CDC Programs Driving Progress
The National Public Health Institute (NPHI) Program Helps Countries Prepare for and Manage Infectious Diseases
Integral to CDC’s mission is the establishment of National Public Health Institutes (NPHIs), which serve as the nexus of a country’s public health functions, a focal point for public health information, and the natural government-to-government partner in times of crisis. CDC is working with ministries of health and other partners to help more than 25 countries develop and strengthen their NPHIs. Functions critical to the success of GHSA, including lab systems, surveillance, workforce development, and emergency management often sit within or are closely linked to NPHIs, and NPHIs may lead and serve as homes for planning, coordination, implementation, and monitoring of capacity building activities, as well as multisectoral coordination of activities outside of their direct responsibility.
With support from CDC’s NPHI program, Africa CDC established the Extension for Community Healthcare Outcomes (ECHO) platform in its Regional Collaborating Centers (RCCs) to improve data and information-sharing in real time. ECHO is a virtual community of practice that develops knowledge networks for learning and teaching with a strong emphasis on peer-to-peer sharing and learning. During the 2018 cholera outbreaks in Zambia, Zimbabwe, and Malawi, the Zambia NPHI, which currently hosts the Southern Africa RCC, facilitated regional surge capacity alongside CDC cholera experts and local health workers in each community. They have also mobilized experts in the region to support the Ebola response in DRC and used the platform to share information about the 2017-2018 listeriosis outbreak in South Africa.
NPHI strengthening efforts in Cambodia, specifically those related to a public health workforce strategy, are contributing to strengthening and cultivating greater recognition for the public health workforce in a clinically-oriented system. CDC has supported Cambodia’s National Institute for Public Health in operationalizing and leading a working group for promoting the recognition and use of public health professions in the country, composed of MOH staff, human resource experts, and other governmental and non-governmental health partners.
With CDC assistance, Mozambique’s National Institute of Health (INS) opened a new biosafety level 3 laboratory facility in June 2018. To help the country safely and quickly identify dangerous emerging diseases, CDC supported staff trainings and connections between INS and mentors from other public health laboratories. INS also trained public health workers around the country in outbreak investigation, sample collection, and interpretation of results. These improvements build upon health security gains in laboratory systems and enable Mozambique to rapidly stop disease at its source.
NPHIs are a way to sustain investments in GHS, helping countries build and strengthen public health competencies and achieve compliance with the International Health Regulations. Having an NPHI, like the United States has with CDC, enables a country to more effectively prevent, detect, and respond to public health threats that can cost lives, cause political and economic instability, and spread to neighboring countries.
GEARS Protects Americans and the World from the Spread of Infectious Disease Outbreaks
A disease outbreak anywhere in the world can travel around the globe to major cities in 36 hours or less. Within CDC’s Global Emergency Alert and Response Service (GEARS), the Global Disease Detection Operations Center detects and monitors events around the world that could be a serious risk to public health. Each day approximately 30-40 public health threats are monitored. GEARS also maintains the Global Rapid Response Team, a deployment-trained workforce drawn from across CDC that is ready to deploy anywhere in the world in response to global public health emergencies. The Global Rapid Response Team has supported response efforts in more than 80 countries and territories since 2015, including 39 countries in 2018 alone.
Using a One Health Approach to Protect Health for All
One Health is a concept that recognizes that the health of people is connected to the health of animals and the environment. CDC experts collaborated with partners to conduct One Health Zoonotic Disease Prioritization Workshops in Ghana, Mozambique, Pakistan and Uzbekistan, and hosted a regional workshop for the Economic Community of West African States. In Uzbekistan, a new toolkit was used to help the country develop a One Health strategy to address the diseases identified as high priorities. Pakistan has established a “One Health Hub” that links the National Institute of Health with the Animal Sciences Division of Pakistan Agricultural Research Council. Commonly prioritized diseases worldwide include rabies, brucellosis, anthrax, and viral hemorrhagic fevers like Ebola and Marburg. By prioritizing the zoonotic diseases of greatest concern, countries can more efficiently build their laboratory capacity, conduct disease surveillance, plan outbreak response and preparedness activities, and create disease prevention strategies to reduce illness and death in people and animals.
Influenza Laboratory Mentorship Program Prepares the World for Pandemic Influenza Response
CDC and the Association of Public Health Laboratories partnered in the design and implementation of a two-year laboratory mentorship program for ten countries in West Africa. The program aims to strengthen laboratory quality improvement processes through engagement with U.S.-based laboratory mentors, regular reporting, and procurement of diagnostic equipment and reagents. Three new countries in the region successfully shipped influenza-positive specimens to the WHO Collaborating Center for Influenza at CDC in 2018. CDC is one of 6 WHO Collaborating Centers for Influenza in the world, which is designated by the Director-General to carry out activities in support of WHO’s influenza program. Increased virus detection capability in the region contributes to the global capacity to detect and respond to novel viruses in addition to ensuring that the biannual influenza vaccine strain selection is globally representative.
National, Binational, and Regional Cross-Border and Border Health Systems Building
Lessons learned from the 2014-2016 Ebola epidemic emphasized that cross-border information sharing and collaborations are necessary to reduce the chances of public health threats spreading between countries. In 2018, CDC worked with the West Africa Health Organization (WAHO), to design and co-facilitate a national-level, three-day meeting with the Mano River Union (MRU) countries of Cote d’Ivoire, Guinea, Liberia, and Sierra Leone to strengthen bi-national outbreak response and advance CDC support of WAHO’s goal to develop formal, operational agreements on cross-border collaborations among all 15 WAHO countries. Meeting participants drafted a memorandum of understanding (MOU) for cross-border public health information sharing, paving the way for stronger public health relationships and coordination.
Early Warning Systems for Health Threats in Ghana, Vietnam, India and Cameroon
Emerging public health threats can be stopped in their tracks when communities are equipped with the knowledge to detect and report them. In India, Vietnam, Ghana, and Cameroon, CDC has supported the respective governments to train about 6000 communities to detect health threats rapidly. This program has resulted in the development of guidance documents, training materials, and data collection tools and trained over 3000 public health staff and 17,000 community health volunteers. As of December 2018, communities have captured over 8000 signals, leading to the detection of more than 3000 public health events that would not have otherwise been discovered. Reported events included suspected measles cases, avian influenza, Dengue fever, clusters of acute hemorrhagic conjunctivitis, suspected meningitis cases, and suspected rabies. The implementation of early warning surveillance has demonstrated that the more prepared communities are, the more protected everyone is from public health threats.
Emerging public health threats can be stopped in their tracks when communities are equipped with knowledge to detect and report them. In India, Vietnam, Ghana, & Cameroon, CDC has supported respective governments to train 6000 communities to detect health threats rapidly.