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tv   Key Capitol Hill Hearings  CSPAN  July 23, 2014 1:00am-3:01am EDT

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could do a lot worse than bear in mind the important words of abraham lincoln who wrote 150 years ago the struggle today is not all together of today. it's also for the vast future. thank you very much for your attention. [ applause ] and for your applause. i'm very happy now to look forward to sitting down with you and discussing your questions and discussing whatever else you want to raise.
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>> thank you. you have no idea what just happened. excellent address, and raised lot of good points and sets up an interesting and complex landscape, and i want to go through a lot of them including the state of affairs and debate in britain right now about defense and the military. relationship to the u.s., nato, but where to start?
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i think defense one, we discuss the future of military power. and what comes next, where we're going. and part of that big question right now is the use of power, the limits of it, and the purposes of our militaries. that's a debate going on in this country. i know in the united kingdom, there is a new kind of recommitment to a future with a major funding announcement, as you said. explain to us and the viewers a little bit about the background there of the debate in britain of how much to spend, what kind of military to have, and how it should be used. >> i think in the u.k., we are very conscious about nato is a very precious alliance, but it is not reasonable to expect the united states to continue to bear more than its fair share of the costs. when i last looked at the numbers, it was something like
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75% of the cost of nato fell to the united states. we believe the other partners have to do their bit as well. that's why we're firm believers in the target of 2% of gdp from each member of the alienls in order to assure that we are pulling our weight. united kingdom is somewhat above that figure at the moment. there are not many of our european partners who are. as i mentioned in my remarks, we believe just four countries. so it's very important in terms of equality of burden sharing, but it is also very important in terms of capabilities. and it's not just about what is the amount of money you spend. it's what you do with it. it is, are you willing to use the equipment you've got? and it's asking yourself to question of whether the equipment you've got for your brave fighting men and women of the armed services is the right stuff to deal with the current or future threats. of course, it's a long lead time with military equipment you design and manufacture, and threats have a nasty habit of
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evolving very rapidly, more quickly than we sometimes can do in terms of design and manufacture. neverthele nevertheless, we believe it's important to keep an eye on what the threats are, what to do with them, and what we can expect to do. hence, what i said about having a 10,000 deployment capability we can sustain. hence the reason to project a long way from home. two new 60,000 ton aircraft carriers, both under construction. one recently launched, one to be completed soon. together with state of the art f-35s, and a whole bunch of other cutting-edge technologies are an indication of what we believe we need to do. we were maintain our territory. we will spend more on cyber defenses. we will spend more on new technologies in a number of different areas. so we're trying to insure that what we do is not just fair burden sharing but it's also relevant and capable in terms of a threat that lies ahead.
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we believe that's an important part of the debate at home for nato, not just on the u.k., so that's why it's on the agenda for the summit that will be taking place. >> you mentioned the capabili capabilities and the f-35s. are you so sure about the f-35s? they just made a no show, and they're constantly delayed. is there a plan b for your country, as has been discussed in this country for carriers that need aircraft that can launch off them? >> we won't be disappointed that we didn't have the f-35 at two air shows in the u.k. last week. it was because there was an engine fire in one of those aircraft. new products, unfortunately, have troubles, but i have to say that we remain confident in the product, convinced that it's what we need, proud of the partnership the u.k. has with the united states as a pretty much prime contractor in this
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project, and we're sure to come out in the end. we're a bit concerned, some people talk about the price. we would like, of course, the best possible value for money, but we're absolutely not wavering in our commitment to this aircraft. >> you mentioned burden sharing. this is high-end capabilities, committing to the nuclear deterrents. in a world where we have these low-end threats, as you also describe. how has either the budget or what's happening now with russia changed either great britain and nato's commitment to both defending the homeland of europe farther out from its actual borders or changed its calculus of how far around the world the united kingdom can be or should be involved in global security? >> i think one of the results of what's been going on in ukraine lately has been a reconfirmation, if you like, within the alliance of the importance of the commitments we
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have given each other and in particular of the commitment of article 5. article 5, which means that an armed attack against one is an armed attack against all. it's only been used once, i think, in afghanistan in the context of 9/11, but it is there. it is a commitment, and because of its importance, we have seen a number of rotations and deployments of nato, armed capabilities into some of the nato countries which are closer to ukraine. we have reminded people through reassurance programs of the importance of the alliance and of the seriousness with which we take our commitments. we have also been trying to engage with non-nato partners to try to insure them we care about their security as well. we need to be clear that article 5 applies to nato allies and not others, and that's one reason why the united states government, my own government have made clear in terms of dealing with ukraine, we need to look at a number of different means of insuring that our
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security is protected, that what's been going on in ukraine is regarded as unacceptable and there is a price to pay for what the russians have been up to, but which stops short of military deployment, boots on the ground in non-nato countries. that's not on the agenda, but we have to include some of the things i mentioned of different policy responses. >> isn't that the criticism of ukraine, simply because there is no article 5 requiring it, ukraine is going to suffer? that even with an airplane shootdown, what really can the west do or is the west willing to do? you mention eed holding them accountable. is accountability going to be stronger sanctions with every one of these events, there seems there's more and more of a clamor for actual military response, a strike, some sort of punishment, some show of force. >> i believe i heard the president say when he spoke to president putin late last week,
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there was a strong complaint about the sanctions which had been ratcheted up by the united states last week. it's much more than possible, probable in the event that the russians do not change their tack. the president does not meet the requirements which have been spelled out by the president and my own prime minister, by a number of people in the last few days, that there will be further pressure through sanctions and other measures. there are already a lot of individuals and entities on the sanction list. more can be done in different sectors. we think it is not reasonable that a russia which destabilizes its next door neighbor in the way it has been in ukraine should continue to have access to high technology and finance and financial services and the means to maximize its energy resources, for example, on all of which it depends on the west, without being any response from
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us to say, no, we're not prepared to play that game if you're going to carry on behaving in this unacceptable way. there are a number of leavers we have, we are by no means at the end of the road, and i think one of the consequences of the terrible event of the shooting down of the malaysian airlines aircraft is a number of european governments which have been a little wary of going down the sanctions route will now be more robust. >> i want to remind everybody watching, we'll get to questions shortly from the viewers and from here in the room. we'll pass around a microphone. on european collective defense, you mentioned the 2% number again, which is one we have heard for a long time now, and there's been a lot of succession of american defense secretaries that go to nato and usually in their final speech, wrap nato of the knuckles for not meeting that goal. it seems to me there's a divide here about what level of security for europe needs that
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washington thinks versus what european capitals either believe they need or are willing to spend. and that is if the europeans don't step up the number, that's either the 2% or the number that makes the pentagon happy, either the pentagon is going to stay there and do the job for them or have to accept a lesser european defense. is there -- is there any real reason to believe that the other members of nato are going to reach that number, and is that number even needed anymore or is this 2% thing a red herring by now? >> the 2% thing is an agreed target of the alliance. we think it has a value. we are proud of the fact that we exceed it. we would like to see our fellow members of the alliance do as much. as i said, the business of insuring that nato is capable, fit for purpose, ready to respond, is not just about numbers and the amount of money you can spend. there are countries which spend
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quite a lot of money on defense but don't actually do anything with what they get for that money. so this is one reason why we want to have a really adult debate about this when the nato summit gets together in just under two months' time. we think it's important to look at all this. we feel in the light of recent developments, european security has rarely been more important. i know on television, senator feinstein, when asked when we're back in the cold war era, she said yes. >> do you believe that? >> well, i'm going to leave senator feinstein to speak for herself, but i think we are in new and dangerous territory. and i think one of the unhappy consequences of recent events is that we are now more and more focused on the importance of insuring that european security and mutual defense is robust and credible. so that's a debate we're going to have in south wales, it's very important. >> let's move from nato into the
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middle east and israel. i guess we'll get into iraq after. in your remarks with lots of the other world leaders have mentioned frequently, israel has its right to defend itself, yet calling for a proportionate response. does that mean you believe israel's response is not portionate? >> i think we are united with many other governments, including many, many people in israel in being very distressed to see the number of civilian casualties in gaza rising above the 500 mark. this is a very high level. there are horrific stories each day of children in schools and cafes and so on, children on the beach losing their lives. we would very much hope that this ground incursion comes to an end quickly. we would very much hope to see a cease-fire. that's why i'm very pleased to see secretary kerry on his way there at the moment to see whether he can build on the initiative that's been taken by
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the egyptians and see whether we can bring the fighting to a stop. >> is there -- in thinking of hamas, hezbollah and other groups, all the way into isis, it's been on our minds, we have the u.s./mexican border as an existential crisis. you were talking about the border. what's the difference between that and calling these groups flatty an existential threat to britain, to the united states, to nato? if they're an existential threat to order, is that enough to send troops to get military involved or realistically, are all our countries going to sit back in this defensive posture after the fatigue of the last 12 years of war and allow a lot of violence, a lot of destabilization, a lot of power control shifts to occur
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without real military-led types of reactions? >> the conclusions of these two very lengthy, very costly conflicts, both of which lasted longer than the first or second world war in iraq and afghanistan, has been the public opinion has become very wary in most western democracies of the use of military action. people can see how you get into wars. they are not so good at seeing how you get out of them. the question that we hear so much more often now than used to be the case is what's the exit strategy? or put another way, i can see how we get in there, but how can we be sure we're going to make things better rather than make things worse? and what about the cost at a time of considerable economic difficulty in many countries? i have seen estimates that iraq and afghanistan cost the american taxpayers between $5 trillion and $6 trillion.
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my own country has taken a lot of sacrifices as well, a lot of lives lost, a lot of blood and treasure. if you look at the polling in britain, france, the united states for example, what does public opinion think about the use of military action, the use of boots on the ground to deal with another country mfs internal turmoil, even a humanitarian disaster, let alone an existential threat to international order? people are wary. they have become more conscious about whether the use of armed force is necessarily the right answer. they want to be very sure that it is going to make things better. sometimes it does. in the united kingdom, for example, i went to sierra leone about three times in one of my previous responsibilities. there was a brief war, it lasted about six weeks, we were able to turn back a brutal campaign from a bunch of drug-crazed kids chopping off the arms and legs of civilians in that country, restore a form of government and make things better. it isn't always that straightforward.
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sometimes it's more difficult. we need to be very sure before you're going to take military action that you're comfortable with the thought that there's a strategy there, a plan in place, that means you will be able to go in and you will be able to come out and that you will be leaving things in better shape. and i think the answer to those questions are necessary for the public opinion increasingly sasing to governments we need you to be sure before you commit more blood and treasure. >> with that, i'll open to question, and keep in mind the thought of talking about a group going in, leaving things better than they were than coming out is not something i think a military might be designed to do. these are instruments of destruction. we have been asking to do a lot of different things in the counter insurgency era. >> they need to be part of a strategy that makes sense. with other measures in place that do make a difference. at the same time, as i was saying, george shuchultz again, democracy is not backed by use of force is ineffecttual, and we
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need to bear that in mind, too. >> in the room, we'll start. we have a microphone to pass around. i think we'll go up there to sir george. he's from our building. >> sir george? >> national journal. >> george condon, national journal. mr. ambassador, if i can take you back to the summit, you said the second theme of the summit would be how to deter further aggression by russia, and just looking at the situation in ukraine, do you see the summit discussion as more planning for the future or assessing what has been done in ukraine and how the alliance could respond? >> i think we're talking about a bit of both. that is to say we want to have in place credible defense arrangements which mean that there is going to be no threat to members of the alliance. that is the fundamental purpose for which nato exists.
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but we're also conscious that we have got a broader responsibility, which goes outside of the territory of the member states, and that's why nato has been involved in many other places, including, as i mentioned, the balkans and the waters of somalia and so on, trying to make things for the better. but i think also that unless we have a change of heart on the part of the crimea in the coming days and weeks, we're going to have to be looking seriously at how we're going to deal with the specific issue of the way russia is treating its neighbors in europe. it will be a little bit of both. i don't want to anticipate in detail what heads will be saying to each other or indeed what the situation will be by the time we get to the beginning of september, but i suspect it will be a bit of both. >> from the department of state, i have a question about kind of
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these two themes that often seem to reoccur in european security. one is the burden sharing between the united states and europe and wib europe, and the other is within europe, nato versus the eu, you mentioned this new and dangerous territory, that might have impacts on the burden sharing debate. i'm curious what impact you think that this new environment might have on the respective roles of the european union and nato and european security. >> thank you. the respective roles of europe and nato, as you know probably better than i, it's complicated. and it gets tied up in a number of different issues, including questions of sovereignty and the question of how far and nato as opposed to the european union, are responsible for collective defense. that said, we have got some pretty good examples of how the european union and nato have been working together.
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either offshore or onshore in trying to make a difference in africa, in the balkans, and in dealing with somali piracy, for example. so we've got some good examples of working together, but from our point of view, we think it is important that we don't either undermine or dilute the nato command structures and the way the alliance functions by mixing things up too much. and it's important that we remain also clear where competence falls, defense policy lies, but i think as threats evolve, as the importance of working together becomes more and more apparent, the scope for the eu and for nato to work together will grow. it should grow. there are now increasing number of capabilities within both organizations, and there is also growing evidence of individual members of nato which are also members of eu doing stuff together. so i think that's an important area of future capability as
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well. >> ywhen it comes to the burden sharing, it's also inclusive of nato, but the u.s. is not thought of as part of that. is the u.s. helping in line with the burden sharing conversation, or is it considered the u.s. is going to take care of itself no matter what. this is for the rest of the members sort out? >> well, the united states pays the share for a long way by the moment. i don't think anyone thinks the united states should be doing more. but what the united states can do is engage with the rest of us in a number of different ways. one of the opinions that i happen to hold is that if we are to continue to persuade public opinion across the alliance that their valuable taxes should be spent on defense, that there's got to be an extent to which they see this contributing to their own industrial defense, employment, prosperity,
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objective. that is to say, if you're going to spend lots of money, it can't always be buying stuff from somebody else, and where you've got a defense capability, where you've got defense industries of your own, it's got to be possible for those industries to be credible and to be able to sell elsewhere in the alienls. we need to have something more than a kind of two-way street, if you like, so we're not all buying off the shelf from one or two suppliers and that everybody feels that there is something for the tax dollars, the tax euros, the tax pounds that we spend on defense, which also strengthens your own defense and industrial capabilities. that's important if you're going to keep public opinion firmly on board and believe it's a good use of public money. >> i like that. move on next. question here. >> harry blaney from the center for national policy and a former
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diplomat, served in nato. the question i'm asking is kind of a more difficult element focusing more on both nato and the ukraine and sanctions. today, prime minister cameron in the house of commons discussed basically three different levels of possible sanctions. on the so-called third level, which is sectorial sanctions, he mention mentioned that the problem that seemed to be at work is that europe, including britain, was not fave rboraborable until now support of the third tier particularly on the financial side of things, which perhaps the city of london would have interest in. and there's a memo that some people have distributed about that issue. i was wondering in the larger
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sense that this relates to a subject you did not get a lot into. that is the membership with the eu. it seems to me that if one is going to have an influence on some very crucial decisions of both defense and security and economics, that britain within the eu would be more a stronger and a better voice and that outside with possible decision zombies at some point, and a more isolated britain might not be an example you have now going to the summit, including the eu, will not have that influence, and that has an impact on your relationship with not only europe but also, i might add, with the united states. i would appreciate very much your thoughts about that. >> let me make two comments in reply. first of all, we very much
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recognize that if we are going to have to ratchet up sanctions in the direction of tier 3 or tier 2 or whatever you want to call it, doing more, this is not going to be cost free. we know it's going to be difficult. we know that for us, it will be difficult, for the financial service industry. we know the sum of our partners, it will be more difficult if there's an arms embargo. we know for those with energy technology or purchases will be painful, but my government, anyway, has taken the decision that if that's what it takes, that's what we've got to do. we've got to make a stand on this point of principal that you cannot allow the playground bully to carry on beating up all the children, to put it in a rather simplistic form. so don't be under any illusion that we are firm or robust in that area, and i think answering your first point a little bit, we have played quite an important role, much of it behind the scenes, in trying to
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stiffen the backbone of some of our other european partners who weren't quite sure whif this wa the right path to go down in response to what we all now, i think, increasingly regard as unacceptable behavior in ukraine, so we're going that way knowing full well that it's going to be costly and it's going to be difficult. we hope very much, i was struck by both the president and secretary kerry making this point in our recent interventions. we hope very much the off-ramp that is available to putin to de-escalate this will be taken. but if not, there will have to be a ratcheting up of the pressure and of the sanctions. on your second point, we do not intend in the british government to see the united kingdom becoming more isolated or less a part of the european union. my primary strategy, i hope i get it right, is that he wishes to secure a better functioning european union and improved terms of membership with the
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united kingdom, and then if he's given fresh consent himself, if given a fresh mandate in the general election next may, to take the issue to the british people, maybe in the end of 2017, to get the british people themselves to give fresh consent to the question of u.k. membership of the european union. that's the strategy. it's not a strategy designed to take us out of the european union. it's a strategy designed to help europe work better and improve the terms of our relationship with the european union, but we do believe in the british government that there are improvements which are necessary, not just to keep the brits happy but because there are an awful lot of areas where it could be working better, and there are a number of european union governments which agree with us, even if some of them don't say so quite as loudly as we do. >> there's a couple on this side. move around, we'll get to sydney and perhaps a question or two from the internet.
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>> sydney freedberg, breaking good afternoon. >> good afternoon. >> i wanted to ask you, you mentioned the special relationship, as it were. in the u.k. has long played this bridging role in some ways between the european continental partners, especially france and germany, and the united states. accused sometimes of being air strip one or a poodle, but generally, i think, providing a helpful intermediary and translator between american english and brussels. how has that role changed? does it come under strain, you know, despite this commitment the uk forces have suffered a lot of cuts in recent years. there's a very strong dependence, especially in
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germany, on russian energy resources. there is a lot of backlash against revelations of nsa and now cia penetration in germany in particular. faced with this common crisis in ukraine made horrifically obvious by the shootdown of a malaysian airliner. how does britain play that role in face of all those strains? including your own domestic discontent with the eu rising? how do you stay the intermediary as opposed to being pulled between the two to no good effect? >> it's an eye sore that we have the kablt of playing a bridging role across the atlantic, but we shouldn't get too pleased with ourselves in this area. i learned from my friend last
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week when germany just sort of in parenthesis wrote america's strongest ally in europe, so france has got a very important relationship, interest, equity, history in the relationship here. a lot of european nations go back a very long way with the united states, and are themselves fundamental partners, allies, friends in lots of different ways. sometimes, perhaps we are able to play a role. we do have a shared language, or what sometimes looks like a shared language, with the united states, and maybe that facilitates a degree of interpretation or persuasion. certainly, there have been moments in the past when the u.k. has been shoulder to shoulder with the united states when some of our other european partners have not been. that is indeed true. i think for the u.k., we would like to continue to play that role where our own interests and values, which so frequently coincide with those of the
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united states, i think, that we would continue to do that. but i think, as i said, different approach towards europe, to answer the question, really, we're not aiming to move away from europe. we're aiming to remain a key player at the heart, but reformed, outward looking to the european union. that's what we would like to be in the years to come. so i think that is not a source of tension. that is a source of strength. and i believe that is in the interest of our other european union partners, particularly those who believe that the european union should have a role in global security and foreign policy issues. that is a role that with cathy ashton in charge has become stronger in stronger in my view in regards to what the european union does for the community. she's been the point person on negotiations with iran, for example. she's been deeply involved in a number of other global foreign
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policy issues. so i think we're all, if you like, bringing a little bit of something different to the table. i think we're all much of the time putting in the same direction. occasionally, we may be able to act as a bridge, if you like, but if you like, when we are trying to persuade some of our european partners to be more robust in their response to russian behavior in eastern ukraine, it is not simply because the white house has said to us, please beat up on your european allies. it is actually because we think it is the right thing to do and that the international community must make that stand. so frequently, it comes from, as i was saying just now, an identity of interest and values, but you've also got to have the capability to do it. that's where some of the things that we bring to the party like permanent membership of the security council and the role we can play within nato and the european union in other respects, these are hard to come about, sometimes an important
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part of trying to conduct conflict resolution in certain parts of the world. those are all different things we would like to think we can do to help move the international situation in the right direction. >> final five minutes here. not looking at our twitter questions, i think we have answered them already, so i am going to ask one of my own, which is on our pivot to asia, as we call it here in the united states. if the u.k. is truly going to be america's closest partner and reliable ally, what role is there for the u.k. in the pivot? i have been around the building saying are we going to see british brigts steaming through the sea and providing hardware and troops to go along with it because we tend to hear measures besides the pivot based on the number of ships and people we send that way. how far is the british military willing to go toward global
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security again, specifically with the asia pivot? why aren't we seeing or hearing more about more british assets alongside america that far away? >> i think there are two things. one is a global foreign policy, and global interest in east asia. the other is defense capabilities. on the first point, if you look at the evidence and the number of times that we have the prime ministers, foreign secretaries and so on engaging with the powers, also southeast asia, william hague visited southeast a asia in a way no british foreign secretary has done because of the importance of the aleaguance, because of the importance to our interests, but we also like to tap into historic relationships with those countries, with china, with singapore, with malaysia. we've got a very strong business
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relationship with south korea and japan. we have a historic responsibility for hong kong. there are a number of different reasons why we remain seriously engaged and why we've got a great deal of competence, language and other skills within our diplomatic service on what is going on in that part of the world, and we see that in the context of our prosperity agenda, that is to say one of the three legs of the stool of british foreign policy, prosperity, security, protection of british interests and abroad, but our prosperity agenda does depend on developmenting our links with east asia to a certain extent that it does. it does in a limited way similar to the united states, so priority for diplomacy, economic, political foreign policy for sure. we also pay close attention to the instabilities, which are out there. that does worry us.
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that is a part of the diplomatic dialogue we're having with our friends here in washington and also with the governments concerned out there in the region. are you going to see lots of vessels steaming up and down the sea? probably not, but are you seeing the united kingdom now equipping itself with a capability in the years to come to deploy firepower and highly qualified, highly skilled soldiers a very long way away from home on aircraft carriers which we really haven't had that capability for a number of years? yes, i think you are. because as the world changes, as the cold war ends and as the risk of different conflicts here and there arising where we might be able to make a contribution, we wish to be able to project ourselves a long way away. that's why we have invested heavily in long range transport aircraft as well as aircraft carriers. it's not the same for the united states. it's not going to be, but i would like to leave you with the impression that asia, east asia,
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for reasons of foreign policy, diplomacy, security, and prosperity, are of great importance to us, too. >> good place to end, and i think a reminder of a former empire to the current united states which has at least when it comes to security, a very large global to-do list, and a list of responsibilities of the importance of burden sharing, as you said, both within the alliance and externally, and figuring out how to deal with such a wide variety of threats facing all of us today. ambassador, thank you very much for coming here to deliver your address and take our questions and for the great conversation. appreciate it. >> thank ylater transportation anthony fox calls on congress to pass a long term transportation spending bill. the head of the centers for disease control dr. thomas frieden says action is need
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freezing drizzle te to protect antibiotic resistance. he spoke at the national press club for an hour. good afternoon. welcome. i'm an adjunct professor at george washington university and 107th president of the national press club. the national press club is the world's leading professional organization journalists committed to our profession's future through our programming with events such as this while fostering a free press worldwide. for more information about the national press club please visit
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our website on behalf of our members worldwide i would like to welcome our speaker and those of you attending today's event. our head table includes guests of our speaker as well as working journalists who are club members so if you hear applause in our audience i note that members of the general public are attending so it's not necessarily evidence of a lack of journalistic objectivity. i would also like to welcome our c-span and public radio audiences. can you follow the action on twitter using the #m pclunch. after our lunch speak concludes we'll have a question and answer period. now it's time to introduce our head table guests and ask each of you to stand briefly as your name is announced. from the usedenses right, thomas snyderman.
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barun. jmal iliani. ruth katz, director of the health medicine and society program of the aspen institute and member of the cdc foundation board. anna miller associate editor at psychology magazine. john lewis co-founder and executive director of the peggy lillis memorial foundation and guest of dr. frieden. donna lagier reporter for u.s. today, vice chair of national press club speaker's committee and former president. doris mar fwmpb olis president of editorial associates and national press club speaker's committee member who organized
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today's luncheon. faith mitchell, president and ceo of grant makers in health and guest of dr. frieden's. susan heavy correspondent for reuters. carolyn block publisher and editor federal telemedicine news. hirito. this time last week dr. tom frieden was busy cramming for his july 16th appearance before the house committee on energy and commerce. the director of the centers for disease control dr. frieden had been summoned to washington to answer questions about the startling and potentially dangerous lab errors at the cdc and while that topic is likely to come up again here today, dr. frieden joins us to explore a much bigger and broader issue,
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looming worldwide health threats including the pathogens that put modern medicine at risk. he'll explain the mr. mers coronavirus a disease that has no known cure and has recently immigrated to our country. it haunts the arabian peninsula and is showing up in travellers through other destinations far away. the virus has reached an arrival in the united states, sent hundreds of cdc staff into emergency mode. and some now refer to this illness as public enemy number one. other issues that dr. frieden will tackle this afternoon includes the dramatic increase in the number of measles cases in america and the growing threat that draws new pathogens pose. they can hitchhike rides and crisscross the globe detain. he'll update us about the new
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program the cdc launched three weeks ago combat drug resistant pathogens. some of these killers microbes jump from an mols to humans and a growing number of them are resistant to currentry known drug treatments. dr. frieden has been director of the cdc since june 2009. a physician with training in internal medicine, infectious diseases, public health, he's known for his expertise in tuberculosis control. from 1990 to 2002, dr. frieden worked for the cdc starting as an epidemic nuclear weapons service officer at the new york city health department. fluent in span injuries he's a graduate of 0 berlin college and received both his medical degree and masters of public health degree from colombia university. he completed his training at yale university. dr. frieden has won many awards
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and honors and has published more than 200 scientific articles. his talk today is titled "mers public enemy number one?" dr. frieden last appeared last september. ladies and gentlemen, please join me in welcoming back to the national press club, dr. tom frieden, director of the centers for disease control and prevention. [ applause ] >> thank you very much. it's great to be here. and thank you so much to the national press club, to the president and doris margolis for the invitation and thanks for your interest in health and what i would like to do is talk to you about some of the biggest threats facing us today. some of you may have heard about problems at the cdc laboratory where we've had two safety
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lapses in recent months. these lapses should never have happened. the cdc laboratories are some of the best scientifically in the world and now we're taking rapid and decisive action to make sure that they are also some of the safest laboratories anywhere in the world. i'll be ethiopia talk about that later but right now i want to talk a little bit more about some of the challenges that we face. sometimes at cdc problems like the one that has come to light recently, occur because people are so used to working with danger. we're currently mounting a substantial response in west africa where three countries in that region are battling eboli. there's more than 1,000 cases and 600 deaths from eboli.
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i had been in uganda, which is as you imagine a cave with a very large python, about 15 feet large and about 10,000 bats and those bats turns out our researchers have identified have a 5% infection with the mabird virus. it's similarly fatal and there were two infection, one fatal one not a few years back and our staff went in there to try to figure out and understand how the bats were moving around the region and what might be able to be done to control mabird there. i asked weren't you scared to go into this cave that had 10,000 bats, lots of them with mabird often fatal virus and this notorious python and they said the python didn't worry us and the bats didn't worry us because
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we were wearing those moon suits and the mabird didn't worry us because we have the protective equipment on. the cobras worried us. [ laughter ] and underneath their moon suits they had to wear leather chance so if they had a cobra strike they wouldn't be killed by it. so we have to always remember above aldo no harm needs be more than a motto. it needs an organizing principle for all of our work. now, like other health care workers i have my personal experiences with risk, sometime back i was working in rural latin america on public health programs in communities and i'm sorry to say this over lunch i won't go into details communities that didn't have great sanitation and i became extremely ill. it was in the brief period between medical school and starting internship and
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residency and i had learned in medical school what a rigor was but if you ever had a rigor you under it's not a shaking chill, it's a violent shaking chill so violent the bed shakes. it's a reflection of having grand negative bacteria in your blood and i became quite ill. i returned to the u.s. feeling a little bit better to start my internship and i was tested and found to have an organism from poor sanitation, it was in my bloodstream, i was very ill with it. highly infectious. ten xx organisms can infect another person and just give you a sense of scale you can fit about a million organisms on the head of a pin. so when i went in for testing the doctor said you not shagilla and resistant to every antibiotic known. i said i have to start my
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internship. [ laughter ] and the infectious disease attending said you need to go home. but we always want to be part of the solution. in health that can be part of the problem. so now a little footnote to that story. that episode of illness -- i did eventually get better not as quickly as i would like and recovered completely. about a year later, a new drug came on the market and two players later i wrote an article published in jama on the inappropriate use of medicine. so i have a quiz for you. what are the six organisms all have in common besides the fact that they are all infectious disease. that's too easy.
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mers. eboli. measles. tuberculosis. and cre. any guesses for what these three, what these six diseases all have in common these six infectious diseases. yes. they are preventable. yes. they are all preventable. that's one thing they have in common. how about how they spread? is there something in common. you have eboli from bats, mers maybe from camels. some are airborne, some are not. three quarters of the new infections we face are zornonic. no. they are all very importantly spread in hospitals. we can be part of the problem if
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we're not careful. all of them and i'll talk a little bit more about that. now when i went to medical school they taught me to use some fancy words. i know reporters never use fancy words but, you know, we don't say we gave to it them in a hospital. we don't say the doctor made him sick. we use fan sip 50 cent words to avoid the uncomfortable truth. my most favorite of all we know exactly the cause of his illness, it's i diopathic. it means we don't know what causes it. another definition is patient is sick and the doctor is an idiot. now mers is very concerning because like sars which occurred a decade ago it has a high case
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fatality rate. maybe as high as 30%. mers also could cause significant not only illness but economic dislocation. sars cost the world more than $30 billion in just three or four months. we're learning more about mers and that quiz i gave earlier was actually the key lesson we learned as we work close wli the saudis and we're now work very closely with them on a variety of investigations and control measures, we found that the overwhelming majority of mers cases in recent months or in the past six to 12 months have been associated with hospitals. they've been spread in hospitals, patients, staff, visitors, others associated with hospitals. that's bad news and good news. bad news because it shouldn't have happened and should be able to prevent it. good news because we know how to turn off that tap. we know how to protect health care workers and other through
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infection control measures and i received an e-mail last week from the saudi minister of health to our staff who reported that in the past ten weeks they not had a single case of mers in a health care worker now they they implemented stringent control measures. when you know how something is spreading you can stop it. there's still more we don't know. we don't have a prevention. we don't have a cure or a vaccine. we don't know how it jumped from animals to people. it does seem that camels have perhaps been infected by bats and perhaps have something like mers whether it's direct contact with camels orca medal products. we're under taking studies to find that out the prevent it. when we under something the better we the prevent it. the next pandemic is not likely mers unless it mutates the capacity to develop easily from person to person. it may not be an influenza like
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the one that emerged in china and that's a wonderful story of how we have global collaboration. but maybe the thing that we are most at risk for is not the thing that we don't know but something that's hiding in plain sight. something that could kill any of us. something that could undermine our ability to practice modern medicine. something that could devastate our economy and something that could sicken or kill millions. now, someone here in this room, christian lillis knows about this problem. christian's mother peggy was a beloved kindergarten teacher. she went in for a routine root canal procedure. within a week she had sepsis.
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and tragically at the age of 56 she died. christian and others have carried the standard to make clear what is the human face behind the tragedies that we read about because in public health we're at our best as bill fagy said when we see and help others see the face s and lives behind the numbers. i think of a 15-year-old who loved music had a congenital, a mall formation, not major and went in for a routine check up. two days later had a resistant bacterial pneumonia and died easter weekend. i think of josh nahem, a young man from colorado, 27 years old, loved skydiving. had an injury from skydiving. got infected, began to recover then developed a highly
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resistant organism and also died at the age of 27. josh's mother victoria has christian elisabeth hasselbeck been be a activist, an advocate information proving the way we address infections in this country. antibiotic resistance could affect any of us. in fact, 2 million americans get resistant infections each year. 23,000 americans die from infections each year, resistant infections each year and another 14,000 americans have deaths like christian's mother from or contributed by. i'm an infectious disease physician. i treated patients for many infections. and i treated patients with no antibiotics left. i felt like a time traveller going before the time of antibiotics. we talk about the pre-antibiotic
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era and antibiotic era. soon we can be in the post-antibiotic era. anti-microbial resistance is getting worse. it creates two problems that are worthying of a little separately. one of them are the thing that we usually think of as infections. urinary tract infections, wound infections. we're seeing more and more resistance from those organisms. but there's a second problem that we may not think of notally and that is how important in control of infections is to the practice of modern medicine. 600,000 americans a year get cancer chemotherapy. when we give cancer chemotherapy we drive down the body's
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defenses so we can wipe out the harmful cancer cells and patients get if he verse and serious infections and we can keep them in check until the body's resistance comes back. so cancer chemotherapy may be at risk. we have more than 400,000 americans who are in dialysis. infections commonly complicate dialysis if we throes ability to treat those infections it will make dialysis much more difficult to do. modern treatments for everything from arthritis to asthma suppress the immune system. our ability to give these cutting-edge treatments is at risk because of the spread of drug resistance. every day we delay means that it will be harder and more expensive to fix this problem tomorrow. bacteria are evolving very quickly. we need to move quickly to get
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ahead, to catch up and to control it. it's possible to keep resistant bacteria from spreading. it's possible for some pathogens to actually reverse the level of drug resistance but only if we act now and act decisively. what we've seen is that organisms can start in hospitals. our most resistant organisms start in the hospital. now we see it go out in the community so now the most common pathogen recovered from patients with cuts and wound infections in the emergency room are mrsa. it's not too late. we know in cre we still largely
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are dealing with a hospital infection. we can keep it in the hospital. we can shrink the numbers and crow it. if we don't then common infections like urinary tract infections could be untreatable. to stop drug resistance we need fundamentally to do four things. first, we need better detection, second better control. third, better prevention. and fourth, more innovation. on detection, we need real-time systems to find out what's happening around the country. in fact, this week cdc will be launching for the first time a system that will allow any hospital in the country to track electronically automatically with no extra work after the initial uploading work all of the antibiotics dispensed in
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that hospital and all the antibiotic resistant patterns of patient whose have infections. that will allow doctors to be empowered with the right information at the right time to make the right decision so that they can give a patient antibiotics that are needed neither too broad nor too narrow. so better detection is the first step in controlling drug resistant organisms, to allow us improve prescribing practices, to identify outbreaks, to figure out our outbreak control measures are working. the second key step has to do with control. as with the quiz earlier, much of this is a problem and we have to take seriously above aldo no harm. too many infections are being spread in our hospitals. too many patients are coming in with one condition and leaving with an infection that they didn't come in with. but prevention requires work across many facilities, even the best of hospitals can't do it
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alone. they need to intersect with the nursing homes w-the outpatient providers, with other facilities in their communities and that can best to be done with public health departments serving a convening, collaborating and facilitating role. state health departments will be key to reversing drug resistant and reversing hospital spread of infections. third is prevention. the fact is that the quality of treatment for many conditions is nowhere near what we would like it to be. my father was a cardiologist. he used to say that when you see how other doctors practice medicine you realize how resilient the human body is. [ laughter ] improving prescribing practices
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in all sectors is crucially important. we recommend that cdc that every single hospital in the country has an antibiotic stewardship program. this means that antibiotics are looked at carefully, the data from their hospital both resistance patterns, prescribing patterns are tracked regularly. and if things are not right they are improved. we have done a study that a third of all antibiotics used in this hospital are either unnecessary or inappropriate. there are enormous difference between one region of the country and another and those don't reflect undertreatment in areas of lower rates of utilization. team-based care, checklists, reporting, feedback, accountability, these are simple management tools that need to be applied systematically to prevent drug resistance and many antibiotics being used are not necessary. with every medication, whether it's for infectious disease or other we need to think of the
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risk benefit ratio and always think about that ratio. there's no medicine without risks. and we have to balance that risk benefit ratio. that risk may include drug resistance. it may even include in the case of antibiotics contributing to the obesity epidemic a current hypothesis which there's some data. there's some data about a lot of hypothesis of what's contributing to the obesity epidemic. another area where we've seen a risk benefit calculation with medications get off kilter. another area is opiates. so we have to keep track of that risk benefit ratio. ironically we underutilize a lot of medications that have a
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favorable risk benefit ratio. aspirin is only used half the time. blood pressure son lie controlled half the time. even among those at highest risk, statins which are very effective only used half the time. we have to get that risk benefit ratio to make sure that we're above all doing no harm and on balance doing as much good as possible. the fourth is innovation. we need to couple with new tools and while we need new drugs and new antibiotics there's at least five or ten years away that may or may not be available, may or may not work for our resistant organisms and today we can stop, slow or even reverse that drug resistant trend and there's also innovation needed in tracking resistance, understanding it better, figuring out what works to reverse it. in the president's budget for 2015 there's an initiative that would allow us to build five
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regional centers of excellence all around the country so we can help doctors understand whether patients have resistance faster and in real-time whether there are outbreaks and how can we stop them. it would help us develop a bank of resistant organisms that pharmaceutical companies and others could use to come up with more rapid diagnostics. we project that if funded we could save money but more importantly save lives. we project based on real data that with this initiative over five years we would be able to cut our two deadliest threats in half. both cre, the nightmare bacteria that's spreading in many of our intensify care units and cdif. we know that because places that have done that right have had that result. we can make this succeed across the country but only with investment. in fact, over five years we
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project we can reduce by 600,000 the number of resistant infections by 27,000 the number of deaths from resistant infections and by 7.7 billion dollars to health care cost from it. public health is a best buy. but we have to act now. anti-microbial resistance that's ability to kill anybody in the country, to undermine modern medicine and devastate our economy and make our health care system less stable. confronting this can protect americans from the moment they are born and throughout their lives but every day we delay it gets harder and more expensive to reverse it. it's too late for peggy, for nile, for josh and for 23,000 people who died this year from infections that might have been
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able to be prevented. and although the problem is big and although it's getting worse it's not too late to reverse it by taking decisive action now we can reverse it and we can protect these antibiotics. the concept of stewardship is an important concept. we're protecting them not only for ourselves we're protecting them for our families, for our children and for our children's children. thank you very much. [ applause ] >> thank you, dr. frieden. according to a recent report by the fda, 80% of all antibiotics used in the united states are fed to farm animals. this means that only 20% of antibiotics which were originally developed frwere mea
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to protect humans. >> we want to see rational antibiotic use wherever antibiotics are used. and i think that means, for example, in farm animals or feed animals that if animals are ill they should be treated. using antibiotics that are of importance to humans for growth promotion is clearly something that we, the fda, the usda and the food industry is concerned about. i think that's something that we'll see progress on in the coming months and years. it's more of an fda, usda issue than a cdc issue but we could recognize as cdc that some of the most resistant organisms we're seeing like cre which is a nightmare bacteria, resistant to virtually all antibiotics and covers multiple different organisms that have a fatality rate as high as 50% in the
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hospital. some of our most serious resistant organisms are in the health care system particularly in hospitals. we want to see rational prescribing every where antibiotics are prescribed. >> antibiotic development is not as profitable for drug companies as drugs such as statins and viagra. how do we encourage pharmaceutical companies to develop new antibiotics to treat these emerging antibiotic resistant infections. >> we do really have a problem with the incentives. one of the, from a strictly business standpoint, a terrible thing about antibiotics is that they cure people. and then you can stop taking them. that's not a model for a highly lucrative pharmaceutical product. you want a product that's going to be taken for a long, long time. and that's not what we want with antibiotics. so we have to figure out a way
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for government and industry to work together so that the incentives for antibiotic production, antibiotic development match the need and there have been important steps taken by congress in the past few years, bipartisan, new laws in place that improve those incentives but it's going to require creativity, going to require innovation, going to require a dialogue between government and industry, thinking about ways to reduce the risk for developers to improve the benefit and to ensure that there's reasonable profit without excessive profit that might result in a backlash. these are tough issues but they are important to address. we do want new antibiotics. they are important. but we also have to recognize that we may or may not succeed. we don't know why the antibiotic pipeline has thinned out in recent years but it has. is that because of less investment? maybe.
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it is because the low-hanging fruit has all been plugged and harder to make antibiotics in the future. maybe. we don't know. we can't assume that we're going to develop new drugs to get ourselves out of this mess. we have to assume we have to make rapid progress with the tools we have and preserve the antibiotics we have while at the same time we promote development of new antibiotics as well. >> is cdc looking into natural cures in addition to prescriptions? >> there's some really interesting developments in a variety of ways to reduce infection. we know that lots of things will reduce your sues septemberibility. there's some intriguing new data coming out on the microbes.
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we got trillions of microbes in us and they are important for our health and we're just beginning to understand that. some of the new tools, some of which congress funded cdc to expand the use of called advance mode less can you lar detection which allow us to sequence the genomes of microbes in real-time. it's teaching us new things about the microbes that are helpful as well has harmful. for cdif new treatment pros avoiding microbes that fight against cdif as a way of battling microbes. after all, if you go back to the first drug developed against tuberculosis, sheldon waxman and his graduate stunt figured out that there had to be things in nature that fought tuberculosis. otherwise you would have tuberculosis every where. they went into the soil of staten island and figured out
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there were bacteria there that produced chemicals that killed the tuberculosis bacteria. so there are ways we can use fire to fight fire, if you will. >> can the cdc or the hhs take any regulatory steps to enforce responsible use of antibiotics in hospitals? >> we have to work in collaboration with the health care system. one of the biggest challenges for public health in the coming years is that integration of public health and clinical medicine. at cdc we've been delighted to have a very positive constructive partnership with the center for medicare and medicaid service. as an example we for many years have run something called nhsm. we had many hospitals involved and then cms said by the way if you don't get 100% of your reimbursements you must participate suddenly we have 14,000 facilities participating.
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they benefit from that. they are given information that they can act on to improve their care. just yesterday the person who is leading much of our work here met with eight different health care systems to figure out how can we sustainablely achieve the hospital stewardship programs. it's not so much a question of mandating and enforce as figure out together what's need and making sure we have a level playing field so that gets done and tools like the national heart care safety network provide tools to hospitals to improve the quality of their care. >> in september 2013, cdc put out a report anti-microbial resistance in which the agency identified new dreg development. congress is currently considering legislation to facilitate drug development by creating a new approval pathway for drugs to treat serious and
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life threatening infections for which there are few or no treatments. from cdc's perspective which are the infections for which we most need new drugs. >> well we have one success story. a new drug that's useful for multi-drug-resistant tuberculosis and the fda was able to approve that rapidly. there was some controversy about that. but the data was strong and cdc recommended it and cdc is in support of that decision. we need to look at the organisms for which we have the greatest risk. that includes the whole spectrum. includes the grand rods, things like eboli in our intensify care units but also the grand positive organisms like staph where we have mrsa. there's a range of organisms for which we need better treatment and we also need to understand them better and the tools that
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we're now using of advanced detection are fascinating. we're learning many of our assumptions were real simplifications. if you have an infection it may not include one organism bath broad range. and how we measure that in the laboratory may be different from what's actually happening and causing illness in people. so there's a lot we need to learn about the patterns of disease not only within the population but within individual people so we can innovate and target our innovations most effectively. >> perhaps the battle against microbial resistance to drugs will have to be fought genetically. >> i mentioned cre a couple of times. let me give you more detail. this illustrates the answer to
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this question. cre is something we really have not seen before. it is a jumping gene, a plasmid, a part of genome, a part of the dn sequence that can move not only between one organism and another but between one species and another and not only can it move between species but it can encode for resistance to an entire class of antibiotics, all the penicillin and penicillin-like antibiotics, first, second, third generation, our big guns what we have got from text people np organism can spread its resistance to multiple species and multiple
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antibiotics and we've seen a couple different ways it can be spread. there's a dominant one in this country and a secondary one. if that's what the jumping gene is doing, if that's what's causing, was driving the resistance to our biggest gun antibiotics what can we do to counter act that across multiple species for multiple antibiotics. >> have you stein latest mers study saying it may be airborne and your thoughts, please? >> we're working very closely with the saudis and with other countries in the region to better understand and control mers. we have teams on the ground but we've done study, we did one in jordan a couple of years ago that was fascinating. it showed if there were lapses in infection-control you had a lot of spread in the health care facility. but if you had good
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infection-control just standard infection-control even if you had several infectious patients and lots of exposure you had no spread as confirmed by check being serology workers. we're understanding how mers spread how it jumped the species barrier. from everything we've seen largely been spread in recent years in the past two years in hospitals and largely controllable by rigorous infection-control. that's good news. done mean it won't change in the future but that's where we are now with it. >> you have called the bird flu safety breaches the most distressing to you of all the breaches. why is that breach most troubling to you? >> we had two laboratory breaches at cdc. one was anthrax where there was potential, probably not but
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potential expossible sure of workers to anthrax. they thought they killed the anthrax. but they hadn't. we've done subsequent studies which suggest it's not impossible some of the anthrax may have exposed other people at cdc but extremely unlikely. still that was a reflection of center policy and lapses that should never have occurred. the h5n1 situation of different. through means we're not sure of through our laboratory a nonpathogenic or nonharmful bird flu was mixed up with a harmful bird flu and stoints department agriculture laboratory. all of this work was done and sometimes called enhanced bsl
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blah towers. very highly contained. people wearing what are called fancy respiratoriors. we were dealing with a deadly virus that had a big impact on agriculture and that there was a six week delay between people at cdc being notified about this and it being notified up the chain at cdc made me very concerned that we need to do a better job of encouraging a culture of safety, of encouraging information report problems or potential problems if they have the slightest concern that there may be a problem and whatever the reason, we're still investigating that second incident, whatever the reason, the facts that first off it happened in our flu lab and without exaggerating i can say our flu slabs good as any in the world. phenomenal laboratory. that made me really stunned that if this could happen at the cdc
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flu lab where else could something like this happen and second i was deeply disappointed that it took so long to notify and still understanding the reasons for that. what we've done since then is take decisive action. we stopped shipment of biological materials from our high containment laboratories until i personally review and approve the procedures laboratory by laboratory. we appoint ad single senior scientist to review those protocols with then of a working group and strengthen them. we have also ensured we'll take a look at every aspect of our safety to improve the culture there and improve, again, as i said in the beginning we have not only some of the scientifically most advanced laboratories in the world but also some of the safest laboratories in the world. >> this touches on your previous
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comments but let me ask. in a recent hearing you told congress you recognize the pattern of weaknesses within the culture of safety. how were those weaknesses allowed to develop? >> when we look back at the last few years we see that there have been isolated incidents and i believe in each of those isolated incidents the staff at cdc and i took responsible behavior to address the concern that was raised. and what i missed and what i think our staff missed was that these isolated incidents did reflect a pattern and it was a pattern of insufficient attention to safety in our laboratories. you can hypothesize -- the story i told at the outset about python cave and ebol spampbt of it. if you work with dangerous or beganisms day after day, month after month, year after year there's a tendency to get lapse.
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what we have to ensure even though human error is inevitable, human harm shouldn't. we will do everything in our power to ensure there are redundant practices in place so if there is human error there will not be human harm. i think the broader lesson is that it's possible to minimize the risk of many things but maybe not possible to achieve zero risk and that has a lot of us thinking hard about what makes sense to do in that risk benefit ratio. if we're balancing a minimal but nonzero risk against a potential benefit we better be very sure both that we make that risk as low as possible, and that we have a reasonable expectation that there will be a benefit. >> can you describe the sweeping
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changes in quotes that you initiate at the cdc and i realize you touched on some of them. you might want to expand. >> we have done a series of things. we have -- i've issued a moratorium on transfer of all biological materials out of high containment laboratories. we closed the two laboratories where these incidents occurred and not re-open them until we're sure they can re-open safely. appointed a single point of accountability to overhe is laboratory safety throughout cdc and his group dr. michael bell are reviewing first and foremost those applications to lift the moratorium lab by lab. they will work not just as an individual group but throughout every part of cdc to promote that culture of safety which has to be every lab worker, every supervisor and team lead. we'll also take disciplinary action as appropriate. we have convened and i've invited an external advisory group of worked for cdc before
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come in and give us a fresh look. tell us what we can do different or better to improve safety. we're investigating the incident with flu that's not completed yet. we're looking at our function as a regulatory agency. we have something called the division of select agents and toxi toxins. we regulate over 300 entities that work with dangerous organisms. what are the lessons from our experience to make sure that we do that regulation effectively. >> do i hear that -- are you advocating for harsh punishment against those who brief safety in labs and what can congress do to improve lab safety? >> it's really important to balance two competing divisions of how you deal with an insid eptd li ent like this. in another vision you fix the culture and policy and procedures.
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i don't think either of those on its own is the right way to move forward. on the one hand, you have to ensure that you have policies and procedures and a culture that promotes safety continuously that recognizes that risks are serious and nonminimal and does everything to analyze what are ways to reduce that risk. at the same time, you look at individual incidents and if there is negligence, if there is a failure to report, then you have to take proemt actiappropr. i think those are either or. that's a combined areport. in terms of congressional action, there are observers who said perhaps there should be a different entity to look at the dangerous path ojens. it's complicated to inspect these laboratories to make sure they do a good job. we do as good of as job on that as we can but we will look at that and see if there are ways we can do that better. several years ago because of it
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looking like a conflict of interest, i asked them to inspect cdcs lab. we're open to all ideas to how to improve safety in these laboratories and more broadly, i think we have to look at do we have the right number of laboratories? do we have the right risk benefit ratio calculations for some of the research that's going on? you faced tough questions during last week's house hearing. >> i noticed. >> what was your take away from what you heard from the committee members? >> i think the committee very appropriately had concerns that if something like this can happen at cdc first off how did it happen? are you going to fix it? what's happening elsewhere? so i think the questions were tough but fair. the approach that i'm taking with my staff and that i
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encourage congress to take is very much a trust but verify approach. we're going to do things to improve safety but don't take us at our word. we will review and share the results of that and ensure that what we do, we do transparently, openly, clearly. we always find that it's much better to be clear and open about a problem then otherwise. i think we have been about these problems from the moment we learned about them. that will be our way going forward as well to say here is what we've done, here is what's achieved and not achieved. i would be disappointed but not surprised if we identified other incidents in the past or other things happened in the future and that may well be a reflection that we're improving that culture of safety and that willingness to report problems rather than failing to correct what is an important issue to address. i think the questions were tough but fair. we will continue to provide information because we have such important work to do.
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this work is not done out of idol curiosity. this work is done because anthrax continues to kill people around the world because it has been used as a bio lomglogical weapon. because these dangerous organisms are spreading in nature and could be used in a bio terrorist event. >> we have some media related questions. what is your reaction to the media coverage of recent incidents involving laboratory safety at cdc? i generally think the media has been responsible in their coverage. i sometimes wish it would be a little different but i don't think that's something that anyone wouldn't say at some point or another. i think the small pox discovery on the nih campus somehow gotten conflated in some of the reported. what happens there was a researcher probably in the 1960s
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before there was small box reraddication put aside her p h small boxes. it was kept undisturbed and touched. the moment it was touched the fdia appropriately informed us to make sure that along with law enforcement we were able to go in safely and securely, secure the materials. transport them securely back to cdc and in a controlled environment in the only laborato laboratory that was allowed to have small boxes in a laboratory who was the most experienced in the world safely opened it, analyzed it, tested it and determined that if fact it was viable small pox. what we will do with that as we
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said from the very first moment it became apparent is we will fully analyze the genome and once that genome is sequenced and analyzed, we will invite the world health organizations observers in and we will destroy the strains and all of the biologically viable materials associated with the strains. that's one part of the study that the story sometimes gets confused with the other parts going on. it really shows cdc staff working 24/7 to protect people and make sure we could understand and control what turned out to be not a risk but that required a very active response. we got that response. >> media related question on behalf of some judournalists. despite the fact that in previous times there were no such restraints? >> as far as i'm aware the cdc
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is not prohibited from talking to reporters. we do like to have hemedia staf present so we can follow-up on questions and make sure you're talking to the right people. we try to facilitate that but we really do like to be quite open and the more information there is out there about what cdc does in this country and around the world 24/7 to protect people from threats, the challenges that we have as well as the programs that we're implementing the better. >> we're almost out of time. before asking the last question, we have a couple of house keeping matters to take care of. first of all i'd like to remind you about our upcoming events and speakers. on august 1 his excellency, president of the republic of
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congo will discuss peace and stability and oil investments in his country. next, i'd like to present our guests with a traditional national press club mug you can add this to your collection. the traditional last question how is it your experience appearing before the national press club compare to your experiences last week before congress? >> the food was much better here. it's a pleasure to be with you. it's a pleasure to share with you what cdc does because despite the recent incidents the fact is that the cdc has more than 15,000 staff. we work in over 50 countries in every state in the u.s. we provide 2/3 of our resources
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to state and local entities. we're there 24/7 to infect people from threats whether they are infectious threats, intentionally created, or nationally occurring in it country or anywhere else in the world. we do see a press as a vital partner in providing information and shedding light on the important health challenges that we face. thank you all so much. [ applause ] thank you all for coming today. i'd also like to thank you national press club staff including the journalism institute and the broadcast center for helping to organize today's event. here is a reminder that you can mind more information about the national press club on our website. if you'd like to get a copy of today's program please check out our website at thank you. we are adjourned. [ applause ]
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>> the former head of proctor and gamble, robert mcdonald was before the senate veterans affairs committee thursday for his confirmation to head the va. you can see that in its entirety at he was asked why he wanted the job. >> in a sense i think you have answered my first question but i'm going to ask it again. you don't need this job. i don't think you're at the age in your career when you want to move up the career latter. you don't need anything more to your resume. you've done pretty well. in the midst of all of these
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problems in the midst of a dysfunctional u.s. congress and bitter partisanship, why do you want this job? >> thank you chairman sanders for the question. i think it's a good question. it's a question my family and i have talked a lot about. desperately want this job because i think i can make a difference. i think that my entire career whether it was starting at west point, being in the second air born division, being in the proctor and gamble company one of the most admired companies in the world for 33 years has prepared me for this task. as i said in my prepared remarks, i think there's no higher calling. this is an opportunity for me to make a difference in the lives of the veterans who i care so deeply about. if not me, who? now tuesday's white house briefing with press secretary jorn josh eanest.
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>> the shooting down of the malaysian airliner in ukraine and the palestinian conflict. this is a little less than an hour. >> good morning everybody. i don't start off too many briefings by saying that. it's nice to see you all. we're doing this early today in advance of the -- i'm glad steve appreciated that. we're doing this briefing to accommodate the president's travel and speaking event that he has in the afternoon today. i will try to be quick. i do have one statement at the top. some of your colleagues in the in town travel pool are not here now. they are with the president who is visiting the embassy of the nenler lands in the washington d.c. to sign a condolence book of the
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shoot down of the malaysian airlines flight shot down in ukraine. there's some footage you guys will have saccess to signing th condolence book. >> is there anything that basically invalidates the health care subsidies for people in states that haven't set up exchanges. >> i know there will be a statement coming from the department of justice on this. they are representing the position in the united states government and the administration before the dc circuit so i'd refer that statement -- i do have a couple of thoughts. the first is that it's important for people caall across the country that this ruling does not have any practical impact on their act to receive tax credits right now. right now there are millions of americans all across the country who are receiving tax credits from the federal government as a result of the affordable care act that is making health care more affordable to them. it has no practical on their tax
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credits right now. the second is there are four different cases of making this point that are working their way through the federal court system. two of them have been dismissed at the district court level. two of them are awaiting their initial ruling. this of course is the appeal of one of those cases. so there is decidedly mixed legal opinion about this. for those who are keeping score we're still ahead 2-1 here. what i do anticipate the department of justice will do is ask for a full ruling from the d.c. circuit as you know. this was a decision that was issued by three members of the d.c. circuit. two ruled for the federal government and one agreed for the government's position. it's important for people to also understand that some of the district courts that have thrown out this case have been decided by judges who used some pretty strong rhetoric in doing so.
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there was a judge in this case at the district level who said there is simply no evidence in the statute itself or in the legislative history of any intent by congress to support the claims made by the plaintiff. in other case that was making the same legal argument, a judge wrote that the neary propounded by the plaintiffs was not a viable theory. the last thing that's important and this is -- there's a lot of high-minded case law that's applied here there's also an element of common sense which is that you don't need a fancy legal degree to understand that congress intended for every eligible american to have access to tax credits that will lower their health care cost whether it was state officials or federal officials running the marketplace. i think that is a pretty clear intent of the congressional law. this will work its way through the legal process. we are confident in the legal case that the department of justice will be making. >> obviously as these cases do work through the legal system there could end up being a practical impact on people
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receiving subsidies. can the health care law work effectively and continue to -- as you say be affordable for americans without the subsidies being available in all states. >> we are confident in the legal position that we have that millions of americans -- >> what if that legal position no longer becomes tenable. can the law work if these subsidies are not widely available. >> that is a hypothetical we may be able to entertain at some point. right now we're confident in the legal basis that supports our case. the department of justice will litigate these claims through the federal court system. again, our confidence is rooted in the fact that it is pretty obvious what the congressional intent was here. their intent was for every eligible american who applied for tax credits to make their health care more affordable to have access to the tax credits whether it was state officials or federal officials running the marketplace. >> can you give us some context
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on the president's decision to send dennis mcdunna and lisa monaco today. >> i think the statement originated in germany where the chief of staff and where ms. monaco currently are. this is the result of a telephone conversation between the president and murkel and they agreed that the president's chief of staff and top home land security advisor would travel to germany to meet with their counterparts to talk through some of the issues that have been covered in the media. it was an opportunity to meet and discuss the state of bilateral relations and future cooperation. there were a full range of issues discussed including intelligence and security cooperation. they agreed to set up a structured dialogue to address
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concerns of both sides and establish guiding principles for future cooperation. >> did they bring with them any specific information or answers on the two allegations of u.s. spies in germany? >> i will not get into the substance of the talks. i will describe the talk as productive and a useful trip. as we've said a couple of times as it relates to these reports, it is the view of the united states that differences of opinion or differences of perspective on these kinds matters are best established through diplomatic and intelligence channels. that is what we're doing. >> what does that mean structured dialogue. >> i think it's simply the basis of future discussions on these kinds of issues. again, it is our view that these kinds of differences are best resolved through these private
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established channels and not litigated through the media. >> vladimir putin is saying he will use his influence to allow a full investigation. are you detecting a change in tone from the kremlin? >> well, there was some news from that region that we welcome for a change. we welcome the news that most of the remains of those that parished in malaysian flight 17 are now in the hands of dutch and malaysian authorities. while that is one step in the right direction. international investigators led by the dutch still need immediate and full access to the site. as you point out russia did say today that it will use its influence over the separatists to fully cooperate. we intend to hold the russians to that. >> the investigators still don't have access though? >> they don't have -- i think what we have seen is we've seen conditions on the ground improve. that's illustrated by the nafac
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that we made progress by the two matters i addressed at the top. i don't think we've seen yet the level of cooperation with international investigators that we'd like to see at this point. this is a complicated issue and one we anticipate that we -- well, we anticipate it's going to require some work to get the kind of cooperation that we would like to see. time is of the essence here. as the president said yesterday, it is the least that those separatists could do to cooperate with international investigators. give them the access that they need to that site so that they can conduct a transparent investigation and determine what exactly happened jim. >> anything new on the evidence in the plane crash investigation? i know yesterday some senior administration officials were telling reporters that the black boxes were not perhaps as important as the wreckage itself. there are some reports about burn marks on some of the pieces
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of wreckage at the crash site. is that a approximapromising si. any new evidence that bulls t the u.s. case what happens. >> i think there's been evidence that paints a compelling picture. we've been saying for months and in some settings the russians have acknowledged that they are actively supporting the rebels, the separatists in eastern ukraine. some of the leaders are actually of russian citizenship. we've seen reports of heavy weapons moving across the russian border into ukraine. in fact that was the reason for the sanctions regime that this administration announced last week was the continued evidence of heavy weapons moving from russia to ukraine. we've seen evidence that russians are training separatists on how to use the weapons, including anti-air craft weapons. in fact they have bragged in the last several weeks of shooting
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down three different aircraft. there's ample association media evidence to indicate that the separatists have access to the kind of saa 11 missile that is capable of reaching aircraft flying at high alt it yitudes. the shaother thing we know is t the airplane was downed by a missile on the ground in a separatist controlled area. at the time the ukrainian military was not operating anti-aanti anti-air craft weapons at that time. after the plane was down, there were ample social media accounts to indicate that a sa 11 system that appeared to be missing one specific missile was being transported across the border from ukraine to russia.
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there were also social media accounts of separatists talking about shooting down an airplane. there's a lot of evidence that has already been marshals. >> is it a circumstantial case at this point? >> well, there will be a role for a more formal intelligence assessment to be presented. i do expect that you will hear from intel officials later today who will have some more data to present and more evidence to indicate -- educate you about what we know so far about that situation but i will leave specific intelligence assessments to them. they are the experts who can analyze this data and can be more effective in drawing a more conclusive case but i will leave tha that to them. >> apparently u.s. carriers are making decisions not to fly over parts of israel because of the violence down there. does the administration support
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that? was the administration pivotal in making that change and asking the carriers to do this. >> as it relates to the air face in gaza the faa has not issued any notices related to the ongoing violence in that region of the world. i think it does serve to illustrate it's individual carriers who make the decision about their flight plans and whether or not to alter specific routes bases on hostilities on the ground. >> some people raised the question about malaysian airlines and whether they should have been flying over that air space in ukraine. >> ultimately it's the malaysian carriers who are responsible for the flight path. >> one point, the president was going to go on the jimmy kimmel show but then i guess booking was canceled by the white house. was the white house concerned about image that might be put out if the president was there
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on a late night talk show? >> well, what i can say jim is that we had been in touch with representatives of his show about having the president participate in that program on this trip. we ultimately elected not to have the president do that interview over the course of this trip. that is at least in part related to the challenges of doing a comedy show in the midst of some of these other more serious matters that the president is dealing with the in the international seen. >> at this point we just elected not to do it. >> john. >> thank you. getting back yesterday to the u.s. being supportive of the european union also joining in the sanctions against russia you're obviously aware of the difference between britain and france on the sale of the misdrawed helicopter care to
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russia. does the u.s. have a dog in the flight or that all the eu members have to be united in order for the sanctions to work. >> well, john we have said many times that we believe sanctions would be most effective when they are closely coordinated with our international partners. that's why you've seen intensive discussions between the president and individual leaders, particularly in western europe about the sanctions regime that should be in place to further isolate russia. so this has been a months long endeavor. there have been important steps that have been taken by the united states in coordination with our partners to impose economic costs on russia. there is ample evidence to indicate that the russian economy has suffered as a result of those economic costs. as it relates specifically to the proposed military transaction between the french and russians, we have in the
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past, i think the president was traveling in brussels in june, and he articulated some concerns about the sale of that military equipment to the russians. again. this is a little bit of a common sense thing. we've seen ample evidence that the russians are flouting international norms. supporting efforts to violate the territorial integrity of independent sovereign nations. it seems like a suboptimal time if you will to be transferring advanced military systems to them. so we've made our concerns known. we will continue to work in close coordination with the british, the french, the germans and others as we coordinate the effort to further isolate the russian regime. >> any concerns for. >> yes, i believe the president had the chance to say this
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privately and publically. >> this intelligence presentation to whom was the setting. who were the officials? i did not get that impression from either the briefing yesterday or the background briefing we had either that you guys felt any sort of pressure or had any intent to lay out more of an intelligence case than you already had. obviously i misread that but did anything change in the last 24 hours that made this discussion necessary? >> no, i don't think that anything changed the calculus on that matter. in terms of the logistics, i'd r refer to the office of the director of national intelligence who i think will have some more information about this later today. look, we want to be as forthcoming as we can understanding that there are important intelligence equities to protect about the evidence of
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what exactly happened. this is something that we would envision would be integrated with an ongoing forensic investigation at the crash site. i don't want to leave you or anyone with the impression that somehow whenever intelligence assessment is arrived by the u.s. intelligence community somehow supersedes the ongoing work being performed on the ground. that work is important. that work will also give us important information about what exactly transpired in this tragic circumstance. but we are working with the international community to try to make sure that international investigators have access to the site so that they can conduct that investigation while at the same time we're going to do our best to present the information that we have already obtained or assessed about what exactly happened last week. >> are you in a position to say whether that intelligence
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assessment has been shared with say, the dutch and the malaysians and the ukrainians -- >> i'm not in a position to talk about how that intelligence has been handled but you can try the office of the dni and maybe they will be able to share some additional light on that for you. >> major. >> thanks, josh. there are reports that the eu is going to impose a new round of sanctions against russia after consultations today. do you have any confirmation of that or any reaction? >> i'm not in a position to confirm that. i know that these talks have been ongoing and are headed into the evening hours over in europe. we certainly would welcome additional steps from the international community principally our allies in western europe that would impose additional economic costs in russia. we would think that those additional costs are justified. >> is there a triggering mechanism that if the eu goes ahead and does another round than the u.s. might go ahead and follow state. or is the u.s. government intent
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on where it is. >> well, content is not the word that i would use. i think we're continuing to review the sanctions regime that's in place. we will continue to work with the international community to coordinate efforts to impose costs on russia. our willingness to consider adding additional costs is something that continues to be a live option here. >> you mentioned that there's no practical effect of this federal appeals court ruling today, is there not a practical effect in that it creates an atmosphere of uncertainty. >> that's what i was trying to clear up. >> for those who are in the health care industry itself and are trying to apply, implement, follow, and are trying to understand if they are going to have patients who have subsidies or don't. doesn't that uncertainty itself have a practical effect as the law is implemented? >> i don't think it does for two reasons. one is that we feel very strong
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about the sound legal reasoning of the argument that the administration is making. the second is that there's a clear common sense case to be made here which is the intent of congress was to ensure that every eligible american who applied for tax credits to make their health insurance more affordable would have access to the tax credits whether or not it was operated by federal officials or state officials. the intent here is pretty clear. we feel pretty confident about our case. >> is the administration considering any legislative fix if necessary to clear up any ambiguity the court noted in the legislative language. >> the president has said countless times he's willing to work with congress to make improvements to the law. the prospects for that considering that republicans have voted more than 50 times to repeal the entire law, the prospects for the kind of legislative fix that might actually improve the law seem rather unlikely. >> when steve asked you about the structured dialogue,


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