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OPERATOR: Welcome to the U.S. Ebola Response Briefing. At this time all participants are in a listen-only mode. Later we will conduct a question and answer session and instructions will be given at that time. If you should require assistance during the call, please press *0. As a reminder, this conference is being recorded. I would now like to turn the conference over to our host, Ms. Tiffany Jackson-Zunker. Please go ahead.
MODERATOR: Good afternoon to everyone from the U.S. Department of State’s Africa Regional Media Hub. I would like to welcome our participants dialing in from across the continent and thank all of you for joining this discussion. Today we are very pleased to be joined by the Secretary of Health and Human Services, Alex Azar. Secretary Azar will discuss the U.S. response to the recent Ebola outbreak in the Eastern Democratic Republic of Congo (DRC) and his trip to the DRC, Rwanda and Uganda.
With Secretary Azar is the Senior Leadership for U.S. Agencies involved in the Ebola response. They are Dr. Robert Redfield, Director of the Centers for Disease Control and Prevention, Dr. Anthony Fauci, Director of the National Institute of Allergy and Infectious Diseases and Tim Ziemer, Senior Deputy Assistant Administrator of the U.S. Agency for International Development. Our speakers are calling from Kampala, Uganda.
We will begin today’s call with opening remarks from Secretary Azar, then we will turn to your questions. We will try to get to as many of them as we can during the time that we have, which is approximately 35 minutes. At any time during the call if you would like to ask a question, you must press *1 on your phone to join the question and answer queue. If you would like to join the conversation on Twitter, please use the hashtag #AFHubPress and follow us on @SecAzar, @HHSgov and @africamediahub.
As a reminder, today’s call is on the record and with that, I will turn it over to Secretary of Health and Human Services, Alex Azar.
SECRETARY ALEX AZAR: Hello everyone and thank you so much for joining this press briefing today. This is an important opportunity to reach journalists and readers all across the African Continent and explain why the United States has put such a strong emphasis on combatting the ongoing outbreak of Ebola in the Eastern Democratic Republic of the Congo.
As the United States Minister of Health, what we call the Secretary of Health and Human Services, I help lead the U.S. Government’s work to prepare for health emergencies and assist other countries in preparing for and responding to emergencies. On this trip, I am joined by Dr. Robert Redfield, Director of the U.S. Centers for Disease Control and Prevention or CDC; Dr. Anthony Fauci, head of the U.S. National Institute for Allergy and Infectious Disease; and Admiral Timothy Ziemer, the Senior Deputy Assistant Administrator handling foreign disaster relief from the U.S. Agency for International Development or USAID.
We also were jointed by Director General Tedros of the World Health Organization, a close partner of the United States and the first African to lead WHO. Our trip began with meeting with President Tshisekedi and other senior DRC and international health officials to discuss how the U.S. has been coordinating with the DRC and WHO. Following that I visited Goma, capital of the North Kivu Province of the DRC and then traveled to Butembo in the heart of the Ebola crisis where I got to meet healthcare workers who are actively treating Ebola patients.
I’m currently in Uganda where I have met with Minister of Health Aceng to discuss the crisis and tomorrow I will be meeting with President Museveni. Before that, I visited Rwanda where I met with President Kagame and Minister of Health Gashumba. The current situation in the Eastern DRC is a genuine health emergency with significant humanitarian and development relief challenges, both for the DRC and for neighboring nations.
More than 2,000 people have died and more than 3,000 people have been infected. Ebola has the potential to steal so many lives and if not checked, will destabilize communities and disrupt economies. Since the outbreak began last August, the U.S. has been the single largest donor providing more than $158 million in financial assistance plus $238 million of technical assistance from places like CDC and support for vaccines and therapeutics.
In other words, some of these resources have gone towards supporting new tools that have helped keep this outbreak less deadly than it may have been otherwise. Many of you remember the outbreak of Ebola in West Africa that began in 2014 and was eventually ended in part, thanks to assistance from the U.S. Government. During that outbreak, we were able to start developing new tools to respond to Ebola which have now been essential in slowing this outbreak. That includes investigational vaccines which have now been used to protect more than 220,000 people, including healthcare workers and those potentially exposed to Ebola.
The United States recently made a commitment to buy $23 million more in vaccines which will support another year of vaccine production by Merck. We’re also supporting the development of therapeutics, that is treatments for those already sick. Right now in the Eastern DRC there is an ongoing clinical trial for investigational therapeutics which has helped treat more than 800 patients and was recently narrowed down because of its success to two of the more promising investigational treatments.
The trials are being done in conjunction with the DRC’s National Biomedical Research Organization, Institut National pour la Recherche Biomedicale. This work should be a point of pride, not only for the people of the DRC but for all Africans. On this continent, thanks for African scientists and health workers, important biomedical research is happening that will help protect the entire world from health threats. The application of these tools and this outbreak would be impossible without the bravery, dedication and generosity of the health workers I have met from the DRC, Uganda, and Rwanda and from across the African continent and around the world.
These are incredibly courageous men and women working incredibly hard to stop infections, provide care and save lives. It is their work on the ground that will eventually bring the Ebola outbreak to an end. Until this outbreak is over, it will remain a top global health priority for the United States and when it is over, continuing to strengthen the health systems of African Nations will remain one of our top priorities so that in the event of the next outbreak, every nation is better prepared to respond on its own and to save lives.
Thank you again for calling in today. And I look forward to taking your questions. Operator?
MODERATOR: Thank you, Secretary Azar. We will now begin the question and answer portion of today’s call. For those asking questions, please state your name and affiliation and limit yourself to one question related to the topic of today’s briefing: the U.S. response to the recent Ebola outbreak in the Eastern DRC and Secretary Azar’s trip to the DRC, Rwanda and Uganda.
For those of you listening to the call in English, please press *1 on your phone to join the question queue. If you are using a speakerphone, you may need to pick up the handset before entering *1. For those of you listening to the call in French and Portuguese, we have received some of your questions submitted in advance by e-mail and you may continue to submit your questions in English via e-mail to email@example.com.
Our first question was submitted by e-mail, comes from the journalist at the listening party in Kinshasa, DRC, Raphaël Kazadi, from Le Phare asks Ebola is a public health and security problem that is potentially threatening other countries besides the DRC. How can the U.S. help mitigate this threat?
SEC. ALEX AZAR: So the first thing that we can do is to continue to support the DRC, the WHO and non-government organizations in the DRC to stop the spread of Ebola. That’s the first thing and most important thing that we can do to stop its spread into other countries. But we must recognize that the threat of spread into other neighboring countries is very real with hundreds of thousands of people crossing very porous borders, this is a very real threat. I believe Uganda is scanning close to I believe 100,000 individuals per day if I’m correct. It’ s a very significant, very significant surveillance operation.
What can we do to help these other countries? The first is to assist them with their preparedness activities and that’s why I’ve been in Rwanda and Uganda. It’s screening at the borders. It is being ready to diagnose cases with laboratory diagnostic tests. It is having isolation facilities ready. It is having Ebola treatment centers ready. It is having emergency operation centers to coordinate response. It is having developed frameworks for how you integrate all partners WHO, NGOs, the United States’ CDC together to respond to that first case. The contact tracing, vaccination and application of the experimental therapeutics.
MODERATOR: Thank you. Our next question will go to the listening party in Dar es Salaam, Tanzania. Operator, can you open the line please?
MODERATOR: Your line is open.
MODERATOR: Please ask your question.
SEC. ALEX AZAR: Yes, please?
QUESTION: Yes, from Dar es Salaam, my question is last week we had conflicting reports on the patient who died from Ebola in Dar es Salaam with a WHO report saying a team of investigation sent to investigate the issue after the issue was refuted by the government. What recent developments do you have in the U.S.?
SEC. ALEX AZAR: So we are aware that one individual has died in Dar es Salaam. And the government of Tanzania has reported that two suspect cases are showing negative from testing. The government of Tanzania, however, has not made available the samples or the ability to test the index case of the individual who died, nor has it made available any other information about the death of that individual. We call upon the government of Tanzania to comply with its obligation under the International Health Regulations immediately with transparent disclosure of information and full cooperation with the international health community to allow for independent verification as to the circumstances of that individual’s death.
MODERATOR: Thank you. Our next question will go to Donald McNeil from the New York Times. Operator, can you open the line please?
QUESTION: Hello? Thank you for the question. Thank you for opening the line. Are there any plans to change the policy of letting U.S. healthcare workers work closer to the front lines of the epidemic in Eastern DRC?
SEC. ALEX AZAR: So we actually do have U.S. healthcare workers including some of the brave heroes of the Centers for Disease Control and Prevention operating in the front lines of the response. We assess the security situation on a village-by-village, town-by-town basis in terms of where it is safe and appropriate for them to deploy in support of the DRC’s, the Ministry of Health of the DRC’s leadership and the WHO response. We have had over 400 CDC deployments in this response. Those are deployments in Kinshasa, in Goma, elsewhere in the impacted areas in the Eastern DRC but also to Geneva and elsewhere to support the WHO and to allow WHO individuals to deploy into the field where perhaps Americans cannot go.
In addition, as we always do, the CDC and NIH have engaged in significant training activities of DRC individuals so that they can engage in frontline response activities with us providing technical support in other locations. We have also conducted an incredible clinical trial, a four-arm clinical trial with the NIH and the DRC conducted under WHO’s supervision in the Eastern DRC. Four therapeutics, a rather remarkable achievement in this conflict-ridden zone to be able to execute that clinical trial.
QUESTION: But there are not any plans to change the policy right now about workers not being allowed to work right at the front lines?
SEC. ALEX AZAR: What I’ve said is your statement is not correct. There is not a policy, there is not a policy that prevents across the board, U.S. employees from being at the frontlines of the response. The decision-making, the ambassador and the regional security officer continue to evaluate security on a territory-by-territory basis. As I said, village-by-village, town-by-town, city-by-city as to whether the environment is permissive for U.S. employee deployment or not. And that will continue to be the policy as it always is.
MODERATOR: Thank you. Our next question was submitted in advance from Beats FM Radio in Zambia. What is the United Nations World Health Organization doing to contain the Ebola virus apart from funding countries with Ebola cases and could you highlight please how the U.S. response contributes to the WHO efforts?
SEC. ALEX AZAR: Well, first, the U.S. is the largest single contributor to the World Health Organization. But also as I mentioned, we have provided surge personnel to support the WHO in its core function so that it can deploy individuals into the field and of course the WHO does more than fund countries. The WHO actually deploys heroes into the field who are running Ebola treatment centers, taking care of patients. I was in Butembo at the front lines of the response just this Saturday at an Ebola treatment center that is being run by the Ministry of Health of the DRC and the World Health Organization. And so that is direct provision of care to individuals who are suspected of having Ebola or who have Ebola.
In addition, other UN arms such as UNICEF are engaged in critical humanitarian outreach and community outreach and community engagement efforts to support the response here. Because it is vitally important that the people of the Eastern DRC know that the commitment of the United States and the international community is not simply to stop this Ebola outbreak but to actually improve their health condition more broadly.
MODERATOR: Thank you. Our next question will go to Kevin Kelly from Nation Media Group, Nairobi. Can you open the line please?
OPERATOR: The line is open.
QUESTION: Yes, thank you for doing this today. So my question is that in the past, maybe into the present time as well, there’s been some resistance in Eastern DRC to treatment and vaccination; there even in some cases the health workers have been attacked. Can you give us an update on whether that’s still occurring and what can be done about that kind of resistance if it is underway? Thanks.
SEC. ALEX AZAR: Yes, thank you for that question and that is a vitally important issue which is we have seen community resistance as we have been engaged in the response efforts. I believe we’re seeing improvement. I’ve certainly witnessed that in Butembo. I met with community leaders from the business, faith, women’s and tribal communities there who have expressed an improving relationship with the responders and improved community engagement. A lot of this is about trust. This is an area of the world where there is not a lot of trust to outsiders, often rightly so.
The increasing engagement, fighting for more support of vaccination. As I said, we’ve had 220,000 individuals vaccinated with the experimental Merck vaccine. We are engaging in humanitarian relief efforts through UNICEF such as measles vaccination campaigns, malaria netting distribution, other activities that show that we are about more than just solving the Ebola crisis in that community. And very importantly and this is something I got to see at the Butembo Ebola Treatment Center, we cannot overstate the importance of the two experimental therapeutics that have now come through and remain in an open-arm, open-extension trial.
I was able to see in Butembo, individuals who have been treated with therapeutics and who now are Ebola-free and will leave those Ebola treatment centers cured of Ebola. That is a radical, a radical change from where we’ve been. From a community engagement perspective, in the past, all too often if one went into an Ebola treatment center, whether in this outbreak or otherwise, if one went in sick, one often died. Now, we have the real potential that you will go in sick and come out healthy, and that word will spread.
I got to see a 23-day old baby. This baby had been born of a woman infected with Ebola by C-Section who died two hours after giving birth. The baby was treated with prophylaxis therapeutic and at 23 days, is Ebola free. I met another young boy who was about to be discharged from the Ebola treatment center who again was negative for Ebola after having been infected with Ebola.
MODERATOR: Thank you.
SEC. ALEX AZAR: So I want to emphasize and I would appreciate in your — in anyone’s reporting, to emphasize this point: it is clear, the sooner you present to an Ebola treatment center with symptoms of Ebola and the sooner we get you on these experimental therapeutics, you have a materially better chance of being healed. The longer you wait, the less likely you will be healed even from these therapeutics.
MODERATOR: Thank you very much. Our next question will go to Helen Branswell from STAT. Operator, can you open the line please? Thank you.
OPERATOR: Your line is open.
QUESTION: Thank you very much. I was hoping you could tell — give us a sense of how you think things are going on the ground. The numbers have been coming down since July, they were down very sharply in August and down more this month. But WHO keeps warning that they’re not certain this is a true decline. What are you hearing?
SEC. ALEX AZAR: Well, Helen, let me tell you my personal witnesses and I’m going to ask Dr. Robert Redfield, the Director of the CDC to discuss some of the epidemiological information with you. I was, as I said, I was very happy to be joined by Dr. Tedros as well as Dr. Redfield on the visit to the Butembo Ebola Treatment Center. They had both been at that center in March, shortly after it had been attacked and burnt by individual militia in the city.
Dr. Tedros had been back again this summer. The reaction of them was that we are seeing significant progress in the procedures and the community engagement, in the overall response efforts. That being said, the basic public health contact tracing is still not where it needs to be. And accordingly, we cannot let up.
Dr. Redfield, can you please give some of the data around community death and contract tracing?
ROBERT REDFIELD: Yes, Helen, I think that you’re right, that there has been a decrease in the number of new cases that have been identified. However that’s not been associated with a change in some of the key public health indicators as Secretary Azar said. The community deaths are still in the 20 to 25 percent of all new cases are presenting that the individuals that have been isolated early still is only between 30 and 40 percent. The individuals that have been known as contacts and then monitored successfully is still only around 30 to 40 percent.
So these indicators I think need to change before we have more confidence in the fact we’re seeing numbers be less than they were before.
MODERATOR: Thank you. Our next question came via e-mail from the listening party in Kinshasa, Julie Sefu of B-Online asked are the creators of the molecule mAb 114 Congolese or American? In other words, what are the respective contributions of Congolese and American scientists in the fight against Ebola and when will a vaccine be available?
SEC. ALEX AZAR: Thank you for that question. I’m going to ask Dr. Tony Fauci, the head of NIAID who has been very involved in those programs to answer that question.
TONY FAUCI: The development of the molecule antibody 114 was a completely joint effort between the Congolese scientist led by Dr. JJ Muyembe and scientists from the National Institute of Allergy and Infectious Diseases, specifically the vaccine research center. One of Dr. Muyembe’s patients from the 1995 Kikwit outbreak came to the United States to the NIH in 2006. Blood was drawn from that person. The B cells from that person were cloned into monoclonal antibody was made from those B cells of one of Dr. Muyembe’s patients. That monoclonal antibody is now referred to monoclonal antibody 114.
With regard to the conduct of the trial that proved the efficacy of two of the interventions, that trial was jointly sponsored by Dr. Muyembe and by the Vaccine Research Center of the National Institutes of Health. So it was a completely collaborative effort between the Congolese and the United States’ scientists. With regard to the vaccine, as it was mentioned by the Secretary, over 200,000 doses of the vaccine have been distributed to contacts and contacts of the contacts and right now that vaccine is being —
MODERATOR: Hello? I think we’ve lost our phone line. Operator, can you put everyone on hold just a moment while we try to call him back?
OPERATOR: Thank you.
MODERATOR: Tawni? Hello? Hello? Secretary Azar, hello? Hello? Secretary Azar, can you hear me?
SEC. ALEX AZAR: Tiffany, can you hear us now?
MODERATOR: Yes. We can. Sorry, Dr. Fauci was just completing his description of the vaccines that were given when we lost you. I’m not sure if he had some final remarks from that answer?
ANTHONY FAUCI: Not sure what the time of the cut-off was but with regard to the vaccines just to very briefly repeat it, the question was, when it would be available and I mentioned that over 200,000 doses, as the Secretary said, had been given to contacts and the contacts of the contacts. With regard to when it would be available, right now the United States Food and Drug Administration is very actively evaluating it for approval for licensure and hopefully that is on a fast-track and we think that is something that will happen within a reasonable period of time.
MODERATOR: Thank you. Our next question will go to the U.S. Embassy in Kigali. Can you open the line please?
OPERATOR: Yes, the line is open.
QUESTION: Thank you so much. I am [INAUDIBLE] from the Chronicle, so my question is, recently in Rwanda the Health Minister was saying about to introduce Ebola screening for those people coming from U.S.A. and Spain. So what is your take on this initiative of[INAUDIBLE]?
MODERATOR: I want to make sure, could you repeat the question about screening from I thought you said USA and Spain?
QUESTION: Yeah, I said USA and Spain, one of the many things in the news, they have been reporting that one of the ministers of health is introducing this system of screening people from USA and Spain, especially US and Spain. So I want you to tell us what your take on this initiative —
SEC. ALEX AZAR: That’s just — so that is just not so. There is no screening of individuals from the USA and Spain into Rwanda. The health ministry is engaged in screening individuals coming from the Eastern DRC and the impacted zone and we continue to work with Minister Gashumba and the Ministry of Health in Rwanda to assist them with technical support and expertise on enhancing the screening procedures for the tens of thousands of individuals who cross the border each day between the Eastern DRC and Rwanda. And we also are working to assist the ministry and support them with rapid diagnostic capabilities, with isolation facilities for suspect cases and with Ebola treatment centers. Thank you.
QUESTION: So —
MODERATOR: Thank you.
QUESTION: — in your opinion of the —
MODERATOR: Excuse me.
QUESTION: — thing —
MODERATOR: Excuse me. So we only have time for one more question. This question has come in from the listening party at the U.S. Embassy Nouakchott, Mauritania. Sy Mamoudou, Editor-in-Chief of L’Eveil Hebdo asks, you have said that the U.S. has financed the DRC’s fight against Ebola. Is there a mechanism responsible for controlling the management of these funds?
SEC. ALEX AZAR: So the United States, the World Health Organization, the World Bank and other major donors are of course very focused on the integrity and accounting of the disbursement of the significant amounts of money that are dedicated to this response effort. And we will continue to work on ensuring the integrity of the flow of those funds. The overall response, especially now with President Tshisekedi’s personal engagement and commitment to improving the health of the people of the Eastern Democratic Republic of the Congo and to the Ebola response, and the appointment of a new health minister, who I had the pleasure of meeting in Kinshasa, Minister Longondo. As working along with Professor JJ Muyembe who is the Ebola Commission Coordinator for the Office of the President. They of course lead the response in the Eastern DRC. The World Health Organization, UNICEF, the U.S., and other parties and non-governmental organizations, et cetera, support that DRC-led response effort.
MODERATOR: Thank you. Secretary Azar, did you have any final words before we end the call?
SEC. ALEX AZAR: Just I’d like to thank everybody for joining this call. I want to emphasize that the United States is committed to the people of the Eastern Democratic Republic of the Congo and partnering with the government of the DRC to address broader health development and stabilization needs for lasting peace, security and prosperity beyond the Ebola crisis. As I said when I was in the DRC and met with community leaders, we were there before the first Ebola case and we will be there for the people of the DRC after the last Ebola case. Thank you very much.
MODERATOR: Thank you. That concludes today’s call. I would like to thank the Secretary of Health and Human Services, Alex Azar; Dr. Robert Redfield, Director of the Centers for Disease Control and Prevention; Dr. Anthony Fauci, Director of the National Institute of Allergy and Infectious Diseases and Tim Ziemer, Senior Deputy Assistant Administrator of the U.S. Agency for International Development for joining us. And to thank all of our callers for participating. If you have any questions about today’s call, you may contact the Africa Regional Media Hub at firstname.lastname@example.org. Thank you.