Fact Sheet: Update on the Ebola Response

Since the diagnosis of the first Ebola patient in the United States, we have achieved tremendous progress across all elements of the Administration's whole-of-government response. In an update provided to President Obama today, White House Ebola Response Coordinator Ron Klain reported that America is far more prepared to cope with Ebola domestically, and much farther along in our efforts to squelch the virus at the source than we were just two months ago, thanks to the work of more than a dozen federal agencies involved in the Ebola response.

Specifically, the progress we have achieved domestically in the past two months includes:

• Expanded the network of hospitals prepared to deal with Ebola patients, increasing our capacity from 8 hospital beds at just three facilities to 53 beds at 35 designated Treatment Centers nationwide;
• Grown our Ebola testing capacity from 13 labs in 13 states as of August to 42 labs in 36 states;
• Required travelers from one of the four Ebola-affected countries to travel via one of five U.S. airports, where an enhanced screening system has been deployed to identify any potential Ebola cases;
• Put in place national active monitoring guidance for public health officials to maintain daily contact with passengers arriving from an affected country—with even more rigorous monitoring and controls on travelers in higher risk groups;
• Completed phase 1 clinical trials of the first vaccine to treat Ebola, clearing the way for large-scale clinical trials in West Africa in the weeks ahead.

During a similar timeframe, we have also made marked strides in our overseas response by:

• Scaling-up our deployment with thousands of additional civilian and military personnel in West Africa;
• Constructing and opening three Ebola Treatment Units (ETU) along with a hospital in Liberia to care for healthcare workers who become ill, which discharged its first two patients Ebola-free in late November;
• Funding medical teams and non-clinical support operations and ensuring essential PPE supply and in-kind commodity support for a total of 24 ETUs across the region;
• Putting new teams and facilities in place to allow for the training of hundreds of health care workers per week in Liberia;
• Galvanizing international support for the response, which has resulted in more than $2 billion in commitments since mid-September.

Virtually every initiative underway requires immediate, additional funding to be continued or advanced. The President's Emergency Funding Request of $6.2 billion, now pending before Congress, would provide critical resources to build out our domestic Ebola Treatment Centers and Assessment Hospitals; take the next steps on Ebola vaccines, therapeutics, and diagnostics; fund our vital Ebola response in West Africa; and strengthen Global Health Security to prevent, detect, and rapidly respond to the spread of Ebola in any other vulnerable countries and to combat similar infectious disease threats.

The following Fact Sheets provide additional details on this comprehensive response and the progress it has achieved in recent weeks.

Domestic Preparedness

Ensuring Hospital and Health System Readiness

We have prioritized domestic preparedness and hospital readiness since the diagnosis of the first Ebola patient in Dallas so that additional cases can be diagnosed and treated promptly, effectively, and safely. Whereas we previously had no formal guidelines in place to judge a hospital's preparedness vis-à-vis Ebola, we have since September devised and implemented a series of tools to assess and improve facility readiness, allowing us to have confidence in our nationwide ability to respond to additional cases at home.

Ebola Treatment Centers. State and local public health officials, with technical assistance from the Centers for Disease Control and Prevention (CDC) and the Office of the Assistant Secretary for Preparedness and Response (ASPR) at the Department of Health and Human Services (HHS), and in collaboration with hospital officials, have identified substantially increased capacity to treat Ebola patients. Prior to October, there were three facilities in the United States recognized for their biocontainment capability for treating Ebola and other infectious diseases: Emory University Hospital, University of Nebraska Medical Center, and the National Institutes of Health (NIH) Clinical Center. Today, HHS is announcing that, working with state officials, we now have a network of 35 Ebola-ready Treatment Centers nationwide with 53 treatment beds available. Additional facilities will be added in the next several weeks to further broaden this geographic reach.

• Hospitals with Treatment Centers have been designated by state health officials, based on a collaborative decision with local health authorities and the hospital administration, to serve as treatment facilities for Ebola patients. Treatment Centers are staffed, equipped, and have been assessed to have the capability, training, and resources to provide the extensive treatment necessary to care for an Ebola patient.
• These Treatment Centers have been assessed by a CDC Rapid Ebola Preparedness (REP) team, a concept created in October that brings together experts in all aspects of Ebola care, including staff training, infection control, and personal protective equipment (PPE) use. Since their inception, CDC REP teams have visited 52 facilities in 15 states and the District of Columbia and continue to work with other facilities on preparedness.
• Because of this approach, more than 80 percent of travelers returning from West Africa are now within 200 miles of a Treatment Center—and would be transported via ambulance.
• Assessment Hospitals. CDC and ASPR have also made progress working with state and local public health officials in identifying Ebola Assessment Hospitals, another concept launched within the past 60 days. Assessment Hospitals have been and continue to be identified by state health officials as the point of referral for individuals who have a travel history and symptoms compatible with Ebola.
• These hospitals have the capability to evaluate and care for those individuals for up to 96 hours, initiate or coordinate Ebola testing and testing for alternative diagnoses, and either rule out Ebola or transfer the individual to an Ebola Treatment Center, as needed.
• While no states had such plans in September, today the states with the majority of travelers from affected countries have developed strategies to evaluate persons under investigation and to provide care for up to 96 hours while Ebola testing can be arranged.

The following 35 hospitals now have Treatment Centers:

• Kaiser Oakland Medical Center; Oakland, California
• Kaiser South Sacramento Medical Center; Sacramento, California
• University of California Davis Medical Center; Sacramento, California
• University of California San Francisco Medical Center; San Francisco, California
• Emory University Hospital; Atlanta, Georgia
• Ann & Robert H. Lurie Children's Hospital of Chicago; Chicago, Illinois
• Northwestern Memorial Hospital; Chicago, Illinois
• Rush University Medical Center; Chicago, Illinois
• University of Chicago Medical Center; Chicago, Illinois
• Johns Hopkins Hospital; Baltimore, Maryland
• National Institutes of Health; Bethesda, Maryland
• University of Maryland Medical Center; Baltimore, Maryland
• Unity Hospital; Fridley, Minnesota
• Children's Hospitals and Clinics of Minnesota; St. Paul, Minnesota
• University of Minnesota Medical Center, West Bank Campus; Minneapolis, Minnesota
• Mayo Clinic Hospital; Minneapolis, Minnesota
• Nebraska Medicine; Omaha, Nebraska
• Robert Wood Johnson University Hospital; New Brunswick, New Jersey
• North Shore LIJ/Glen Cove Hospital; Glen Cove, New York
• HHC Bellevue Hospital Center; New York City, New York
• Montefiore Health System; New York City, New York
• New York-Presbyterian/Allen Hospital; New York City, New York
• The Mount Sinai Hospital; New York City, New York
• Hospital of the University of Pennsylvania; Philadelphia, Pennsylvania
• Children's Hospital of Philadelphia; Philadelphia, Pennsylvania
• Methodist Hospital System in collaboration with Parkland Hospital System and the University of Texas Southwestern Medical Center; Richardson, Texas
• University of Texas Medical Branch at Galveston; Galveston, Texas
• University of Virginia Medical Center; Charlottesville, Virginia
• Virginia Commonwealth University Medical Center; Richmond, Virginia
• Children's National Medical Center; Washington, D.C.
• George Washington University Hospital; Washington, D.C.
• Medstar Washington Hospital Center; Washington, D.C.
• University of Wisconsin Health; Madison, Wisconsin
• Froedert and the Medical College of Wisconsin; Milwaukee, Wisconsin
• Children's Hospital of Wisconsin; Milwaukee, Wisconsin

Outreach and Training. We have in the same period conducted extensive outreach to the health care community, including hospitals, clinicians, healthcare unions, and medical and nursing provider associations, focusing on training and keeping health care workers safe and preparing frontline facilities to diagnose and isolate potential Ebola patients. In recent weeks, HHS and CDC have hosted over 100 conference calls, more than 30 webinars, and multiple live training events on infection control principles and appropriate use of PPE.

• Specifically, HHS and CDC have educated more than 150,000 healthcare workers via webinars and over 525,000 healthcare workers via online clinical training resources. This includes regular calls with 10,000 nurses, 20,000 physicians and dentists, and targeted outreach to emergency responders, laboratory workers, waste management workers, hospital executives, and others involved at all levels of the response.
• In addition, more than 8,000 individuals have received instruction at live training events on infection control and PPE, with an additional 20,000 trained via livestream.

Additional Resources. In the past 70 days, CDC has also provided additional resources and guidance to assist with hospital readiness.

• CDC has released an algorithm for health care facilities to evaluate returning travelers for Ebola;
• CDC has provided guidance for hospitals on the safe handling, transport and disposal of waste generated from the care of persons diagnosed with or suspected of having Ebola; and,
• CDC has issued tightened guidance on infection control and PPE for U.S. health care workers, to ensure there is no ambiguity.

Ensuring Adequate and Effective PPE. We have worked closely with state and local authorities, as well as with domestic and global manufacturers, to ensure an effective Ebola PPE supply chain. Following the release of the updated PPE guidance by CDC in late October, ASPR and CDC began a dedicated effort to assemble PPE kits to deploy to hospitals to supplement other supply mechanisms. As of late last month, CDC had sufficient PPE to supply 50 days of Ebola patient care in its Strategic National Stockpile (SNS).

• PPE kits or specific PPE items can be delivered from the SNS to any hospital in the continental United States in less than 24 hours, and can be delivered in significantly less than 24 hours to hospitals in large cities and population centers.
• To support optimal hospital preparedness and PPE delivery times, HHS is working with the Health Industry Distributors Association and PPE manufacturers to prioritize and, as needed, redirect PPE supplies should any designated Treatment Center be unable to obtain sufficient supplies from within their hospital network, state and local supply chain.
• CDC has partnered with Emory University and the University of Nebraska Medical Center to develop a PPE assessment tool for use by CDC's REP teams to assist hospitals with estimating the volume of products needed to care for an Ebola patient. The REP teams are now providing direct technical assistance to hospitals, starting with those hospitals near points of entry and those in areas with the largest proportions of returning travelers from the affected countries in West Africa.
• In collaboration with CDC, OSHA has developed and released a PPE selection matrix to help employers select appropriate PPE for workers who may be exposed to Ebola in the course of their work duties. This matrix will provide guidance to employers to both make sure that employees are safe and that regulatory guidelines are followed.
• Through its Ebola Grand Challenge for Development, which was launched in October, the U.S. Agency for International Development (USAID) is working closely with the Department of Defense (DOD), CDC, and the White House to rally innovators, scientists, and experts to generate pioneering solutions to improve PPE. USAID is moving rapidly to select and test the best ideas from more than 1,200 submissions with the goal of fielding improved PPE in 2015.

Enhancing Domestic Ebola Testing Laboratories

Just as we have expanded the network of hospitals capable of responding to an Ebola patient, CDC's Laboratory Response Network (LRN) has grown the network of laboratories able to test a potential Ebola specimen. In order to qualify as an LRN Ebola testing lab, the facility must have the appropriate and functioning biosafety level 3 laboratory, the necessary test reagents, and needed PPE to perform the assay safely. A testing lab demonstrates competency by successful completion of a quality assurance panel. Upon completion and evaluation of the panel, the laboratory is considered approved to test for Ebola using the DOD assay.

• Prior to the recent outbreak in West Africa, Ebola could only be confirmed at the CDC laboratory in Atlanta. In August 2014, 13 LRN laboratories in 13 states were qualified to test for Ebola. As of December 1, 42 LRN laboratories in 36 states are approved to test for Ebola using a DOD test authorized by the Food and Drug Administration (FDA). This has dramatically decreased turnaround time for Ebola results domestically.
• Typically, from receipt of a specimen in the lab, a result is available in 4-6 hours. When compared to the first Ebola specimen domestically tested at Mt. Sinai in August, which took close to 24 hours to complete, this represents a significant decrease in turn-around time. This significant decrease in turnaround time allows clinicians to make patient-care decisions in a shorter timeframe and protects the American public from unnecessary exposures.
• Since the authorization of the first test for the detection of Ebola in August, there are now a total of six diagnostic tests, which have been authorized for use by FDA, including two commercial tests which are available for general hospital laboratories. One of these has a turnaround time of less than one hour after receipt of a specimen in the laboratory.

Strengthening Prevention and Detection Measures

Just as we have enhanced our domestic capacity to diagnose and treat Ebola patients effectively and safely, we also have made strides in establishing additional protocols to minimize the risk of imported Ebola cases. The approach we have developed is multilayered and involves overlapping safeguards to mitigate risk.

Passenger Departure and Transit Screening. We have worked with our international partners to increase capacity to identify travelers who may be experiencing symptoms of Ebola or diseases, prevent them from traveling, and refer them for appropriate care as necessary.

• Since August, CDC personnel have worked with officials of Guinea, Liberia, and Sierra Leone to establish robust exit screening procedures. Based on this screening, travelers with fever or other symptoms that may be suggestive of Ebola are denied boarding and referred to appropriate medical care. A similar program was put in place by French doctors working in Mali, starting in November.
• In October, we coordinated with foreign governments to institute temperature checks and questionnaires to identify possible symptoms of or exposure to Ebola for passengers in transit. As a result, all travelers transiting through Belgium, Canada, France, Ghana, Morocco, Nigeria, Senegal, and the UK en route to the United States from Guinea, Liberia, and Sierra Leone are subject to such screening. France, the transit point for the vast majority of travelers from Mali to the United States, started to implement the same screening regimen for travelers from Mali in November.

Arrival Screening and Monitoring for Early Detection. Pursuant to our layered screening approach, health officials now actively monitor recently-arrived travelers for 21 days since exposure, so that public health officials can rapidly identify a potential case, respond with the medical support the patient needs, and prevent transmission to others in the community.

• The Department of Homeland Security's (DHS) Customs and Border Protection (CBP) officers observe all passengers as they arrive in the United States for overt signs of illness, and question travelers, as appropriate, at all U.S. ports of entry. Since early October, CBP personnel have conducted enhanced screening of all passengers arriving in the United States from the Ebola affected countries of Guinea, Liberia, and Sierra Leone to detect signs of illness or potential exposure to Ebola. Specifically, CBP and CDC began administering questionnaires, temperature checks, and additional health evaluation as necessary, to travelers arriving from the Ebola affected countries; in mid-November Mali was added to this screening regime.
• Since late October, air travelers arriving from these countries are required to arrive to one of five U.S. airports where DHS and CDC conduct joint and enhanced screening.
• Since late October, CBP has collected screened travelers' contact information, which CDC has since passed to state public health departments at their final destination in the United States.
• Since CDC released guidance on October 27th, State public health officials have actively monitored travelers from West Africa for Ebola symptoms for 21 days after the last possible exposure. Under this protocol, passengers identified by screening whose trips began in one of the West African nations are questioned by public health officials daily to check whether they have experienced fever or other possible symptoms of Ebola, and required to report twice daily temperature checks.
• Through active monitoring, dozens of people have reported fever or other symptoms to public health officials, who were then able to safely transport and isolate the individual for evaluation.
• Since late October, individuals deemed to be at elevated risk, including returned health care workers, have been subject to "direct active monitoring." Under this protocol—in addition to twice daily temperature checks—individuals have direct interaction with a public health official daily so that the public health authorities can generate a holistic picture of the individual's health and take early action should any worrisome indications emerge.

Reducing the Risk of Ebola's Maritime Spread. While there have been no cases of Ebola in the maritime sector, the U.S. Government, in coordination with state governments and industry, has developed comprehensive procedures for tracking, screening, prevention, and response to the spread of Ebola via ships calling on the United States.

• In October, the Coast Guard developed targeted questions, aligned with CDC guidance and with those currently being utilized at airports and other points of entry, for any vessel that is known to have had a port call in Guinea, Liberia, or Sierra Leone within 21 days before arrival. Additionally, DHS began sharing tracking information with international partners in November to increase capacity to identify vessels that have visited the Ebola-affected region.
• The Administration released comprehensive guidelines on four separate occasions between September and November that provide specific Ebola preparedness, awareness, and isolation guidance or reporting sick passengers. DHS instituted daily coordination with state and local marine exchanges and port authorities to track and screen arrivals at U.S. ports from Ebola-affected countries.

Developing Countermeasures to Prevent and Treat Ebola

Over the longer-term, vaccines and therapeutics will be a key tool in our arsenal, and we have significantly ramped up development and clinical trials of vaccine and drug candidates. While no therapeutics or vaccines have yet been certified to be safe and effective for treating or preventing Ebola, HHS, led by efforts at NIH, has made progress in recent weeks and is expediting the human clinical trials of several Ebola vaccine and therapeutic candidates.

Ebola Vaccine Development. We are supporting the development of five Ebola vaccine candidates in various stages of development. Two vaccine candidates—cAd3 and rVSV—have been in Phase 1 human clinical trials; three others are still a few months away from the start of trials.

• We achieved a major milestone on November 26th when the initial National Institutes of Health's (NIH) Phase 1 clinical trial for the cAd3 Ebola vaccine candidate, which was developed by the National Institute of Allergy and Infectious Diseases (NIAID) and GlaxoSmithKline, was completed successfully, with results published in the New England Journal of Medicine. The results indicate that the vaccine candidate is safe and induces an immune response. Additional clinical trials of the vaccine are underway or imminent in Atlanta, Baltimore, the United Kingdom, Switzerland, and Mali, among other sites.
• Phase 1 clinical trials of a second vaccine, rVSV, are underway at the Walter Reed Army Institute of Research and at NIH, with results expected in December. Additional Phase 1 studies are underway or planned to begin in the near future at clinical research centers in Switzerland, Germany, Kenya, and Gabon in a WHO-coordinated effort, and in Canada. Merck and NewLink Genetics Corporation are collaborating to research, develop, manufacture, and distribute this investigational rVSV vaccine candidate.
• West African governments are collaborating with the NIH and CDC to plan large Phase 2/3 studies to evaluate the safety and efficacy of vaccine candidates in the community and in health workers in West Africa. These trials are anticipated to begin in the near future.

NIH, DOD, and HHS' Biomedical Advanced Research and Development Authority (BARDA) are supporting production of tens of thousands of doses of these vaccines on a pilot scale for planned trials. BARDA with FDA assistance is supporting the rapid scale-up and optimization of vaccine manufacturing for these vaccine candidates to ensure that the capacity exists to produce millions of vaccine doses in a timely way if mass vaccination campaigns are able to occur in 2015 in Africa.

In addition to these vaccine candidates, there are three other candidates supported during early stage development by NIH and DOD that are a few months away from the start of Phase 1 clinical trials.

Ebola Therapeutics Development. Additionally, the U.S. Government is supporting the development of several investigational candidate therapeutics to treat patients infected with the disease. Some have already been employed in patients in the United States and Africa.

• ZMapp: Under contract with DOD's Defense Threat Reduction Agency (DTRA) and BARDA, ZMapp's antibodies are produced in specially grown tobacco plants and have only been produced in limited quantities. BARDA is sponsoring the manufacturing of ZMapp for Phase 1-2 clinical studies. ZMapp has shown evidence of antiviral activity in animal models of infection. Clinical studies are expected to start in early 2015 at NIAID. Other clinical studies are slated to begin in affected African countries in early 2015. This therapeutic candidate has been used under an emergency investigational new drug (eIND) application in Ebola-infected patients in the United States, Africa, and elsewhere. Mapp Biopharmaceutical produces ZMapp.
• TKM-Ebola: TKM-Ebola has undergone testing in nonhuman primates and showed a significant benefit in terms of survival. This therapeutic candidate has been used under an eIND in some Ebola-infected patients in the United States. Plans for studying this drug in clinical trials are under discussion. TKM-Ebola is produced by the Canadian company Tekmira Inc. under a contract from DTRA.
• BCX4430: BCX4430 is a small molecule drug with recent NIH support that, in preliminary investigations, has been reported to have some antiviral activity against a range of viruses, including Ebola. NIH and the U.S. Army Medical Research Institute of Infectious Diseases are collaborating to evaluate activity in nonhuman primate models of Ebola virus disease as well as human clinical safety trials. Potential for clinical trials has been under discussion depending on assessment of animal study results.
• Brincidofovir (CMX001): Brincidofovir, originally supported by BARDA as a potential smallpox drug, was reported in one study to show possible inhibition of Ebola virus replication in infected cells. This therapeutic candidate has been used under an eIND in some Ebola-infected patients in the United States. Potential for clinical trials has been under discussion depending on assessment of animal study results. The drug is under development by Chimerix.
• Favipiravir (T-705): Favipiravir has been in clinical trials for treatment of influenza but also been reported to show some activity against other viruses, including in Ebola-infected cells. This therapeutic candidate was developed by Toyama and is licensed to Fujifilm and Medivector with support from DTRA. Potential for clinical trials has been under discussion, and it has reportedly been used in some Ebola-infected patients in Europe.

A Scaled-Up International Response

Recognizing that the only way to eradicate the threat of Ebola in America is to defeat it on the frontlines, we have significantly ramped up efforts to fight the virus in West Africa since the President announced an international scale-up at the CDC in mid-September. Our international response is civilian-led with leadership from USAID and CDC and important roles from HHS, the State Department, and other agencies, totaling more than 200 civilian responders on the ground. Complementing this civilian cadre is the U.S. military, which since mid-September has brought to bear its unique capabilities and scale; nearly 3,000 service members are now in West Africa, augmenting what was a small force of several hundred less than three months ago. The Department in October reprogrammed $750 million in funding for this deployment and the broader response.

In Liberia, the country with the highest number of Ebola-related deaths, we have achieved progress against a range of activities in recent weeks working together with the Government of Liberia and partners on the ground.

Isolation and Treatment Facilities. In the past month alone, the U.S. military has completed three ETUs in Liberia, and several more are slated to come online in December. The U.S. military will construct a total of 10 ETUs and USAID-funded partners built an additional four; all are slated to be complete within the next several weeks. The United States is funding medical teams and non-clinical support operations and ensuring essential PPE supply and in-kind commodity support at a total of 20 ETUs. As a result of this support, a total of 24 ETUs providing isolation and care facilities throughout Liberia are expected to be operational by the end of January.

• In large part due to the U.S. government's efforts, the number of ETU beds in Liberia has nearly doubled since September. As of December, there are approximately 800 beds available to Ebola patients in facilities built or supported by the United States, and we expect nearly 2,000 to be online by January 1.
• To complement the ETUs, we have also worked with the Government of Liberia and NGO partners since September on a comprehensive Community Care Strategy that brings effective care to hotspots inaccessible to treatment facilities and areas prone to flare-ups. Under this strategy, the United States has established six of the 21 needed Community Care Centers located in 15 priority hotspots, and the establishment of rapid response mechanisms to build county-level case management capacity to respond to outbreaks in remote areas that are inaccessible to treatment facilities.
• Additionally, we are supporting rapid Ebola laboratory testing through six laboratories, which have helped reduce time required for testing samples from several days to hours. Personnel from the U.S. Naval Medical Research Center operate three of these mobile medical labs, the number of which has more than doubled in the past month and will continue to rise.

Recruiting and Training Health Care Workers. As we have brought additional infrastructure online in recent weeks, we also have sought to ensure sufficient personnel are available to staff these facilities and provide the highest quality care to patients. We are supporting training for health care workers and foreign medical teams in the United States and in Liberia. Prior to their deployment, more than 200 health care workers have been trained in the United States. As of November, we have the capacity to train 200 health care workers per week in Monrovia alone.

• Through the U.S. military, moreover, we have established mobile teams to train up to 100 health care workers per week outside of Monrovia. We had no such capacity prior to last month, and the U.S. military since last month has trained hundreds of such health care workers.

New Hospital for Infected Health Care Workers. To encourage experienced health care workers from around the globe to join in this effort and help ensure they can get the care they need should they become ill, we now have in place an advanced Ebola treatment facility in Monrovia, which the U.S. military constructed. More than 70 members of HHS' U.S. Public Health Service Commissioned Corps are now treating health care workers in this facility, the Monrovia Medical Unit (MMU), which opened its doors in early November. The MMU last month achieved a milestone by releasing its first two patients, both of whom are now Ebola-free.

Establishing Effective Incident Management. We have provided technical support to establish a fully functioning national Emergency Operations Center (EOC) and Incident Management System in Liberia, which came online in October. We are now working to support county-level EOCs throughout Liberia.

Increasing Safe Burial. Since September, we have met our target of supporting 65 active safe burial teams across all 15 counties in Liberia—greater than 90 percent of responses to dead body alerts occur within 24 hours. In early September, only 12 U.S.-supported burial teams were operational.

Supporting Infection Control. We are facilitating large-scale infection control in Liberia, including procuring and airlifting 130,000 PPE sets to Liberia and trainings for health care workers in infection control outside established Ebola facilities.

Increasing Outreach and Social Mobilization. Through our partners, more than 1.5 million Liberians receive daily radio Ebola messages, and nearly 100,000 households have been directly reached by mobilization teams to date. This comprehensive social mobilization coverage has resulted in significant behavior change that has played a large role in bending the curve.

A Regional and Global Approach to Mimic Our Success. The decline in infection rates in Liberia witnessed in recent weeks confirms that we have the right strategy in place. With these signs of progress, however, we must not relent in executing this strategy. We know that small outbreaks can quickly flare up and wipe away months of progress. We are committed to expanding the pace, ingenuity, and scale of our response in Liberia, and across the region, to stem this deadly epidemic and to meet the longer-term recovery and prevention needs in West Africa. As such, we have supported the same approaches in Sierra Leone, Guinea, and Mali. The Senegal-based Intermediate Staging Base, which DOD established in September, has helped to facilitate an approach that reaches beyond Liberia.

• In Sierra Leone and Guinea, we are supporting EOC and Incident Management Systems; four ETUs, including two in Sierra Leone and two in Guinea; social mobilization; support to a combined six NGO partners to carry out community outreach activities in Sierra Leone and Guinea; contact tracing; safe burials, including 50 teams across all 14 districts of Sierra Leone; and infection prevention. In Sierra Leone, where the outbreak has intensified, we now have more than 60 U.S. Government personnel deployed. In Mali, meanwhile, we surged personnel and resources there and began applying the same response lens, adapted to the current scale of the outbreak.
• In order to prevent the further spread of Ebola, we are assisting the 13 most at risk countries in West Africa to strengthen their capacity. To date, the United States has hosted three preparedness workshops for regional stakeholders and has sent rapid response teams to the region to provide hands-on assistance to governments in neighboring countries. CDC is also sending staff to each of these countries to provide technical guidance and leadership to preparedness activities, including contact tracing, specimen transport to laboratories and early alert and rapid response systems.
• More broadly, we also have strengthened capacity in countries across Africa, Asia, and the Middle East that are not equipped to handle Ebola or other deadly biological threats. In late September, the White House brought together ministers and other senior officials from 43 of these countries. We are now working with these partners to implement over 100 new, concrete commitments, including standing up emergency operations capacity, strengthening laboratory safety, and improving rapid disease detection and surveillance to end outbreaks before they become epidemics.

Leading and Expanding an International Coalition

The United States has led the international effort to confront Ebola, but, as the President has said, we cannot take on this challenge alone. U.S. leadership has successfully galvanized others to take part. Since mid-September, when President Obama called on the world to act, other nations, private sector stakeholders, international organizations, and multilateral development banks have come together to pledge more than $2 billion to end the epidemic at its source in West Africa. Other senior U.S. officials—including the National Security Advisor, Secretary of State, Secretary of Health and Human Services, and the Ebola Response Coordinator, among others—have since continued to dialogue with their counterparts to enhance and optimize the international response. Fifteen countries have committed more than $800 million in financial and in-kind assistance following engagement by senior Administration officials.

Among the contributions announced since mid-September:

• The European Union, including the European Commission and member states, has collectively committed more than $1.2 billion in financial assistance, $171 million in development and early recovery assistance, and other valuable in-kind assistance, such as health care workers and medical evacuation support.
• African nations have joined together to commit to contribute 2,000 health care workers through the African Union to the affected countries in West Africa, while African business leaders have pledged $28.5 million in financial assistance.
• The United Kingdom has committed a $359 million package of direct support to help contain, control, treat and ultimately defeat Ebola in West Africa. This includes a commitment to deliver 700 treatment beds in the coming months to Sierra Leone, helping up to nearly 8,800 patients over a six month period, and supporting the roll out of 200 community care centers.
• Germany has committed more than a $126 million to the Ebola response effort, and pledged to recruit and train several hundred volunteers. Additionally, Germany has established of an airlift capability from Dakar to Monrovia, Conakry and Freetown, and committed to providing equipment and operational support to a 100-bed World Health Organization (WHO) ETU in Monrovia.
• France pledged $124 million to the Ebola response, including $14 million to construct an ETU in Guinea.
• Japan announced $100 million in assistance on top of about $45 million in assistance previously committed. This aid will help rebuild the health system of the affected countries, in addition to support the treatment of patients currently infected with Ebola. Additionally, the Japanese have announced that they are prepared to send up to 700,000 sets of PPE to Liberia and Sierra Leone.
• China has announced more than $130 million in assistance, including construction and staffing of a 100-bed Ebola treatment unit in Liberia, $6 million for the UN Ebola Multi-Partner Trust Fund, and another $6 million for the World Food Programme.
• Canada has committed $20.5 million to support further research and development of Ebola medical countermeasures, namely Canada's Ebola vaccine and monoclonal antibody treatments. Additionally, Canada is contributing $18.3 million to aid organizations, two mobile labs that provide rapid diagnostic support to help local healthcare workers to quickly diagnose Ebola, and $2.2 million worth of personal protective equipment.
• The African Development Bank contributed more than $220 million towards strengthening West Africa's public health systems.
• The Organization of Islamic Cooperation and the Islamic Development Bank announced a $34 million package to support health programs in the countries affected by Ebola, including $6 million for fighting the disease.
• The International Monetary Fund (IMF) has approved $130 million in emergency financial assistance to Guinea, Liberia, and Sierra Leone to help respond to the Ebola outbreak. Additionally, the IMF plans to make available a further $300 million to stem the Ebola outbreak and ease pressures on Guinea, Liberia and Sierra Leone, through a combination of concessional loans, debt relief, and grants.
• The World Bank Group is mobilizing nearly $1 billion in financing for the countries hardest hit by the crisis, including more than $500 million for the emergency response and to help speed up the deployment of foreign health care workers to the countries, and at least $450 million to enable trade, investment and employment in Guinea, Liberia, and Sierra Leone.