The Canadian traveler began to feel ill on a return flight from Beijing to Vancouver in late December 2013, Canadian health officials said. The traveler got worse, was hospitalized and died Jan. 3.
The patient was found to have the H5N1 variant of avian influenza — the first and only confirmed human case of the virus in North America. Luckily, the patient’s family did not become ill, according to health officials, so the case was an isolated incident.
This time, the illness did not spread. This time, it was contained to the person who brought it to North America. Next time, it could be worse.
That knowledge, and the knowledge that there are steps that can reduce the risk of a lethal worldwide epidemic, spurred the U.S. to announce the launch of the new global health security agenda in February.
“We know that outbreaks anywhere in the world are only a plane ride away,” said Laura Holgate, SM, senior director for weapons of mass destruction terrorist and threat reduction with the National Security Council, during a briefing on the launch of the agenda. “So that’s the challenge we’re trying to deal with. Even though the U.S. has done a lot and other countries have done some important progress, there’s more to be done.”
According to a Harvard University study, one death in three is the result of an infectious or communicable disease, but the burden is not distributed equally. Most of those deaths occur in the non-industrialized world.
Workers at a lab in Vietnam. CDC experts shared training and standard protocols with health workers in Vietnam to enhance the country’s ability to detect new pathogens such as H7N9 influenza and Middle East Respiratory Syndrome coronavirus.
Photo by Niki Pham, courtesy CDC
The agenda will have the U.S. partner with at least 30 other countries over the next five years to prevent, detect and respond to infectious disease threats. U.S. agencies involved in the agenda include the departments of Health and Human Services, State, Agriculture and Defense. International groups include the World Health Organization, the Food and Agriculture Organization of the United Nations and the World Organization for Animal Health.
The Centers for Disease Control and Prevention’s 2015 fiscal year budget contains a proposed increase of $45 million for global health security. It will allow for training of field epidemiologists, developing new diagnostic tests, building capacity to detect new pathogens, building emergency management capacity and supporting outbreak response, according to a news release from the HHS. In addition, the Department of Defense’s Defense Threat Reduction Agency will partner with CDC and up to 10 countries in 2014 to begin implementing and accelerating efforts in field epidemiology and new diagnostic tests, Holgate said during the briefing. That effort has a $40 million budget.
The agenda is not the first attempt to bring countries together in the battle for global health security. In the wake of the epidemic of severe acute respiratory syndrome, or SARS, more than a decade ago, which caused $30 billion in economic damage, WHO developed its International Health Regulations and began implementing them in 2007. The legally binding regulations aim to improve global health security by providing a framework to guide countries through events that might constitute a public health emergency of international concern. It also was meant to help countries improve their capacity to detect, assess, notify and respond to public health threats.
But years later, just 20 percent of countries have actually met the requirements laid out by the regulations, said CDC Director Tom Frieden, MD, MPH.
“This is not something the U.S. can do alone,” Frieden said. “We really need to be working more closely and more collaboratively with other countries and need to increase the focus and participation of other countries in addressing these challenges.”
The inclusion of those countries in the list of 30 participating in the agenda is a good start, said Amesh Adalja, MD, FACP, a member of the Public Health Committee of the Infectious Diseases Society of America and an infectious disease physician at the University of Pittsburgh Medical Center’s Center for Biosecurity.
Health workers in Uganda wear protective clothing. A CDC pilot program conducted in the country last year focused on multidrug-resistant tuberculosis, cholera and Ebola virus as well as work to improve Uganda’s laboratories.
Photo by Justin Williams, courtesy CDC
“I think, ideally, you’d want every country (participating), because disease can occur in every nation,” he told The Nation’s Health. “But we can learn from this and apply these types of approaches to countries across the world.”
Countries that have signed on to work with the agenda include European nations such as France, Germany and the United Kingdom, as well as Argentina, Chile, China, Ethiopia, Kazakhstan and South Africa. Efforts are already underway.
In the Republic of Georgia, the Ministry of Health has partnered with the Department of Defense’s Cooperative Threat Reduction Program to create a center for public health research in Tbilisi. The center will be a state-of-the-art laboratory for the country’s public and animal infectious disease surveillance system, said Andrew Weber, assistant secretary of defense for nuclear, chemical and biological defense programs, during the news conference.
The work among countries will be individualized, Frieden said. He pointed to CDC’s work with China, a middle-income country, that helped the government strengthen its system so that it could rapidly identify the H7N9 influenza virus when it emerged and share that information with international partners.
“So for larger income countries, it’s largely technical assistance,” he said. “For lower-income countries, there may be some assistance in strengthening laboratory networks or establishing a cadre of disease detectives or securing some of their dangerous materials...as examples.”
CDC pilot projects serve as examples
CDC has already tested its capacity to help other nations with their infectious disease preparedness through a pair of pilot projects in 2013 in Uganda and Vietnam.
In a pair of studies published in the Jan. 30 issue of Morbidity and Mortality Weekly Report, researchers outlined efforts to upgrade those countries’ abilities to detect and handle pathogens of concern and respond to global health threats. In Uganda, they chose to examine multi-drug-resistant tuberculosis, cholera and Ebola virus and to work to improve laboratories. At the end of six months, laboratories were found to have improved their scores in all assessment categories.
In Vietnam, U.S. researchers worked to establish an emergency operations center, improve the nationwide laboratory system and create an emergency response information systems platform. Thirty Vietnamese officials also received training in their country as well as at CDC’s Emergency Operations Center in Atlanta and the WHO Regional Office for the Western Pacific. They were trained to detect H7N9 and other diseases.
“Stopping outbreaks where they start is the most effective and least costly way to prevent disease and save lives at home and abroad — and it’s the right thing to do,” Frieden said in a Jan. 30 news release. “Progress in Uganda in less than a year shows how effective strategic investments can be.”
Of course, strengthening international preparedness and ability to recognize and combat infectious disease is only part of the battle of keeping the U.S. safe. In 2013, the Association of State and Territorial Health Officials convened a meeting aimed at identifying patterns of migration and their impact on infectious diseases at the state level and how the U.S. can best protect itself.
“A global disease threat is basically a local disease threat,” said Jim Blumenstock, MA, chief of public health practice at the association. “Our focus is what can we do within our borders to protect citizens from global disease threats?”
That includes working with federal agencies that get surveillance and intelligence and distributing that information to health officials “so they have a sense of how it is spreading and escalating,” Blumenstock told The Nation’s Health.
The ASTHO meeting helped zero in on the tools that are available to state and territorial health officials to help spot a health threat or potential health threat as it enters the U.S., said Kathy Talkington, MPAFF, an APHA member and senior director of immunization and infectious disease with the association.
“It’s the beginning of a conversation we’re having,” she told The Nation’s Health.
For more information on the global health security agenda, visit www.cdc.gov/globalhealth/security. For more information on ASTHO’s 2013 “Global Infectious Disease” report, visit www.astho.org.
- Copyright The Nation’s Health, American Public Health Association
