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tv   Key Capitol Hill Hearings  CSPAN  September 25, 2014 12:00pm-2:01pm EDT

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were totally out of whack, structural adjustments were promulgated by the washington institutions. one artifact is the company stopped investing in health systems. the ebola outbreak is one way of talking about the consequences of three decades of neglect in health systems. donors prefer things that are short term have easily defined simple linksave between input and outcome that can be somewhat easier to implement. they are wary of ongoing commitments and urgent tasks usually take accident over others. so here is a calculus for your very think of how you would conceptualize malaria versus health system investments, the annual death toll in a specific diseases clear. it can be measured. it can be estimated.
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a health system is diffuse. what is the intervention? nets, drugs, spraying. but in health systems, the intervention is diffuse. there are many possible courses of action. think of credit claiming opportunities with a specific disease, there is a number of people treated or burden averted. but there it -- but it is hard to measure the functioning of a health system in costs are easy to specify but for health systems, it is not. induration, a particular program might end, but health systems never do. donors are worried about these things. when it comes to advocacy, they look around the room and say, well, who else is engaged? who is leading? many nations pay some kind of lip service or make some .nvestment in health systems
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but the answers to do much more of that. ebola is a warning to us. it is a warning for a disease that is often fatal, that is relatively hard to trend. but as you can see, in crumbled states, in non-functioning health systems, it has gone viral. i mean it, in a literal sense. things used to just burn out. little epidemics of ebola would pop up here and there. it is so deadly and kills so fast that it would not spread. but now it has entered the general population in urban areas. services have called for us to take care of the long-lost healths, to invest in systems, infrastructure, capacity, and to face the political economy for managing implementation. thank you. [applause]
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>> thank you very much for that presentation. speaker isd final dr. elizabeth cameron. she is the director for counting biological threats with the national security council staff at the white house. prior to this assignment, she served in the office of the secretary of defense. earlier in her career, she worked from 2003 to 2010 at the department of state. an did extensive work on international scale related to biological, chemical, and nuclear weapons production.
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prior to working in the executive branch, she was a the american association for the advancement of science. at that time, she worked for senator edward kennedy. >> thanks to everyone for inviting us here today and putting together this whole symposium and thank you, dan, for your personal heroism for going to the effected countries and for helping. it is definitely an untapped resource.
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one of the things we're trying very hard to do is put in place the mechanism so that people will be able to do that more because there will be the training in place needed to get more people there. we have a pretty somber occasion today with the ebola epidemic. we have heard people talk about the possibility of it becoming and then i can we have seen the number is continue to rise in the news reports. today, in the number -- in the modeling from the view hon cdc, certainly show will he -- what can happen if we don't inject a large bolus of international assistance which is something that, as many of you probably saw last week, president obama is very dedicated to doing. so i have the pleasure today of talking not as much about the immediate response the building on what dr. but talked about and
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what we also need to focus on at the same time, which is very we get aheadhow do of this, not only in west africa, but all over the world. on the last slide i think was a reminder that .-full-stop our at the root of the situation, and they are often one of the most difficult things to measure and find and that is actually one of the reasons why we launched the global health security agenda as not only a substantive agenda about a political one as well. so, i'm going to focus most of my remarks on that, starting in 2011 president obama said we must come together. by this he meant not just other nations but also across the government so bringing together colleagues like my great colleague from across the u.s. government and now colleagues from all over the world from the department of defense, from the foreign affairs, from usaid and
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other agencies to the public health ministry's. this is a mission that cannot be done by one country or one agency alone. it really has to be a group and it has to be synergistic and it has to be organized and all of those things make health systems strengthening of the global health security incredibly difficult but incredibly important. so, we launched the agenda with 29 other countries and i will talk a little bit more about that in a minute. but we launched in february of this year before the first cases that were reported and we have been speaking about this not just within the u.s. government but with who and colleagues around the world for quite some time. how do you make this issue something that is palatable and as president obama has now said recently about the epidemic this is a national security priority.
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it's a public health priority but it's a security priority. so what is the proper vision? our vision is pretty ambitious, but i think it's the right vision and that is to obtain the world that is safe and secure from the global health posed by the infectious diseases. so you're not going to end outbreaks but what we would like to do is prevent them from becoming epidemics. so, we need to put in place the mechanisms that are needed to do that around the world. when we launched the agenda in february on but then secretary sebelius of the health and human services, secretary kerry and the president for homeland security and counterterrorism they also put out the administration's vision for this agenda. and i'm going to read it because it is operational and i will tell you that when we released it and when i was talking about this with people in the february there was a lot of that aspirational.
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if you look at what is happening now i think it actually reads a little bit differently then it did then. new diseases are inevitable but in the 21st century, we have the tools to greatly reduce the threat posed by the global epidemics. we can put in place a safe, secure, interoperable system to prevent the disease threats, detect outbreaks in real-time and share information and expertise to respond effectively. this is the vision. if we could do this we wouldn't see what is happening right now in west africa. and this is the vision that we need to get to. so, i don't actually have to answer this question anymore and that's and the slide reflects that it was made many months ago. so why the global health security is no longer a question that needs to be answered as many and that is unfortunate because it can epidemic of this magnitude to get to that point. obviously, we are
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interconnected. and obviously this is no one nation's responsibility to the international health regulations harsh and back -- hearken back to what we talked about earlier today on the panel briefly. i i think it's important that the devastation in life but also the economic consequences of sars in four months. if you look at the investment flowing into ebola and the need for significantly more investments because the gap is enormous and what we need to do, you look again at what the value of the response on the front end - is versus what we will be paying for on the backend and lives lost into the and the economic and peace and security consequences as well. the ihr i'm preaching to the choir for this but they were put in place after the epidemic and in 2005 to really put together
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the core capacity to the countries would need to be able to effectively prevent, detect and respond to outbreaks before they become epidemics. and the ihr is wonderful because every country that is on the planet that is a member has the responsibility of implementing them, but it's very difficult to have resources for all of the capacities across the board. and as the doctor mentioned actually synergize them across the pillars in the non- diseased manner and to seek funding to do that is also a difficult challenge. so, they've been successful but in 2012 only 20% of the countries, less than 20% of the countries where able to report that they admit them which means -- that they had met than, which those presented the
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countries in 2012 were not prepared. and i think that was a huge wake-up call for us and many other countries around the world and it was directly linked to the global health security agenda. so, before i show a slide of what the agenda actually is i will say what it is meant to do. it is meant to basically discuss and identify three basic risk. risks posed by the emerging threats, drug resistance and the intentional creation into the intentional creation of the organisms and the bioterrorism. it's supposed to address the opportunities. right now we have enormous societal commitment. i think that has grown tremendously since this site was conceived back in february. this is the slightest over from him and it is the best one in the back. we have a lot of models out there for how to build good global health security capacity. one of the challenges of supporting those models and replicating the models in an
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organized way that is not piecemeal so the countries actually end up with a capability capability at the end of it that is the sustainable and exercisable. and that's been difficult. measurable has been very difficult for the ihr. into s. preventing where possible, detecting rapidly and responding effectively. so the agenda itself is much nicer looking online and very difficult to fit into the slide and be able to read so i made a rather ugly slides that you could actually read the words. but in a sense, it capitalizes on everything that is part of what relates to the infectious disease. so recognizing that it does look at the chemical and radiological threats into the agenda does not. that's related to the infectious disease threats the agenda doesn't include all of the elements in support of implementing but also importantly the performance of the veterinary services pathway of the world organization for animal health. it also includes areas that have been a huge priority but are not included in the speedy 11 prominently such as countering the antibiotic resistant bacteria and another issue that is of huge importance to the administration in which we also announced a large effort
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on earlier this month. so, also when we announced the agenda in february, we put forward this plan as a way to not only say exactly what we want to achieve in layman's terms but to elevate this issue with other countries and so if you look at the foreign ministers of the national security advisers, this threat is currently at the top of the list because there is an epidemic going on but that is usually not the case and if you look passed over the last decade it is very hard to keep this on the front burner, generally speaking. one of the reasons for that is it's hard to feel the economic consequences unless you are actually in the middle of it. we are currently in the middle of that and everyone is feeling the consequences, not the least of which every affected country who is dealing with this untold lives and economic consequences. but keeping this has national
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security parody since sars has been very difficult so how can we capitalize on that by using language it by using language that the leaders understand and target and effective measures that can actually be devised by the countries to show that they are achieving success and measured externally by others which is another thing that steve levin has not typically included overtime. so we launched a target for ourselves and published, and these are available online, the 12 targets for our own efforts to improve the capacity in at least 30 countries over the next five years and the targets are not going to go through because they are incredibly long lists but they were put in place with a lot of consultations from experts across the u.s. government into taking this into account scientific literature and implementation studies that have been done over time and we also wanted to choose things that were measurable so i would encourage those of you interested in this to take a look. next step so as mentioned
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earlier, friday we are bringing together countries at the white house. we have had seven months of work that has gone on since february with an incredible amount of work and leadership around the the world. we've had to development meetings one who stood in finland and one in indonesia that has more than 200 participants and we are bringing the countries to the white house on friday with international organizations, the director generals. we have the united nations and the goal is to highlight the progress that's been made. we have a tremendous number of new commitments and every country invited was asked to bring one for the event. president obama will participate in that event come and the goal is to spur action to prevent
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this from happening again we will be looking forward in the sustainable mechanism to keep this going over the next several years and without taking away from the leaders who will most certainly be making statements about these in the coming days i would watch this because we are very much interested in how we will take this model forward and most important for this group how the non- governmental and academic sector and the young leaders of the united states and the planet can take part. the the epidemic has garnered a tremendous amount of interest in the academic leaders community. and i think that is another thing that georgetown has taken a leadership role and we are looking forward to how that can be capitalized on to build this agenda and also provide great assets to the immediate response. just in closing i would say that
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the last thing it is difficult to book a spoof on the short-term immediate response which is overwhelming at paramount while also looking at what we need to do for the future. i think it is critically important and i would like to close by using a quote from our president from last week where he talked about the immediate response but if you read what he said which was on the slide and if you read a little bit further in that speech, the president himself is focused on the future and i think that we have to be because the message here is that we can do this. we have the tools for the national security threat and many other threats are less tractable than this one that we have to be able to mobilize together and organize in a systematic way to do it. thanks. [applause]
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>> thank you very much doctor cameron. we have just about four minutes left for questions, some of which you have submitted it to me now. dr. cameron i think doctor cameron is going to have to return to her place of work, however i was wondering if you wouldn't mind just joining me out here for a few minutes and one or two questions. after this, we will go ahead and transition to the panel. again, in the interest of time i was wondering if you'd be willing to expand a little bit on what you have already mentioned but in more detail with being a catalyst for helping to bring new vaccines, medications, devices that are safe and effective to the market particularly now in this context
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of ebola in west africa and the international community response. if you are going to geneva perhaps you have been there not that long ago. in terms of clinical trials for the vaccines or treatments where the drugs were antibodies can you just in general terms without referring to anything proprietary of course talk about is there a precedent for this type of international response during the public health emergency and if not how do you see looking with international partners and regulatory and otherwise for a response to ebola in west africa. >> thanks. is this on? clearly there is precedence for this scale that would have to
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respond has been somewhat different of course because of the unique characteristics of this outbreak. and because of where we are today as a net ea. five years ago, the president launched the initiative that provided additional resources to be able to more effectively engage to the resources and added to the scientific it to the scientific program specifically to address these types of issues. so come as a result for example in the area of diagnostics we have a long-standing collaboration in the department of defense, and we have been engaged with them and getting ready the diagnostics for passages such as ebola that are very difficult to validate in the absence of disease because usually these are the foundations of the requirement
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of the actual disease. because we were -- we had readied all of this work we were able to in a matter of days authorized the use of the test for emergency use and this diagnostic test correctly used not only overseas but also in the response network to end a patient's come back from affected countries and there would be a suspicion that has been authorized for use of the emergency that is being used. as that is just one example that it's not just the emergency response, but there's a lot of activity that happens even before the emergency. and the same thing with the developers for the products. in addition to the regulatory review, an expert in the review and helping them to ready the applications we have incentives that we can make use out of to speed the development as well as
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some financial incentive. so we have designated one of the companies, one of the products for the drug designation that provides economic incentives for them and the additional resources for clinical testing as well as if they get the credit approved or have it extended over the perco of exclusivity for the companies to engage in the air. it's. so come it is a multifaceted response. and again, we will look at every possible way to engage with the developers to speed up development and to the development and to facilitate access to the products for the emergency. >> we have about two more minutes. one question that we have for doctor bump to expand on what you already talked about. you mentioned
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in the past and there is a there is a focus on this sleeping sickness and now there is a focus on one disease, ebola. but can you comment on how the response to the ebola epidemic is going on now in terms of health care systems and how it might be approached in a more optimal manner in terms of not only responding to the ebola crisis that we have right now, but england forward in terms of trying to strengthen the health care system across the countries impacted by ebola and i hope that this will lead into the next two panels in the morning as well. >> that is a great question and it's one that is hard to operationalize. it's easy to imagine what a single intervention should look like and it is easy to feel the heat in a crisis. so, in this case to make a clinical example, this is like someone in the midst of a heart attack thinking about how they
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should really exercise and stop smoking durin. those are going to kill you even if you get over this, so even though it is challenging to conceptualize what it is going to look like the obstacles here certainly begin with trying to put out this fire. the ebola is deadly. case, a 50% mortality. so, we really need to step up as we are stepping up to me to think about what are the underlining systems. the workforce? are the supplies or the numbers enough? then we have to ask where do they get health information. what is their interface with the government to actually trust the
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government? the underpinning includes the technical and the moral as well as a political. so, we have the most promising and most attractive approaches in the first world usually just think about the second goal trade so we need to do that and that is the basis of our response but then many to think about what are the political systems into the decision-making process that we can use to set the priorities to manage implementation, and then what are the moral things like what are the that are the choices, what are the trade-offs of one disease versus another those are not things that should be done in in those countries. holderwhite house says intends to remain until a successor is announced. we will have that for you live right here on c-span. reaction to eric holder's resignation? join the conversation on facebook. you can also leave a comment on twitter using #c-span chat.
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more now from the georgetown university meeting on the ebola formerk with the economic adviser to the liberian residents who says the country will face long-term economic challenges due to the evil outbreak. the world health organization, the outbreak is in five countries, guinea, liberia, nigeria, sierra leone, and congo. uninspiringrtainly -- certainly an inspiring and also sobering to hear directly , aboutesident johnson her challenges and her plans. you toexciting so thank steve in particular for organizing that segment. this panel is entitled "where do
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we go from here?" accordingly, we brought together some panelists to help us not only take stock of what we have heard already about to take a bit more of a forward focus on what are the applications of what we have heard this morning and particularly what are the applications when we look again and to what can be done? i am really excited about the group we have here. let me briefly introduce the panelists going across from my left. first is susan kim, the deputy director of the o'neill institute for international and global law. susan is trained in law, public health and business and holds a provea and hd degrees to it. in 2001, she served as special consultant to the state department to fight aids, tb and malaria. susan has worked extensively on a wide range of health watches,
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including of a mentation of the ,nternational health regulation pandemic response and infectious disease control. we are looking forward to susan bringing a legal perspective to the discussion. next is susan, we have already heard from dr. radel. but to give a broader background , dr. radel is the distinguished officer in the practice of development and the donnell f mckinley chair at yorktown university. steve has held senior positions in the u.s. government it including senior development for development to the tiller clinic -- to secretary clinton. steve, as you could tell from the earlier presentations, the government of liberia. last but not least is dr. ron waldman, professor of global
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health at the george washington university. ron has had an exceptional and distinguished career in public health, including centers for public disease control and prevention. his resume is very long and very distinguished but includes an extraordinary list of initiatives, including smallpox eradication campaign, developing a new center for forced migration and health, pandemic preparedness for the u.s. government, and lead roles in respect to the current crisis, he is the team leader for saves the children ebola response. one thing i would say as i have had the fortune of working with all three of these panelists in different parts of my career. susan with the o'neill steve at, sees --
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state and ron at hhs. we will follow the same format as the earlier panel. we will do some general questions and i will those specific questions developed by the student here. andgoing to ask everybody ask the general question to each of you to kick this off. let me start with susan. heard much discussion about roles and responsibilities that governmental institutions both global and domestic. the issue of law comes to bear here because those are the instruments we use to decide who does what and where and when. i would like for you to reflect on what you have heard about the legaltragedy from the perspective, particularly with respect to the implementation of the international health organization. >> thank you very much for having me.
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will speak about it in the context of the international health organization. dr. cameron spoke about them earlier this morning. is a global framework to diseaseto detect outbreaks and it is to prevent the international spread of disease. it is an international treaty under the purview of the world health organization. since 1969n around and dr. cameron mentioned this morning that they were revised respond toffectively diseases that transcends national borders. at its core, it's a complicated instrument, but what it is is
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that it establishes a mechanism for capacities at the domestic and international levels. aretries themselves responsible for implementing includingelements monitoring and surveilling local disease out rakes. one -- when specific criteria to are decided, the ability transcend international borders, then there's a reporting mechanism back to the view hl about whether they need to sound an international alert system. this would be at the global level what you have referred to as the republic international agency of health concern. what it is -- the simplest way to describe it is a global amber alert for public health emergencies. this signals that it is an emergency.
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potential to transcend international borders, so in terms of resources, whether it's a natural, medical and human. additional actions can be taken and there are temporary recommendations that restrict travel and trade. there are multi-sectorial implications that can be severe because -- i think you heard from the president -- with the travel and trade across borders, this has to be economic implications. of the returnsion in 2005, they have only declared them three times. in august, it was with ebola.
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it's hard to assess overall, but i think the answer is probably yes. from some of the remarks made earlier today, you can see inla had taken a foothold other countries and had begun to traverse borders around may or june. as a type of emergency alert the declaration sends a clear message that the world needs to mobilize. because they have done that too the very've heard difficult consequences of this timeline. >> thank you. let me turn to dr. waldman i would like to lay out the architecture for the legal responsibilities of how the international community should respond.
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given your experience working in the government and internationally, i welcome your sense of where we are now, but what lessons do we draw from this experience in terms of going forward, in terms of health systems we have heard about and the international response? >> thank you. i would like to address the problem in two parts. one is what we can do about this horrible out right now and where we can go from here. i'd like to start by saying in regards to those statements that every time she uses the word probably too late, i would take off the probably. i don't think it is an issue the world did respond to late. we allow the out rake to spread and allow the number of cases to grow to a point where it's very difficult to contain.
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the outbreak probably began as long ago as the number in the first vases were reported in the forests of guinea. without orders announced in june that their resources had been overwhelmed and they could no longer try to contain the outbreak from spreading and the world health organization responded in august. the u.s. government announced its first major foray last week. responded -- there's no point at this time in pointing fingers. that can be done as part of a case study. reasons ranging from the humanitarian to the very practical, political, social and economic consequences seen,re yet to fully be
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we need to do as much as we can. i think many of you, if you are following this out rake, maybe you saw an article in the washington post this morning that reports on a newly evolving strategy that may or may not be able to have an impact on the situation. let me go over briefly the planks of the strategy most of the partners now agree on. number one is the management of cases of ebola virus disease. aroundly, this revolves getting people off the streets and isolating them for the duration of their illness. peopleot want to allow that have any opportunity to transmit the virus to others. it is a highly infectious disease. fortunately it is not spread through the air. one has to come into contact with surfaces contaminated by
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body fluids of a sick person with the fluids himself, but when people are exposed, when they developed own list after an incubation time that can vary from a few days to three weeks, the proportion of people who come down with this disease to die is scary. it is well over 50%. as a result, the worst-case scenarios might have been mentioned earlier this running that are going to be released by the cdc this week. her theirys without intervention, the number of cases is estimated to surpass 500,000, which means we are very likely to see between 300000 and 400,000 deaths over these countries. it numbers are so big that is hard to get a grip on them. area of intervention are the
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hospitals called ebola treatment centers. pledged tobama liberia 17 100 that hospitals. whether or not that is the best proportion of the overall strategy those hospitals need to play is up in the air. we have been pushing at save the children very hard to have an intermediate layer of care develop closer to the community with less strict isolation procedures so we know what we are proposing in terms of facilities will be leaking and we will be part of the problem of transmission. we hope it will be a bigger part of the solution to getting people out of their homes, off the streets, and in laces were transmission can be restricted to an absolute minimum.
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but the president stole my thunder -- this won't work unless the communities are convinced to take ownership of this situation and of the problem. for all the reasons the president mentioned, this is proving to be extremely difficult to do. people keeping their ill family members home, becoming exposed themselves to stop if there family members or die,ge neighbors should they are conducting burials a very unsafe manner. wherea spreading event people because of traditional burial rites put them selves at particular exposure. crowds come and touch the dead body and easy to be carefully supervised. the community action, and attempted behavior change, these are the only things that will
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bring about a relatively rapid end to the epidemic, if that is even feasible at this time. the president emphasized many people in liberia are dying of non-ebola disease because there are no health authorities currently functioning. so common diseases like malaria and diarrhea the diseases, pneumonia, complications of regnant see, people are dying because they have no place to go. if there are facilities functioning, mixed in with all of those people are people with early symptoms of ebola virus because the symptoms are the early symptoms are characterized by diarrhea or coughs or fever, the same things that are the characteristics and symptoms of the most common potentially fatal diseases. it is a real disaster and a
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difficult problem to overcome. triage needs to be done and ebola patients need to be separated from non-ebola patients. test for theapid detection of the ebola virus. there is taking blood, sending it to a laboratory, doing a test that takes for to six hours to complete and in the meantime, all of the mixing of ebola and non-ebola patients has occurred and health facilities, were they functioning, would be super spreading sites or amplifying sites, so we are looking at some major challenges. two other quick things -- one has to do with the protection of children. there's a growing number of orphans in the street. they don't know what to do or where to go.
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they need to be cared for and protected and it's difficult to convince people to foster or take in children whose relatives had ebola and whose children may be exposed. this will tie and some with what steve was saying -- there are hardships in terms of people's ability to preserve their livelihood. there's no money coming into household and there's no purchasing power even for basic things like food that people need. food distribution is becoming a growing issue and a growing area of concern. even in villages and communities, people are having difficulty. there was a locked down in sierra leone this weekend and the biggest length i heard from the population was the inability to store enough food to carry
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them through those days. people lived from hand to mouth and don't have large reserves full up the same is true in liberia. i want to say we might be able to figure out what to do, but there are severe constraints and in just one minute, there's not enough money in this response yet. and is bige is ok and is getting bigger. the world health organization has called for over a billion dollars in hunting. i know what is coming from the ngo so far, but there's not that much money and if we concentrate on the high-level facilities, the beds president obama promised, the edge it for those right now being said it to the government call for more than a million dollars a month for their operating costs.
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whatever money has been pledged will be exhausted all too rapidly. second, human resources -- this is the biggest constraint all responders are facing. neither ex-pats who may not want is a dangerous situation. local staff is also very up to work onign this. personnels of health and support personnel required are really high when you are talking about the needs for isolation and sanitation fort disinfection for burial purposes. these are not good jobs and people don't really want to rush up and volunteer. don't know very much about
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what is going on. these are uncharted waters. there have been ebola outbreaks but the responses been more rapid and we have been able to contain them early on. here, we've never dealt with anything like this. we have no idea if they'll be part of the solution or part of the problem. needs to be taken carefully evaluated in real-time so we can see the impact it is having and see whether or not we want to pursue that line of work. i guess i'm coming across as not being quite as optimistic as the president and i nature i'm very -- i'm fairly cynical to begin outbreak, the director of the cdc, the un's special representative -- we've
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heard all of these people say the situation is out of control. it is out of control and it's going to take a gargantuan effort just to bring it back to a situation that can be controlled. not even bringing an end to it in the immediate teacher, but just getting a handle on what is going on, reducing transmission to the point where there's no more growth and the only slow ourth of the outbreak and more traditional means of containment can be more effective. >> thank you. that was sobering. i think ron's message is clear. it has been reiterated by global health leaders will stop the epidemic is out of control. are putting in place or are being put into place by various partners aren't
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unchartered space right now. works in thiswhat context. if youd be terrific could build on the conversation you started with. where do you see the economic three here for the countries, for the region, for the continent? how do you think about the kind of investment that will be needed to sustain economies while public health measures are brought to bear that will take a considerable time? isfirst point i want to make this is an epidemic of poverty. not strictly a disease of poverty but it is an epidemic incomesty just as low and lack of food and lack of water are all manifestations of andrty as is illiteracy
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many other manifestations of poverty, the weaknesses and lack of capacity in institutions to respond to the public health crisis is just as strong an indication of already. , unfortunately, there is a self reinforcing negative cycle we are beginning to see here. thate disease worsens, undermines capacity and undermines finances and economic ability and political systems and legal systems. further weaken the entire economic and social are cutting incomes and leading to more poverty. crisis becausee
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for the last nine years since the elections in 2005, liberia has been a positive reinforcing inle, that improvements economic and political systems are leading to higher incomes, less already, increases in school enrollments, strengthening of democracies, which in turn our reinforcing each other or have been reinforcing each other. the positive steps were reinforcing positive steps. progress been so much since the end of conflict in 2003 and the elections in 2005 in liberia and sierra leone, to less an extent in guinea because the political system just began to change more recently in two date. reversal from a positive cycle back to a negative reinforcement cycle. ofce this is an epidemic
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poverty, one of the things that has made me angry is the lame the syndrome that has been around for the last several months. that the problem is these people are stupid in terms of their cultural practices or the government doesn't have the competence or capacity or they make dumb mistakes in retrospect. we can all see these are mistakes and if we were able to treat people, this would all end. it is quite sad that once again we see the blame the situation. anyone's all. it's an act of nature. it is unfortunate he came into a region of the world that was very fragile in terms of its, sing recovery and was overwhelmed quickly.
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expected they would have had the systems in place to respond? there are big lessons for the future of the system and its inability to respond. this will not be the last ebola crisis or the last public health crisis and it has exposed to enormous weaknesses in the global ability to respond to emerging disease threats. not an expert and others will comment on that but there is a huge is an going forward. a couple of comments -- the president outlined a lot of the devastation going on. quite enormous. i will highlight one that she did not touch on which is the impact on the budget which you might not think of. downnment revenue is way because they rely on import tariffs.
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there's a big question as to whether the government can make its payroll, much less get kids in school. most of the schools are closed but if they want to reopen, are they going to have the money to reopen? all the court systems and kinds of things the government normally does. among many other things, they need a big infusion of cash just to keep government operations running. we don't have the flexibility to respond in a set of circumstances like this when one .f the things they need is cash usaid is providing $5 million in cash and we are twisted pretzels to figure out how they are going to provide $5 million in cash will stop the imf is going to step up in the next two weeks
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and provide $50 million cash to the liberian government and slightly smaller amounts to guinea. to be one of the first organizations to step up in the crisis. i worry about the longer-term impact of the economy and the impact on investment going forward. out, ther this drags more of a dark shadow will be cast and the harder it's going to be to attract investors going forward. this is having huge impact on individual people. poor people are not able to work on construction sites as taxi drivers, working in hotels and restaurants. a lot of them have lost their jobs. anger is rising both in terms of the disease and everyone is worried about that.
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people's incomes are down and they are not able to provide for their families. andr is on the rise alongside the economic implications, there are going to be longer-term political implications and ramifications. these countries are young and fragile democracies. they had begun to deliver the goods and i worry that among many other casualties, one will be a loss of faith in the ability of democracies to provide the goods. in liberia, we see former warlords and associates of former war lords saying they can't actually do it, i should be in power. with elections coming up, we will have to see how that takes shape. i believe there are much bigger implications here on economics and political systems and people's belief in those economics and political systems and not to mention their belief
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in the world order in international systems and their ability to respond. they president has outlined steps going forward, but it does not have to end in catastrophe. we are running out of time but there still is some time. the key will be not just for people in liberia -- they've been stepping up, but to continue to step up and for the international community to buy the -- to provide the cash. aroundxperts can turn us and make investments in toiculture through trade make sure there are trade concessions outside investors would be more open to investing in these countries going forward and investing in infrastructure roads which will have the long-term benefit of getting people back to work quickly.
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there will have to be another prong to this effort, which so to is not really happening get people back to work to care for their families and get these economic systems going back in a more positive direction. but thank you. i would like to follow up directly with you on that last point will stop it seems to me we have seen the global public health community responders slowly to this crisis but what you are laying out as an economic agenda for these three countries. withmf is to be credited the initial steps it has taken but it seems the president laid out a much broader investment around trade. who can take that lead? is this the role of the u.s.?
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who needs to be the lead? >> we have an insufficient level architecture. it is slightly different in each country just because the major bilateral act her is different. it is going to take -- that's not going to change and the reality is that the united states is going to focus on liberia and not to much on guinea. there is ape regional response, but it's not going to happen. all three of those governments will have to step up in several key organizations -- the are national monetary fund -- who would have guessed that darth vader himself, the age-old emesis -- it is long over but they have this reputation. out of date image of strong conditionality and we will never do it unless you do
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it our way, they will be the ones who will step up as part of existing programs and commitments that have been made and the governments were in compliance with. --hink it will be october 3 thinkard will approve i $48 million and the imf is a big piece of this. the world bank will have to step up. they've made many commitments so and as far as i can tell, there is less happening on the ground. the bank is going to have to step up on the infrastructure side and on power and roads. cash toas some of the supplement the imf will stop bilaterally, the u.s. response so far is certainly good.
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if you look at what the president said, there is nothing on the economic side of stop what they are saying is that will come. i hope it comes fast. there will have to be similar efforts i the united kingdom and it will have to support farmers getting back to or to feed the future. infrastructure investment will stop i hope the millennium challenge corporation is flexible. we are going to need usg are and commerce to step up on trade and think very creatively about the kinds of things we can do to encourage trade and remove tariffs and open up the doors. it is going to take efforts rum a number of actors and there is not an overall coordinator to do it. it is different pieces that will
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puzzle fit together in a and get the economic uses to the puzzle we need as quickly as possible. but let's turn to the public health response. me if that's the case from the standpoint of the global economic architecture, i would like to go back a little bit to where we started. i agree with ron that you can drop the probably. there are people working in all these organizations incredibly hard to respond, but is just a question as to whether we as a global community have the instruments and infrastructure to respond. it seems in this race that we have responded to slowly and ineffectively full top the question i would ask you is is the ihrituation where
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instruments are sound but in this case we did not use them to their full potential or are you beginning to see lessons emerge thee we need to rethink infrastructure in which responses like this will be constructed? >> overall, i think it is a legally sound instrument. i think it's the execution and implementation. to, it isople alluded very difficult to think about what is the process and execution of how you address a heart attack and you're in the midst of a heart attack. in the 2012 assessment of whether countries had ,mplemented their full capacity there was around 20% in the region. the 2013 report is a little more positive, but for those of you who do surveys, take that for
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what you will. part of it is the institute was engaged in terms of resource allocation in a training course. for low and middle income companies to think about what are the capacity requirements and how do you implement this resource because of constraints, that was stopped a few years ago. what we found in doing that trying to explain to them what are the requirements and how do you implement them -- it does not have to be a lawyer. few of them had anyone in the ministry of health that could explain what are we required to do? when you think about you these countries have -- is the ihr and effective mechanism, yes, if it is implemented correctly?
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has it been implemented correctly? no. public emergency has been declared three times to stop the first was with h1n1. overall, they said yes but one of the anxiety raised was h1n1 -- we got lucky because it may have been diffuse in spread but it did not have orbited the and mortality. one of the questions is what would happen with a disease out rate that will would be significant in mortality and i think you see the consequences of that now. even if we have legal instruments that describe roles and responsibilities, it requires institutions to do so. i know we focus a lot on the countries and i want to be cognizant of steve's cautioned
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that this is not about blaming the victim. experience in public health responses, what lesson do you see here that we can think about in terms of the international system? what do we need to be thinking about because we need to be thinking how do we avoid eating in this situation again. >> who has made a number of announcements regarding the fact that they were undefended in this area which way -- which may or may not be true. we are seeing a shift in global health priorities as countries are growing economically, we are going through something called the epidemiological transition profileans the disease and many low and low middle income countries is starting to shift from one dominated by infectious diseases 21 that has
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to put greater priority on the diseases that occur when people live longer and are healthier and societies are healthier. people are trying to put a greater emphasis on cardiovascular diseases. that means the money is shifting from one area to another. there has been some decline in attention to infectious disease control at the global level. certainly there are in the wealthier countries like our own. you don't have to read far in the newspapers to read about epidemics that have taken place in this country, but the global the global out , they don't have the same funding now as when we had
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the imminent threat of not even h1n1, but age five and one. theree of that threat, had been a lot of preparedness activities in a lot of countries in a lot of hearts of the world. was engaged as were other parts of the u.n. system. was a whole of society approach adopted to the control of these emerging pandemic threat. interestingly, the one part of the world where there was the least preparedness activity taking lace was in this art of the world where it is occurring now. it just was not seem to be a for thenerable area emergence of these pathogens. when i was working at aig, we had a high risk map and we thought west africa, there were some threads there but it was not on the map and did not reach
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the level of eating an area of high concern stop we have in addition to the fact that these are poor countries with very fragile health systems and little light being shone on them because of their lack of an epidemic history like this, all of the circumstances coming together that resulted in this late response. i want to add that even when the response did occur, let's say we responded appropriately in june when doctors without borders said they could no longer deal with the. -- deal with it. people have a tendency to hold themselves guilty and we are responding out what we know we should have responded in june and we are responding to the problem as it existed in june. we are doing what we should have
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been then, we are doing it now. toneed to be responding now the situation as it will exist in october or her -- or november. everyday we spend chasing this virus will be another day we fall behind ultimately. drastice some fairly solutions being opposed. they have to do with restricting bothes rights of movement, at the individual, community and national level. that, it does not come to but for the control of a disease like this, who knows? i assign them to watch the movie
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"contagion." although i hasten to add and i want your the that there's really no threat. nore is extremely little or threat to the wealthier countries of the world. we will know when the first case of ebola arrives in the united states and our public health service will be able to take it very rapidly and effectively and that is the situation with most countries. it's an epidemic of poverty. we have an obligation on many to continue to do our best to bring this under control now or roll it back to the point where more conservative and traditional measures of containment can be put into effect and reversed the tide. on theou want to comment human rights? >> i think basically in the midst of emergency, the
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intervening authority has the ability to and act what could of extraordinary and colors azure's. this is within the legal framework, both domestic and global levels, it is permissible. i think for those of you familiar with it, it is the notion of our restraint. the state has the power and duty to react, but they must do so with restraint. outlined within international human rights incidents and not just with ebola but any public health measure that could infringe upon race, it is looking at whether these measures are to directed ,oward legitimate addresses
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based on scientific evidence, my limited duration and the least intrusive and restrictive measure to achieve the overall of active. one of the suggestions folks health experts are much more knowledgeable about this but whether regional quarantine is appropriate or as individual quarantine enough possible tof it is throw someone in koran team, that's not the best measure to achieve the objective, it might not be lawful to do so. >> i'm going through some of the questions we've got careful before we switch to these, embedded in steve's phrase, which i do think this is an epidemic of poverty. i really do like that. is the political will and the
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global community. the council acted and it's not something that they usually do. likely future epidemics -- it is very plausible future epidemics will happen in poor countries with globalesources and communities and international communities need to be mobilized you'really to respond if going to hope to be ahead of this. i don't know if any of the three of you want to share -- i think the u.s. is taking some leave later and convening this agenda, but how do we start a i a law this is a public good mark it's something that's helpful to people in poverty but also something we need to do globally. i think that larger argument is
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going to be necessary to whatever we have. or part of the trick is to try to stop some of the fear mongering, but at the same time be serious about the potential impacts on the epidemic, not just in west africa but are broadly, especially as it begins to spread. the fear mongering, some people do it with the intention of we have to wake people up to realize how challenging the situation is. some of the proclamations about the threat to international security were overdone in the years after 9/11 as a mechanism to get people to act on various issues. balancek is to get the where we are not just scaremongering getting the message out in clear ways about
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the threat not just the immediate outlook health threat but the threat to international democracy,ews on views on the international economic order. that for a variety of other reasons have been taking a hit since the 2008 financial crisis and the invasion of iraq. we are seeing democratic recessions in a number of be getting to question the effectiveness of democracy. the prime minister of hungary calling or and illiberal democracy. i worry this feeds into the broader narrative. part of what we have to do is get that narrative out and convince people of the seriousness of this issue without the fear mongering. i think for all the pessimism , these areges
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matters of choice. as much as this is a natural disaster that comes out of that we cannot completely stop, there is a collective choice for the international community to make over the coming weeks and months. you use the phrase local will, but we have in our collective power the ability to begin to at least bring this thing under control if not stop but in the months to come. unfortunately, before that happens there will be much or suffering that we have choices to make. place where it is at least under control and stabilizing? yes. we have done it with hiv. it is not over by any shot at it is stabilized. we have done it with valeria with the number of deaths from malaria after escalating for decades have fallen very sharply because of international decisions to fight it and fight
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it harder. where it with smallpox finally people ramped up and made choices in the resources and deployed people. .e did it with polio it's almost eradicated. it is in many ways similar to those. in the early 90's -- i've been hanging about the early days of when people were recognizing the severity of the hiv crisis and it took the international community way too long to step up, but when we did, it had a big impact. the question for me now is whether we will collectively make that choice. a lot of it falls to the united states, not only i laterally, but the leadership in the united nations and world bank, in the imf and other places where people still look to the united states. i worry because there are retired generals saying the same had use of u.s. troops and obama's ligament harm's way and
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all that stuff. they still don't recognize the bigger issues at stake. be donea lot of work to but the good news is this is a choice and we have the brains and resources and people to fight this thing. i hope we make those choices. we are beginning to nudge in that direction but we need to move much war aggressively in the months to come will stop if we do that, we collectively can bring this thing under control, i think. >> thank you. i'm going to go to some of the questions now. been focusing on the three countries most immediately impacted, but this question asks if we are in a situation where this spreads to surrounding senegals, whether it is -- could you describe -- will we
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just see more of what we have seen in the three countries or are there more dynamics in all here as we see this breading dramatically? >> it's obviously speculative. i'm a little surprised and i don't fully understand why the disease has not read through other countries. senegal travel the lake of the country. apparently there was no spread from that stop another case in nigeria into sites and we don't know what's going on in nigeria. maybe it has spread to other countries and hasn't yet reached the point of visibility. i know there are people looking and on the alert in the ivory coast another neighboring
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countries as well. i know usaid is conducting regional preparedness workshops now in those countries as we speak, taking lessons from the pandemic or parent in this plan. i don't think we entirely understand the dynamics of this epidemic or how it is brad. termse heard the exponential growth and accelerated growth. i don't exactly -- it's hard to model the spread of this out rate, even when we observe a those he could even every county in these countries have reported cases, so the way it moves is not really clear. it seems to move somehow in spurts and will reach a particular area and a lot of people in that area and then we won't see an and. that contributed to the lateness
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of the response. although we knew the ebola virus was spreading as early as december and january of this year, there was a time when it he came classic and the who did not react because it appeared to be on the wane. very few cases were being reported and there was an explosion in the month of a. it is not clear what dynamics are, except if it does start affecting other countries and there's a chain of transmission established parallel to the ones we are seeing now come a all of the things that can be said about the economic consequences and political consequences, that is going to affect other countries as well. gets to thequestion issue of medical countermeasures. an appropriate economic
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investment in medical countermeasures as a global resource for this pandemic, thinking particularly of treatment, but also looking down the road? making their bees available when science allows them to be available to address some of these issues -- this is a question of whether it should be a worldwide or global activity. to a great extent, the medical countermeasure development is done by the united states and a few other countries. >> i think yes -- investment in these types of things should be as the doctors can attest to, when things have to be framed in a global context,
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you talked about political will and investment -- it's not about the money, it's where is the money going to come from? if these things are done, how do you figure out the appropriate allocation? it requires people to think about it beforehand. there's a place to think about making future investments in the countermeasures, but folks need to give serious consideration to what that framework would look like. i just want to say one thing to get it off my chest. i think the saddest part of this out rake is that we wait until these events occur and then we start talking about we really ought to throw a lot of money into developing drugs or vaccines or worse -- this is a failure not so much of the our right response community as it is the development community. what have the development agency's been doing for the last
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two years? if we would have had stronger systems in these countries in the first place, we would not be where we are now. i went to usaid early on in the talking and they were about putting massive amounts of money into strengthening the health system in liberia which is fine and ought to be done, maybe not now, but it should have it done all stop i hope we learned the lesson and don't have to wait for the next catastrophe to occur before we to make theed appropriate assessment and development. >> i want to ask you a question. we have plotted the u.s. government efforts in the last onyears to build responses hiv primarily, valerius, to a lesser extent tb.
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you know where my question is going. in terms of vertical responses to disease. executiveust the ranch. the honest truth is congress love it and the american people love it will stop we can ask blaine we are providing an whoever ito agnes or is and we can bring agnes to testify in front of the foreign relations committee and say your money is keeping her alive and because we are providing her with antiretrovirals full of we can do that less directly but it is easy to understand. by that nets and children live. we see all the campaigns in junior high school -- contribute $10 and somebody can buy a bed that pulls up the clinical -- the at its best level
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american people want specific actions on specific diseases. well and weut very have all talked about the importance of health systems. you have been more involved in this than anyone else. how do we square that circle of congress wants results measurable now with the need to build systems over time. question that has been haunting me for the last several years. timee spent quite a bit of working on the bilateral and wee to disease focus have had considerable debate in the global fund about the extent to which countries should be supported to build health systems as opposed to systems to deliver responses to the three diseases. so cbo outlined why it is
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much more politically attractive to make the argument that an investment of u.s. tax dollars leads to a specific outcome -- i if the- i don't think conversation is only going to be a direct program versus a relatively nebulous investment, i don't see how that argument is going to be persuasive over time. i think you have to do a couple of things. you have to change the conversation. one thing this crisis provides to think aboutty health systems as a protection for the world as well as for these countries for the kinds of problems ebola illustrates. there is an argument -- people in the united states want to look health infrastructure. we may not think about it they today for year-to-year but we sure do want the cdc functioning before 2009 with h1n1.
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we knew it was not as serious a pandemic, we forget about the constant drumbeat of news stories on cnn, the lines in the parking lot at cvs. there was a demand for public action. argument we are going to be safer as a country of the world a safer and thereby investing? i'm wondering when we change the conversation. the long-standing hope is can you make the diagonal argument ?ather than a series of argument that we can actually invest in systems with accountable countries. health system should malariaople with hiv, and etc. effectively.
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at every endeavor we know systems that are well organized can share the basic costs of operating. walmart does not have a separate company for each product on its shelf, right? it makes sense to have institutions that are well organized. if we could mace -- make the case that broad-based investments could give you the kind -- maybe not exactly but something close i think is the way you would engage congress to the executive branch in exchanging the conversation. harderthat is a much couple -- case to make. >> i had a sense you were being so nice earlier.
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>> i want to offer anyone here at chance for briefly concluding process. anything? >> i have said plenty. >> i want to say i just urge everyone to continue to follow the outbreak closely. it is a really important event. there are other things happening in the world that are also extremely important. sometimes they will get more coverage and attention because they are easier to understand have been there before. a very unusual event that can have of major importance. for people who do the kinds of
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work i do, it is like an invasion of outer space and does require everyone's attention and maximum cooperation. we have to rise to the occasion. >> i would like to ask everyone in the audience to thank our panelists. [applause] invite dean to anderson to come up and give us the final remarks. >> thank you. i opened the session by saying i observed those who of tried to teach international affairs of of foreign service, we have come out of a time that is particularly enhanced by the cold war era to which we thought of international affairs as a matter of relations between human beings.
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ed has been the organization of the state, threats to the state, alliances between the states that have made up the stuff of international affairs and with maybe on the brink of a redefinition of international affairs in which the major conversation becomes less relation between human beings that all human beings and the fromenges that have come global climate change, food shortages and water shortages. as the analysts have observed today, the reality of the change may be more upon less than the recognition and ability to respond to the change. i am pleased to say that community at georgetown and in a wider circle have come together today to deal with that issue in a way the school of foreign services is not fully equipped. i very much appreciate those in the community you have joined us, particularly lucianne dan
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monahan in helping us think about international affairs. a way that may be more appropriate for the 21st-century. i want to thank all of you for being such an appreciative audience. >> today the expected announcement of eric holder's resignation. the fourth-largest -- longest-serving in history and one of only three of the original numbers of president obama's. will hear from president obama on the attorney general's plan to stay at the department until a successor is in place. pat leahy released a statement saying under his leadership that apartment has had remarkable success in convicting terrorists and disrupting threats to national security. the chair of the house government reform committee says by needlessly injecting politics into law enforcement, the legacy has eroded more confidence in
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the legal system than any ag before him. on hisan 600 posts resignation, including one from pat who writes he served honorably and with distinction, his restaurant -- his record is exceptional. you can share your thoughts and see more of what others are facebook. turning to the current campaign season, c-span 2014 campaign coverage includes more than 100 houston senate governors races from across the country, including the recent iowa debate between terry branstad and jack hatch. here are some of the debate. i am only repeating, not accusations but lawsuits, investigations, even the state auditor says the governor handled the investigation of the
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secret settlements, that there were more secret settlement even after the governor and the staff said there weren't. you have to be a leader and need to be a governor who will be open and transparent and it is unacceptable the governor stands in front of us and says he is open and transparent and has nothing to hide when that is all they been doing. not just an, and attack of the candidates but accusations come from legitimate sources of the legislature. auditor's office, the courts and from individuals who have taken the time to sue him personally and often. these are not the acting -- actions of the governor who can lead. is iowa, not illinois. most of the former governors of illinois are in prison. the people of iowa trust me.
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i have been totally open and transparent. i am a press conference every week and i take the top questions from the press. lawsuit but ie a can tell you we work with the auditor. there was one agreement agreed upon before i signed the executive order and was signed later in when it was discovered that was the case. eliminated the confidentiality clause in that. that has been enforced. to localo extend it government and legislature and the house passed it with an overwhelming i partisan vote. because theyed it do not want the public to know the truth about what is in those confidential files on the employee personnel. i think the people of iowa deserve to know that because it
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is their tax money paying it. >> and virginia the two candidates in the race for the 10th district debated yesterday. they are competing for the seat ofn after the retirement republican frank wolf. four major republican strength the race. we will take a look at their debate. >> good to see you again. we will begin with opening statements. each candidate will have five minutes for opening statements. timekeepers in the front show the candidates how we will do this.
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can you see this? it will look like this. i will let you finish the sentence. when you get to the end i may not stop you in midsentence but try to finish as opposed to a paragraph or chapter, that way there will be no complaints that i have favor of one side or another. at my discretion. certainly if one of you references or attacks or whatever your opponent, that will be an obvious opportunity for me to get the person referenced an opportunity to speak. let's begin with opening statements. five minutes. need it comstock, you -- you get to go first. >> today the real battles we face are not a bottle of left versus right or really the past
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versus the future and status quo of moving forward. what i love about the district is the opportunity to work for and with the p all in denting the future. the people who understand how innovation will restore the american dream, lift people out of poverty, ease the middle-class burden and get us path to prosperity. into virginia general assembly, i have worked with so many of you on getting that back on path and getting the job done. my priority that your congressman will be first getting back to work. repealing and replacing obamacare with patient centered reforms that put you in place with health care. stopping the sequester cuts that threaten not only our jobs but threaten our national security. i opponent and i do have different visions for the
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future. he thinks the answer to many and almost all of our problems is to raise taxes. he is voted raising property taxes year after year. 20% sales tax increase. medical device taxes. additional taxes on the sale of a home. he will hold the line on taxes. those are a lot of taxes. i get it, we need to ease the burden on hard-working taxpayers. that is why my priorities have always been jobs and the economy. i have had bipartisan successes and results to prove it. legislation ir know you're familiar world it is helping grow the 21st century jobs. workplace stability and getting those cars off the road. the research and development tax
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credit that we passed this year that so many of you worked on and the governor signed into lace, we need a permanent at the federal level tax credit and permanent 20% tax reform in washington. it went so far as to attack me personally to say i never have had a real job. those who know a thing or two about real jobs have now looked at both of us and have endorsed me in the case of the u.s. chamber of commerce, national association of women business the realtors or credit union, former chairs of the northern virginia tech ologies council, former chairman of the chamber in the police. democratse supported and republicans alike. i passed legislation reform that is already saving us hundreds of
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millions of dollars as we move forward on this project. legislation my opponent opposed. i worked a good offshore drilling in virginia and approach to energy development including the keystone pipeline. with today's increasingly volatile international situation our energy economy is not only about jobs, not only about getting jobs for transportation with offshore drilling but an important and vital foreign policy area. legislation cracking down on the growing crime of human trafficking and legislation for testing of newborns for congenital heart defects so we can save those babies lives early on. coming from a family of educators i have always focused on education. one of the first things we had to do together that we did here
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with the chamber was to reverse the cuts the previous democratic governor had made to the northern virginia schools. he got rid of the cuts to the schools and got rid of tax increases and balanced the budget. together we balance the budget every year. many and washington are cynical. i totally disagree with that. everything here allows us to get back on the past and make sure everyone can live the dream and the most diverse district. on thatwe can get back path. i can hit the ground on day one that the majority in congress to continue the tradition of my mentor, congressman frank wolf. i ask for your vote on november 4 to continue work with and for you. thank you very much. [applause]
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to something ime should've said earlier, and that is, please hold your applause. those of you trying to applaud for him to do so but after that, the most important voice you have in the debate is the loaf you cast on election day. this just takes away from our ability to question candidates and their inability to say where they stand. so if i can ask politely at we not applaud. after the one applause we will be even. five minutes were opening statements. >> thank you. good afternoon, everyone. it is a real pleasure to be here. i have enjoyed working with the northern business community over the past seven years. as an active member
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of the business community. to working with you and continue to work with you in serving you as your congressman. i have often been asked why i am running for congress. say toto pause and answer that i have to tell you a story. i will tell you about my background and values. born iny i was johnstown, pennsylvania. as deal milltown. my dad was a laborer on the railroad. -- it is a miltown. mecould not afford to send to college. i had to work in a steel mill. i paid for my education. when i was done i got an mba and a law degree in the financing and accounting department. i went to school full time at night.
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i tell you that story so i can tell you why i am running for congress. i have tremendous opportunities. and to ultimately live the american dream. that is not happening in america today. enough opportunity. education has become too expensive and limited to two few. i believe we have to change that. to do that we have to deal with the congress that is broken. obviously far too partisan. holding our country back. we have to make a change. the way to make a change is to send new people to washington. i have served on the their fax board of supervisors -- on the board of supervisors for seven years. we do them the right way.
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ien i ran into thousand 11 was the first democrat ever reelected in my district. i carry every single precinct and over 60% of the vote. i hope you agree that demonstrates i have been a leader that works with both parties hum of businesses and the residents to solve problems and to get things done. on the board of supervisors i served as vice chairman on the committee. i balance seven budgets and tough economic times by working and fellow board members community. tens -- cut tens of millions of dollars of wasteful spending. i have saved taxpayers millions of dollars by cutting waste and inefficiency. as chairman of the economic advisory commission i spent six years working with county staff and dozens of those missed
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leaders in the northern virginia community to expand in the economic environment. our mission is to improve the business climate. we make accounting more attractive to business and a knowledge-based 21st-century economy. this by supporting public schools and infrastructure investment like the silver line project. transit oriented development and tysons and the core door. these are things we do. we focus on reviewing and improving the regulatory process. so when i go to congress my priorities will be to get past partisanship and work across the aisle like we do in fairfax county so we can deal with fiscal challenges and make washington work again. we need a functioning congress to address and solve fiscal challenges and create jobs and opportunities by investing in job creators ike education and
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infrastructure and research and development. we need to improve education at all levels, including expanding early childhood education am a more emphasis on stem subjects and making college more affordable. to pass comprehensive immigration reform so we can take advantage of everyone's challenge and make it easier for highly educated foreigners to come to our country or stay and our country and contribute to our prosperity. over the next hour you will hear between herself and myself. i'm looking forward to the discussion. you will take away from this debate. tank you very much. -- thank you very much. [applause] >> i will not ask many questions
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but i will start by asking one. virginia's congressional delegation will take a hit. emma isn, a senior retiring. frank wolf, senior republican with committee assignments is retiring. tons of proven ability to get things done. eric cantor was defeated surprisingly in the area. a lot of seniority, know-how going out the door. one of you will be a freshman member of the house. which of you is better equipped to at least help in part to offset some of what virginia is losing? the firstill have opportunity to answer first. >> i have been a senior aide and senior justice official and have been in the private sector as a
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senior in a law firm i have worked extensively on the issue we have addressed here. when i worked for congressman wells am obviously i worked on so many of the issues important to the district. him a federal employees issues. i think this is a big part of the partnership tom and i think it is very important for there to be a republican voice in the majority advocating for federal employees for federal contractors on a tech industry -- industry in northern virginia and have the bipartisan present. i think it is pretty clear from everything you see out there republicans will be in the majority and i will be a very strong voice and experienced voice and as a legislator let's work with so many of my colleagues in loudoun county, i the the issues and i know expertise. if i do not have the expertise, then i know -- i know the
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experts in all of the areas in the fence in business and tech community and health communities. for over 25 years since i have worked for congress i have worked with all of you and i already have the bipartisan success in the legislation that i outlined to be able to hit the ground running on day one and work with my colleagues across the aisle, work with people on getting true results. that is what people want. and all of the bills i just who were we had people on one side and the other who never worked together on something like the human trafficking though. we came together and got solutions. we've put together a coalition working with you in the business community. i want you all to be the advocates to take expertise and make sure we do everything right for northern virginia. thank you. >> thank you very much.
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the question is who is going to get something done in washington ? think about what is happening in washington right now. they are not getting the job done. why is that? because they are hyper partisan, refuse to come together and work together to get rings done. i would put my record as a hard-working, problem-solving supervisor working across the aisle and say that in and of itself demonstrates i can get more done. i also want to point out i will be working with two virginia senators who support my campaign , warner and cain. i also want to point out delicate comstock has a history of extraordinary partisanship. that partisanship is a problem in washington. it is exactly what we have to solve. she made her name by investigating the clintons for four years as a chief investigator for the house
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reform committee. -- he haspresented been a lobbyist to the coke others. these are the type of people we have to get out of washington if we're going to solve our problems. >> i think you can take a minute to respond to that. my opponent did not note any accomplishments he has done on a bipartisan basis. reminds me of maggie thatcher used to say, you want something instead, ask my mail calling, if you want something done, ask me. i have gotten results on a bipartisan basis. when i worked for congress, we -- we had constituents who were wrongly fired who i am very proud we
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went to bat for because congressman wolf always goes to bat for employees. that is the investigation that we started and they ended up at the end of the day, apologizing to the employees wrongly fired. one of them was prosecuted and exonerated. i'm very proud of the work we did to exonerate him and for congress to pay the legal bill back in part for apology. started doing with congressman wolf at his behalf. , thepervisor faust affordable care act is unpopular with many americans. for business owners health care reform has created a great deal of confusion, complexity and cost. lees tell us if you believe the health care reform law has been a success or failure and what if anything, you would do to improve or repeal it? i would not >>
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repeal it. i believe it is a step toward what we need to accomplish in health care. i believe there are a lot of fixes that are required, particularly concerned about the onerse impact of obamacare costs. do not want it to be an anchor on creating new jobs and opportunity. one of which we are looking at. this is a board of supervisors. is the so-called cadillac plan. anyone in northern virginia knows we get punished because we have higher health care costs in northern virginia than other areas of the united states. therefore, more of the plans qualify for the cadillac tax mot. we need to rule out medicare to with pharmaceuticals
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for reduce drug prices. that would be a huge savings to health care costs. the veterans administration can do it. we cannot do a right now under medicare. i am supportive of mark warner's create a copper plant that would create a lower cost and adaptable plan for consumers. ist i am not willing to do to allow health care to be returned to the insurance decide of they can pre-existing condition disqualifies us from getting coverage, so that they can too much have used health care and decide to cancel our policies. so they can raise prices without any control at all. remember how bad the health care mess was before obamacare.
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situation where it needs fixing that we have to make sure insurance companies do not go back to overcharging and taking away our health care. >> obamacare clearly has been a failure. the president himself has done over three dozen exemptions saying no, do not let it go forward because it would be that bad. i opponent has acknowledged it is costing is mrs. moore because that is why the economy is having a tough time because of the cost. we werethe premiums told were going to go down has actually gone up by thousands of dollars. your deductibles have also gone up people are finding. when i go around throughout the 10th district and talk to businesses they tell me how they are lowering the work hours of pete old were not give them the plans that used to have. we can have good, patient centered reforms. we can have portability.
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deductibility, health savings accounts. we need to start over not with the washington centered one-size-fits-all plan you just heard from my opponents, but a and that puts the control money back into your hands. that we can keep the good things without destroying our entire system. >> a question for delegate comstock. >> delegate comstock, america's deficits --den debt and deficits. cutting waste, fraud, and tax abuse is not enough to solve the problem. what are programs would you be willing to cut or eliminate and what federal taxes -- what federal taxes would you be willing to increase? >> the problem

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