[Congressional Record Volume 160, Number 135 (Friday, September 19, 2014)]
[Extensions of Remarks]
[Pages E1459-E1460]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]




                     GLOBAL EFFORTS TO FIGHT EBOLA

                                 ______
                                 

                       HON. CHRISTOPHER H. SMITH

                             of new jersey

                    in the house of representatives

                      Thursday, September 18, 2014

  Mr. SMITH of New Jersey. Mr. Speaker, yesterday, I convened a second 
hearing in just five weeks on the Ebola crisis in West Africa to 
underscore just how serious a crisis we are facing--an international 
pandemic which threatens to balloon unless confronted head on.
   Earlier this week, I spoke with Dr. Tom Frieden, Director of the 
U.S. Centers for Disease Control and Prevention and the lead witness at 
our August 7 emergency recess hearing on Ebola and he said that this is 
the worst health crisis he has ever seen and that Ebola is at risk of 
spreading beyond those countries currently affected--Guinea, Liberia 
and Sierra Leone.
   Since our emergency hearing in August, we have seen a constant 
movement upwards in the number of cases predicted. The World Health 
Organization now estimates that we will see as many as 20,000 cases of 
Ebola in this epidemic before it is ended. One hopes that that number 
does not increase further, but it may be a conservative estimate.
   I held yesterday's hearing to take stock of where our intervention 
efforts stand, particularly in light of the President's decision to 
commit U.S. military personnel to Liberia to fight this disease. 
Liberian President Ellen Johnson Sirleaf, with whom I also spoke 
earlier this week, has conceded that the Ebola epidemic ``has 
overwhelmed'' her country's containment and treatment capabilities. A 
global response, with the United States in the lead, is thus necessary.
   It is important to note that in in a letter last week to President 
Obama, President Ellen Johnson Sirleaf wrote that ``The virus is 
spreading at an exponential rate and we have a limited time window to 
arrest it. Mr. President, well over 40% of total cases occurred in the 
last 18 days. Our message has gotten out and our citizens are self-
reporting or bringing in their relatives. But our treatment centers are 
overwhelmed. MSF is now running a 160 bed-unit that will expand even 
further. I am being honest with you when I say that at this rate, we 
will never break the transmission chain and the virus will overwhelm 
us.''
   I held the follow-up hearing yesterday morning to determine if there 
is a reasonable hope for vaccines, treatments and detection strategies 
in time to help with this health emergency.
   I hesitate to provide figures for the number of people infected or 
who have succumbed to this virus because even as we hold this hearing, 
dozens, if not hundreds, of new infections will be documented. 
According to the latest figures, infections are approaching 5,000 
people, and 2,500 deaths.
   Ebola, which is mostly unknown in West Africa, presents itself early 
in the infection like usually non-fatal diseases such as Lassa fever, 
malaria or even the flu. The temperature seen in early stages might 
even be brought down with regular medicines. Therefore, many people may 
not believe, or may not want to believe, they have this often fatal 
disease.
   If someone is in denial or unknowledgeable about this disease, they 
may not seek treatment until it is too late--both for them and for the 
people they unknowingly infect. Families in Africa tend to help one 
another in times of need, an admirable trait that unfortunately 
increases the risk of infection. The sicker a person gets with Ebola, 
the more contagious they are, and never more so than when they die. So 
burials that don't involve strict precautions to avoid direct contact 
with highly contagious corpses make transmission of this deadly disease 
almost inevitable. Burial traditions make avoidance of infection 
problematic.
   The porous, lightly-monitored borders in West Africa lend themselves 
to cross-border transmission, as people go back and forth along well-
travelled roads and into marketplaces where hundreds of people, also 
travelling, make contact with those who are infected.
   Patrick Sawyer, a Liberian-American, reportedly was caring for his 
dying sister a few weeks ago. After she died, apparently of Ebola, he 
left Liberia on his way to his daughter's birthday party in Minnesota. 
He collapsed at the Lagos airport in Nigeria and died within days. Had 
he left Liberia a week or even days earlier, he might have made it home 
to Minnesota, but he likely would have infected people along the way, 
including his own family. We can say that because Sawyer infected 
several people in Nigeria, which led to Ebola being transmitted to 
health care workers and then to dozens of other people.
   We'll never know now if Sawyer realized he had contracted Ebola and 
just wanted to go home for treatment or whether he thought his symptoms 
were from some other illness. Many people are just like him, however, 
and they are spreading this disease even to places where it had been 
brought under control. For example, the Macenta region of Guinea on the 
Liberian border was one of the first places this disease surfaced, but 
by early September, no new cases had been seen for weeks. Doctors 
Without Borders closed one of its Ebola treatment centers to focus on 
harder-hit areas. Infected people leaving Liberia for better treatment 
in Guinea have once again made Macenta a hotspot for the disease.
   The U.S. Centers for Disease Control and Prevention has established 
teams in Guinea, Liberia, Sierra Leone and Nigeria to help local staff 
do fever detection and to administer questionnaires on potential 
troublesome contacts. The agency also is helping to establish sites at 
airports for further testing and/or treatment.
   Liberia and Sierra Leone are the hardest hit by this Ebola outbreak. 
This is undoubtedly partly because of the weak infrastructures of two 
countries emerging from long conflicts. However, post-conflict 
countries also have significant segments of the population who don't 
trust the central government. The unfortunate mishandling by the 
Liberian government of an attempted quarantine in the capital 
demonstrates why trust has been so difficult to come by.
   The Liberian government established barriers to block off the West 
Point slum area after a holding center for Ebola victims was ransacked 
and contaminated materials were taken. This quarantine was done without 
informing its 80,000 inhabitants or consulting with health care 
workers. Not only did this prevent people from pursuing their 
livelihoods or bringing in much-needed supplies, this move created 
great suspicions over the motives of the Liberian government. This 
suspicion was heightened when the official in charge of the area was 
called to a meeting and was seen leaving just as everyone else was 
trapped behind barriers.
   The furor over this quarantine forced the government to abandon it 
10 days into its planned 21-day term. Liberian officials assure us they 
have learned from their mistakes, that the quarantine and has alerted 
Liberians to the reality of the Ebola epidemic. The human rights of 
victims and those who live in proximity to them must not be sacrificed 
by the emergency situation Ebola presents.
   Despite the fact that the drug ZMapp appears to have saved the lives 
of Americans Nancy Writebol and Dr. Kent Brantly, one of the witnesses 
from yesterday, there are no proven, readily available treatments for 
Ebola. The death rate for this disease, once more than 90%, is now down 
to 53% despite the number of cases growing exponentially.
   In Africa, a few patients apparently have been successfully treated 
with ZMapp, and some others have been saved using other treatment 
methods, especially when the disease was identified early. Yet there is 
not now, nor will there be in the short term, large quantities of this 
medicine or any others. There are several Ebola therapeutics under 
development, but if this outbreak cannot be brought under control soon, 
even the most optimistic timetable for the testing and production

[[Page E1460]]

of these drugs will not be sufficient to meet the ever-expanding need.
   ZMapp was used with the informed consent of those to whom it was 
given. But how can we guarantee that the many Ebola victims whose most 
likely salvation would be to use an experimental drug truly understand 
the risks of using a drug that has not been fully tested and vetted by 
the authorities in the country in which it is developed? No drug is 
100% effective, so what will other victims think if some people die 
despite taking experimental treatments? We must protect the rights of 
those willing to take a chance on unproven treatment when they have no 
other alternatives.
   Lack of faith in national and international systems fighting Ebola 
also has impeded the replacement of the many African health care 
workers who have died from this disease. For example, even before this 
Ebola outbreak, Liberia had fewer than two doctors for every 100,000 
people. As of late August, 164 Liberian health care workers had 
contracted Ebola, and 78 had died.
   African health care workers face an epidemic that threatens to defy 
control. The lack of diagnostic techniques and insufficient supplies of 
safety equipment have put these health care workers at extreme risk. 
These health workers know that the lack of treatment centers and 
medicines means that those on the front lines of this epidemic are most 
at risk. Some have asked for insurance for their families should they 
succumb to Ebola and certain evacuation for treatment outside the hot 
zone. These heroes deserve all the support we can muster.
   Ebola not only challenges the collective ability of the world 
community to meet the demands it poses, it threatens the progress made 
over the last decade by African countries in overcoming conflict and 
improving economic development. Even after this outbreak is finally 
brought under control, its damage will be seen in lowered gross 
domestic product and diminished foreign investment.
   So we must be prepared to create effective strategies to help 
affected African nations recover. A large part of any successful 
strategy will feature efforts to recreate and dramatically expand 
health care systems in West African and other countries on the 
continent. This epidemic has shown that we must not be complacent about 
weak governance or health care systems. To that end, Ranking Member 
Bass and I will soon introduce a bill to address the emergency and 
ongoing needs in the fight to contain the Ebola epidemic in West 
Africa.
   We live in a world that is increasingly interconnected, and Ebola 
has demonstrated that our neighbor's problems can soon become our 
problems.

                          ____________________