cross and Drs. Vell Porter's here and they are among the heroes of this response along with IMC and International Rescue Committee and SAVE US and many others that are really diving into this and thank you for bringing that up. Don, your job there in the Envoy's shop is to convince others to do a heck of a lot more a lot faster and to help move towards where the UNMIR, the UN operation can have enough competency and functionality to give us a vision looking forward for a transition towards a broader coordinated effort. Tell us a bit about your work so far. Thank you, Stu. It's very humbling to be up here with our leading public health specialists, our leading humanitarian relief specialists. I'm neither of those things. I'm working on Ebola because I was really touched when I lived there by the kindness and generosity of people of West Africa. My guess is many of you are in the audience for the same reason and if you go to small towns and big cities around America, you find these connections between the peoples of this region and the United States and I think it gives us a special role and a special responsibility in responding to this crisis. As Steve said, I'm gonna talk a little about what the rest of the world is doing. I'll start by taking it back in time. Let's go back five weeks to when our response was in its first few weeks and months and the world had really not started. So I'm gonna quote President Obama. I'll be very honest with you, although we have seen great interest on the part of the international community, we have not seen other countries step up as aggressively as they need to. Very frank words from a U.S. president in public about what the rest of the world was doing to contribute. So if you go from that point in the first week of October to now and you trace the commitments made by other countries, it has been an overwhelming outpouring of support. We have seen over a billion dollars in contributions from 35 partner countries. But is that enough? Are we there yet? Do we have what we need to get the job done? I think all of my colleagues would say no, we're not even really close. And in particular, there needs to be a focus on getting healthcare workers out to the field, both international healthcare workers as well as West African healthcare workers who can be people on the front line fighting these battles. The other thing we are very focused on is how do we keep borders open? How do we encourage countries to maintain commercial air links and open borders that allow us to flow people and materials and logistical capability into West Africa? So I'll say in the past for a moment, talk about the beginning of this coalition. September 25, Ban Ki-moon holds an Ebola summit in New York. President Obama attends many of the world's leaders attend this summit. And he kicks off this global coalition. And once he does that, you have the US government and many other governments on the phone, in meetings, in video conferences with colleagues from around the world to figure out how we all use our unique capabilities to bring to this fight. You had Dr. Frieden. You had the president himself. You had Secretary Burwell, Secretary Kerry, Secretary Hagel. You had USA Administrator Raj Shah, National Security Advisor Susan Rice. You had our UN Ambassador, Samantha Power, everyone working the phones in a way that I have never seen in my 23 year career. So what was the result? Let me give you a few highlights, but it is a really unprecedented response in a very short amount of time from the international community. From the United Kingdom, we have seen commitments of $320 million to include the creation of Ebola treatment units in Sierra Leone with more than 700 beds and a military hospital to treat Ebola-infected healthcare workers. From the EU, we have seen $250 million in commitments. From Japan, $145 million, of which $100 million of that was just last week. The French have committed $130 million, including supporting Metsans en Frontières in the building of ETUs, in the building of training facilities in France and in Guinea. China has committed $130 million and committed to building an Ebola treatment unit that will have more than 100 beds. The African Union has sent to date 78 healthcare workers to the three affected countries and has pledged to attempt to send up to 2,000 more. The World Bank has contributed $400 million. The African Development Bank, $150 million. The IMF, $130 million in zero percent loans. And then you have the private sector. What's amazing to me is some private sector actors are contributing as much as some of our leading country partners. The Paul Allen Foundation, $100 million. The Bill and Melinda Gates Foundation, $50 million. Mark Zuckerberg, last week, $25 million. So do we need more? We absolutely need more. Part of the puzzle now is with all this money pledged, it's taking time to get from the press release of the pledge to getting people, materials, and logistical capability on the ground. So part of it is a timing issue. The other is what's the total scope of the need? I don't know that any of us can answer that. Someone compared this to the Haiti earthquake. In the Haiti earthquake, you knew pretty early on how many people had died. We don't know how many people are gonna die in this crisis. So we don't know the scope of what the response has to be. And that's in part why when we've gone to Congress now to get more money, there's also a contingency fund added on because we need to be ready to quickly respond if this epidemic goes in a different direction. The UN has said what it needs to respond between now and the end of March is $1.5 million. Where are they today? Today they're at about 787 million, about 52% of their goal. So they're not nearly to where they need to be to stand up the capabilities to offer the leadership in this crisis. Talked a bit about the challenges in recruiting healthcare workers. There are two that I wanted to focus on. The first is if you're gonna recruit anyone, they wanna know if they get sick, are they gonna get good medical care? And so the first line of the defense is something I hope Anne will talk about, which is a hospital the US military has opened up this past weekend in Monrovia. And there's a parallel hospital that was opened earlier in the week in Kerrytown, Sierra Leone by the UK military. Both are providing healthcare for Ebola responders. Both local responders, Liberians and Sierra Leone, as well as international responders. The other piece of this puzzle for medical care has been medical evacuation. Really interesting data point for me is that 75% of all of the Ebola effective people evacuated from West Africa have been evacuated by the State Department. Not usually an agency of the US government that has that sort of operational capability. We were very fortunate to have worked with CDC, the US military to have through a contract mechanism an aircraft that could safely bring people out of West Africa and into hospitals in Europe and the United States. We continue to offer that service both to Americans and non Americans, bringing the Americans back to the US, bringing the non Americans so far back to Europe. And we will continue to do so on a cost reimbursable basis. The other thing that you need to know if you're a healthcare worker thinking about volunteering is whether you can go home again. Who would volunteer if you can't return to your country or transit another country to get home? And so the interagency, the White House and the rest of us have been working very hard to encourage companies, I'm sorry, encourage countries to keep commercial air links open. And that's been a huge struggle. As you know, there are very few flights that fly in and out of these countries. To keep our borders open, because if you shut our borders, how are you gonna get people back out once they've served in West Africa? How are you gonna get our air crews to be able to bring supplies into those three countries and then return to resupply and refuel in other countries? As well as maintaining science-based decisions for the screening and monitoring of people who are returning from these three countries. And for the US, I'd quote Raj Shah who said, this is a question of American leadership. The moment we shut our borders, the rest of the world does exactly the same thing. And this will have a direct impact in our ability to bring in relief, bring in people into the region of West Africa. Let me conclude by again quoting the president. The best way to protect Americans is to stop this outbreak at its source in West Africa. It's most important message I hope you take away from this talk today, it was Dr. Frieden's biggest message that our own security as Americans, our safety of our family members and the people in our communities is directly linked to what happens in the next few weeks in these three countries in West Africa. Thank you. Thank you, Don. And could you talk to us a bit about the military mobilization, commitments of upwards of 4,000 troops, a lot of ambitious targets, a lot of operational requirements to get things moving. How does this all work out from where you sit? Absolutely, thank you, Steve. And I have to say it's very good to be back at CSIS in what is not such a new building, but is a new building to me after having spent a number of years with the institution. So let me fill out what my colleagues have started to discuss and give you a little bit on the what, the why and the how of the U.S. government response from the DOD, the Department of Defense perspective. And I think as has already been explained, but is worth underscoring, represented by all of us up here today, this is truly a whole of government response, an interagency response, we work very closely together. And on the ground in West Africa, DOD's efforts are in support of our civilian partners and specifically in support of USAIDs, disaster assistance response team as coordinator of the operational component of the Ebola response. As you've heard today already, the U.S. government considers the epidemic a global threat and a national security priority. The Department of Defense has been brought to the response because it has some unique capabilities to bring to it. Notably, the ability to respond with a certain amount of speed and scale to act quickly to stem the spread of the disease. We are providing an interim solution with these capabilities to allow other departments time to expand and deploy their own capabilities. And the U.S. military's efforts are also, I think it's fair to say, helping in some way to galvanize a more robust and coordinated international effort, which is so essential to containing the threat. Now a little bit about what we're doing. Secretary Hagel has approved military activities in the response to Liberia and the region in four key areas. Command and control, engineering support, logistic support, and training assistance. Let me walk you through briefly some of the key points in each of these areas so you get the full picture. Command and control, on September 15th, Secretary Hagel established Operation United Assistance to conduct our efforts in the response to the outbreak. On October 25th, Major General Gary Fuleski is the commander of the Army's 101st Airborne Division, assumed command of the mission, taking over from its interim commander, Major General Daryl Williams. So U.S. military elements have been in the region for about eight weeks, coordinating with the DART, the U.S. Embassy team, the Liberian government, and others who are on the ground. And we now have more than 2,000 Department of Defense personnel there, directly supporting the mission, with the overwhelming majority of those forces in Liberia and the remainder in Dakar, Senegal. The second line of effort is logistic support, and this has already been mentioned. The department provided a 25-bed hospital, it's called the Monrovia Medical Unit, which provides a local treatment facility for any healthcare providers in the region for their use, should they be exposed to Ebola. And this has been a very important piece of the response so that first responders, healthcare workers, have the confidence that they can get the treatment they need should they be exposed. So the department constructed the hospital and is committed to its resupply for up to six months. It's being staffed by the U.S. Public Health Service, and it did open last week on November 8th. The department is also providing quite a bit of material, cots and tents, other necessary supplies for the response effort, including personal protective equipment that is so needed for the work, not only in the Monrovia Medical Unit but in the Ebola treatment units. We've also established an intermediate staging base in Senegal, working in close coordination with our regional and international partners to facilitate the movement of personal equipment into the region and specifically the Liberian, particularly given the state of the commercial flights today. This has been very important. So we're also providing some strategic airlift in and out of West Africa, as well as tactical airlift as necessary within Liberia itself. Third, the engineering support we're providing. So the department is constructing, in the process of constructing, 12 Ebola treatment units of about 100 beds, each to deliver care to Ebola-infected patients. Military engineers in Liberia are facilitating the site selection and the construction of the ETUs and also working closely with engineers of the Armed Forces of Liberia who are committing their efforts to ETU construction as well. The first of the ETUs, which is in Tubmanburg, is finished and just opened earlier this week. Two more in Sinje and Buchanan will open before Thanksgiving and the remaining are in various stages of planning or construction. And then the fourth line of effort is training. The department has established a training site at the Minervian Painsville Police Training Facility and is also putting together several mobile training teams in Liberia, which are being manned by dozens of U.S. military healthcare workers. They themselves received training in a curriculum that was built through the World Health Organization, CDC, and in coordination with the Liberian government. And having been trained, are now able to train others, healthcare workers, hundreds of them per week, potentially in Ebola prevention and protection, enabling them, these workers, to provide direct supportive care to Ebola patients. The first class graduated 70 healthcare workers and support staff on the 31st of October. The second class is 63 students graduated last week and a class of 121 students started on Monday. So we're beginning to move these through the system, which is great. Just wanna flag, it's important to keep in mind that the U.S. military personnel have not and are not providing direct patient care to Ebola patients. We'll be engaged in the training effort only in that regard. And with that, through all the planning and the operations, the department is extremely focused on the safety and well-being of our deployed forces. They are, this is of particular importance to us. So it's developed stringent policy guidance regarding training, screening and monitoring of DOD personnel that they're gonna undergo prior to, during and after deployments to West Africa. In all these circumstances, the protection of the personnel and prevention of any additional transmission of the disease are paramount planning factors for the Department of Defense and for U.S. military response efforts. So that's a basic frame of what we're doing. It's not all of it, but it's a few of the key activities. And I'm just gonna close by mentioning three key challenges ahead that have in some respects been touched on by the previous speakers. These are challenges that the department is not only facing, but I think are challenges that are for the government as a whole. The first is the dynamic nature of the epidemic. So the department's gonna continue to work tirelessly as we get these different reports with our interagency partners to fulfill its mission. But infectious disease is not a hurricane. It's not an earthquake. It's not a tsunami. And while every major disaster is and response effort is unique, this one is probably more so than the others. We've experienced and worked on together in the past. The second meeting, the requirements requested by the DART requires advanced planning. It's the way the department rolls. And DOD has moved with speed in constructing the Ebola treatment units, conducting the training and carrying out other aspects of its mission. But the government has been and must continue to be watchful of how these needs change over time and their implications for our response. And then finally, the Department of Defense's contributions are time limited and will at some point need to transition. So although they've supported the conditions for civilian departments and agencies to expand and deploy capabilities and for the international community to come in behind us, we have budgeted and planned for a specific role over a limited period of time and successful transition is gonna require a high degree of complex coordination resources and the sustained political will to eradicate the outbreak. So we look forward to continuing the great cooperation that we have had already with our inter-agency partners working through some of these very difficult and unique challenges in the outbreak and look forward to your questions. Thank you. Thank you, all of you for those very rich remarks. It is pretty remarkable stepping back and listening to you as to how much has happened in the last 60 to 80 days. I mean, since folks came back from the end of summer Labor Day and then the rush of events and an enormous amount has been accomplished. But there's also this, as you've all pointed out, there's this exceptional level of uncertainty that we all have to deal with here, that the epidemic itself remains somewhat unpredictable and unknown in the direction it's going to take. It's difficult to scale accurately what is going to be needed when and what form exactly, but we know it's going to be more than we have today. And so you get into a thing like the $6.2 billion request. We know there's going to be a greater need for adaptability, flexibility, quick course corrections because this bushfires type of epidemic is evolving in ways that catch us off guard week by week. We know the health worker problem is not going to be resolved in the short term. It's going to require just a constant, continual level of attention and effort and reminder of people. And we know that health security as an overarching concept guiding action is new. It doesn't have preset budgetary lines and authorities in the same way as other foreign assistance priorities. Having said that, perhaps you could all say in a few additional words of how do you now in the where we are at this intermediate point with a big request, a big ask being put forward now, how do you make the best case to an American public around the need to live with this uncertainty, invest at a much higher level and move ahead. We know we've had some tough experiences here in the United States where we've been shocked to see the level of distrust or skepticism around public authorities, public health, science. We've seen a roll of fear and panic that can be incited through just a few cases and the public communication side of that. That is a factor too in trying to make the case to the American people around the magnitude, the timeline and coping with uncertainty that seems to be cutting through every dimension of this. Tom, maybe you could say a few words around making the case and then others could jump in. Ultimately, we want to reduce uncertainty. We want to reduce the threat by addressing Ebola at the source. And doing that requires really three key principles. Speed, flexibility and front lines first. Those are the three core principles by which we have to apply the strategy that has worked in every Ebola outbreak until now. Speed, because the speed with which this can change is quite remarkable. Even week to week, we're seeing big changes in the approach and that's why transfer authority and contingency funds is so important here. We were preparing for a case in Mali. We had a team in Mali. We had a larger team in Mali when they had their first case. Now we have a cluster in Mali that we're going to have to respond to urgently. Friday evening, we didn't. So the speed with which this changes and the speed with which we have to act by the DOD and the Dart capacities are so important is to deploy immediately. DOD is now bringing our teams in Liberia to and from clusters by helicopter because that's the only way to reach them. That kind of speed is key. The CDC modeling from a couple of months ago showed that even a one month delay in addressing the outbreak resulted in a tripling of the number of cases. That's just a mind-boggling speed. The second is flexibility. We know that to be effective, we're going to have to adapt to local conditions and address the needs. The Mali outbreak is related to unsafe burial practices and unsafe care practices. We're going to have to be flexible in addressing those two drivers of the outbreak. And to do that, we're going to have to work in a wide variety of places. We're going to have to give the folks on the front lines the authority to adjust as needed. And the front lines have to come first. And to do that, we're going to have to surge resources in to these countries, around these countries, within the US to protect ourselves and more broadly to emergently deal with the risk to global health security that Ebola is the latest but far from only example of. Yeah, that's absolutely right. And you asked about the structure of the quest and the contingency fund in particular. And that's so needed because we don't know yet what future twists and turns they may be in this outbreak. I mean, Tom's absolutely right. We need adaptability, flexibility. We need the people on the ground who are seeing this firsthand to have that authority but also to have the resources and the backing to make the adjustments and the course corrections that they see because the virus will move faster than us otherwise. And we need to be able to keep pace and ultimately outpace the spread of the virus. This is, when I look at the whole range of things that the Oxford disaster systems does, we will respond to an earthquake. That's a pretty straightforward response. We've done that many times. We basically know how that's going to go. There can be a few twists and turns but the basics of what the needs are and how do you respond, that's a pretty well-trod path. Right now, looking at the other responses, we're mounting a large response in South Sudan right now trying to avert a potential famine there. That again is something we've done many times. It's not an easy thing to do but the basic path, the basic elements of how you do that and in what proportions are pretty well-known. If I had to compare this to one of the, to what we're, to one of the other active responses, I'd say it's almost most like our serious response in that there are lots of variables that you don't necessarily have visibility on that can totally change or alter what you can do, what you need to do. There are variables outside of your field of vision that define how you're going to need to respond and so you need to be comparably adaptable to that and we need budget and staffing and capabilities that are comparably adaptable to that and will enable us to go where we need to go and do what we need to do but also to get out ahead of potential threats that we're seeing. And you made clear that the DOD is not seeing this as an open-ended commitment and is going to take it step by step. That implies that there has to be something to hand off to, right, there has to be an air bridge, there has to be some sort of international structure. Unmere, presumably, is that structure that Tony Bambary and David Navarro and others are busy trying to get that up and running. Maybe, Don, you could say a few words and maybe Anne or others here who are familiar with that. It seems to me that's the sort of story that lies just one half a step behind what we're talking about in terms of the US mobilization is can you create a coordinated mechanism that has a multilateral face to it that is competent and reliable on an urgent basis that we could invest in and it would permit this sort of transition that you're describing. Maybe I'll just start. So President Obama announced his decision to deploy US military assets on September 16th. So we were way out in front of a lot of other people in terms of getting logistical capability on the ground. AID and T.C. had been there from March, AID from August, but in terms of the huge logistical piece that the military brings, that started in September. So you have the UNMIR, UN Ebola Emergency Response, created at the end of September, really looking at October one as their first days that they're putting people on the ground. Where have they gone in the last five weeks? It's fairly impressive to go from zero to where they are now. They have 270 people on the ground. They have a logistic space in Accra, Ghana and they have special representatives and teams in each of the three countries. They have not only created logistical hubs in each of the capitals of the three countries, they are creating 18 forward logistic spaces of country in more remote rural areas. They're done with 12 of those. So they're making some serious headway. They've moved 190 tons of supplies, 400,000 sets of PPE. This is an impressive buildup. It's not anywhere near where the US military is, frankly. It's a different scale and so we need to be there through our support, our guidance, our encouragement to the UN so they can scale up to where the US military is so that at some point we enter a phase where it looks comparable and we can really look to hand off. Ann, what do you think it's gonna take to have, you said that it's gonna be an intense, complicated coordination that gets us to that next stage. How is that gonna happen? Well, I think we're laying the groundwork for it right now. We're very, very close coordination, again, across agencies and with the UN, with the various elements of the UN, including, of course, the lead element in the form of UNMIR. And I think that is going to be the critical piece because as we look ahead, we will not only have a changing, potentially a changing trajectory of the virus in the region and we hope a continued diminishment in the rate of increase of cases, but we will have established some infrastructure there that then will need to continue to be utilized appropriately. So this requires a certain amount of planning and coordination and I have every confidence that we're gonna be able, that we will get there. We have moved with incredible speed as has already been pointed out these last few weeks, but we're gonna have to keep it up. There's more to be done. And we're pressing the UN extremely hard to be ready to take the baton from DOD and that is very much part of the plan. DOD has probably the best international logisticians in the world. If anyone comes close, it's the World Food Program. And so WFP is running the logistics elements for UNMIR and we're working both to make sure that their planning aligns with what we see will be needed and also resourcing them accordingly. So they'll be able to take that baton. Don mentioned the African Union, but I think it's worth highlighting the tremendous potential they have. They were there on the ground. They've got workers on the ground now. They're willing to send hundreds more. That includes to Francophone countries where it can be difficult to get Francophone staff working. They've adjusted their approach to make it more ground driven and frankly more economically advantageous. So that's a critical capacity that's being built on the continent and it's critical component of the response, very positive. I think of it as the health keepers parallel to the peace keepers. Well it is remarkable some of the things that we did not expect, right? The West Coast foundations come in with $200 million of quick dispersing funds to do a number of very important things on a very urgent basis. The Cubans come in with substantial numbers. The Chinese come in with very substantial numbers. These are all along with the AU, quite promising. Let's open for it. We have a few minutes left. What we're gonna do is take some quick comments and questions, start down here and we're gonna bundle together three or four and then come back to our speakers. Please identify yourself, keep your remark very succinct. One intervention please, yes, right here. Hi, Rachel Oswald, CQ Rocall. With Republicans gaining control of Congress, that's the side of the aisle where we've mostly heard calls coming from to shut the border and to put in place mandatory quarantines from healthcare workers coming back to the states. In that, with that, would you have, and a couple of you I know did hit on this, but do you wanna hit on it again about why that would not ultimately help quell the epidemic? Thank you, so questions around both travel bans and mandatory 21 day quarantines, okay. Over here. Hi, my name is Justine. My question is for Jeremy. You mentioned that there was a huge need to improve PPE, personal protective equipment, and I was just curious what agencies or companies you're working with on R&D for this. Like DARPA or NSF or any private companies, thank you. Just behind here. Yes, my name is Marion Mamoud with IMA World Health. I have a comment. The Ebola crisis is in three countries in West Africa, but there are 15 countries in the region, and the media often lamps the whole region when reporting Ebola. And this is important because it has economic implications on the other countries in the region. Senegal, tourism industry is suffering, so it's affecting tourism and private investment. And then I have a question on the cases in the DR Congo. Is anything being done? If so, what's being done? Thanks. Let's take one over here, Sahil. Thank you. And then we'll come back to our speakers. We'll do one more round after that. Yes, please. Thank you. My name is Beth Creason from Northrop Grumman Corporation. My question is what aspects of addressing the trust issue that we have in countries have we been addressing? I've heard our attempts to address the medical aspects of it, but I think that a lot of the issues beyond the burial strategies regard the distrust of our personnel as we try to make an impact, and I'm wondering how that's being addressed. Thank you. Why don't we start? I know, Jeremy, there was one question directed to you and Tom on the first question around quarantine and travel ban, and there's some other issues. Well, let me mention with DRC first, we did that was a traditional Ebola outbreak. It looked like from all the genetic sequences that's unrelated to the West African outbreak. It was responded to, it was relatively large, and it appears to be over. Contacts are still being traced, but we're actually, contact tracing is finished, but the 42-day period isn't over. So that's the way we hope every Ebola outbreak, if it happens at all, will be stopped. In terms of trust, just very briefly on trust, what we see in many of the communities is when Ebola comes in, there's a process that communities go through of understanding it, understanding how to deal with it, and then dealing with it. The problem is, by the time you go through that process, it has spread. So the challenge is to get there first before Ebola does with good information. AID, UNICEF, and many other partners are working on it. It's particularly a problem in the forest area, especially in Guinea. On the issue of protecting Americans and quarantine and border safety, we're willing to consider anything that will reduce risk to Americans. So it's important to understand what we're doing now about people leaving the three affected countries in West Africa. Every one of them goes through an exit screening process. If they have fever, they don't enter the airport. Everyone who comes directly to the US, there are no direct flights, but who has an itinerary that comes to the US is funneled to five airports. At each of those five airports, they're asked detailed questions. Their contact information is obtained. The temperature is taken. If they have a response that indicates that they may be at risk or they have a fever, they're referred to CDC staff in the quarantine station for tertiary screening. For everyone who comes in through that process, their information is transferred within hours to the state health department. They're then tracked every day for 21 days to see if they have fever. Multiple times over the past week and a half, people who've come in have had fever and they use the thermometer they were given. They use the call card they were given. They use the information sheet they were given to contact the state health department. The state health department, in each case, arranged for a safe transit to a facility that was waiting for them and prepared to deal with them. They all ruled out for Ebola. They had malaria or other infections. All of those systems would not be in place if we were not able to have that kind of orderly movement of people from the three affected countries to here. So our bottom line is reducing risk to Americans. And ultimately, that's going to require stopping the outbreak in West Africa and preventing it from spreading to other countries in the region and other countries around Africa which have much more travel to the US and which would be much bigger of a challenge for us to deal with. Tom, how likely, in the discussions with the Hill, among the newly empowered Republicans in the Senate and those that power in the House, how likely are you to hear greater calls for travel ban and mandatory quarantine as a precondition for getting the sort of funding that you're looking for? I can't predict the future. I will tell you that one Republican legislator said to me recently, you know, initially, when you look at it, it looks like the obvious thing to do but the more you look at it, the more complicated it is. And I think we're all willing to look at anything that will reduce risk to Americans. That's the bottom line here. Jeremy, there was a question from the PPEs. Yes, on the PPE grand challenge, we're looking at a number of different proposals. So the structure of the grand challenge is, and you can go, you can Google PPE grand challenge, USAID, and find all the websites. The structure of that is we are soliciting proposals and ideas and brainstorms from a very wide range of different companies, partners. Anyone with a good idea, we're taking a look at that. We don't yet have the final outcome of what we're going to work with, so I can't really speak to that yet. It'd be premature, but we're looking at a wide range of different companies and proposals, and any good idea, it's not always easy to predict where the good idea is going to come from. It's sort of the nature of innovation, so we're casting that quite widely. I would absolutely echo what Tom said, and as someone who is currently being actively monitored by the Maryland Department of Health, I can tell you it is rigorous. I went through, I traveled with Ambassador Samantha Power on her trip to the region recently. We stopped in JFK, we all went into the room, we all got our temperatures taken, we all had the fairly detailed questionnaire, and our each get talking with our respective departments of health every day for about another week. And the concern, I think from our side, having talked to partners and prospective partners, we need to ensure that whatever controls we have in the U.S. do not impede our ability to defeat this overseas because that is the end game, the end game of defeating this overseas, and that is how we bring safety to the United States. So we need to balance, we need to be based in science, we need to be based in fact. And if steps are taken that serve to impede or disincentivize Americans from going, I think we have to expect that those are gonna be mimicked around the rest of the world. And the health workers who are going to work on this are not just Americans, they're from all over the world. And so if we do something that makes that flow harder to maintain, we're actually going to cause greater risk and threat to the United States. On the, just quickly on the question of trust, I think one of the things that is really contributing to the reduction in cases in Liberia is that people are now more trusting and they're taking ownership of this at a community level in the way that we didn't see in the early days. So when I was out there with Ambassador Power, we heard a lot of stories about community members taking charge in their communities, helping to organize, self-organize isolation at a community level for people with symptoms. We heard about one village where they have two old men on each major road in and out of the village, armed with thermometers, they take the temperature of everyone going in and out. So there is a lot more awareness, a lot more trust that this is real and awareness of what to do about it. And that too is really helping to decrease the risk. We're getting towards the end of our hour, let's take three more quick comments right back here. Yes, and then up front, Sahil, yes please. Yeah, my name is Tia Emmerling, I'm from the European Union delegation. I found this a very interesting panel, especially as regards the link short-term, longer-term activities. I would like to stress that the EU and its 28 member states have so far already pledged more than one billion euros for to fight Ebola. We are very active on the grounds and we cooperate with the UN, with the WHO and with all key partners there. We've also said that we are a reliable partner in development, we will not go away once Ebola is over and our development assistance will be there. Now I would like to ask one question, especially as regards for USAID, what are your thoughts on longer-term health system strengthening in this region and how will that fit into a sequence of US military, unmer operations and then longer-term health system strengthening? Great, thank you. Yes, sir. Thank you very much for giving me this opportunity. Salute all your service for what you're doing for this particular case. I'm Dr. George Alula. I'm from the Democratic Republic of Congo. The question I have is the Ebola appeared in Congo in the 90s, 70s, 76. Why up to this time, we didn't find any vaccine and to fight this disease up when it's raised? Thank you. Thank you, right here. I'm sorry, we won't be able to take everyone's questions. I apologize in advance, we're running out of time. One last question and then we'll come back and close. My name is Deirdre Lupin, University of Pennsylvania Africa Center. In March, I was in Nigeria working on a health project and at that time, the professional health workers were very aware of the potential threat that was posed by Ebola. Some months later, there was a global mobilization that's been very nicely described here in this meeting. My question is, next time, what lessons have been learned for taking ownership and responding to a potential outbreak of this kind? Okay. What I'd like to do is, I'm gonna offer you the last word here and I'd like to start with Ann and then move through here. Any closing thoughts on the questions raised or any other things you'd like to add, Ann? Not specifically to the questions that have just been raised, which I think are better answered by my colleagues. I think that however, with respect to mobilization, we will be taking a close look at how it is that we work together to conduct this response, as we do after every response, every disaster response, understand what worked, understand what we could have done better, except that it's hard to talk about this in the past tense now. We are still very much at the front end. We're very much in the throes of it. I just do wanna assure you, however, that part of our best practices, one key element, is to understand what we've done, why we've done it, and then to incorporate those lessons learned the next time around. On the question about the long-term health system strength, Ann, I'm sure Tom will have some words to say about this as well. The USAID has done health system strengthening in these countries for many years, particularly in Liberia, but never focused on Ebola, because it had never been an issue there before. So we are going to be adapting our investments accordingly, and we're looking now at how some of the immediate things that we're doing around training, around infection control and prevention and in partnership with the CDC around developing greater isolation capacity around the country, not just in a few sites. I think those are all things that serve the immediate response, but also will bear fruit in the long run in terms of getting the health systems back on their feet. And that's going to be a huge, huge effort because health workers have been among the most affected population by this disease, having been affected in caregiving settings. So there will be a huge amount of rebuilding to do. And I just wanna also appreciate, we stopped in Brussels a few weeks ago and have been talking regularly with my EU counterparts, and I just wanna echo what you said about no pun intended, actually, about the great work that Echo and others are doing in this response, it's really a critical piece. On the lessons learned, there will be a lot. And we always do, at the end of a major disaster response, a very rigorous, very intensive lessons learned after action exercise. So we'll be getting more out of that. And the one thing that I would identify now is there was very limited global capacity to deal with something like this when this broke out. All the capacity that previously existed was premised on every outbreak that had happened before, which was small, rural, much more manageable. And when we needed to then try and scale that, we found, and worked around for partners who could scale that they didn't exist. And they're now starting to exist, and you have a range of NGOs that are now building this capacity so that it's not just MSF out there on the front lines, and others are stepping up, IFC, IOM, Save the Children. But none of them had that capacity in-house two months ago. And so I think there needs to be much greater, broader global capacity, not all just centered in one single organization. And we need to invest in keeping that sustained and deployable even if there's not an active outbreak on them. Thank you. Don, closing thought? Every Peaceful Volunteer in Sierra Leone, the first week you're on board in country, you learn a saying, which is something that you respond when someone asks you, how are you doing? You say, I did Fidon Grap, I fall down, but I picked myself up. And I have no doubt our friends in West Africa will pick themselves up. I think in this case they're gonna need a little help. So we're gonna continue to be out there trying to make sure from the United States and from the rest of the world we're there to give them what they need to pick themselves up. Thank you. Tom, closing thoughts? Three quick thoughts. You asked about vaccine. We hope to begin vaccine trials in the next month or so with one or two promising candidates. Innovation is important. New diagnostics may actually make a very big difference if we can get to point of care within the next couple of months. And many parts of the US government, including CDC are working very intensively on that. So that's important. But second, we do know how to stop Ebola still. It does require a speed and scale that we've never done before. And that brings me to the third point, which is what are the lessons? What do we need to make sure is in place? And that really brings us to global health security. We need in every country of the world a bare minimum of finding health threats when they emerge, responding promptly so they don't spread and preventing them wherever possible. And that will keep each country safer, that will keep their region safer, and that will keep us here in America safer. Thank you.