The Global Health Security Agenda Its First Years
The Global Health Security Agenda: Its First Years and the Way Forward A Conversation with Dr. Thomas Frieden. Moderated by Dr. Stephen Morrison.
The world is safer than ever from global health threats AND The world is at greater risk than ever from global health threats
A HEALTH THREAT ANYWHERE IS A HEALTH THREAT EVERYWHERE Global aviation network Source: Kilpatrick & Randolph. Lancet 2012; 380: 1946 -1955. Note: Air traffic to most places in Africa, regions of South America, and parts of central Asia is low. If travel increases in these regions, additional introductions of vector-borne pathogens are probable.
PUBLIC HEALTH THREATS Zika Ebola SARS Anthrax XDR TB Food Supply Intentional Release and/or Reemergence of Rise of Drug Engineering known Pathogens Resistance Avian Flu HIV Globalization of Travel, Food and Medicines Emergence & Spread of New Pathogens
1918 -19 GLOBAL INFLUENZA PANDEMIC § 50 -100 million people killed worldwide (3 -5% of global population) – Life expectancy temporarily declined by 12 years § Massive global economic disruption lasting months § Killed more people in 24 weeks than AIDS killed in 24 years; more in a year than Black Death killed in a century – Most killed were previously healthy young adults – Health care systems overwhelmed worldwide US Army soldiers in hospital ward ill with influenza
INTERNATIONAL HEALTH REGULATIONS (2005)
MOST OF THE WORLD IS STILL UNPREPARED Fewer than 1 in 3 countries self-reported being fully prepared for outbreaks as of 2014
LESSONS LEARNED FROM EBOLA § Speed is of the essence – every minute counts § Every country must be prepared to – Find a threat when it emerges – Stop it promptly – Prevent it wherever possible § The world must be ready to surge in when a country’s capacities are overwhelmed § We must move from non-accountability & no assistance to mutual accountability & partnership
THE GLOBAL HEALTH SECURITY AGENDA A unifying framework to improve our global response to disease outbreaks “This [the Global Health Security Agenda] is indeed a timely initiative. It raises the political profile of the threat from emerging and epidemicprone diseases. And it energizes efforts to improve health security… in line with WHO International Health Regulations. . ” World Health Organization Director General Margaret Chan February 13, 2014
GHSA: PREVENT, DETECT, RESPOND Prevent avoidable outbreaks Detect threats early Respond rapidly and effectively
GHSA ACTION PACKAGES Antimicrobial Resistance National Laboratory Systems Zoonotic Diseases Surveillance Emergency Operations Centers Public Health and Law Enforcement Biosafety/Biosecurity Immunization Reporting Workforce Development Medical Countermeasures
GLOBAL HEALTH SECURITY IS SMART SPENDING Cost of pandemic versus cost of building capacity to prevent, detect and respond BY THE NUMBERS $6 Trillion $0. 65 Estimated global cost of next pandemic Annual cost person for protection against current global health threats Sources: The Neglected Dimension of Global Security. GHFR Commission 2016. Gostin et. Al. , Neglected Dimensions of Global Security. JAMA 2016
GHSA WILL SUPPORT US EXPORTS AND JOBS $80 billion 470, 000 Approximately value of US exports to GHSA priority countries Domestic jobs supported by US exports to GHSA priority countries
HEALTH SECURITY PROTECTS MORE THAN HEALTH § Health security is a national security issue § Protection from diseases before they reach our borders § Promotes economic and political stability § Promotes US economic interests § Soft power – best diplomacy tool § The US has the resources and expertise to save lives – the right thing to do
JOINT EXTERNAL EVALUATIONS Transparent, independent, and objective § Each country accountable to itself & global community – world accountable to each country § Independent assessments key to knowing status and filling gaps JEE Progress (as of November 29, 2016) 23 Completed 28 Scheduled 21 Expressed Interest
JEE RESULTS Many countries are somewhat prepared – but none are 100% prepared Country Overall Prevent Detect Respond Joint External Evaluation Bangladesh 50% 58% 70% 33% Ethiopia 52% 56% 59% 45% Liberia 47% 42% 50% 49% Mozambique 47% 46% 51% 46% Pakistan 50% 46% 51% 53% Tanzania 50% 51% 54% 48% United States 87% 91% 85% GHSA External Assessment Georgia 65% 72% 68% 51% Peru 67% 59% 76% 67% Portugal 88% 79% 100% Uganda 55% 44% 77% 42% 40 -79% Ukraine 55% 58% 54% 51% 80 -100% United Kingdom 96% 97% 98% 92% 0 -39%
ZIKA AND THE GLOBAL HEALTH SECURITY AGENDA GHSA goals Prevent avoidable epidemics Detect threats early Respond rapidly and effectively Zika-specific interventions § Mosquito control § Contraception – condoms to prevent exposure; ready access to full range of voluntary, reversible effective contraceptives § Vaccine § Diagnosis – laboratory testing, test interpretation, and networks § Surveillance – mosquito and insecticide resistance, syndromic, birth defects § Travel advisories § Protection of pregnant women to prevent exposure § Vector control
Training Frontline Epidemiologists in Liberia Measles outbreak investigation, Lofa County, Liberia 2016 Investigating Polio in Mali Dr. Fomba Ibrahim, a FETP STEP graduate, who investigated the polio case Fighting Cholera in Tanzania Emergency responders atop a water truck collecting samples Stamping out Infectious Disease Outbreaks in Pakistan FELTP fellows and residents investigate disease outbreaks all over Pakistan, often travelling long distances to remote areas
Community-Led Surveillance Identifies Anthrax in Tanzania Community members being trained and role playing how to refer a case to a health facility Labs Rise to the Challenge in India An India EIS officer helps the district rapid response team take interviews after a food poisoning outbreak in Gujarat, 2015 Using Health Data to stop Measles in Sierra Leone 2. 8 million children in Sierra Leone were vaccinated against measles during campaigns this year Community health workers review reports from a health facility in Kambia district
Stronger Labs Improve Detection in Thailand Aedes aegypti is a small, dark mosquito with white lyre-shaped markings and banded legs Improving Biosafety and Biosecurity in Ethiopia Engineers cleaning the biosafety cabinets in the polio lab Halting a Meningitis Outbreak in Ghana CDC microbiologist Mahamoudou Ouattara training Laboratory Staff on real-time polymerase chain reaction (rt-PCR) technique Building Capacity Post Ebola in Sierra Leone Program Management Course for districts and chiefdoms at Njala University in Sierra Leone
Addressing MERS in Saudi Arabia A veterinarian collects a sample for MERS testing in Saudi Arabia Stopping Yellow Fever Before It Spreads in Uganda In March 2016, the Mo. H quickly contained a Yellow Fever outbreak and established a surveillance and specimen referral system to identify potential new cases
STRENGTHENING WHO § WHO is key to strengthened systems globally & improved ability to surge rapidly § We are all stronger when WHO is stronger § WHO does important work – but not as strong as it could or should be – Human resources – Politicization
WHO AND CDC COORDINATION US involvement in global health is imperative § CDC’s life-saving global health work protects the American people 24/7 – US must maintain strong & effective global health effort to ensure America’s health security interests – Cannot assume WHO coordination alone can stop complex global health threats, or that WHO will prioritize risk to American citizens as CDC does § WHO sets international health/crisis response goals, but depends on member countries such as the US to meet those goals – – No single agency can meet the scope and intensity of all global health challenges CDC front-line staff in >60 countries address disease threats close to their source WHO has no laboratories – CDC labs serve as global/regional reference labs Knowledge and lessons learned from CDC’s work abroad are critical to our public health efforts at home to protect Americans
GLOBAL RAPID RESPONSE TEAM Enhancing CDC’s global emergency response capacity § Deploy rapid response teams to the field within 24 -48 hours § Provide stable, long-term staffing for emergencies § Assist partner countries to improve preparedness § Interim solutions for global CDC staffing gaps
STRENGTHING NATIONAL PUBLIC HEALTH INSTITUTES § National institutions promote evidencebased decisions U. S. CDC – Scientific – Shielded from political influence MEXICO INSP – On major public health problems – Human and financial resources FINLAND THL – Infrastructure – Linkages and networks – Accountability ETHIOPIA EPHI CHINA CDC NETHERLANDS RIVM
HOW SECURE IS OUR FUTURE? Top priorities: sustainability and accountability § Expand GHSA and establish stable funding § Complete JEEs for most countries in world, follow-through on action plans, and begin follow up assessments § Maintain accountability – Of LMIC countries – to improve capacities – Of OEDC countries and global institutions – to support countries in closing gaps
Strong Country GHSA Capacities Less Disease Spread Global Political and Economic Stability Safer and More Secure US and World
For more information, contact CDC 1 -800 -CDC-INFO (232 -4636) TTY: 1 -888 -232 -6348 www. cdc. gov
The Global Health Security Agenda: Its First Years and the Way Forward A Conversation with Dr. Thomas Frieden. Moderated by Dr. Stephen Morrison.
- Slides: 30