tv Key Capitol Hill Hearings CSPAN May 26, 2015 2:00pm-3:31pm EDT
>> one of the questions about freedom of speech is, is it a value in and of itself or is it there because it's designed to promote democratic decision making? you might come out to different kinds of results on some of these campaign finance cases because there's something the matter with a system where the first thing you ask about a candidate is how much money can she raise. and a system in which somebody has to sit in a room for 20 hours a day dialing for dollars to be competitive, or a system many which poor people do not have access to the decisions being made. it's troublesome for government to do any regulation, i've got to agree with that. so you have a deep, a deep conflict going on there but it's not an easy result on either side. and the first thing i tell my first amendment students is if you think this is an easy decision on either side, rethink it. >> just part of the discussion on freedom of speech and
campaign finance that took place at the constitution center. you can watch it tonight in its entirety at 8:00 eastern on our companion network, c-span. [inaudible conversations] >> and taking you live today to the heritage foundation for an update on the global response to ebola and the defense department's role in fighting the disease. this should be getting under way shortly. [inaudible conversations]
louis lehrman auditorium. we, of course welcome those who join us on our heritage.org web site. would ask everyone here in house if you'll be so kind to make that last courtesy check that your cell phones have been turned off. it's always appreciated. we will, of course, post the program on the heritage home page following today's presentation for everyone's future reference and our internet viewers are always welcome to send questions or comments, simply e-mailing email@example.com. hosting our discussion today is cully stimson is. mr. stimson is manager of our national security law program. he is also a senior legal fellow in the katherine and shelby davis institute for national security and foreign policy. he is a nationally recognized expert on homeland security as well as crime control. he writes and lectures widely on these issues as well as military detention and commissions, intelligence and criminal law immigration and the war on
drugs. before joining us here in 2007 he served as deputy assistant secretary of defense for detainee affairs. he has also worked as a prosecutor at the local state and federal levels. he has served for three tours on active duty in the navy judge advocate general's corps as well. please join me in welcoming cully stimson is. cully? [applause] >> thank you very much, john. and i want to welcome all a of you to heritage on this second day of the summer 2015. a come years ago -- couple years ago my colleagues here at heritage formed an ebola task force to look at policy decisions and the actions our federal government took with respect to the ebola outbreak. the task force's mandate was to
identify and make certain findings on how the u.s. could better respond to future crises. they issued a heritage paper. these were scholars in and outside of heritage, which was published on the 24th of april this year. three days later we hosted a panel event entitled ebola outbreak and response, assessment of initial u.s. actions. we heard from dr. daniel cause knew sky from george washington university peter fam, director of the africa center, and our very own dr. john o'shea senior fellow in the center for health policy studies. they shared their thoughts on state quarantines, federal and state preparedness the world health organization preparedness to deal with ebola the role of u.s. doctors in the centers for disease control and other
related domestic issues. but that's not the whole story, which brings us to today's panel. and i think it's altogether fitting that on day after memorial day we highlight dod's critical medical research and development role in fighting the ebola virus. theirs is a story, quite frankly, that's not well known and hasn't been well publicized. but one which is, nevertheless, impressive and was critical to semiing the tide. to stemming the tiled. we've assembled leaders of four key dod organizations who are dedicated to protecting our war fighters and our country against injury and disease to include ebola. now i'm not a doctor, but as a 23-year veteran of the navy, i have have immense respect for what dod can bring to the table in almost every area of
national defense. and i've followed the task force's work closely, and in civil society i happen to know one of the key leaders in the dod medical research field who, when speaking with him at a social event we thought that we needed to tell dod's story a little better. and heritage is delighted to do so today. the format for today's event is quite simple, i'm going to sit down and be quiet, and i'm going to turn to the experts, and we're going to go in the order in which they're sitting. each will make prepared remarks assisted by some powerpoint slides perhaps, and at the end of their collective talks, i'll moderate a q&a. carmen spencer is the joint program executive officer for chemical and biological defense jpeocbd. in that position he provides
acquisition management and professional leadership on issues related to joint service chemical and biological defense acquisition programs. he plans, directs manages and coordinates the execution of that mission and is responsible for the development, acquisition, distribution, and deployment of highly specialized and dynamic joint chemical and biological defense devices as well as medical diagnostic systems, drugs and vaccines. he also provides management oversight for the chemical demilitarization program, an acquisition category 1d program for the assistant secretary of the army and army acquisition executive. he received his bs degree in hawaii. colonel russell e. coleman, ph, is the joint program -- ph.d. is with the office for countermedical systems located in maryland. he leads the dod organization responsible for the development,
acquisition and fielding of food and drug administration approved medical countermeasures to chemical, biological, radiological and nuclear threats. he is the author of over 85 peer-reviewed scientific publications and has been the primary investigator on nih world health organization and dod grantings n. 1995 colonel coleman deployed to zaire as part of a team responding to an ebola virus outbreak, and in 2003 he was deployed for operation iraqi freedom as the chief of preventive medicine section of the 520 theater army medical laboratory. in 2008 he became deputy commander of the u.s. army medical material development activity. he was selected as tenth commander of that organization in 2010 and served in this position until 2013. he received his bs in biology from the state university of new
york you'll tell by his accent he's a new yorker, a master's degree in medical etymology and a doctorate in medical etymology from the university of massachusetts. colonel stephen j. thomas m.d. is the deputy commander for operations and ebola response management team lead at walter reed army institute of -- army institute of research. u.s. army medical research and material command. he also serves as the infectious diseases consultant to the army surgeon general. he is the chief operating officer for that enterprise which encompasses over 2,000 military u.s. government, civilian, foreign national and contract employees and laboratory facilities in northcom africom, paycom. colonel thomas is also an internationally recognized i havologist and spent more than five years of his early career living and working with thailand and other areas in southeast
asia. he too, has authored more than 55 articles and seven book chapters and routinely represents army medicine's expertise by speaking at national and international scientific events. he sits on expert scientific committees and boards for the dod, nih the bill and melinda gates foundation and numerous pharmaceutical companies working on u.s. military development priorities. he took his bachelor's degree with honors in biomedical ethics from brown university and a medical degree from albany medical college. finally, colonel neil e. woolen, dmv, mss, ph.d., is the director of biosecurity at u.s. army medical research institute of infectious diseases. this is one army acronym i do know. did i get that right? >> yes sir. >> all right. a biological defense laboratory that is part of the u.s. army medical research and material command. during his first tour of duty
he participated in ebola outbreak investigations in zaire and the thai forest of the ivory coast as well as animal outbreak investigations and field studies in the northwest territories of canada and montana for anthrax plague and other diseases. in 2010 colonel woolen returned where he served in his current position while also completing senior service college through the distance education program at the army war college. he received his doctorate in veterinary medicine in 1985 and a doctorate in veterinary pathology in 1989, both from kansas state university. he also received a master's degree in strategic studies in 2012 from the u.s. army war college. mr. spencer the floor is yours. >> thank you.
>> first off thanks, cully, for giving dod the opportunity to tell its story. that's kind of rare for us, you know? when you tell folks that your job in life is preparing the armed forces for chemical and biological and radiological events you're not the most popular guy at cocktail parties. and most people just run away. so we do appreciate the opportunity. our mission is pretty simple actually, and what we do in dod, we develop the medical countermeasures to combat chemical biological, radiological and nuclear threats. and the threats are real. when we look at the last four years and what we've experienced in global crises around the globe, we've had three major events. in march 2011 at talk about she that -- fukushima when three of six nuclear generators went down creating a global crisis dod was there for the response. in august of 2013 the use of
chemical weapons in the country of syria, and the u.s. was called upon as part of a u.n. effort, in support of a u.n. effort, and we destroyed those syrian chemical weapons. so we had the r, the n and the c, and then, of course, we're here to talk about in april of last year with the ebola outbreak. and then we had the biological. so three out of the last four years major global threats that dod has had to respond to. despite numerous you know smaller scale outbreaks we still don't know the origins the natural vector or the carrier of the ebola virus. it's highly contagious on its own, we all know that. it's a pathogen that poses a risk of deliberate misuse with significant potential for mass casualties or devastating effects. the dod's been engaged in research and countermeasure development for many years and during that time we've developed
a number of unique capabilities. this outbreak though posed some new challenges for us. sierra leone, liberia and guinea had never experienced a widespread epidemic of this kind. moreover the public health infrastructure presented challenges. a lack of trained medical professionals was a critical problem. for example, before the epidemic started cia reported that for every doctor in liberia, there were 100,000 patients. in the u.s. that ratio's roughly 242 doctors for every 100,000 patients. the affected preponderancelations were large -- populations were large, mobile and urban. local funeral customs included prolonged exposure to the infected deceased personnel. in responding there's a limited -- very limited -- incentive for private industry the proactively develop response
tools whether they're diagnostics, therapeutics, vaccines or other related equipment. even with therapeutics and vaccines in development, largely with support from are the u.s. government, the path to fda approval is somewhat unclear. and no mass production capability more these materials is readily available. and in the response dod did not lead the response. we were part of massive whole-of-government response and in support of a whole-of-government can response. and it really was a great example of the interagency working and pulling together for a common cause. you know, our government is bureaucracy. in time of crisis, it's amazing what we can accomplish in short order. and this certainly was a time of crisis. even within dod it was a team approach, as you sue -- as you see these gentlemen here.
not only was my office that's responsible for the life cycle development of these products but we also had medical countermeasure systems that leads the effort to develop and require safe, effective and innovative medical solutions. the walter reed army medical institute of research conducts biomedical research that's responsive to needs and delivers life-saving products that sustain the combat effectiveness of all of our war fighters. and, of course the united states army medical research institute for infectious diseases is the lead laboratory for medical, biological defense research. let me talk just for a few minutes and give you an overview of the response. the response was four-pronged; identifying the causative agent providing diagnostic tools treating the infected and preventing further infection. the diagnostics therapeutics, vaccines and quarantines protocols developed by department of defense provided
the core for this response. usamrid and r.a.r.e. and others within the dod partnered to respond to the outbreak. mcs under colonel coleman's leadership provided diagnostic biosurveillance efforts and accelerated production efforts. it also accelerated the development and production of two experimental drugs that colonel coleman will discuss in his presentation. and lastly, mcs also funded clinical trials for ebola vaccines. the planning and executing of a safe deployment of u.s. forces relied on r.a.r.e. predeployment training and global biosurveillance. the results speak for themselves. while deployed no american service members contracted ebola or for that matter, malaria a disease which affected 44 of 150 deployed marines in 2003. usamrid supported training and consultation on patient care, transport and dead body
management. they rapidly helped fill public health knowledge gaps in the outbreak arena. in conclusion, given the events of the last four years, fukushima syria, west africa, we mow that these threats are not academic and that surprise is becoming routine. preparing a response to unknown threats requires massive flexibility. preparation from biosurveillance to intelligence, research, development planning and coordination is key to minimizing or containing the next major event. the u.s. department of defense is leading the way in each of these areas. thank you again and thank you to the heritage foundation for hosting this event and i'm really looking forward to the q&a period. thank you very much. >> now i'll introduce colonel neil woolen. >> thank you sir. ladies and gentlemen, it's a real pleasure to be here with you this afternoon to be able to to represent the u.s. army
medical research institute infectious diseases and talk to you about the contributions that that organization has recently made. as has been pointed out i'm a veterinarian currently serving as director of biosecurity at usamrid, and our mission is to provide solutions provide capabilities to service members in the way of medical countermeasures to counter a bio threat. the hallmark, i believe from this outbreak response is if you see the bottom line of this slidenb whereñr it says medical biological defense insurance policy for the nation, this is what our commander wants us to be. everyone that walks into that building daily, this is what he wants us to be. the irony of this is that solutions built for biodefense were readily and easily transferable to a real world outbreak of infectious diseases. i think that's one of the hallmarks of this current outbreak response. this next slide shows you what we consider to be our mission essential task list at usamrid.
they're simply core capabilities that the organization must excel at for it to be successful in its contribution to the global effort. and these are what the commander has established for usamriid, providing world class expertise of biological defense to rapidly identify biological agents, train and educate the force daily and everywhere we go establish biosafety, biosecurity and biosurety capabilities and protocols and then develop and test and evaluate medical countermeasures most importantly the last one is to prepare for tomorrow's problems, being prepared for elements of uncertainty. usamriid has a legacy research program that has given us a wealth of knowledge and experience in working with the ebola virus. usamiriid has a basic science
program as its core fundamental element of contribution where it works on both discovery and development of medical countermeasures, and it has done that with ebola for several years. it leverages this in field activities as well. kickwit outbreak in 995 was one of my first experiences and it's one i'll bring to your attention today. but usamriid's presence in outbreak investigations predates the 1995 outbreak. and then again in society due soy, this was a -- coat due soy, the concern was the virus may be high up in the canopy. it never looked at species high up in the canopy, and we partnered with other nations in this effort to develop catwalks through the canopy and trap and collect blood from species that
live up in the canopy rather than on the forest floor. we brought an element of experience to these and coupled with our interagency and international partners built strong teams where we worked in collaboration with the centers for disease control and world health organization. this is a pretty busy slide. areas we are currently working on the research and development and testing evaluation but i wanted to draw your attention to the four bolded bullets on this slide. ebola therapeutics, vaccines and then the joint biological identification system and the ebola virus diagnostics. vaccines and therapeutics usamriid i think there only may be one of current candidates that has not passed through usamriid for some sort of testing and evaluation.
we support this effort heavily, have a lot invest inside looking at these various candidate therapeutics and vaccines. the joint biological identification and detection system was heavily tested, and it was one of those field trial test that is we did when we were talking in the introduction about the times we spent up in the northwest territories of canada looking at natural outbreaks. we would take those to the field and try to field test them. and then most importantly, the ebola zaire diagnostic for this outbreak it provided a realtime diagnostic capability on ground. and i want to, i want to take just a moment to highlight that because when i was in kickwit in 1995 one of the critical things that was missing was the ability to diagnose realtime on the ground, because every patient after the first patient was diagnosed as ebola, any patient after that that looked like ebola went into the ebola ward. during this outbreak with
realtime diagnostics on the ground, we were able to set up screening capabilities to where patients could be tested and then sent to a different treatment facility if they were not positive for ebola. is so this is critical. this assay was also approved by the fda emergency use authorization to be able to diagnose samples from u.s. citizens on the ground. we talked a little bit about rapid diagnostics already. usamriid has years of experience in operational support to deployable laboratories and we are part of the cooperative biological engagement program. and we were actually in west africa -- or have been in west africa since 2006 helping nations develop diagnostic capabilities for hemorrhagic fever viruses. most of those efforts got channeled towards ebola as early as march in sierra leone and then april in liberia to combat
the current outbreak. we also put genomic capabilities on the ground in liberia, the intent to be able to monitor virus, to be able to track any genetic changes in the virus because if it would genetically mutate during the outbreak, a lot of the vaccines and therapeutics may not work, so we wanted to be able to track that throughout the outbreak. training, education, consultation a number of standard publications were used as reference materials and core training courses, but i want to highlight the other operation the united states citizens support. this is where usamriid personnel stood up to the challenge to add additional training that's not part of their core element. they provided training to over 4,000 deploying personnel on how to don and doff personal protective equipment. they also consulted with various agencies on dead body management and patient transport to
minimize the spread of ebola infection throughout the course of an outbreak. and then the field identification of biological warfare agents course is a standard course but it was leveraged heavily by every laboratory capability that was going into liberia to assist. this slide kind of shows a summary, and i've already talked about these so i'm not going to run through these, but you'll see how each of the commanders' mission essential task lists or core capabilities were able to be brought to bear on this outbreak. and usamriid stands ready to do that in the future with any other agents that we have a mandate to work on and therefore, have training, knowledge and expertise to do such. bottom line is usamriid provides, has provided and continue to provide nonstandard skill sets and solutions to operational problems that deal with infectious diseases of a high consequence type of organism.
usamriid is uniquely prepared to support infectious disease outbreaks and we must be prepared for the uncertainty of tomorrow. thank you for listening to my presentation. i'll be followed by colonel russ coleman. >> so, good afternoon. my name's russ coleman, and as you heard colonel woolen and i had the opportunity the deploy to zaire back in 1995, and i can still remember clear as day. my wife was seven months pregnant at the time. when i was coming home and she heard that, well, the army was going to give me a thermometer and if i got a temperature, they were going the throw me in the slammer, and that's the isolation ward at usamriid where if you came down with something bad something nasty that's where they'd isolate you.
my wife clearly concerned about her own health and the health of our unborn child said the heck with that, you throw him in the slammer right now. [laughter] so you flash forward, you know, '59 to now, just -- '95 to now, just about 30 years, and you look at where we are. and there were complaints, and we've all heard them, where are the drugs, where are the vaccines, but i think the story we're telling is we've really come a long way and i'm going to highlight some of those issues. so i'm an advanced developer, so what does that mean? i've got to put that into context. you've heard from colonel woolen about usamriid and all the science stuff that happens there. they investigate ebola virus look at what are potential ways to block virus from developing in a person. but that's basic science, and that doesn't get you a fielded drug or vaccine or therapeutic. and that's where my organization, the joint project
management office for medical countermeasure systems comes into play. there's a handoff that occurs, so they've got this science going on and, aha, it appears they've got a potential therapeutic product for ebola. and it transitions to my group, and we bring an entirely different set of skills to bear, because my job is to take that science and work with a commercial company and somehow spit out a fielded product at the end that's approved by the fda, that we know is safe, that it's effective and it's manufactured consistently. and is so it's a different skill set -- so it's a different skill set that exists in my group from colonel woolen's or colonel thomas' group at the walter reed army institute of research. so what i'm going to talk to you now are about some of the areas that we've been involved. and as mr. spencer said nothing we do takes place in a vacuum. i may talk about what occurs in my organization but the reality
is we partner with r.a. a r.e., with us aukes mriid with the centers for disease control, with the nih. it's a true collaborative effort at so many different levels. so i'm a going to really highlight now a little bit about our history, how we got involved in the outbreak. i'm going to talk, as i just mentioned, the whole-of-government approach that it really took. for example, we worked with r.a.r.e.. they were doing some clinical trials to see how safe was this vaccine they were working on, and we had a direct and relevant role partnering with them. we worked with usamriid on different assays, different aspects of testing going on in their facility. and really what you hear, the story that we're telling here is throughout this whole ebola outbreak we remained agile and flexible and responsive. so as mr. spencer had mentioned, our mission in the joint program executive office is chemical and biological threats, you know?
nefarious use of an agent for some evil purpose. but reality is the compounds that have been weaponized, they also occur naturally, and so we've got the capability to provide to respond when these natural outbreaks occur. is on this chart -- so on this chart, and i don't know how clear -- well, i would gather you can't see that at all from where you sit, but this really highlights the key areas that our organization actively was involved in. and it ranges up top it's detection of the virus, we get into the treatment of the virus and into vaccine development. and i'm not going to belabor any of this here, but this was the timeline that shows how and when and where we were involved. i've got some more detailed slides that i'll use to highlight some of these points. so when it comes to ebola virus detection our team partnering with usamriid we really identified the first cases in
west africa in this outbreak. our assays that were on ground there were used to detect the first cases. you heard a -- you've heard a lot about cases here in the u.s., you know, the number of personnel who came back and were infected and the testing that took place. that was always conducted by the cdc. well the story that's not really told is that all those assays were dod-developed assays that, with existing memorandums of agreement between the department of defense and the department of health and human services allowed us to provide our dod assays to cdc. because there was a gap there, and we were able to support them in their mission. and so you may have heard about the ebola easy one assay. what i'm going to talk about and you'll hear from me, is the challenges of developing these medical countermeasures. and what i when i say that what i mean is we're developing products that we hope will never be used.
and that's a fundamental fact. we're developing products for threats that we don't know what, where or when will occur we just know something will happen. as mr. spencer highlighted over the past three years we've seen a bio outbreak we've seen use of chemical weapons, and we've seen use of nuclear. we really weren't able to predict any of those. for example when it came to bio, it could have been ebola it could have been something else and we have to be prepared for all of it. the challenges that my group faces, though, is that when it comes to developing these countermeasures, we do this in partnership with commercial companies. and these are companies that are driven by return on investmentings. they've got to make money -- investments. they've got to make money. so the business model that exists is tremendously challenging, you know? hey, we want you to work with us and make these countermeasures you're probably not going to make any money doing it. that's the reality of the business that we're in, and it's extremely difficult. so when you hear an outcry from
the folks in the west africa, hey, where were the drugs and vaccines? they should have been here? we absolutely agree with that. however, it's incredibly challenging. and the fact is that over a number of years it's the u.s. government department of health and human services with nih and barta, and it's been the dod with our laboratories and our advance ared developers who are conducting the research that goes into the development of these products. and that's really a fundamental point that it's important to understand. i'll get back to it at the end with my comments about the challenge of getting these countermeasures actually commercialized and available. so back to virus detection. we've got a couple of assays here, and with diagnostics we're trying to be prepared to respond to upwards of 20-30 different threats out there. it would be cost prohibitive for everything in the near term, and we haven't been able to do everything in we want. but we had assays that were
prepositioned with the food and drug administration that had data that showed they were safe and effective. and when this ebola outbreak hit in less than 30 days, we were able to get fda approval under an emergency use authorization to use these assays. and that was a tremendous accomplishment, and that allowed us to move our assays forward throughout the u.s. working with the cdc where they were available to detect ebola in those patients. when it comes to ebola treatment obviously there are no currently fda-approved therapeutics. that's a widely known story. they just don't exist. it is a hard business when you take a virus like ebola -- which is jai highly lethal, 50%, 90%, it's difficult to say, but we know it's highly lethal. and so seeking out and this is where usamriid comes into play. they've been working on ebola for many, many years and
working trying to find therapeutic products. the challenge comes, as i said, how do you get those approved by the fda with a commercial partner onboard? the point that's usually lost is they had funded the development of a number of promising candidates. they had commercial partners. they had some data that showed these products were effective and safe but not enough to get full fda approval. and so by working with the fda, we were able to take some of these compounds and they were put into patients here in the u.s. op an emergency use basis. and with the full support of our fda. and so two compounds listed here in the portfolio -- one is a compound that was developed by the japanese for influenza, but it's effective against a wide range of viruses so our team has been working on getting the
data to show this works against influenza and also ebola. so we were able to work with the fda. and this went into, i believe, a total of 13 patients here in the u.s. now, at this point we can't say for sure did this product work in those patients because they were getting a whole smorgasbord of cocktail of treatments, which this is one of them. the second compound is something that's interesting because it's what's called a platform technology. and so what this means is you have a platform that's capable of spitting out a product on pretty short notice. so you could have a platform established, and if something pops up like ebola, in short order you're able to identify the threat sequence gene type and produce -- gee know type and produce a compound that will hopefully be able to treat it. and in this case we had a product that was really for ebola zaire that was found in
kikwit and it turns out it's different than the one circulating in western africa. so working with our commercial partner in a of i want to say two or three months, they were able to identify the sequence and develop a product that was specific for the virus in west africa. now, there are some ongoing tests of this compound in west africa. not done with us, but done with the european consortia. and, again this highlights once again the relationships that are needed to keep these products under development and keep them moving forward, it's just not dod can, it's not even just u.s. government. in many ways they're international efforts. and the last tier of our three areas to work on is prevention some of the vaccine work. so we began working on ebola vaccines back in 2010. and so that's our group in advanced development. but in the he can tech-based louisiana laboratories, they've
been working on it far longer than that. we had a trivail lent vaccine effort going, and that was intended to treat not just ebola zaire, but ebola sudan and marburg virus as well. and at the start of this outbreak when it became clear hey, we're dealing we with ebola zaire, there were efforts to identify is there a vaccine candidate that could treat the disease circulating in west africa, and you've all heard about, i believe, the vfv delta g vaccine candidate. and that -- the testing has gone on at r.a.r.e. our group was involved,nih was involved, i think, colonel thomas you'll touch upon that in your talk. so what i've tried to highlight is that when we talk about medical countermeasures, it's much more than just the science that has to take place. it's getting the commercial partners, it's a business model
that exists. i don't know if any of you are familiar with the fda priority voucher programs. so a number of years ago it was recognized that we were not delivering medical countermeasures more some of those threats that occur in the less developed parts of the world, you know? where diseases occur that there's just not a commercial market. and so the u.s. congress established fda priority voucher system that would incentivize industry to work on diseases these neglected diseases that were seen of minimal importance. but what i would like to highlight is we face the same situation when it comes to chemical biological, nuclear threats. we recognize they're important, but there's a lack of incentives, and that makes this business incredibly challenging. so at that point, you know, key points here, you've heard about how our organization has a long history working with other partners. you've heard about and will continue to hear more about
working with the other government agencies and our ability to deal directly with this outbreak. and my final point here is the need to really be proactive about looking at medical countermeasure development whether it's for ebola or other threats that face our nation. and with that, i'm going to turn it over to colonel stephen thomas. >> okay good afternoon. i'm really glad to be here, thank you very much. i'm going to talk to you about the walter reed army institute of research. i'm going to tell you who we are, what we do and how both of those were leveraged to participate in the ebola response. so this is a question of the r.a.r.e.. it's located in silver spring maryland, just inside of the beltway. we were established in 1893 so just over 120 years. a very long time. we have the dod's largest biomedical research facility. as you've heard before, we have around 2100 u.s. government
military foreign service national and contract employees working not only in silver spring, but a number of locations around the world. and we work in two main areas. the first area would be behavioral health and brain health. so we work on issues like traumatic brain injury, post-traumatic stress disorder we work on sleep and the interface between sleep and performance. and then we work in areas of infectious diseases and that's what i'm going to highlight for you today. as long as we have had an army and a nation, infectious diseases have posed a threat not only to the u.s. service member but also to the citizen. and that occurs in peacetime and at war. and it occurs both here locally as well as overseas. and it's been the organization that i work for, our charge to try and develop countermeasures to mitigate or to eliminate that threat to the service member and to the nation. and we have done that successfully for a number of years, and i list a couple of examples of just the vaccines
that we have developed. and these make a difference not only in military recruits but those people that deploy overseas into harm's way. finish we have done that successfully in the past working on and figuring out solutions to past problems but we're also looking at current threats and what the future threats may be. and you see a couple of examples there, things like hiv dengy, malaria and ebola as well. and we co-- we do that because we are an institution of competencies and capacities and research pratt forms -- platforms. we have people that know how to do research and development, and to combine those two things is important and very strategic. and in addition to the expertise that we have and the domestic platforms that we have we also have a large network of overseas research capabilities. we have a behavioral health unit in germany which is currently in
the process of transitioning to washington state we have a relatively new unit in the caw cays just outside of georgia, and then we have a longstanding presence in africa and southeast asia. and these are very deep and enduring partnerships with host nations where we identify common threats and common interests and then work together at government level, at the civil society level and at the community level to try and come up with countermeasures that serve both of our needs. and as you'll hear, these platforms are incredibly important for the u.s. military and our countermeasure development activities. so that's who we are and that's where we are and that's what we do. how is this all leveraged for the ebola response? the first you've already heard alluded to was testing of vaccines. so when these vaccine toes complete their early development testing at places like usamriid
they eventually need to be tested in humans. we do that both here nestically as well as overseas. so when the defense threat reduction agency came to us and asked if we wanted to participate and we were able to do the first human trial of this ebola vaccine candidate, we were very pleased to be a part of that and we did that. and we did it very quickly and we were able to do that because we can -- we're agile, and we're able to redirect personnel and other resources to acute needs that arise. so in a very short period of time and in a small number of volunteers, we're able to demonstrate that the vaccine was safe and produced the immune response that we wanted it to. but we didn't do that in isolation. we worked with dr. a few che and dr -- fauci and dr. lane's team at the nih at the same time with the same vaccine candidate. and we jointly published those results in the last couple of months. but it didn't stop with the u.s. government. we were also working with the
world health organization because there were other groups that were also doing these small safety trials. and together we were able to take all the blood samples send them to usamriid and they were able to generate the data that was required to make informed decisions what about vaccine dose needed to be use inside west africa. and you've probably seen the lay press those trials are ongoing right now. so as colonel coleman mentioned it's not just dod it's not just whole of u.s. government, it's an international effort. and our vaccine trials that we were doing here in the u.s. were also being done overseas. and, in fact the vaccine trial we did at the the r.a.r.e. this past year, it wasn't the first time we had done an ebola vaccine trial. building on military hiv research program which has had a presence in you uganda for many years and collaborations we did the first -- that i'm aware of -- human vaccine trial on the innocent of africa -- continent
of africa back in 2008, and those results were just published as well. they just finished enrolling in a second ebola vaccine trial in uganda, and we are scheduled to start an ebola vaccine trial in nigeria. so i think this is a prime example of how the dod is very good at expeditionary medicine, but more than that, expeditionary research and development. and i think that is a unique characteristic of our organization. so that was the vaccine testing story. but we responded in other ways as well to support operation assistance and to support domestic ebola preparedness. this was a different kind of operation than the 101st airborne and other operational groups had been involved in before. so it was very important to provide them predeployment training so that they understood what the threats and the risks were. and in my mind, ebola was not the number one infectious diseases threat to the deploying
force, it was malaria the most severe form of malaria. so we conducted a lot of predeployment infectious diseases threat briefings with the southern regional medical command and brooke army medical center to all the deploying troops. you remember me telling you about the behavioral health side of our institution. we also sent behavioral health teams deploying troops, to gain their understanding and perspectives about the operation they were about to undertake and to understand what the specific mental health stressors may have been on that group. we also looked at controlled monitoring for that group. and that data is coming in, and we're analyzing it now. and then if you remember back to that map that large presence we have in africa and the large presence we have in southeast asia, those nations had travelers returning from west africa that they needed to test. and they needed to understand if ebola was being imported into their borders. we've had 50 or 60 years of
collaborating with some of these nations, and so we provided technical assistant to them -- assistance to them. again, the mutually beneficial relationship we have had again, in some cases for over half a century. now, what you've heard is activities at the lab level and maybe at the program level, but i can tell you this was being tracked at the highest levels of the government. so the dod ebola working group which was occurring in assistant secretary -- [inaudible] shop ose policies, they were responsible for coordinating the dod response in west africa. and so they coordinated dod activities in support of the primary responder they got all the different stakeholders together in dod and we ran through on a weekly basis all the issues that were confronting do the and con fronting the interagency. they represented dod with the joint staff at white house-led
meetings, and they worked with congress to make sure that people were remaining informed of what we were doing and why we were doing it. the point here though is that they were tracking very very closely, on a weekly basis, all of this work that we were just telling you about. they wanted to know what were the vaccine trials, what were the results, what were the drug trials, where are they when can they be deployed? and all this information was going up to the president. so that's a summary of what the walter reed army institute of research what their contributions were to supporting operation united assistance and supporting domestic ebola preparedness. and i think taken with all the other talks that you've heard, it gives you a pretty good idea of what department of defense was doing. so i thank you for your time, and i'm going to turn it over to our host. >> well, thank you very much.
first, i want to commend you on not devolving into military acronym speak. [laughter] which i know is easy for folks to do. look a few questions and then i want to open it up to the entire room. and this term may not be a term you have in the army but in the navy we have a term -- you may know this because you served in the navy -- hot wash. hot wash is when after you do something, after you have an evolution, after you do a deployment, etc., you get all the stakeholders together, and you sit around a table or a room or a conference, and you figure out what worked, what didn't work, what went wrong how to sort it out how to figure it out and the best way forward. i assume you had some version or multiple versions of hot wash not only within your various components, but across dod. and i was surprised to learn
that solwick really played the role they did. i think that's interesting. i would think it would be health affairs but it makes sense. and i'd like i'd just like to go down the row here and ask you what are the one two at most three top lessons learned from your perspective through the ebola response crisis management way forward? colonel, i'll start with you. >> i think the biggest lesson for us as dod was no one agency was in the federal -- within the federal government has all the answers. it is a whole-of-government response to any type of global crisis and when it comes to something like a biological incident like ebola, there are no borders. and it's not a dod issue, it's a public health issue.
and dod has resources and assist, but we don't have all the answers, and we must work as part of the whole-of-government team to provide capabilities that we can provide. >> colonel woolen? >> one of the phrases you hear almost to the a point where you get tired of hearing it when you're a student at the u.s. army war college is the term jimm joint interagency intergovernmental mull i national -- multi-national, is what it talks about. and students there are encouraged to start thinking in that area if they haven't already before they come in. this outbreak rolled all that together. this has to be a joint interagency, intergovernmental multi-national type of solution. there can be no single agency that can respond "24" to this type -- respond to this type of an outbreak and bring to bear
the resources that are needed to really be able to render a positive solution rapidly. the other thing that i -- and i talked a little bit about this in my presentation -- is that we cannot be stovepiped in our thinking. >> are right. >> you know, as we develop solutions in the name of biodefense, we have to be thinking about how else can those be used and how else should those be used. and an infectious disease outbreak is a classic example of how something that is being developed for a relatively specific intent and purpose has tremendous ability to be cross-leveraged for other purposes as well. >> good point. >> colonel coleman? >> on a similar thread, by training, i'm a preventive medicine officer, and i think most people know it works, but it's also unappreciated and sometimes, you know, physicians for example, more time is spent on treating rather than preventing. but we know that prevention works and in this case i think
we saw the value of the investments that have been made over a many year period where we're trying to be prepared for any contingency that might occur whether it's naturally occurring infectious diseases or a bioterrorrism event. and we saw the benefits of that investment that prevention that people had the foresight for and that we really were well positioned to provide support to this outbreak when it came to the r&d investments that resulted in whether it was diagnostics vaccines or therapeutics. >> i guess the lesson learned for me is that once again it's been proven that the world is a really small place. and when you can get anywhere from one location to another in less than 24 hours, it is very possible for what is a west africa issue to become a global issue. and that can have incredible certainly morbidity and mortality ramifications and
financial ramifications and political ramifications. so to me, i think the requirement to enhance our biosurveillance networks globally are of incredible importance. and it is not just the ability to identify and detect and characterize the pathogen but when you build biosurveillance, you are building public health infrastructure. it's dual purpose. which i think of course the west african nations had not been so challenged in those areas, there may have been a different, a different outcome. so that's the main lesson that i've gotten from it. >> uh-huhment so before i open it up, the last question i have is so let's assume for the sake of the question that there is a verifiable outbreak in a west african country of what people
highly suspect because of biosurveillance is ebola. it happened this morning. this is a hypothetical, of course. but not beyond the realm of possibilities. walk us through, to the extent you can share, what each of your organizations does day one. what happens? dod in your lane -- >> in my lane the first thing that would happen is russ and i would be on the phone together -- [laughter] for a nice long phone call and getting the best and the brightest minds that we have together and basically war gaming it. what do we know what don't we know what are the capability gaps what do we have on shelf where do we need to put investment in the short term to get the biggest bang for the
buck. and strategizing what's going to happen over the next few weeks and how are we going to be prepared and ready to meet that challenge. and colonel mid slow right here would be one of those guys, because he's guy that's making it happen. and that's what my organization would be doing. >> but i assume that in addition to phone calls, what not there's going to be personnel eventually put in that area, american military personnel or doctors or civilians or somebody. because i think the public, especially people who aren't experts like you guys assume -- and they could be wrong -- that we're going to have people on the ground here, there pretty quickly to figure out what it really is, how important how widespread it is, etc. so -- >> and -- >> is that wrong? >> no, that's not wrong. at that level that's going to emanate within the office of the secretary of defense within the
office of the joint chiefs of staff and we will react to the warning orders that they produce. so -- and they're going to be asking us a lot of questions. and so that's why we get the best minds available to respond to their questions to include what would it take to provide a response. and in the case of ebola, one of the first things we're going to want to know and why we're going to want smart people on the ground as soon as possible is, as has been mentioned twice already, is to get a dna sample to determine what strain we're dealing with. ..
i've been through this three times now with ebola and it's basically been the same each time. and that is until we get a request for assistance, we are not doing anything. the current people operate with a little bit different. i say we not doing anything meaning we are not pushing people out of the door. what we are doing is having meetings discussing that task that i talked about what capabilities we possess that could be brought to bear on the problem is asked to assist. that's a standard whenever the person -- the news of an outbreak hits, our commander starts convening those meetings, and it doesn't even sometimes take a commander to initiate that. people that have a vested interest work in that day to start thinking about what we have available that could be brought to bear if asked to do that. but it all hinges on the request
for assistance before we can engage. this one was different because we had a presence in west africa. we had people on the ground as part of a cooperative biological engagement program to build host nation capability capacity for these types of diagnostic. we were already there doing there. when the ball hit they rapidly transition specifically to ebola diagnostic both in sierra leone and then in liberia. >> i think i will build upon colonel woollen's comment. our mission really is for dod operation. if an accident like this occurs in west africa that's not a traditional dod mission that's how it initially evolved before became operational assistance. i've got to look at what mikey goes on and what can be brought to bear as colonel woollen said but i've got to figure out a way to publicly provide that support. we have to look at who our
partners were another would be operating. so for example cdc responsible for homeland defense the many ways, diagnostics. we have the mechanisms in place that allow us to provide cdc with things that we've been working on. my advisor came to the u.s. come how we provide our therapeutics that are u.s. government owned respond. look at those mechanisms and figure out how can we provide the support. those are conversations that took place with ms. spencer and levels higher. >> you've heard a couple times it's not just the desire to go but it is the ask. that ask us to come through usually diplomatic channels into the department of defense. if the ask is coming from africom or africa command in my particular organization, what we can do again because we did expedition research and development, we can take the
drug candidates or the vaccine candidates and we can relatively quickly deploy, if you will to start doing trials to demonstrate in the population of interest safety and potential for clinical benefit. my organization is a research organization. that's one of the things we could bring to bear. and again in the process of doing that you are setting a public health infrastructure, setting up surveillance systems. you are educating the local communities or them force multiplier scum if you will, in helping you achieve your mission mission. >> anything anyone else wants to add on the panel or to add anything any of the other panelists have said? negative response, all right. do you have a question? simply raise your hand and what my colleagues with a microphone
will come to you and please identify yourself by name and organization and ask your question. the lady in front, please. >> victoria from the commerce department. thank you so much for your work. i feel a lot safer. thank you very much. my question is going to be more on the r&d and commercialization that you're working on. i would assume that you to come in addition to the voucher and a fast-track system where you are probably going to get fast review and extension of patents either considerations on agency which are advanced market commitments guaranteeing these companies -- amc -- like a certainty for contract with the
commercialization? and also once these products are finished, are they subjected to licensing under the trips agreement? and bonus question, bonus come is not all right? [inaudible] a lot of these diagnostics and a lot of the drugs you use probably are not approved in west africa. during crises duties get a blanket consent to use on west african population? >> 's like is probably between the two of us we can handle that one. suggest we talk to commercial companies about their ability to provide as long-term with the products. it's important to understand the dod requirements are relatively tiny. so for example when we're
developing vaccines we may require 400,000 doses, and depend on the shelf life we may only need that every couple of years. very small number. when you talk about the cost and investment that companies that may come as i said there's a lot of reluctance to say this is something we are going to take our resources. so even the small licensing commitment is in many cases not enough. so i'm glad you mentioned they have to have your doctors, patent extension of that sort of thing. those are the discussions i believe we need to get into because if you truly believe that this is a strategic and national priority our ability to respond to these outbreaks, whether they are naturally occurred among people or a chemical or biological weapons event, we've got somebody going to crack the code on a. right now most difficult aspect of this whole process we have great scientist doing great things coming up with potential technologies.
it's getting them across the finish line. the second part of the question was related to what is our desired end state? we want fda approved products. that is the gold standard and that is what we strive for. in this case we did not have fda approved products. our the fda has mechanisms that allow not cross the finish line products to be used like emergency use authorization like expenditures protocols and so during this outbreak we took full advantage of those. eua was used with the diagnostic products. emergency imgs were used for taking some these experimental compounds and treating individual patients here in the u.s. those did involve informed consent. there's a whole spectrum of tools potentially available that we've got to adhere to those requirements established by the fda to ensure patient safety first and foremost.
that will turn over to the physician. >> entrance of us-based trials we were able to move faster than usual but it was not because we skip any regulatory steps for any ethical steps. we just focused a lot of resource and were able to do things in parallel versus sequentially which is how that normally works. my organization is not involved in the vaccine trials that are ongoing in west africa now. i cannot comment from a first person view but what i can say from the experience we have had with field trials in other parts of the world informed consent is always a component of that. actually children are able to understand basic concepts are is that the population that's involved, that is also always a component above what we do. so my assumption is and i would be very surprised if it was not the case that that is ongoing
in west africa now. and these countries have their own ethical review committees and own regulatory frameworks as well so these are not being done in a vacuum. >> your question in multiple parts, can we touch upon all the parts? >> did we get the bonus? >> one thing i will add to what my colleagues just commented on is what we are talking about is a low-frequency but high impact disease. you kind of get on the subject already about how do you commercialize? so one of the things that has been looked at at by several other scientists are working on a therapeutics, not so much of the vaccine site because it's more difficult to do, on the therapeutic side is repurposed in drugs that have another intended purpose and has significant potential merits to also treating ebola virus. you also get a leapfrog type of start with reproducing other types of drugs that are also being researched for another
type of disease because you can leverage those early clinical trial data on the safety testing that can help propel that forward towards a solution. that's another area that a lot of scientists are looking at. >> we mentioned 30 doctors and i thought it was great that the fda come on the should you do specifically but we got legislation that award ebola was added, eligible for vouchers. that's terrific but it occurred in the middle of an outbreak and that's not the optimal time to be thinking about these things. when you look at drug or vaccine development cycles which are many many years in order to be prepared we've got to be doing the thinking far in advance. so this is great were able to respond actually and fairly flexibly but we could've been better position if we have some of the tools in place in advance. those are the incentives. i like the fda priority vouchers. >> that's what we're looking at now the preparedness peace.
when a crisis hit hits that's the worst time to exchange business cards. we've got to be prepared rehearsed and ready for any eventuality anytime anywhere on the planet. that's going to concentrate our efforts on now. >> i do think this speaks to why the department of defense needs to be involved in infectious diseases are indeed, countermeasure development. because a lot of the problems that would work on do not necessarily have a large market share. it's not necessarily going to be the case but there is a corporate entity or pharmaceutical entity that will be willing to take it on. but the u.s. servicemember still needs a countermeasure. still need that drug or the vaccine to protect them when they deploy parts of the department of defense in some cases has to be the one taking the initiative to develop it. and in all cases needs to have a seat at the table. to ensure the military gets what it needs. >> other questions?
the gentleman in the middle. >> thank you. thanks to the panel by the way. this is not a great session i think i'd like to build on the question comment that colonel thomas made. given you can get from monrovia to uganda to calcutta in 24 hours, the host workers in this country, given that the world health organization and other institutions fail to respond in a timely manner on interesting issues about the about the need for global team occasions of warning systems the civilian or the military. >> i will toggle the about surveillance. a number of the panel numbers have stressed the importance of bio surveillance. that's a global capability because it is a public health issue. and we are doing a number of things around the planet now to increase our bio surveillance capabilities because that is the early morning and the
indicators. we can say anything we want but the human is going to be the early warning signal. and then it's a question of time. so our buyer -- biodefense efforts right now and dod is leading the way is going to be the cornerstone of that early warning system, and we are expanded to assess as we rapidly can. you can learn more about it. it's called the global bio surveillance system. >> so the department of defense has the global emerging section surveillance and response system led by colonel jim cummings is also an infectious disease physician. they are in approximately 70 countries and that's both dod academic and host nation government facilities. but it's not enough. the network in west africa is not as robust as it should be or needs to be. and so that's an issue for the
people who allocate resources and to prioritize programs but i am a staunch believer that that network needs to be larger. and again because of the secondary and tertiary effects of building bio surveillance networks. >> i personally believe just the notion come an example. there are literally hundreds of outbreaks occurring on a daily basis. most of them are well within the needs of the local population to respond to. the concern is what if the outbreak is larger when the local entity government, whether district, whether it's a nation, can respond effectively or what it's got to pandemic potential. and how you separate that out the one that is the 990 day daycare versus the big one. that's a reference or. so the networks that have been described are truly fundamental to allowing us to get that information. i think was a long way to go but
there's been tremendous progress made in recent years. >> the only comment i will add to that because this is not, my area speaks specifically on -- but the point has been raised we don't know -- [inaudible] we don't know what it is. we don't know what the risk factors are for people to contact with. we don't know whether to pop back up again. it reemphasizes the point you're making and my colleagues have talked about about the urgency of the need for something like a mobile surveillance system. thank you. >> this the gentleman in the middle please. >> and robert malone a physician scientist and they specialize in facilitating the interface between industry and government, particularly dod at hhs. and i was trying to solve some problems with call it the -- [inaudible] personally i think you guys are being way too modest.
i saw in mr. spencer's shop and colonel coleman's shop risk-taking advanced risk-taking to expedite product development. and i saw flexibility in contracting that i have never seen before. and i think the fact that we have millions of doses of potentially potent vaccine available in the fall, reflected that risk-taking and that forward thinking. the question i have and this surprised me is someone who specializes in this is what happened to the whole logic of that entity was to address this kind of problem and the intergovernmental interface issues were quite abundant.
i have not had anybody explain to me where that broke down. i would love to understand that. >> your question, what happened to the fencing for your voice kind of dropped. that's the question on the table. t. want to try and tackle that or you want me to take a stab at? >> '08 and i will follow on. >> it's been around for a while and it's -- >> explain to the audience -- >> is able to move public health emergency medical countermeasure here it's intended to ensure that u.s. government as a whole is working collaboratively with each other and not competitively to make best use of limited resources that we have. because of public they are -- very active. there is bodies tend to facilitate this. and so although your push baby where was the phemc, i was at thousand there were discussions
occurring at the phemc level look at the candidates that were unavailable accelerated to be able to respond and they were decisions made with phemc but if killers take it to a higher level i will. so decisions such as the map which is probably the most bio therapeutic what agent most advanced and resources there that the vaccine was the one that had been a true that could be explored most rapidly. so some of those decisions were made. additionally i don't know whether it originated at phemc that they can we understand how to develop is a risk it to be. even though we may prioritize is the map or of the vaccine can look at the other things in your portfolio and consider how you can accelerate those. so those sorts of discussions were taking place and discussions were sent back to phemc for their awareness.
>> i'm a member of the phemc can we did have discussions but in the early phases it was what came each in agency partner bring to the table if you will. i don't think it broke down. i don't think was defective come as effective as it could then and i would acknowledge that. but it was because we are working in crisis mode and we attend a lot of meetings but it was about doing and not about meeting. so we from a dod perspective which is trying to port everything we could into the fight and get there as quick as we could. and we may have left some people behind in the process and that maybe one of our lessons learned that come out of this. but the phemc has been a very good tool for me to ensure that i'm not duplicating what barda is doing a what department of homeland security is doing a what the cdc is doing.
if the deconflict so we are not all that spending money on the same problem. >> what is barda? >> the acronym escapes me. spoke biologic advanced research development agency. >> department of health and human services. medical countermeasures. >> thank you. we get a lot of money from you from the taxpayers to do this business. and i want to spend why can get the biggest bang for the buck. i want to leverage what they're doing to take it to the next level if i needed. i want them to know i'm spending money on so they can leverage the great research that's been done, and they can expand on that. we get the biggest bang for the buck it is very good. >> i gave an example. it's easy to say this fell apart
but things that were in place many people don't know phemc a lot of activities going on. animal nonclinical working group and this is really for a number of years has harmonized efforts among notches dod and not just hhs but i like this as well standardizing. what type of pathogen will use? that's provided tremendous value to all the organizations and in many ways best positioned as to be able to respond as effectively as we did. [inaudible] >> hold on. rephrase your questions or internet and c-span and other audience can do. please speak louder. >> i had understood that phemc -- [inaudible] directive, by their charter were to play a key leadership role in
a situation like this. hence my question. in an operational sense tactical and operational sense. balance of the gap i was referring to. >> understand. other questions for the panelists? well please join me in thanking this excellent group of experts and thank them for keeping us all safe. [applause] >> [inaudible conversations]
>> my point of view is that people should be able to give money anonymously or on the record. it should be up for them to decide and not for the government to decide. a government, remember the bill of rights, i'm going to paraphrase the late great justice william brennan which i'm sure he will be very flattered by. but it basically the bill of rights, the framers didn't like what our rights were. and nature that government could infringe upon those rights because they were presumed to be pre-existing. my point of view is that the extent they want to disclose there's a lot of disclosure laws that are compared. and trust me bill and i were talking before we got on here and if charles koch and david koch pretty much blame, but of your point of view is for every single penny that is spent on the conservative or libertarian cause or issue or candidate, so there is no dark money with
regard to the koch's in my opinion. the reality is there's a cost to disclosure. from a cost-benefit analysis in my opinion i don't quite see who really pays attention to this other that activists on each side of want than activists on each side that wanted a rest intimidate, create a list that we've seen over time and i think both sides do. i know the dude on our side against us with the koch and i've been a number of death threats. i'm not asking for sympathy or empathy i'm guessing it comes at a cost. who really benefits from the disclosure? >> that was just part of a discussion on freedom of speech that took place at the constitution center in philadelphia. you can see the entire event tonight at eight eastern on c-span. senator tim scott gave the commencement address at south carolina state university. senator scott is the first african-american elected to the senate from south carolina and the first african-american republicans are elected from the
south since reconstruction. his speech is about 10 minutes. >> thank you. predicting to everyone. thank you, president clinton for such a kind introduction. and let me say first and foremost that on any question my prayers are with south carolina state university for financial success and for peace and for the position of significance that you currently hold. from ideas on county council mr. president through my days at the statehouse i've been a supporter of south carolina state. as your united states senator i will continue to be a supporter of south carolina state university. [applause] now to the parents. i know that the day is a day of joy and happiness. it is a joyful day because you get to see your kids graduating
from college. how many of the personal site thank god for that. alleluia. all right. and it is also a very happy day that it is a happy day because as you know, given thinking about it come as your kids graduate it almost feels like a raise. and that brings a tear to your eye. now let me speak to the graduates themselves. graduates, please take just a moment to look around. look to your left, look to your right, hear the voices screening your name out there. [cheers and applause] all the people.
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