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Health and Human Services: We Have the Right Strategy in Place

Health and Human Services Sylvia Burwell details the strategy for fight against Ebola at home and abroad at a Senate hearing.

President Barack Obama's request for $6.18 billion to fight Ebola will go to fill years of funding cuts at home and abroad that have put the U.S. at risk of new disease outbreaks, experts argued Wednesday.

Republicans critical of the federal government response complained about what they called a confused and uncoordinated policy, but no one at a Senate Appropriations Committee hearing seemed to indicate the money wouldn't be approved before the end of the year.

"The situation is serious," said Maryland Sen. Barbara Mikulski, who chairs the committee. "First, we must fight the disease at its epicenter in West Africa — in Liberia, Guinea and Sierra Leone."

"We have to have a strong worldwide public health effort."

More than 50 organizations weighed in with written testimony supporting the spending and saying budget cuts have damaged U.S. preparedness.

"We have to have a strong worldwide public health effort."

"We believe we have the right strategy in place both at home and abroad," Health and Human Services Secretary Sylvia Burwell told the hearing.

Alabama Sen. Richard Shelby, ranking Republican on the committee, criticized what he called a “confusing and, at times, contradictory” U.S. government response.

“For example the CDC’s guidance to hospitals has been a moving target,” Shelby said. “This uncertainty may have exposed healthcare professionals to unnecessary risk.”

Two nurses were infected by the first domestic U.S. Ebola case, Thomas Eric Duncan, and the CDC said later that nurses appeared to be using protective gear incorrectly at the hospital where Duncan was treated.

More than 14,000 people have been reported with Ebola infections, the World Health Organization says, and more than 5,000 have died — although the actual numbers are almost certainly higher.

"We believe the number of true cases is larger than the number of reported cases," Centers for Disease Control and Prevention director Dr. Thomas Frieden told the hearing.

But the threat is in West Africa, he said, not the United States. "We do not think a large outbreak is likely in our country," Frieden said.

Much of the money would go to helping build better public health systems in the three worst affected countries, Frieden said. They lack the ability not only to treat patients, but to detect disease outbreaks in the beginning. "You don't need to look any further than the difference with what happened in Nigeria with Ebola and Liberia with Ebola to see what a difference a prepared public health system makes," Frieden said.

As they spoke the U.S. military announced plans to scale back the number of troops to be sent to Liberia from 4,000 to about 3,000, saying that's all that would be needed.

Ebola began out-of-control spread in Liberia over the summer, overwhelming communities wrecked by years of civil war. In Nigeria, an intense track-and-trace effort stopped an outbreak quickly when Liberian-American Patrick Sawyer carried the virus there. "It took enormous effort, but they stopped it," Frieden said. "Today Nigeria is Ebola-free. The world would be a different place if Liberia and Sierra Leone had those systems in place today."

"We are now facing a cluster in Mali."

And now, Frieden said, Mali has doctors worried. The World Health Organization says a prominent religious leader from Guinea traveled to Mali while sick with Ebola but no one knew until after he died and had been through elaborate funeral preparations in two countries. One nurse infected while treating him has died. Now, weeks later, disease detectives will have to track down hundreds of people who may be at risk.

"We are now facing a cluster in Mali," Frieden said. "The challenge is to make sure that cluster ends as the Nigerian cluster did."

Public health systems like the ones the federal government hopes to build will help do that, he added.

Other groups said Congress has gutted public health funding for years and the country will suffer more consequences if it isn't replenished.

“The budget sequester and other funding cuts to state and local governments have harmed our public health infrastructure. Years of cuts have meant losses in experienced and trained public health staff," the American Federation of State, County and Municipal Employees said in written testimony.

Hospitals have been unprepared because of cuts, also, the American Hospital Association said, citing repeated cuts to the Hospital Preparedness Program that pays for emergency preparations. "For fiscal year 2014, Congress appropriated only $255 million for the HPP, more than a 50 percent reduction from prior years," the group said.