Press Briefing by the Press Secretary, 10/15/2014

James S. Brady Press Briefing Room

 

Please see below for a correction, marked with asterisks.

**Secretary Hagel ordered a comprehensive review of the Military Health System, which is now complete.  He will continue to monitor our progress at making improvements to it. 

 

2:34 P.M. EDT

MR. EARNEST:  Good afternoon, everybody.  Thank you for joining us today.  We will go straight to the questions.  The President, as many of you know, is convening a meeting this afternoon at 3:30 p.m. in the Cabinet Room with members of his team who are responsible for responding to the Ebola diagnosis in Texas.  So I'm actually manifested for that meeting, so I need to leave here about 3:25 p.m.  Would be a little embarrassing to walk in late. 

Q    Are you going?

MR. EARNEST:  Yes, so I don't want to be late. 

So, with that, Darlene, do you want to get us started?

Q    Thank you.  Can you give us any more details on the meeting that you said you're going to?  What does the President want to get out of it?  Who are some of the people who are participating?  And does this in any way affect the travel that's on the schedule for tomorrow?

MR. EARNEST:  Darlene, the President is convening members of his team who have been responsible for responding to the Ebola situation in this country.  The President wants to do that because he wants to make sure that all of the needed resources of the federal government are being deployed to deal with this specific situation. 

We'll have a full manifest of those who are participating in the meeting for you.  At the conclusion of the meeting you’ll have the opportunity to hear directly from the President himself about what decisions were made in the course of that meeting. 

At this point, I don't have any changes to tomorrow’s schedule to announce.  We're obviously operating at a pretty dynamic environment right now, so we'll do our best to keep you updated.  If there is something that requires a change in the President’s schedule then we'll definitely let you know. 

Q    Can you explain why he thought it was necessary to cancel both trips, both stops in New Jersey and Connecticut, to stay here and have this meeting?

MR. EARNEST:  Well, obviously, we have a second diagnosis of Ebola.  Again, this is a health care worker who was working to treat the patient at Texas Presbyterian Hospital, the first individual who had been diagnosed with Ebola in this country.  So that indicates the seriousness of this situation.  And the President believed that it was important to convene the senior members of his team who are responsible for coordinating this response, and the President was not able to host that meeting and travel at the same time. 

And what we have always indicated is that the President of the United States is President wherever he goes, and that's true 24/7.  But what’s also true is if the President determines that it's necessary for him to return to the White House to fulfill his responsibilities as the leader of the country and as the Commander-in-Chief, then he'll alter his schedule accordingly.  And the decision that we made about today’s schedule is consistent with that guiding principle.

Q    I know this question was asked yesterday; I wanted to ask it again today.  Does the President and the White House -- is there continued confidence in Dr. Frieden to lead the CDC at this time?  And also, is the administration now going to rethink the idea of appointing someone to be an Ebola czar, given this new urgency?

MR. EARNEST:   The answer to your first question is yes.  Throughout this process and throughout this response -- dating all the way back to March, I might add -- this administration has been guided by the science, by our medical experts who have experience in dealing with Ebola outbreaks.  For almost four decades now, the global health community, led by the United States, has been dealing with Ebola outbreaks in Africa, and as we are dealing with a public health situation in this country, we continue to be guided by the advice of medical experts and scientists who have knowledge in this field and can use that knowledge to protect the American people.

As it relates to a so-called Ebola czar, I'll reiterate what we've said in the past on this, which is that we have designated very clear lines of responsibility in terms of which agencies are responsible for which aspects of this response.  We've got CDC and USAID personnel who are operating in West Africa to work with those local governments to try to meet the urgent humanitarian public health needs in those countries.  You have a Department of Defense that is responding to the orders of the President of the United States to set up enhanced logistical capacity so that the international community can benefit from improved logistics as they seek to move equipment and personnel into the region to try to confront this outbreak. 

You’ve got Department of Homeland Security staffers that are responsible for securing our transportation infrastructure and monitoring individuals who are entering this country at ports of entry across the map.  And then, in addition to that, you have HHS and CDC officials who are responsible for coordinating with state and local public health authorities to ensure that the American public is safe.  And there are clear lines of authority for each of those sets of responsibilities.

At the same time, you have the President’s chief Homeland Security Advisor, Lisa Monaco, working here at the White House who is responsible for integrating the efforts of all of the agencies and making sure that they have access to the information and resources that they need to do their job. 

All of that said, we have said on a number of occasions that if additional resources or if additional staffing is necessary to augment the response, then we won't hesitate to consider it.  But at this point, the lines of authority are clear and the person responsible for coordinating those efforts here at the White House continues to do that work well.

Steve.

Q    So it sounds like you're not inclined to appoint a czar.

MR. EARNEST:  Well, again, there are clear lines of responsibility that are in place.  There is an individual here at the White House, highly competent individual, Lisa Monaco, the President’s Homeland Security Advisor, who is responsible for integrating that response.  But, again, if we determine that additional resources or additional staffing or additional expertise is needed to augment this response, then we won't hesitate to take advantage of it.

Q    Is the President wanting to know how this health care worker was able to get on a commercial plane?

MR. EARNEST:  Well, there are a number of things that we're eager to know.  The first is -- and this is the subject of an investigation by CDC officials -- is to determine exactly how this virus was transmitted from the so-called index patient in Dallas to at least two of the health care workers who were treating him.  That is the focal point of an investigation that the CDC is expediting, at the direct order of the President of the United States.

The other thing that the CDC is reviewing are the protocols that were in place to protect the health of the health care workers who were treating this patient.  It's not clear exactly what protocols were in place and how those protocols were implemented, and the CDC wants to try to get to the bottom of that so that they can offer advice to medical professionals and hospital administrators and others across the country about the protocols that are needed to ensure that their health care workers remains safe. 

What the CDC is also doing, and they’re expending significant resources to do this, is to do contact tracing of the two health care workers that have contracted the virus.  And that involves, as it sounds, tracing the contacts these individuals had after they got sick.  And so you saw the news release from CDC and from one of the domestic airlines today indicating that they were contacting passengers who were on the same flight as this individual to make sure that they are educated about the risk to which they were exposed. 

Now, what our medical experts tell us is that that risk is quite low.  But it is important for people to have access to that information so that they can get the facts about what sort of risk they’re facing -- again, that risk is low -- and what steps should be taken if necessary in the unlikely event that they do start to display some symptoms.

Q    Yesterday the President said that an Ebola epidemic in the United States is highly unlikely.  Is that statement still operative today?

MR. EARNEST:  It is true.  It's guided by the science.  That's what our experts say.  Our experts say that because the way that Ebola is transmitted is very clear and it is something that is not likely to happen in the United States.  Let’s walk through what that is.  Ebola is not like the flu.  Ebola is not transmitted through the air.  Ebola is not transmitted though the food that we eat in this country and it's not transmitted through the water that we drink in this country.  The only way that an individual can get Ebola is by coming into close contact with the bodily fluids of an individual that is already exhibiting symptoms of Ebola.

That's why, in this case, tragically, we've seen two health care workers that obviously were in very close contact with the index Ebola patient contract this virus.  How exactly that transmission occurred is something that remains under investigation.  But the risk to which they were exposed was elevated by the fact that they were in close contact with this patient trying to meet that person’s medical needs.

Mark.

Q    Can I follow up?

MR. EARNEST:  Sure.

Q    The President used the word “epidemic.”  Yesterday he used the word “outbreak” as something that's exceedingly -- chances are exceedingly low.  Isn't what we've had in Dallas now an outbreak?  We've had multiple transmissions.

MR. EARNEST:  Well, I think there is a medical professional who could probably give you a specific definition of what actually constitutes an outbreak.  My layman’s understanding that I think the vast majority of the American public would agree with is that we're talking about a situation in which two health care workers who were treating an individual with Ebola contracted the virus.  We are -- the CDC, our medical experts, are conducting an investigation to determine how that transmission occurred.  But that is different than images that are conjured up with an outbreak, where you have individuals who are basically in public transmitting the virus.  That is something that we think on a large scale is exceedingly unlikely.

Q    WHO definition of an outbreak says that it's something that is an occurrence in excess of what normally would be expected in a defined community.  And it also can be the case where a disease has long been absent from a population.  That may also constitute an outbreak.  It really sounds like, even if it's not large-scale, it's an outbreak.  So I guess I wonder if that calls into question some of the reassurance that we've heard in this room.

MR. EARNEST:  No, I don't think it does, Mark, simply because what we're talking about here is a situation where there were health care workers who came into direct contact with an Ebola patient who did, tragically, contract the disease.  We are very focused on making sure that those individuals get the treatment that is necessary, and our thoughts and prayers are with them and their families as they fight this terrible virus.  But that is wholly different than, for example, the situation that we see in West Africa, where, tragically, you're seeing people who live in the same household be passing the virus from one to another, or we're seeing as the result of unsafe burial practices that individuals are contracting the virus from corpses.

Again, that is a tragic occurrence.  It is an indication of the poor medical infrastructure that exists in those countries.  And that is something that poses a much broader risk to the population in West Africa.  That's why the President has devoted significant resources from the federal government to combat that outbreak.  But that is obviously a far cry from the situation that exists in Dallas right now.

Jon.

Q    Josh, you said that the President still has confidence in the Director of the CDC.  Let me ask you a broader question.  You were pretty strong in defending the federal government’s response to this yesterday.  Now, given what we've learned about another case in Dallas and the fact that that individual was able to -- did fly on a plane while she was supposed to be monitored, how would you -- would you still say that the federal government’s response to this situation has been successful, has been up to the President’s own standards?

MR. EARNEST:  Well, I'll say a couple of things about that. The first is Dr. Frieden, the Director of the CDC, himself has said that it is unacceptable that even one health care worker was exposed to this virus while they were providing medical treatment to this patient.  So that is an indication that there were shortcomings, and that is something that is being thoroughly investigated by the Centers for Disease Control and other medical experts.

That investigation obviously will also now expand to cover the second health care worker that has now been diagnosed with Ebola.  So that is a clear indication that -- well, let me say there is a second thing that Dr. Frieden also said, was that I believe it was earlier this week he noted that knowing what he knows now about the situation in the hospital, he indicated that he regretted not sending a team of experts to that hospital sooner to assist the hospital as they responded to this specific diagnosis. 

So what you are seeing from the federal government, however, is the kind of tenacious response that reflects evolving circumstances.  So Dr. Frieden indicated that he would send a whole team of experts earlier this week after observing that he believed they should have been there sooner.  What you are seeing is after this diagnosis you are seeing stepped-up monitoring by health officials in Texas of other health care workers that were responsible for treating the index Ebola patient.  So this is a response that indicates a commitment to protect the health and safety of the American public.

There are other ways in which this has happened as well.  We have adapted to circumstances by beefing up airport screenings, for example -- that at the end of last week, you’ll recall that we announced new screening measures that would go into place at five airports across the country.  These are airports that cover essentially 95 percent of the arrivals of travelers that started out in West Africa.  Those improved or strengthened screening measures are indicative of our commitment to constantly evaluating our policies and, where possible, putting in place measures that would strengthen them.

Q    So why do so many Americans feel, first of all, that there’s a real risk of an epidemic in this country and that the federal government is not doing enough to stop it?  I mean, in the latest poll -- ABC-Washington Post -- two-thirds of Americans think the federal government is just not doing enough on this.  Are they wrong?

MR. EARNEST:  Well, let me say this about that.  It sounds to me that a significant portion of the American population agrees with Dr. Frieden that even one transmission of the Ebola virus to one health care worker in this country is something that is unacceptable and something that won't be tolerated and something that has prompted a review of protocols and a careful investigation of how that transmission exactly occurred.

What people can continue to be confident in is the priority attention that this issue is receiving across the federal government and here in the White House.  I think that's evident by the fact that the President is convening some of the top-ranking officials in his administration to discuss that response.

But again, what I would urge people to do -- I think the other thing that is motivating the answer to that question is something related to fear.  This is a deadly, terrible disease, and it is wreaking havoc in West Africa.  It’s having a debilitating effect on the population there.  And it’s genuinely tragic.  At the same time, because of the way that that virus is transmitted, because of the modern medical infrastructure that exists in this country, the risk of a similar outbreak like that in this country is exceedingly low.  That’s what our medical experts tell us, and that is advice that we continue to follow.

However, the administration continues to pursue the kind of tenacious response that will both protect the American public here at home, but also do what is necessary to completely eliminate the risk to the American public from the Ebola virus, and that’s to stop this outbreak at the source.

Q    And then just two quick ones.  Still no consideration of a travel ban from the affected countries in Africa?

MR. EARNEST:  That’s something that is not on the table at this point.  And again, the reason for that -- just in case people haven't heard the previous answer that I’ve given to this question, it’s important for people to understand exactly why that’s the case.  Shutting down travel to that area of the world would prevent the expeditious flow of personnel and equipment into the region.  And the only way for us to stop this outbreak and to eliminate any risk from Ebola to the American public is to stop this outbreak at the source.

So we are mobilizing significant resources to make sure that supplies and personnel can get to the affected region and start meeting the needs of the affected region to that we can stop the outbreak there.  And that’s why right now the travel ban is not on the table.

Q    Okay.  And the President cancelled political travel today, obviously, to do this meeting.  Does he plan to cancel further political travel?  Is the President going to continue his campaign schedule going forward despite the situation, or is this just kind of a one-day thing?

MR. EARNEST:  Well, Jon, we’ll evaluate it on a daily basis. This is obviously a dynamic situation.  If necessary, I have no doubt that the President will postpone his political travel to attend to important priorities here.  But whether a change in tomorrow’s schedule is required, we just don’t know that yet, and when we do we’ll let you know.

Major.

Q    Josh, a couple of months ago, when the Malaysia Airlines jet was shot down over Ukraine, the President carried on with his campaign schedule.  A member of the staff said, “Abrupt changes to his [the President’s] schedule can have the unintended consequence of unduly alarming the American people or creating a false sense of crisis.”  Did you do that today?

MR. EARNEST:  No, Major.  What drives these kinds of decisions are the President’s responsibilities.  And you’ll recall -- I don’t remember if you traveled on that trip with us to Delaware and New York, but over the course of that trip I think the President called five different world leaders while he was on the road, including President Poroshenko, including the leader of Malaysia, including the Prime Minister of the Netherlands, who -- that’s the nation that bore the brunt of that tragedy.  So the President was able to continue his schedule, that it did include some public -- that did include some political events, while also tending to his responsibilities as the Commander-in-Chief.

As it relates to today’s schedule, the schedule did need to be changed so that the President could fulfill his responsibilities as the leader of the country.  We’ll evaluate the schedule tomorrow based on his requirements, and if we need to make a change to his schedule so that he can do what’s necessary here at the White House, then we’ll change his schedule.  I don’t know yet whether that will be required.

Q    And is today’s meeting a decision meeting?  You had indicated at the top of your remarks that some decisions may very well be announced by the President.  Is that what makes this of such signature importance that he had to cancel the travel plans?

MR. EARNEST:  No, again, the reason that this meeting is important is because we’re talking about the senior members of his team who are responsible for dealing with what is a pretty urgent situation here in this country.

Q    But will there be new decisions or new methods announced after this meeting.  Is this meeting --

MR. EARNEST:  Frankly, Major, I don’t know the answer to that.  But if there are, the President will have the opportunity to discuss them with all of you at the conclusion of the meeting.

Q    Have there been additional meetings that the President or his senior staff have convened here in the last three or four days on Ebola that have not appeared on the public schedule?

MR. EARNEST:  The President has frequently been updated and briefed on this issue.  I don’t know if there have been any other formal meetings that have been convened, but I know that there have been a number of occasions in which the President has been updated on this situation.

Q    Following up on Jon’s line of question, can you understand that the public watching this story play out can have a genuine sense of either skepticism or possibly alarm because they hear, “we know how to deal with this; we are taking all the proper steps; all the precautions are being implemented,” and then yet someone who has it, doesn’t show symptoms, gets on a commercial aircraft, even though the exposure risk is minimal, everyone on that plane has now been in contact.  That creates at least a low level sense of alarm by everyone that was on that plane, everyone who knows a person on that plane, and everyone who remembers hearing just a couple of days ago, “well, that’s not going to happen, we’ve got this under control.”  Do you understand how the public is becoming less confident and possibly more alarmed as the story plays out?

MR. EARNEST:  People should continue to be confident in the response that was organized by the government in reaction to this specific situation.  The reason for that is simply that we have a modern medical infrastructure in place that, again, has not been flawless -- we pointed out why that was the case, that even one transmission to a health care worker is unacceptable -- people should take solace in the fact that, quite frankly, we know exactly how Ebola is transmitted.  It’s not transmitted through the air, it’s not transmitted through food or water, but only through close contact with the bodily fluids of an individual that have symptoms of Ebola.  But this is a deadly, graphic disease.

Q    But Dr. Frieden said this person should not have traveled.  That was a big mistake.  That looks to me, and I think it looks to most people evaluating this fairly, as sort of a gap in the system, that something that should have been communicated very tightly within the Texas Presbyterian community, hey, don’t get on a commercial aircraft, happened anyway.  Do you understand how that can create some degree of uncertainty among the public when trying to evaluate where the story is going and how tightly you have your arms wrapped around this situation?

MR. EARNEST:  Major, I can certainly understand the concern by the American public about this terrible disease.  It’s a deadly disease.  But it is a disease that we know -- whose outbreak we know how to contain here in this country.  And that’s what we’re very focused on -- from trying to meet the needs of the health care workers who have contracted the virus, to investigating how exactly that virus transmission occurred, to doing the necessary contact tracing to ensure that other individuals who may have come in contact with somebody who had the Ebola virus are aware of the risk that they face and are monitoring their own health.

Active monitoring has now been expanded to include all of the health care workers that came in contact with the index Ebola patient in this hospital in Dallas.  So there are a number of steps that we have taken, and I think that people can be encouraged that the federal government is demonstrating the kind of tenacious, adaptive response that’s required to dealing with what is understandably a pretty concerning situation.

Q    I guess my last question is, does the President want his response team to be more tenacious and more urgent, so stories and situations like this stop happening?

MR. EARNEST:  Well, I can tell you that the President himself certainly feels a very strong sense of urgency about ensuring that his administration and the medical experts are mobilizing the kind of response that will ensure the safety and health of the broader American public.  That’s what the President expects.  It’s what the American people expect.  And I’m confident that will be discussed at today’s meeting.

Olivier.

Q    Josh, the President spoke today with the leaders of Japan, the U.K., France, Germany and Italy.  Ebola was part of the conversation in each of these conversations --

MR. EARNEST:   I don’t mean to interrupt you.  The conversation with the Prime Minister of Japan was separate from the conversations with the other leaders.

Q    It was.  I didn’t mean to imply they were all together. But he spoke to those leaders either together or separately, or however you want to put it.

MR. EARNEST:  There’s been intense interest in the modality with which the President communicates with world leaders since the very first day I did this briefing, so I’m cognizant of the importance of those kinds of details.

Q    I respect that and I appreciate it.  The President has said repeatedly now that he’s not satisfied with the global response in terms of stemming Ebola at the source.  So my question for you regarding these various conversations is whether he made any specific asks of these world leaders, or whether he is satisfied that they have fully stepped up to their responsibilities.

MR. EARNEST:  Well, I’ll say two things about that.  The first is, more than a month ago -- or I guess it was about a month ago -- the President made an announcement at the CDC headquarters in Atlanta that he was going to make a significant commitment of Department of Defense resources in Western Africa to put in place the logistical infrastructure that was needed to ramp up our response to the Ebola outbreak in that region of the world.  That continues to be a priority for his administration.

The President is receiving regular updates from the Department of Defense about their ongoing efforts to put in place that logistical capability.  The Department of Defense has tremendous expertise in this area.  And the reaction to that commitment has been an increase in resources and personnel that are being supplied by non-governmental organizations and from governments around the world.

We’ve been heartened by that response, and that is an indication of just how important it is for the United States to show leadership in a crisis situation like this.

Now, that said -- that all being said, the President does believe that we need to see more from the international community; that we have not seen a sufficient commitment of resources and personnel from other countries to dealing with this urgent situation in West Africa.  The stakes are high, and impact on the local population there is tragic.  And we need to see a more significant commitment of resources from countries around the world to dealing with this effort.

Q    At the risk of restating my question, did he make any specific asks of the world leaders today?  Or is he satisfied that the countries involved have met that challenge?

MR. EARNEST:  Well, we’ll have a more detailed readout of the secure video teleconference that the President conducted today with those European leaders.  But as a general matter, I can tell you that the President did urge those world leaders to commit to make a more significant commitment to dealing with the Ebola outbreak in West Africa.

Justin.

Q    I wanted to circle back on the question about why the President is staying here in town today.  I know that you said it was necessary to respond to the outbreak, but I’m wondering why that is, especially since not only with the Malaysia Airline plane that went down, but everything from Ferguson to Egypt to the Fort Hood shooting, we’ve seen the President either maintain his political schedule or is vacation schedule.

MR. EARNEST:  Each of these situations we consider on a case-by-case basis, as you would expect.  In this situation, the President felt it was important to convene a meeting of the senior members of his administration who are responsible for responding to this particular incident.  And so the President is convening that meeting this afternoon.  And because of the meeting was this afternoon, the President had to postpone the political travel that he had already planned.  We do anticipate that the President will be able to reschedule this trip in advance of Election Day.

Q    And the reason that I ask -- I mean, presumably, Air Force One has got a phone, a video conference; he could do it while he was traveling, as he did in these other instances.  But we’re three weeks out in the midterm elections and this is obviously a story that’s come to dominate headlines.  And so I’m wondering if this was made out of any sort of political consideration.

MR. EARNEST:  It was not.

Q    And then, generally, I guess, can you evaluate how you guys see this politically?  I know that you’ve said repeatedly that politics don’t come into your decision of how to respond to the crisis, but obviously this is something that’s dominated every question of this briefing, and we’re in a political time.  so I’m wondering how you guys see this playing into the midterm election.

MR. EARNEST:  Well, to be candid with you, Justin, I try to consider my words carefully when I speak up here, and the fact is I haven't given any thought to the political consequences of this response.

Q    Have you not thought at all about the politics?

MR. EARNEST:  I haven't.  It’s been a very busy day here that’s been focused on making sure that we’re mobilizing an appropriate response to this urgent situation.  I’m sure there are many people who have considered the political ramifications of this response and of today’s decision to alter the schedule.  But the fact is that hasn’t crossed the minds of the President’s senior advisors here at the White House.

Move around.  Scott.

Q    Josh, Dr. Frieden said today that, going forward, the CDC would make sure that people who are at risk of having been exposed would not be getting on commercial airliners.  But when he was pressed on the authority for that, he said just that the CDC work with state and local officials.  And I’m curious, does the White House feel like that authority is clear, or do you need some extra powers?

MR. EARNEST:  Well, again, in terms of the powers that are necessary, I’d refer you back to the CDC.  They are the ones who are principally responsible for monitoring the health and, therefore, the movements of these individuals.  So I’d refer you to them for what they feel is necessary for them to do that successfully.

Q    It sounds a little vague.  I mean, it sounds like, well, we’re going to trust that the folks in Dallas are going to, and folks in Ohio are going to keep these folks off airplanes.

MR. EARNEST:  Well, again, Scott, I’d refer you to the CDC that’s principally responsible for this.  Let me just take this opportunity to remind you and everybody who’s watching that the risk that has been presented to those individuals who are on the airplane with the second health care worker earlier this week do not face a significant risk here.  In fact, the risk is, according to our medical professionals, rather low.

But what we will do, because of our -- as is guided by the tenacious response that you’ve seen, is contact these individuals, encourage them to contact the CDC to make sure that they are properly educated about the risk that they do face.  And in the unlikely event that any sort of health concerns should arise, that they have the available information about what they should do in response to that.

Mike.

Q    So I want to follow up Jon and Major a little bit.  There are crises that happen that are instantaneous, that the response then sort of starts on that day or that moment that the crisis happens -- an earthquake or a terrorist attack.  This is not one of those, right?  The presence of Ebola in the United States, starting with the first patient and proceeding through the other two, was something that was -- that could have been anticipated easily in the weeks and months before, as the Ebola situation in West Africa was playing out.

And so when you talk about the “tenacious response,” I guess I’m wondering if the President is angry, if you guys are frustrated, if there is a level of upset at the fact that each time another kind of moment in this crisis has played out since Ebola arrived here in the United States, the CDC has responded to it, but hasn’t anticipated it.

So the issue of flights of medical personnel, shouldn’t that have been talked about in meetings six weeks ago, and determined that what the policy of the CDC is going to be is that medical workers that might be infected by a patient are not going to be allowed to travel?  Shouldn’t that have been decided long before it ever arrived here?  Shouldn’t issues of transportation of materials or -- I mean, all the things that we’ve gone through, you’ve described being satisfied with the tenacious response after the things happened, but is that good enough for the President that these things weren’t anticipated and figured out ahead of time?

And is he frustrated that these scientists have repeatedly told him and you and the other people in this building, “we got this, we got it under control,” and then something happens and they say, “okay, well, now we’ve got in under control;,now we’re going to do something to respond to the thing that we now see is the case”?  I mean, all this feels like they should have anticipated this before, shouldn’t they?

MR. EARNEST:  Well, let me say it -- there are a variety of ways I’m trying to think I can answer your question.

Q    It was a long question, I apologize.

MR. EARNEST:  But it’s an understandable one, so let me try to answer it in a couple of ways.  The first is, there are a number of things that the President is concerned about.  We’re talking about a deadly disease, and we’re talking about now two American health care workers who have contracted this disease in this country.  Now, they have done that when they were treating a patient with Ebola that had originally contracted the disease in West Africa, so the circumstances are important.  But yet the concern that the President has exists nonetheless.

The President is also concerned about making sure that we’re monitoring the health of the other health care workers who came into close contact with this individual patient, the index patient, as he’s often described.

What the CDC is also doing, and what the President is concerned about, is making sure that we do all the necessary contact tracing, particularly as it relates to those individuals who were also passengers on the plane from Cleveland to Dallas.  That is -- again, the risk to those passengers is low, but the President and everyone in the administration believes that it’s important for that contact tracing to take place.

The other thing the President is concerned about and focused on is making sure that health care professionals across the country are getting clear guidance from the Centers for Disease Control about what protocols they should put in place.  He wants to make sure that those health care professionals are appropriately aware of the need to be cognizant of the fact that

He wants to make sure that those health care professionals are appropriately aware of the need to be cognizant of the fact that there could be other Ebola patients that present themselves for treatment at health care facilities across the country.  He wants to make sure the health care professionals are getting guidance about how to handle that individual when they present themselves, how to diagnose Ebola, and then what protocol should be put in place from there. 

So that clear communication is something that the President is very focused on.  So I think it’s appropriate for you to describe the President as very concerned about this situation.  And that's why the President is urgently convening this meeting this afternoon to make sure that the response is commensurate with the level of concern that he feels.

At the same time, I think it’s also important to point out that there are a number of health care workers who were Americans who were conducting relief missions in West Africa who tragically contracted this virus who were then safely flown back to the United States, were treated in medical facilities in the United States, recovered from that illness, based on the sound medical treatment that they received in this country.  And to date, we do not yet know of any situations where a health care worker who was treating those individuals contracted the virus.

So the Director of the CDC has already indicated his concern that more experts were not deployed sooner to Dallas to help them deal with this Ebola diagnosis in their hospital.  But the fact is that there are multiple other patients who have been treated and recovered from the disease at other facilities in the United States where those health care workers, at least as far as we know now, weren’t put at risk of catching Ebola themselves. 

So there have been situations where the response and treatment of patients has been consistent with the expectations of the President and with the American people.  And the fact that that treatment was rendered in a way that did not ultimately pose a risk to those health care workers contracting Ebola I think is an indication that what our medical experts tell us about having the necessary knowledge to treat Ebola is correct. 

And we need to make sure that the necessary protocols are in place so that when -- and again, our medical experts tell us this too, there are likely to be more cases of Ebola -- what the President and what our administration is focused on is making sure that when those cases present themselves, that those patients get the treatment that they need to recover, that those patients can be treated in a way that doesn't put health care workers at a significantly elevated level of risk, and that we can ensure the safety of the broader public.  And that's hard work.

Dr. Frieden himself has said that fighting Ebola is hard.  But if you consider the wide range of the government’s response, there’s plenty of reason for people to feel confident about what we're doing.  But there is a reason that the President and people all across the country are concerned about this deadly disease.  And we're going to make sure that we're mobilizing the kind of response that is up to the expectations not just of the President but of the people he serves.

Q    Just one real quick follow-up.  I promise I won’t be long.  So is there a fear that by expressing that concern as criticism of CDC or of the government itself, that that undermines the need to keep public confidence high and not cause a panic?  Is that why the concern is not expressed as a criticism of the response so far?

MR. EARNEST:  Well, I think what you’ve -- what’s evident I think from this President’s leadership style is that he’s focused on solving problems, that pointing fingers of blame will not be constructive here.  And that's why the President is focused on results.  And that's why the President is convening the meeting today with his team who is responsible for responding to this situation.

Jim.

Q    Josh, getting back to Lisa Monaco.  You said she’s overseeing the federal response on Ebola --

MR. EARNEST:  Well, again, I hate to be nitpicky here, but what she’s really doing is she’s coordinating the activities of all the government agencies who are themselves responsible for responding to specific areas of their own expertise.  So she’s not overseeing --

Q    So who’s in charge?  Who’s in charge?

MR. EARNEST:  Well, she’s not overseeing the construction of Ebola transmission units in West Africa.  The Department of Defense is responsible for that.

Q    I understand that, but who is in charge of --

MR. EARNEST:  She’s not responsible for coordinating --

Q    -- who is in charge of the overall response?

MR. EARNEST:  She’s not responsible for coordinating the activities of the international community as they interact with local governments in West Africa.  USAID is involved in that effort.  They have an area of expertise. 

Q    You understand my question --

MR. EARNEST:  She’s not diagnosing people in the field.  So the point is --

Q    I get you're interrupting me because you feel like you have a point to make.  But you understand my question.

MR. EARNEST:  Well, I think the point that I have to make is directly relevant --

Q    You seem to be reluctant to say who’s in charge of the federal response to Ebola.

MR. EARNEST:  Jim, I think that I’m reciting very clearly to you who specifically is responsible for which activities when it comes to this government’s tenacious response to Ebola.  And that is the Department of Defense who is responsible for putting in place the logistical capacity in West Africa.  That's USAID that's trying to meet the needs of communities in West Africa so that we can stop this outbreak at the source.  We see CDC lending their expertise to West Africa to help local governments mobilize the resources that they need to stop this outbreak.  You’ve seen the Department of Homeland Security play their role in ensuring the safety of the American public, whether that's people traveling across the globe, or individuals who are attempting to enter this country.  You have the responsibility of HHS and CDC who are responsible for working with hospitals and doctors all across the country to treat Ebola patients if they materialize at their medical facilities.  So --

Q    There’s not one person in charge?

MR. EARNEST:  I think that there are individuals who are --

Q    Or is that the President?

MR. EARNEST:  There are individuals who are directly responsible for their line of responsibility.  And you have an individual here at the White House who is responsible for coordinating the actions of those government agencies to make sure that they are properly integrated.  I think that is a completely reasonable management structure.  And if it is determined that additional resources are needed to manage this response, then we won’t hesitate to add them.

Q    The only reason why I ask is because Lisa Monaco is also the Counterterrorism and Homeland Security Advisor.  With the threat posed by ISIS and various other terrorist groups around the world, it seems like she has a lot on her plate right now.

MR. EARNEST:  She does have a lot on her plate.

Q    She can do that and Ebola?

MR. EARNEST:  She is a highly capable individual who can fulfill her responsibilities in terms of coordinating the government’s response, the government agencies’ response to this Ebola situation, while at the same time ensuring that she is playing the role that she plays in protecting our homeland.

Q    And on Dr. Frieden, I mean he mentioned yesterday he said he wished he had done this sooner with the special teams that go in and supervise the treatment.  Today he said that this second patient is going to be transferred to the Emory Ebola experts.  That suggests that that precautionary step of having teams in place to supervise care may not be enough.  Do you think that what the CDC is recommending right now is a crystal-clear set of protocols when it comes to dealing with Ebola patients?

MR. EARNEST:  Well, there are experts from the CDC who are on the ground in Dallas who are doing a variety of things.  One is they're offering some expertise about the treatment of those Ebola patients that are currently under the care of Texas Presbyterian Hospital.  You also have experts from the CDC who are nurses who are doing some peer-to-peer training when it comes to the use of personal protective equipment.  You have experts in infection control and experts in dealing with the Ebola virus itself who are advising hospital administrators and doctors there about treating these individual patients. 

You have CDC experts who are responsible for doing the contact tracing that is necessary, not just of the index patient himself and his family who he spent some time with before he was admitted to the hospital, but also doing the contact tracing that is related to the two health care workers that contracted the virus.  That's a pretty work-intensive effort.

Q    The administration said these patients can be treated in hospitals.  Now the second patient is going to Emory.  Isn't there an inconsistency there? 

MR. EARNEST:  Jim, I think what you're seeing is you’re seeing an adaptation in terms of the government’s response.  I just talked earlier about how the facility at Emory had successfully treated other health care workers who contracted the virus in West Africa.  Those individuals were treated.  They recovered and were released.  And that treatment was rendered without the health care workers themselves contracting the Ebola virus.  So that may be an indication that they have expertise that can be used and dedicated to this specific case.

But again, the treatment of these individuals is going to be guided by our medical experts and by the science.  I guess if you have additional questions about that I'd encourage you to reach out to CDC.

Q    You said that there were shortcomings and flaws with the response.  You acknowledge that.  Did the President register his frustration --

MR. EARNEST:  What I acknowledged is something that our medical experts themselves have acknowledged.

Q    You acknowledge that medical experts said that there are shortcomings and flaws.  Did the President tell Dr. Frieden he’s dissatisfied with that?

MR. EARNEST:  Well, I think it's fair for you to assume that the President shares the view that the transmission of the Ebola virus to even one health care worker is something that is not acceptable.  The President does share that view.

Q    Josh, you said you have confidence in Dr. Frieden.  On the question of who is in charge, we notice on the morning television today it was not Dr. Frieden, it was Sylvia Burwell at HHS -- not Lisa Monaco.  And then the conference call that happened about an hour or so ago with Dr. Frieden, at the last minute it was, well, it's not going to be on camera with him anymore.  Sylvia Burwell at HHS is going to be on the call with him and she’s going to start it off.  Doesn’t that suggest that now she’s taking on a more hands-on role and yet another personm is involved at the top?

MR. EARNEST:  Again, Ed, a couple of times I’ve described the important role that HHS has to play in terms of protecting the American public here at home and communicating with public health officials across the country at the state and local level and also communicating with doctors and nurses, health care providers and hospital administrators.  So there’s been an important role for HHS to play in this response from the beginning; they have played that role.  And the Secretary of Health and Human Services has been actively engaged from the beginning.

Q    Okay, so the CDC today is saying it was improper for the health care worker to fly from Cleveland to Dallas Fort Worth.  Why is it still appropriate for the U.S. to allow people to fly into America from the hot zone?

MR. EARNEST:  Quite simply, Ed, because there are -- there is a multilayered screening protocol that’s in place to ensure that individuals that may have symptoms consistent with Ebola are not even able to board planes in West Africa.  As we’ve discussed, dozens of people have been denied boarding over the last few months because they are exhibiting symptoms consistent with Ebola.

There’s also a screening that’s in place on international flights to ensure that our flight crews are aware of what they should be looking for in terms of people exhibiting symptoms of Ebola.  And then there is also a layered screening -- a screening layer here in this country where we have CBP officers who are responsible for observing people who are reentering the country and subjecting those who have traveled in West Africa to additional screening to make sure that those individuals aren’t symptomatic.

Obviously, that multilayered screening approach does is not in place for domestic flights.  And that’s the difference.

Q    And I wonder if you can address nurses unions and just nurses around the country who are expressing alarm not just at health care workers being exposed, but they say that Mr. Duncan was in an emergency room at this hospital in Dallas for hours in an area with not just health care workers but citizens sitting there, and that waste -- once he was admitted in, waste was piling up.  The nurses were around this waste.  How concerned is the White House about that and how many more people could have been exposed, and why that just was not handled properly?  He was sitting in an open area for hours.

MR. EARNEST:  Well, but again, Ed, the thing that’s important for people to understand is to understand how the Ebola virus is transmitted.  The Ebola virus is not transmitted through the air, so people who breathe the same air as this individual when he was --

Q    -- come into contact with him when he’s in a public area and has Ebola.

MR. EARNEST:  Well, again, they have to come in contact with his bodily fluids in order to contract Ebola.  There are very clear guidelines for how this disease is contracted.  Now, that all being said, it’s the CDC’s responsibility to communicate clearly with hospitals and health care facilities across the country about the proper protocol for evaluating individuals that may have symptoms consistent with Ebola and for isolating those individuals that need to be isolated based on their travel history.

There’s also a protocol that the CDC has in place for rendering treatment to those individuals who have been diagnosed, who have tested positive for Ebola.  The CDC is reviewing those protocols.  They’re constantly assessing and reassessing those protocols.  And I mentioned earlier that one of the things that we are concerned about is making sure that the CDC is offering clear guidance to health care professionals across the country about what those protocols should be and how those protocols should be implemented.  And that continues to be a priority and it continues to be something that the President is worried about.

It’s evident in this particular situation in Dallas that there was -- that something unacceptable occurred; that we saw a health care worker contract the Ebola virus after treating somebody that had Ebola.  So there are some protocol changes that are being reviewed by CDC, and when those changes are determined to be necessary, CDC will make those announcements and communicate them clearly.

Q    One other topic so others can go.  The New York Times has a story about American troops being exposed to chemical weapons in Iraq.  I know that exposure, at least most of it, appears to have happened during the Bush administration, but the story is alleging that the Pentagon kept this secret from troops, from veterans, continuing into the Obama administration.  So I wanted you to address when President Obama was briefed on this first, and why this administration appears to have continued to keep this secret.

MR. EARNEST:  Ed, let me say a couple things about that.  The first is we’ve seen the reporting about U.S. military personnel and Iraqi exposure to chemicals related to Saddam Hussein’s weapons of mass destruction programs.  Needless to say, we have the deepest concerns for these individuals.  The Department of Defense has indicated that they’re going to conduct a review of this specific situation.** There’s a full statement that I won’t read from here, but I’d refer you to the Department of Defense to get a better understanding of exactly how we’re responding to this particular situation.

I know that Secretary Hagel, who himself is a combat veteran and somebody who was wounded in combat while serving his country, so he obviously takes these kinds of issues very personally, and I’m confident that they will conduct the kind of detailed review that’s necessary.**

MR. SCHULTZ:  The President’s meeting is starting.

MR. EARNEST:  Okay.  Kristin, I’ll give you the last one and then I’d better run.

Q    Okay.  Does this underscore the need for a surgeon general to be installed?  And who should the American people be listening to right now?  And talk about the fact that we’re hearing from a number of different people and I think there is a confusion -- obviously we’re trying to get at the idea of who is in charge, but who should people be listening to right now?  President Obama is not out here answering our questions.

MR. EARNEST:  Well, you’ve heard a number of medical experts talk about the necessary protocols, about the low risk that faces the American public right now.  You’ve heard the President on a number of occasions talk about the need for a robust response in West Africa to deal with this outbreak at the source.  So there are a number of administration officials who have been talking about this publicly.  All of them are talking based on the guidance of our medical professionals.  They are all talking about how our response reflects our commitment to the safety and security of the American public, and how those principles are guided by the science.

Q    But the buck stops with the President, right?

MR. EARNEST:  No doubt.  That’s always true.  That’s always true. 

Thanks, everybody.  I’ve got to run to this other meeting.  Send me an e-mail and I’ll see what I can do to get you an answer.

END
3:25 P.M. EDT