Global Health Security

Local Participation is the Key to Success in Global Health Security

This guest post was originally published by Management Sciences for Health. The post is written by Ashley Arabasadi and is an overview of “Getting Local with Global Health Security,” a World Health Assembly side-event co-sponsored by partners under the Global Health Security Agenda Consortium including MSH, the Global Health Council, Resolve to Save Lives at Vital Strategies, Nuclear Threat Initiative, PATH, the Global Health Technologies Coalition, the Global Health Security Agenda Next Generation Network, and US Pharmacopeia. 

Loyce Pace of the Global Health Council moderates an expert panel at the WHA71 side event in Geneva, May 22, 2018. Panelists included Dr. Diane Gashumba, Rwanda’s Minister of Health; Catharina Boehme, CEO of the Foundation for Innovative New Diagnostics; and Rüdiger Krech, Director of Health Systems and Innovation at WHO. Photo credit: MSH

Is the world safer today from the threat of infectious diseases than it was a generation ago?

It is true that we have more tools at our disposal: better surveillance and diagnostic systems, stronger frameworks and regulations, such as the Global Health Security Agenda and Joint External Evaluations (JEE), and a deeper understanding of how diseases spread and what is needed to stop them. It is also true that climate change, deforestation, population growth, and our proximity to farm and wild animals are making the threat of epidemics greater than ever before. Although the challenge is great, we have the knowledge to solve it. So what do we need to do?

This is the question we set out to answer during a discussion on the sidelines of the 71st World Health Assembly in Geneva last week. Industry experts, including Dr. Tom Frieden, President and CEO of Resolve to Save Lives, an initiative of Vital Strategies; Peter Sands, Executive Director of the Global Fund to Fight AIDS, Tuberculosis and Malaria; Dr. Diane Gashumba, Rwanda’s Minister of Health; Rüdiger Krech, Director of Health Systems and Innovation at the World Health Organization; and Catharina Boehme, CEO of the Foundation for Innovative New Diagnostics, engaged a room of more than 200 people on what they see are critical gaps—and how to fill them—in global health security.

Knowledge is King

“Three years ago, we were flying blind,” said Dr. Frieden, reflecting on the progress the world has made in strengthening our capacity to prevent, detect, and respond to infectious disease threats. “There was no information about which countries were ready, what they were ready for, or what needed to be done.” While we’ve made important progress in understanding where the gaps are and how to address them, says Frieden, we’re far from filling those gaps.

To date, more than 76 countries have completed the JEE process, and a few dozen of them are developing national action plans for health security. However, virtually none have costed these plans, identified necessary resources to implement programs, or established sustainable systems to close gaps and stop outbreaks at the source.

Frieden signaled where the gap is greatest: “Countries in Africa have the furthest to go and require the greatest partnership, following the leadership of countries like Rwanda, which are in front of implementing effective programs.”

The better we understand the gaps in a country’s capacity to prevent, identify, and fight infectious disease outbreaks, the better positioned we are to implement the right interventions to strengthen health systems in support of health security. But we need to move from awareness into action.

Money Motivates

“The number of infectious disease outbreaks is going up,” Peter Sands said. “This is not a problem that is going away as mankind gets bigger and richer. This is a problem that seems to be increasing in magnitude.”

“Although we appear to be getting better in controlling the mortality impact of such outbreaks because of the advances in medical science, we actually appear to be getting more vulnerable to the economic impact,” Sands continued. Fear of an outbreak travels fast, and the behavioral consequences of that fear are extremely powerful and can disrupt economies, even in countries where the disease never appeared.

The challenge is to recognize the cost of epidemics and prepare locally in advance. We must invest now in prevention and preparedness or pay later in lost lives, closed businesses, and disrupted economies.

Prepare Locally

Poor planning and preparation leaves populations vulnerable to illness and undercuts efforts to treat patients and curb new infections. Each country needs to understand its weaknesses so they can start addressing them right away.

Rwanda, for example, recently finished its JEE.  “Each country has to adapt global health security work to its own specific situation,” said Dr. Gashumba, reflecting on the process. “Sometimes it is very difficult to make priorities, especially when you have lot of health and social issues . . . the strategy we adopted is to focus everything on the ground because the issues are on the ground, but also the solutions are on the ground.”

If we are to get local with global health security, we must get local in context and recognize that the threats facing communities today may be endemic diseases, like malaria, tuberculosis, and HIV. Active prevention and constant readiness must break down silos and follow an integrated and holistic approach to health.

Better Diagnostics

The ability to quickly and accurately diagnose an infectious disease where it starts, at the community level, can make or break an epidemic. According to Catharina Boehme, diagnostics is a “blindspot” in global health security. “Effective, affordable diagnostics is critical to every country’s surveillance and response system . . . and diagnostics is one of the pieces that is absent in many of the countries that would be most in need to have early response and preparedness mechanisms.”

She continued: “For six of the nine blueprint pathogens, we have no diagnostics available at all, and even when diagnostics exist, health systems are rarely equipped to deploy them when needed.”

Early response, aided by efficient diagnostics, could save countless lives and billions of dollars every year. According to Boehme, only one laboratory in all of Africa (Senegal) today can confirm yellow fever. For Ebola, she says, despite progress, it took three months in 2014 to diagnose it. “Now in the current Ebola outbreak in DRC, we’re faced with a situation where there’s again a major access problem to diagnostics.”

This is an area where the world clearly hasn’t made enough progress over the years compared with vaccines, says Boehme. “There’s no manufacturing capacity in place to scale up diagnostic manufacturing when needed.” Local partnerships, sample sharing, clinical trial capacity in countries, and local R&D are also lagging far behind. Speaking about the progress made by global vaccine initiatives, she says, “it wouldn’t take much money to leverage these same mechanisms towards some diagnostics.”

A Political Choice

Epidemic preparedness is within any country’s reach, said Rüdiger Krech. But in the end, it’s a matter of political choice. “By and large we know what to do. It’s not that we can’t afford it. We can afford it. That is why it’s a political choice.”

“There will be outbreaks and epidemics if you have weak health systems,” Krech said. “For quite some time, we’ve tried to address the low-hanging fruit, which is disease-specific programs, and we’ve always thought that this was done on the basis of well-functioning health systems, but as we’ve seen, that is not the case.” To make real progress, he says “ We need to much better align the JEE and the Global Health Security Agenda with what’s actually going on in health systems.”

No matter where you live in the world, the risk is universal. To stop outbreaks at the source and prevent threats from becoming epidemics, local preparedness is key. We know that bridging the gap between awareness and action requires us to engage citizens, communities, frontline health workers, and those working with animal populations in the direct reporting of suspected outbreaks. It also requires having in place the tools and skills needed for an effective and efficient response that ensures essential services remain in place when battling an outbreak. The challenge now is to persuade government leaders that preparedness is worth the price tag.

Read more about this event from Global Health NOW:


“Two Sides of the Same Coin”: Can a health systems lens inform health security efforts?

This guest post was written by Taylor Williamson of RTI InternationalRTI International is an independent, nonprofit research institute dedicated to improving the human condition. They are a 2018 Global Health Council member.

The discussions at the 71st World Health Assembly (WHA) have been wide-ranging, from non-communicable diseases (NCDs) and youth engagement to citizen participation and Universal Health Coverage. With the 2018 Ebola outbreak in the Democratic Republic of Congo (DRC), health security, and its link to strong health systems, is at the forefront of the discussion as one of the three strategic priorities in the General Programme of Work. In fact, Dr. Tedros, the Director-General of WHO, has taken to saying that “health security and health systems are two sides of the same coin.” However, it is not yet not clear to me how Dr. Tedros, WHO, or the wider global health community think a health systems lens could add value to the health security discussions.

RTI International’s Dr. Boni Ngoyi takes a canoe to Muma, DRC to investigate an Ebola outbreak in June 2017.

Sessions on health security have so far focused on metrics and measurement, as 76 countries have conducted Joint External Evaluations (JEEs) to evaluate their own health security capacity. Speakers recognize that these evaluations are necessary, but not sufficient, to ensuring that countries focus their efforts on key health security priorities. To complement the JEEs, a team from Hopkins, the Economist Intelligence Unit, and the Nuclear Threat Initiative is developing a Global Health Security Index to provide regular updates on preparedness efforts. The index should be ready by mid-2019. Additionally, about 25 countries have developed health security action plans, based on the gaps found in the JEEs. Regardless, countries are not seeing the political commitment, at either global or national levels, to ensure that these action plans are adequately funded, implemented, and monitored.

Nonetheless, efforts to advocate for these commitments exist. For example, Resolve to Save Lives, under the direction of former CDC Director Dr. Tom Frieden, has consolidated JEE findings to spur global action on the highest priority areas. During the JEE process, several health systems challenges have emerged, including analyzing surveillance data, training epidemiologists, and coordinating across sectors. Building on the JEE findings, I see three systems approaches that could add value to the health security discussion: contextualization, use of complexity science, and adaptation of existing tools.

First, we know from our experience in health systems and governance that solutions must be contextualized to specific environments.  In the health systems space, we are beginning to use more political economy thinking and adaptive management techniques to inform programmatic design and technical assistance packages.  Health security, through the JEE process, takes a much more normative approach by evaluating the existence of set policies, standards, and processes. Contextualization could include using a political economy lens to understand incentives and motivations for prioritization and/or tailoring action plans to endemic disease patterns, geographic differences, and cultural practices when developing health security action plans.

Second, I wonder to what extent the health security community has embraced the knowledge on complexity science, which seeks to describe systems that have multiple, interconnected elements. In the sessions I have attended, health security is described as a complicated system of widgets (simulation sessions, laboratory diagnostics, reporting procedures, etc) where the effects can be predicted and replicated. We know, however, that systems with interpersonal relationships and various stakeholders are inherently complex.  Understanding and strengthening the complex systems that prevent, detect, and respond to pandemics requires knowledge of the relationships between actors, responding to their interests and motivations, and iterating effective, if not always perfect, solutions.

Third, the health systems community has developed several relevant tools and approaches that could be applied to health security issues. As Ministries of Health seek to finance and implement health security action plans, investment cases, as with those for NCDs or HIV, can influence Ministries of Finance to invest in health security. The Health Systems Assessment Approach takes advantage of the wealth of qualitative data and experience at national and sub-national level. While costing models, such as the OneHealth tool, provide powerful, low-cost ways to collect and analyze country-level data.

So how can we, as a global health community, make use of these systems approaches? The most obvious use is to inform the ongoing development of the Global Health Security Agenda 2024 that will outline how international, multilateral, and country programs can improve health security efforts. Using a health systems lens can also strengthen data use and political analysis that drive resource allocation decisions.

Preventing, detecting, and responding to pandemic threats is at the heart of public health.  When John Snow first removed the handle from the Broad Street pump in 1854, he was responding to an outbreak of cholera.  Though our profession has moved beyond wrenches and bolts, outbreaks of Ebola, measles, yellow fever, and H1N1 keep calling us back to our roots. We should use all the tools at our disposal to create a truly secure and healthy future.

The Local Path to Global Health Security

This article was originally published in Global Health NOW.  The article is around a WHA side-event organized by Global Health Council & partners. Global Health NOW has gathered thousands of subscribers worldwide who rely on it as a source for their global health news. The mobile-ready website came online in March 2015, delivering more exclusive stories and commentaries, breaking news, and news summaries. To follow the #healthsecurity conversations online, follow @GlobalHealthOrg on Twitter.

The Global Fund’s Peter Sands speaking at a #WHA71 side event in Geneva on May 22, 2018. (Image by Brian W. Simpson, Global Health NOW)

Global Fund executive director Peter Sands set an ominous challenge before experts at a Monday side event of the World Health Assembly: “The number of infectious disease outbreaks is going up,” Sands said. “This is not a problem that is going away as mankind gets bigger and richer. This is a problem that seems to be increasing in magnitude.”

The challenge is to recognize the cost of epidemics and prepare locally in advance, he told an audience at the “Getting Local with Global Health Security” event sponsored by Management Sciences for Health, the Global Health Council and others. The costs in human lives and in dollars should drive better preparedness, Sands argued, citing an estimated $500 billion per year in economic and human costs.

“This is a phenomenon with a significant economic impact,” he said. Drawing on his experience in the financial industry in Hong Kong, Sands noted the 2003 SARS outbreak cut tourism there by two-thirds 2 months afterwards.

“We live in a world where fear travels extremely fast,” he said. The result is massive changes in personal behavior resulting in impacts that can shake national economies.

Preparing in advance is more effective than trying to respond afterwards. And the key to preparation, explained Tom Frieden, President and CEO of Resolve to Save Lives, is for each country to know its weaknesses and fix them.

Frieden then displayed a slide covered in green, yellow and red squares that chart countries’ preparedness status across the 76 indicators of the Joint External Evaluation. The evaluation is meant to provide a gauge of how countries are doing in meeting targets that are in the 2005 International Health Regulations.

While acknowledging the JEE’s intimidating detail—it looks like a block by block heat map of a sprawling metropolis—he drilled down into the chart and surfaced advances in preparedness that Sierra Leone achieved in just 6 months in 2016. Tanzania scored similar wins from 2016 to 2017, Frieden said.

“This is the kind of focus that we are going to need if we’re going to make progress against epidemics,” he said.

Diane Gashumba, Minister of Health of Rwanda, found JEE to be a helpful exercise. Essential to the process is being transparent and open about your country’s weaknesses. If that’s not embraced from the start, the process is destined to fail, she said.

Each country has to adapt global health security work to its own specific situation, Gashumba said. “Sometimes it is very difficult to make priorities especially when you have a lot of health and social issues,” she said. “In my country, Rwanda, the strategy we adopted is to focus everything on the ground because the issues are on the ground but also the solutions are on the ground.”

Sands noted the issue with JEE is that more countries have done the assessment of their capacity than “have actually closed the gaps.” The Global Fund, he noted, too, has room for improvement. It can do a better job making sure that the hundreds of millions of dollars supporting AIDS, TB and malaria efforts can do double duty by more broadly helping countries prepare for future epidemics. “I think we have a bit too much-siloed language and thinking,” he said.

Rüdiger Krech, director of Health Systems and Innovation at WHO, said the preparedness for epidemics is within any country’s reach. “First of all, it is a political choice,” Krech said. “By and large know what to do. It’s not that we can’t afford it. We can afford it. That is why it’s a political choice.”

The challenge is to persuade government leaders preparedness is worth the price tag.

It’s (Past) Time We Prepare for the Next Pandemic

This blog post was originally posted on the Center for Global Development website. It was written by Rebecca Forman of Center for Global Development’s Global Health Policy Center. The Center for Global Development works to reduce global poverty and inequality through rigorous research and active engagement with the policy community to make the world a more prosperous, just, and safe place for all. They are a 2018 Global Health Council member.

Last week, the Center for Strategic and International Studies (CSIS) hosted an advance screening of the PBS Great Decisions episode, “Global Health: Preventing Pandemic.” After the screening, a panel of American global health experts took to the stage to discuss US leadership in global health and health security. On the panel were Ambassador Debbie Birx, U.S. global AIDS coordinator and special representative for global health diplomacy; Dr. Helene Gayle, president and CEO of the Chicago Community Trust; Chris Collins, president of the Global Fight Against AIDS, Tuberculosis and Malaria; Stephen Morrison, senior vice president and director of the CSIS Global Health Policy Center; and Amanda Glassman, chief operating officer and senior fellow here at CGD. While the group highlighted the scary realities that pandemics present, they also expressed optimism and explored ideas for how we can improve on pandemic preparedness—some of their ideas are in the box below. The bottom-line? The next pandemic is just a matter of when. It’s (past) time that we prepare.

How can we do better on global health security?

1) Direct funds towards hoped-for results
2) Less focus on inputs and more on progress towards outcomes, or system functionality
3) Collaboration and coordination across global health funding mechanisms
4) Develop a storyline and action plan on how these mechanisms fit together with a joint accountability framework to keep everyone aligned
5) Support and nurture youth and country leadership
6) Double-down on performance and use data to focus interventions
7) Form public-private partnerships to enhance technical support and financing for global health security

Calls for a greater focus on global health security aren’t new. Back in 2015, a Blue Ribbon Study Panel on Biodefense released short-term and long-term recommendations for how the United States could prepare for biological threats. Short-term recommendations included institutionalizing biodefense in the Office of the Vice President, establishing a biodefense coordination council at the White House, determining and establishing a clear congressional agenda to ensure national biodefense, implementing an integrated national biosurveillance capability, and empowering nonfederal entities to be equal biosurveillance partners, among many others. But three years later, most of these recommendations have yet to come to fruition. The Blue Ribbon Panel’s warning from three years ago remains true today: “the United States is [still] underprepared for biological threats. Nation states and unaffiliated terrorists (via biological terrorism) and nature itself (via emerging and reemerging infectious diseases) threaten us.”

Changes in the US have been slow, even in the face of new threats. We’ve recently seen the creation of horsepox—a cousin of the virus that causes smallpox in people. While creating viruses using synthetic biology can advance research and help scientists come up with cures, these viruses can be a major threat to the US and the world in the wrong hands. Throw in increased antimicrobial resistance (read about CGD’s work on this here) and, as New York State health commissioner Howard Zucker said at a recent Hudson Institute event on transnational biological threats and global security, “oy.” The threat of drug-resistant strains of diseases (manmade or natural) that will continue to spread without an arsenal of antibiotics to combat them makes this picture even starker.

This could be devastating not only in terms of lives lost but also in terms of economic and political instability. Experts estimate that the 2003 SARS epidemic cost the global economy between $30–40 billion in just six months. As Dr. Rebecca Martin explained at a CGD event on Preventing the Next Pandemic in May last year, “it costs a lot less to prevent now versus being able to respond later.” According to Dr. Martin, by some estimates we’ve spent $6 trillion on epidemic response so far in the twenty-first century. That’s about $60 billion a year. If we put that money towards prevention, experts say that number could be reduced to about $4.5 billion a year, or 65 cents per citizen of the world.

If we aren’t paying attention and reacting to biosecurity threats here in the US, how can we expect low- and middle-income countries to have biosecurity at the top of their agenda? When the Spanish flu hit in 1918, an estimated 500 million people died worldwide, with more American deaths than US casualties in World War I and World War II combined. Today, more than half the world lives in densely populated urban settings, and with air travel, a disease could spread around the global in under 48 hours. Urbanization and globalization, combined with the fact that most infectious diseases are zoonotic (caused by infections that are shared between animals and people), are setting us up for a huge spillover event. As CGD COO and senior fellow Amanda Glassman states in the PBS Great Decisions episode, this “could be catastrophic if we had a disease spread more quickly and widely than what we’ve seen so far.” Thus, even if an outbreak occurs on the other side of the world, we could see effects here in the US within days.

Officials know a major disease outbreak—intentional or not—is bound to occur (we just don’t know what, where, or when yet). But still, the US is not prepared: in most US cities there are only one or two hospital beds equipped to treat a person in quarantine, stockpiles of medicines and devices have proven low or full of expired treatments time and time again, and there is a major lack of control systems. As former Secretary of Homeland Security Tom Ridge and former Senator Joe Lieberman wrote in their preface to the Blue Ribbon Study Panel’s 2015 report, “We have no choice—the Nation must take action to defend against the biological threat. We have done much already, but we need the leadership only a top-level official can bring to bear to optimize the biodefense enterprise.” It’s time to prepare for the inevitable and put the systems in place to protect Americans’ health both at home and abroad against global infectious disease outbreaks.

View CSIS’s panel discussion on “An Advance Film Screening and Discussion: U.S. Leadership in Global Health and Health Security” below:

Diseases Do Not Respect Borders: A Conversation With CDC’s Dr. Rebecca Martin on The Economic Case for Preventing Disease Outbreaks

This blog was originally posted on the Rabin Martin website. It was written by Tina Flores, VP, External Engagement, Rabin Martin and GHC’s Advisory Council member. Rabin Martin is a strategy consulting firm that helps clients be leaders in improving health and access to global health technologies and is a 2018 Global Health Council member.

Dr. Rebecca Martin, Director of the CDC’s Center for Global Health. Source: CDC

Dr. Rebecca Martin is a fixture in the global health community. As director of the CDC’s Center for Global Health, Dr. Martin’s leadership has been a driving force in engaging the public and private sectors to accelerate progress towards disease prevention, detection and response around the world. Dr. Martin and her colleagues at the CDC are also important partners to the Global Health Security Agenda (GHSA) Private Sector Roundtable (PSRT), a coalition of companies that acts as a central touchpoint for industry to mobilize efforts to protect against, detect and respond to disease threats.

PSRT members generate private sector insights to address specific health and development risks and vulnerabilities, identify opportunities to apply the unique expertise and resources of its members, and facilitate industry engagement to strengthen health systems and outbreak preparedness. The CDC provides technical support to the PSRT to ensure alignment with country priorities.

Tina Flores, who leads the PSRT’s secretariat at Rabin Martin, talks with Dr. Martin about some of CDC’s recent research on the effects of pandemic outbreak on the U.S. economy and the organization’s relationship with industry, and gets Dr. Martin’s take on why an ounce of prevention is indeed worth a pound of cure.

Tina Flores: The CDC recently published a series of studies that explore the economic impact of pandemic outbreaks on the U.S.What was the impetus for the studies and why was the focus on impact to the private sector, specifically? 

Dr. Rebecca Martin: We have to start by acknowledging a reality of our world today, that disease knows no borders. Pathogens exploit gaps in the world’s ability to prevent, detect, and respond to existing or emerging diseases, and in today’s interconnected world, diseases can spread from a remote village to major cities in as little as 36 hours.

These studies help make a clear business case for investing in public health capacity building around the world.

The first economic impact study, for example, Relevance of Global Health Security to the U.S. Export Economy, depicts the extent to which the U.S. economy is affected by infectious disease outbreaks in other countries.

1) Using 2015 U.S. Department of Commerce data, CDC assessed the value of U.S. exports and the number of U.S. jobs supported by those exports to a set of countries where CDC supports health security activities.
2) U.S. exports to the countries where CDC is partnering to strengthen and improve health security exceeded $308 billion and supported more than 1.6 million jobs across all U.S. states in agriculture, manufacturing, mining, oil and gas, services and other sectors.
3) These exports represented 13.7% of all U.S. export revenue worldwide and 14.3% of all U.S. jobs supported by all U.S. exports.
4) The economic linkages between the United States and these global health security countries illustrate the importance of ensuring that countries have the public health capacities needed to control outbreaks at their source before they become pandemics. We must all work together to close these gaps to protect the health and safety of Americans and U.S. interests.

Tina: How can these studies help policymakers, at home and abroad, make decisions about resource allocation and further the discussion of how health, finance, trade, and agriculture can work together to prevent and minimize the threat of outbreaks?

Dr. Martin: These studies demonstrate and quantify that even in a country where a disease outbreak does not spread to U.S. shores, it can trigger direct and measurable economic fallout in communities in the United States. Global health security is important for us all, and we are only as strong as our weakest link.

For example, the CDC study, Impact of a Hypothetical Infectious Disease Outbreak on U.S. Exports and Export-Based Jobs, predicted that the hypothetical outbreak would carry a cost inside the United States of between almost $13 million to $64 million if only one country was affected, and that it would quickly escalate as the epidemic spread to more counties, peaking at about $8 billion to $41 billion, if the outbreak were to spread to nine countries.

These results demonstrate that there is value in investing in systems to strengthen the tools and policies in countries for detecting disease at the earliest possible moment, and for responding decisively when an outbreak occurs—value for the country facing the disease threat, and for preventing potential disruptions to markets and associated economic and job losses in the U.S.

The U.S. government strongly supports the Global Health Security Agenda (GHSA) as a mechanism to focus the world on the capacities to prevent, detect, and respond to human and animal infectious disease threats, whether they are natural, accidental, or deliberate.  U.S. government support of the GHSA is truly a whole-of-government effort and is a model for program coordination of health security activities. For example:

1) CDC remains committed to supporting the U.S. Government’s July 2015 pledge of $1 billion to support GHSA capacity building in 17 partner countries over five years.
2) In addition to the $1 billion investment in 17 countries, the U.S. continues to partner with 14 additional countries and the Caribbean Community to make progress toward GHSA targets.
3) As highlighted in the U.S. government’s GHSA Annual Report, published in March 2018, we have shown measurable progress from our investments in global health security, including demonstrated improvements in partner country capacity to detect and respond to health threats faster and more effectively.

Tina: What are the implications for industry– for healthcare companies as well as other sectors?

Dr. Martin: In our increasingly interconnected world, outbreaks can destabilize countries, disrupt economic forces, and affect businesses no matter where they are located.

We know that successful businesses need healthy, productive employees and the presence of disease threats can diminish that essential need. We also know that a disease outbreak—and in some cases even the threat of a disease outbreak—distorts the economy in powerful ways that can touch both global and domestic businesses.

During the Ebola outbreak, for example, imports to the three affected countries—Liberia, Guinea and Sierra Leone—plummeted.  The number of commercial airline flights to the region decreased, providing further disruption to travel and trade. All three countries had rapidly growing economies before the Ebola outbreak, and even into the first half of 2014. By the end of 2014, the World Bank reports that the total fiscal impact felt by the three countries was over half a billion dollars, nearly 5 percent of their combined GDP.

Tina: For many people, global health security is quite amorphous. But disease detection, infection prevention and control, vaccines and supply chains are such a critical part of the global health security equation. What are some of the ways the CDC collaborates or can collaborate with companies and organizations that do this work?

Dr. Martin: No single country, sector or organization can achieve global health security alone. Multi-sectoral collaboration and public-private partnerships are critical to ensuring the world will be ready to prevent, detect and respond to the next inevitable infectious disease outbreak. Businesses and NGOs have a stake in the success of these endeavors―their investments, workforce, and mission is affected positively or negatively by the capacity of a country’s public health system.

For more than 70 years, CDC has worked in partnership around the world to protect the health, safety, and security of the American people, to protect U.S. interests and save lives. We have seen examples of synergies in expertise, knowledge, and technologies―most recently partnering in the Global Health Security Agenda―and for many years in HIVmalaria, and immunization.

For example, in the area of vaccines, CDC is working with Gavi, The Vaccine Alliance and public and private sector partners on vaccine delivery technologies. These innovations are addressing some of the major hurdles to vaccine delivery so that we can eliminate barriers and reach at-risk populations faster and more efficiently than we do today.

Tina: How can investments in global health security strengthen health systems, and especially the health workforce?

Dr. Martin: More than anything else, stopping disease outbreaks early and decisively takes capable, well-trained frontline personnel that can spot, identify and respond to threats correctly. These facts underlie much of CDC’s work abroad, helping train “disease detectives” in countries, and improving the knowledge and capabilities of laboratory technicians, as well as an array of other health care officials ranging from policymakers to those involved in immunization campaigns and other disciplines.

Source: CDC

We have to protect our frontline workers, as they are at increased risk and play a vital role in detecting and rapidly responding to disease. For example:

1) During the Ebola 2014 outbreak, ExxonMobil partnered with CDC Foundation to support improvement to healthcare worker safety and infection prevention and control (IPC) at Nigerian healthcare facilities through the Field and Epidemiology Training Program (FETP).
2) In December 2016, CDC provided technical assistance to Nigeria’s African Field Epidemiology Network as a pilot with 34 Field
3) Epidemiology Training Program (FETP) residents. Shortly thereafter, a health worker at a hospital in southwestern Nigeria died after being admitted with Lassa Fever. Six of the residents who participated in the training investigated this outbreak, helping to prevent the spread of Lassa Fever to any further health workers at the medical center.
4) In 2017, through FETP, CDC trained nearly 2,000 “boots on the ground” disease detectives in partner countries around the world. These disease detectives were among the first on the scene to identify and contain outbreaks of international concern like yellow fever, Ebola, and Marburg virus. FETP graduates form the backbone of the public health effort in many countries, with a high percentage also moving into leadership positions in their respective ministries of health and related organizations. Since 1980, FETPs have trained more than 10,000 disease detectives in more than 70 countries.

Tina: Let’s talk regionally. The recent CDC study exploring the impact of a hypothetical outbreak on the U.S. economy focused on Southeast Asia. What was the thinking around focusing on this region?

Dr. Martin: There are two reasons that Southeast Asia is a fitting region for illustrating the potential economic impact on the U.S. economy:

1) Risk – CDC tracks many disease outbreaks that start in Southeast Asia, from SARS to avian influenza. One reason is that animals and humans live in close proximity to one another and a virus that infects wildlife or farm animals can more easily spread to humans.
2) Trade ties – Southeast Asia is an important economic partner for the U.S. A large-scale infectious disease outbreak in the region presents one of the biggest risks of significantly disrupting the U.S. export economy.

Tina: Africa is a big focus of global health security. In terms of public-private engagement, how does the post-Ebola landscape different from the pre-Ebola environment? Do you see more openness to industry collaboration?

Dr. Martin: CDC has always worked strategically with industries from many sectors. It is clear that the private sector, and especially businesses, can offer a great deal during an emergency response.  For example, The Paul G. Allen Ebola Program, the William and Flora Hewlett Foundation, and Mark Zuckerberg and Dr. Priscilla Chan (through their donor-advised fund at Silicon Valley Community Foundation) provided financial support to help build, furnish, and supply temporary and permanent emergency operations centers in Guinea, Liberia, and Sierra Leone during the Ebola epidemic in West Africa.

All of the emergency structures stood up during the Ebola response, contributed significantly to the control of this epidemic and have been activated for subsequent responses such as measles, vaccine-derived poliovirus, and the recent meningococcal disease outbreak in Liberia.

There is no doubt that in the aftermath of Ebola, the desire to find additional ways to work with industry to advance mutual goals and priorities has expanded. Private sector partners have been some of the most important champions for global health security—and it is a win-win partnership, with countries and companies both benefiting. Private sector expertise, innovation, and capabilities are critical in logistics and supply chain, diagnostics, drugs and vaccines, health, technology, data management and financial services. In addition, companies often have great connections with local communities and their respective workforces, which can play an important role in moving public health goals forward through community engagement.

Finally, it is important to emphasize that partnership opportunities need not be limited to financial support or public health emergencies. Our work with partners―both government and private―have repeatedly demonstrated this point and the mutual benefits, such as in our work related to HIV, malaria, vaccine preventable diseases and global health security.