Area 6: Public Health Training and Capacity Building
Presentation of certificates: Workshop on
HIV/AIDS Epidemiology, Surveillance, and Prevention,
May 2000, Nha Trang City, Khanh Hoa Province,
Vietnam. Since Vietnam and United States renewed
diplomatic relations, Vietnamese and U.S. scientists
and public health workers have collaborated on
workshops, training courses, and research projects
that build national capacity to detect and prevent
HIV/AIDS, TB, malaria, typhoid fever, influenza,
hospital-acquired infections, plague, and dengue
and dengue hemorrhagic fever.
Nguyen Thi Thu Hong, HHS/CDC/Hanoi
CDCs growing visibility as an international outbreak consultant
has also led to increased participation in efforts to build global public
health capacity. Although CDC is not a development agency, CDC has traditionally
assisted USAID with the public health and research components of development
projects (Box 22) and has consulted with private foundations and development
banks on efforts to strengthen public health infrastructures (Box 23).
Over the past decade, CDC has also helped strengthen healthcare systems
in developing countries, working with hospital administrators and physicians
to improve infection control practices and ensure safe blood supplies.
CDC has also managed overseas field stations that facilitate on-site collaborative
research on diseases of regional and global importance (Box 10). In addition,
several foreign scientists enroll each year in CDCs Epidemic Intelligence
Service and the Emerging Infectious Disease Laboratory Fellowship Program,
which is a joint effort between CDC and the Association of Public Health
In recent years, in the aftermath of outbreaks and other infectious disease
crises, CDC has responded to requests from more than 80 foreign governments
for epidemiologic, laboratory, or research assistance to ensure preparedness
for future emergencies. However, most of these effortswhich included
training courses, research collaborations, program evaluations, health
education campaigns, and the provision of laboratory reference supportwere
limited in scope and duration and were not integrated into a larger effort
to build public health capacity.
As part of the global strategy, CDC will propose the establishment
of a series of International Emerging Infections Programs (IEIPs) in developing
countriescenters of excellence that will integrate disease surveillance,
applied research, prevention, and control activities. Each site will represent
a partnership between a ministry of health and CDC, with additional partnerships
involving local Field Epidemiology Training Programs (FETPs) and one or
more local universities or medical research institutes. The IEIP sites
will build on existing CDC overseas activities to strengthen national
public health capacity and provide hands-on training in public health.
Over time, they may have a regional as well as a national impact on health.
The IEIPs will be broad-based public health collaborations between the
ministry of health of the host country and CDC, with both parties contributing
resources and reaching agreement on the priorities of the program. Each
site will be built on existing CDC field capacity in that country. Some
IEIPs may be based at research institutions where CDC has long-standing
collaborations. Others may be based at CDC field stations or adjacent
to other U.S. institutions abroad, such as NIHs Tropical Medicine
Research Centers or DoDs overseas laboratories. Each site will maintain
close ties with WHO country and regional offices, and, if possible, will
collaborate with one of the Field Epidemiology Training Programs (FETPs)
that CDC has helped establish in more than 16 countries (Box 24).
The IEIPs will be modeled in part on the U.S.
Emerging Infections Program (EIP) whose nine sites conduct population-based
surveillance, provide emergency outbreak assistance, invest in cutting-edge
research, and address new problems whenever they arise. Because the EIP
sites combine specialized epidemiologic and laboratory expertise, they
are able to go beyond the routine functions of local health departments
to address important issues in infectious diseases and public health.
For example, when mad cow disease was reported in the United
Kingdom in 1996, the EIP surveillance sites were able to reassure the
U.S. public within a short time that the disease had not spread to the
Like the domestic EIPs, the International EIP sites will perform multiple
functions, including research on endemic diseases and emergency surveillance
when a new threat appears. They will also provide disease surveillance
data to ministries of health and finance to help assess the burden of
specific diseases and evaluate the cost effectiveness of national public
health programs. Also like the EIPs, the IEIPs will incorporate preexisting
sites (e.g., U.S. institutions, public health agencies, research institutions,
and nongovernmental organizations); use the sites in an integrated fashion;
and establish an international steering committee to provide guidance
for core projects conducted at all of the IEIP network sites. Areas in
which IEIP sites might play an especially important role are in surveillance
for drug-resistant forms of malaria, TB, pneumonia, and dysentery. All
of the sites will be linked by electronic communications to keep health
experts around the world in close contact with one another.
The long-term goal of the IEIPs will be to develop sustainable, in-country
capacity for disease surveillance, outbreak investigation, and research
on diseases of regional or global importance by fostering the next generation
of international public health leaders (Box 16). The implementation of
this goal will require extensive scientific, human, and financial resources
from both private and public sources, as well as sustained efforts over
many years. However, the costs will be low in relation to potential benefits,
in terms of both human health and increased global prosperity.
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