Infectious Disease

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.

One in 50: When It Comes To Water, Sanitation and Hygiene, Too Many Health Care Facilities Are Being Left Behind

This blog was written by Danielle Zielinski, Sanitation Policy Project Officer at WaterAid as part of Global Health Council’s Member Spotlight Series. WaterAid is an international not-for-profit determined to reach everyone, everywhere with clean water, decent toilets and good hygiene, within a generation. WaterAid is a 2018 Global Health Council member.

When you’re sick, you’re likely to visit a health center. Many of us take for granted that our local health center will have a toilet, a place to wash hands with soap and water and a system to safely dispose of medical waste.

These seem like basic requirements. But if you live in the developing world, new estimates put your chances of reaching a facility with adequate water, sanitation, hygiene and waste management at only 1 in 50—about the same chance as the average person making a half-court shot in basketball.

Hope you’re feeling lucky.

A recent study from the Water Institute at the University of North Carolina, looks at the environmental conditions in nearly 130,000 healthcare facilities across 78 low- and middle-income countries. The study—published in January in the International Journal of Hygiene and Environmental Health—offers the most comprehensive analysis to date of inequalities in healthcare.

The news is grim. Half of healthcare facilities surveyed lack access to piped water, a third are without access to improved toilets, and even more—39%—do not have facilities for washing hands with soap. A sampling of six countries showed that only 2% of facilities provide a combination of piped water, improved toilets, decent handwashing facilities and adequate waste management.

Without water and sanitation services, health care facilities can harm the patients they are supposed to help. A lack of water, sanitation, and hygiene (WASH) puts both patients and health workers at a greater risk of infection, disease and even death. The World Health Organization estimates several hundred million patients annually acquire infections in health care settings due to poor handwashing practices—due in part to the lack of available soap and water. And as we saw with the 2014-2016 Ebola epidemic in West Africa and the recent cholera outbreak in Yemen, inadequate WASH infrastructure allows deadly diseases to spread unchecked.

New mothers and newborns are especially vulnerable. Every minute, a newborn dies from infections caused by a lack of safe water and an unclean environment. Sepsis and other infections due to unhygienic conditions are also a leading cause of preventable maternal deaths.

People shouldn’t have to roll the dice when they enter a health facility. They shouldn’t have to worry that the place they come to for care might make them sicker. Healthcare workers should have a safe and quality environment in which to do their jobs, to the benefit of us all. It’s time to start closing these gaps. And it starts with treating WASH as a fundamental part of health systems.

The US Global Water Strategy includes a key outcome around decreased mortality/morbidity from causes linked to lack of WASH and plans from USAID and the CDC which call out improving WASH in health care facilities. This is a good start. But it requires support from Congress through funding and policy, and must not be undermined by current efforts to reorganize USAID or other political tug-of-war. After all, epidemics like Zika and Ebola don’t respect national borders. More advocacy is needed to ensure the strategy lives up to its potential, and truly informs practice and program implementation.

Citizens around the world are also speaking up and taking action. In Burkina Faso, citizens and journalists recently questioned their health minister about sanitation in health care facilities during a live broadcast, leading to promises of improvement. In Cambodia, advocacy has led to cross-sectoral commitments to improve WASH in health centers. The Ministry of Rural Development has set targets for 70% access to improved WASH in health centers and schools by 2025, and the Ministry of Health has set targets for 95% of health facilities to have basic water supply and 90% of health facilities to have basic sanitation by 2020.

And in Malawi, WaterAid is leading efforts to address infection prevention and control in 16 health centers across Kasungu, Nkhotakota and Machinga districts. Work includes training health care workers and modeling improvements like solar-powered water systems, inclusive toilets and bathrooms and repairing septic tanks and incinerators for waste management.

It is up to all of us to work toward better data, plans, funding, and action to ensure health facilities meet WASH standards. The UNC study is a sobering reminder of the sheer volume of work left to be done. But the good news is we don’t need to wait for new technology or medical advances to get started. We have the tools we need right now to save lives.

Safe water. Decent toilets. Soap for handwashing. In every health facility.

Let’s not leave anything to chance.

Esther Elias and her new born baby at Nyarugusu Dispensary, Nyarugusu, Geita District, Tanzania, September 2017. (WaterAid/ Sam Vox)

Strengthening Sierra Leone Health Systems: Applying Lessons from the 2014 Ebola Outbreak to Future Emergencies

This guest post was written by Laurentiu Stan (laurentiu_stan@jsi.com), MD,MPH, MBA, Chief of Party, Advancing Partners and Communities (APC) Project, Sierra Leone, JSI Research & Training Institute, Inc. John Snow, Inc., a member of Global Health Council (GHC), and the nonprofit JSI Research & Training Institute, Inc., are public health management consulting and research organizations dedicated to improving the health of individuals and communities in the US and around the globe.

Zainab Jalloh, holding her one-year-old daughter Khadijatu, at the Gbanti Community Health Post (CHP) on April 3, 2017 in Bombali District, Sierra Leone.

I’ve lived in Sierra Leone for almost two years, working to help this country’s long-battered health system recover from the Ebola outbreak that took the lives of more than 200 health professionals. Now the country has been affected by an epic landslide. Despite these tremendous setbacks, health systems and health indicators are improving.

Even before the Ebola Virus Disease (EVD) outbreak, Sierra Leone had the world’s highest maternal mortality ratio: 1630 of 100,000 live births (UNICEF, 2010). By 2015, the ratio had dropped to 1360, but Sierra Leone still held the top spot in this dismal measurement. Ebola compounded the problem because about 1 in every 4 women stopped coming to clinics for prenatal care and delivery. In fact, although almost 4,000 Sierra Leoneans died due to the EVD outbreak (between May 2014 and January 2016), during that same period more than 4,500 women died in childbirth.

The Ministry of Health and Sanitation (MOHS) focused its post-Ebola health recovery priorities on strengthening the health system’s capacity to safely detect and prevent diseases and respond to future epidemics in cooperation with its neighbors. It also recognized the need to contribute to global health security to improve health and economic opportunities.

A health facility water pump before APC revitalization. Photo courtesy/ JSI Research & Training Institute, Inc.

Between September 2015 and August 2017, under the umbrella of the USAID-funded and JSI-managed Advancing Partners & Communities (APC) project, I have helped implement a number of programs that are contributing to MOHS recovery objectives by improving primary care service delivery in the communities hardest hit by Ebola. APC has revitalized 305 primary care facilities, ensuring access to basic health services—with a focus on improving quality of maternal health services—for almost 2 million Sierra Leoneans, including the 3,400 registered Ebola-survivors.

A health facility water pump after APC revitalization. Photo courtesy/ JSI Research & Training Institute, Inc.

APC’s community health facility upgrades dramatically improved water and sanitation standards, installed solar power systems, provided basic equipment, and trained more than 900 health professionals and 1,500 community health workers (CHWs) on reproductive, maternal, newborn, and child health and as—importantly, given how Ebola was spread—infection prevention and control practices. Today, more than 2 million Sierra Leoneans in five districts have access to revitalized primary care and community health services in these primary care units and their catchment villages.
We know that another epidemic or emergency could come at any time, and while the Sierra Leone health system is going through significant transformations as part of the five-year recovery plan, it is better equipped now to address it.

The tragic August 14 landslide was just such an emergency—and the new systems that the U.S. government has invested in are working. The emergency coordination and resource mobilization mechanisms put in place with CDC support reacted well and fast. Mental health nurses who were trained to support Ebola survivors are providing psychosocial support to the several-thousand people who lost homes and relatives: more than 1,000 people died in the landslide. The CHWs recently trained by APC have undergone a 15-day social mobilization exercise to identify and convey messages on the prevention of cholera and other waterborne diseases to at-risk populations. With USAID and DfID support, JSI is assisting the MOHS relief efforts with emergency delivery of essential pharmaceutical and medical consumables to one area hospital and six primary care units.

This most recent tragedy has demonstrated that the country’s service delivery system has improved. One year after the outbreak ended, the MOHS data showed about a 10% positive change in uptake of facility deliveries and outpatient services in the four districts where 70% of Ebola survivors live. Now that health facilities have been revitalized, and health care workers are providing higher-quality services, we are seeing more and more Sierra Leoneans returning to their local health facilities.

There is still much to be done, of course. But Sierra Leone is on its way to a health system that meets the needs of its people—and, given the toll that Ebola took, is ready to confront the next infectious disease—be it Ebola or some other virus—with stronger, better prepared health services. And that helps us all.

CDC Protects People from Disease Threats and Outbreaks in the U.S. and Around the World

This blog post was written by Carmen Villar, MPH, Deputy Director for Strategy, Policy and Communication, at the the Center for Global Health, Centers for Disease Control and Prevention.

Opinion polls show that the Centers for Disease Control and Prevention (CDC) is one of the federal government’s most admired and trusted agencies.

Since its founding in 1946, CDC’s history as America’s premier public health agency has been tightly intertwined with its work abroad. CDC experts were on the frontlines in the efforts to eradicate smallpox, the only disease in history to be eliminated. Now CDC experts are actively engaged in current efforts to eradicate polio, a disease that once ravaged the United States and countries worldwide. Today wild polio virus remains active in only three countries: Pakistan, Nigeria, and Afghanistan, and only five cases of wild polio virus have been reported this year, which is a record low number. These encouraging results reflect a novel partnership, the Global Polio Elimination Initiative (GPEI),that holds promise for future efforts to protect people’s health.

GPEI is a public-private partnership led by national governments with five partners – the World Health Organization, Rotary International, U.S. CDC, the United Nations Children’s Fund, and the Bill & Melinda Gates Foundation – who have locked arms to defeat polio. CDC’s record and commitment to global health is also evidenced in its work combatting HIV/AIDS, TB, malaria, neglected tropical diseases such as River Blindness, and its more recent, and widely reported, efforts to defeat Ebola in West Africa and Zika in numerous countries.

CDC has more than 1,700 staff stationed in more than 60 countries, including scientists, disease detectives, laboratory technicians, and other experts who are on the frontlines working to detect disease outbreaks at the earliest possible moment, to respond to them decisively, and to stop them from spreading. That mission is driven by the same principles CDC uses wherever it works – rigorous science, accurate data, quality training, and strong collaboration with partners.

Yet when it all works as designed, as it often does, the results can be hard to see. The best outcomes are an absence of disease outbreaks and the accompanying fear about their impact, an abundance of healthy people who contribute to U.S. interests by supporting more stable governments and more robust economies, and a lower chance of disease erupting and spreading.

CDC’s values and guiding principles are the same as they’ve been from the beginning – working to protect Americans by rapidly detecting and containing new health threats anywhere in the world before they can come to the United States. The focus is on providing strong, effective public health systems and on training healthcare professionals who can identify outbreaks in their own countries to prevent those threats from crossing borders.

For example, CDC’s Field Epidemiology Training Program (FETP), established in 1980, has trained more than 9,000 disease detectives to date in more than 70 countries. They provide critical frontline disease detection and surveillance, and, significantly, more than 80 percent of the FETP graduates continue working in their countries, with many moving into public health leadership positions. From 2009–2014, FETP graduates took part in more than 2,000 outbreak investigations, which kept their countries, and the world, safer and healthier.

It works with countries to immunize children and adults to protect them from vaccine-preventable diseases. Preventing diseases such as polio and measles allow children and adults to live healthy and productive lives. It means laboratorians from CDC’s world class laboratories work together to provide training and technical expertise to laboratorians in other countries to upgrade and expand laboratory services. This results in accurate and reliable laboratory networks, which are essential to finding and understanding disease threats, and in using resources for maximum public health benefit.

CDC’s dedication to global health can be measured by outbreak response mobilizations, staff trained and ready for deployment, person-days of response support, ensuring that all people have access to safe water and sanitation around the world, and collaboration with global partners.

An example is CDC’s participation in the Global Health Security Agenda (GHSA). Formed in 2014 with key contributions by CDC, GHSA is designed to implement the tools and practices necessary to prevent, detect, and respond to outbreaks at the earliest possible moment in countries throughout the world. To date, 31 countries are participating, with each pledging to meet universal standards for quality disease surveillance, a well-trained workforce, rapid and accurate public health laboratory capacity, and emergency response via emergency operation centers.

Another example is CDC’s Global Rapid Response Team (GRRT), a “boots-on-the-ground” program ensuring that, from a pool of 400 trained experts, 50 are on-call to travel anywhere in the world within 48 hours to confront an outbreak at its outset. The GRRT was mobilized more than 230 times in one year after it was created in 2016, and provided 8,000 person-days of response support in more than 90 outbreaks worldwide, including cholera, yellow fever, Ebola, Zika, measles, polio, and natural disasters. The GRRT also has experts in global health logistics, laboratory management and training, communication, and disease detection.With the world more connected than ever through travel and commerce, GHSA is a systematic effort to provide universal and tested standards to prevent, detect, and respond to disease outbreaks worldwide and to close gaps in these areas that allow disease to cross borders.

Taken together, all of CDC’s work abroad contributes to making the world and all Americans safer and more secure, healthier and more confident that threats to their health will be identified and resolved no matter where they live and travel.

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