Looking forward based on past...

Looking forward based on past experiences:

What’s old is new againInternational Conference on (Re-)Emerging Infectious Diseases

March 12, 2018

Rebecca Martin, PhDDirector of the Center for Global Health

US Centers for Disease Control and Prevention

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1. (Re-) emerging infections2. Defining the factors for (re-)emergence3. Creating global health security4. Minding the gaps5. Moving forward

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Emerging Infections Factors of Emergence Global Health Security:Prevent, Detect, Respond Minding the Gaps Moving forward

Pandemic flu: Then and now

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Examples of (Re-)Emerging Infectious Diseases

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Zika: Latest in a Series of Unpredicted and Unpredictable Health Threats

Zika first discovered in Zika forest, Uganda in 1947

Unprecedented, extraordinary complexity, unique challenges• Microcephaly, other serious birth defects, and poor pregnancy

outcomes• Sexual transmission• Associated with Guillain-Barré syndrome

Top priority - protect pregnant women

The sooner we act, the better we can protect

5Emerging Infections Factors of Emergence Global Health Security:Prevent, Detect, Respond Minding the Gaps Moving forward

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Major CHIKV genotypes in Africa with introductions into Asia. Subsequent importation via travelers to other areas

7S.C. Weaver, W.K. Reisen / Antiviral Research 85 (2010) 328–345


Factors for (Re-)EmergenceGlobalization and movement

• Rapid mass movement of people, animals, and goods

• Urbanization/migration to urban areas

Demographic and behavior changes

• Greater human population and density

Environmental Social, political, and economic

events8Satellite Image of International Flight Patterns


Ecological • Increased contact with animals

Habitat encroachment Lifestyle practices

• Intensification of animal production systems

Public health infrastructure

Microbial adaptation and change

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Factors for (Re-)Emergence


Urbanization: Impacts on Cholera

• Expecting slides 3/8

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Increasingly common for cholera to make its way to informal settlements in large cities

Outbreaks in cities can be persistent and difficult to control

Early detection and a strong, coordinated, multi-sectoral response are key to success


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Youth bulge in Sub-Saharan Africa

By 2030, the youth in Sub-Saharan Africa will have

doubled from the start of the HIV epidemic (1990)

Projected growth of youth population 15-24 years of age in Sub-Saharan Africa, China, and India, 1950-2050


Medical tourism

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Nontuberculous Mycobacteria (NTM) On May 1, 2017, CDC was notified of 3 patients with NTM surgical site

infections; all received surgery from a single surgeon at one facility in the Dominican Republic

CDC notified Dominican public health authorities

Dominican authorities reported the facility closed on 8 July 2017

As of October 12, 2017: 54 patients with a surgical site infection (SSI) after cosmetic surgery in the DR reported to CDC from 9 states, District of Columbia. 34/54 (63%) met CDC’s confirmed case definition


PH: Environmental change

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Guinea

Sierra Leone Liberia

Gueckedou


Zoonotic diseases are a threat to global health security

14www.oie.int/onehealth


Antibiotic resistance: A growing crisis worldwide

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Retrospective analyses show rapid emergence of different C. auris strains worldwide

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At least 4 strains circulating globally

Strain sequences pending

PakistanVenezuela

IsraelU.K.

S. AfricaKenyaKuwait

United StatesColombiaJapan

2009 2010 20122011 20142013 2015 2016

Korea India


Global Health Security

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Global health security: Prevent, Detect, Respond


“Detect, Respond, and Prevent” is smart spending

18Sources: The Neglected Dimension of Global Security. GHFR Commission 2016.Gostin et. al., Neglected Dimensions of Global Security. JAMA 2016

BY THE NUMBERS

Estimated cost of pandemics in the 21st

century

Annual cost per person for protection against current

global health threats

$6 Trillion $0.65

Annual expected loss from potential

pandemics

$60 Billion


Acute febrile illness surveillance: India

Acute febrile illness (AFI) surveillance captured >30,000 patients from 2014 through the end of February 2018

India tested for 80+ pathogens from 33 sites • 50% successfully diagnosed

7 diseases accounted for 90% : malaria, dengue, Scrub Typhus, leptospirosis, Japanese encephalitis, Kyasanur forest disease, influenza

India is using this information to appropriately supply health facilities with diagnostics and drugs

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Pre- and post-implementation of enhanced VHF surveillance and

diagnostics in Uganda 2000-2017

Community involvement in surveillance leads to increased reporting of signals


Number of clusters, suspect cases related to clusters, and single suspect cases of measles (left) and yellow fever (right)

Kafadougou-Bafing-Folon Health Region, Cote d’Ivoire, 2014-201721

Importance of government

leadership and partner

coordination through

Emergency Operation Centers

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Importance of Disease Detectives at all levels for an effective response

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November 2015 June 2017

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Nigeria quickly contained the 2014 Ebola outbreak by using existing public health infrastructure that had been built

over the last decade for diseases like polio


Building laboratory capacity for current and advanced technologies allows

rapid detection and diagnosis

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SLIPTA: A framework to encourage, support and recognize the implementation of QMS in medical laboratories in a stepwise manner

1 Star

5 Star

2 Star

3 Star

4 Star

55-64 %

65-74 %

75-84 %

85-94 %

> 95 %

↑ Score on external evaluation using a checklist

0 Star

End Point

National, Regional or International Accreditation Body


Regional network developed to create a standard certification model for biosafety and

biocontainment in laboratories

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Thailand Laos CambodiaMyanmar Vietnam


Preventing vaccine-preventable diseases through a second year of life approach, Ghana

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Increasing immunization delivery, including MCV2, in the second year of life requires:• Raising awareness of vaccination schedule

• Developing catch-up vaccination policies

• Removing barriers to opening a vaccine vial for a single child

• Tracking children who “drop out”

• Revising forms to record and report 2YL doses

• Making vaccination convenient: in daycare and urban community clinics


Joint External Evaluation conducted

National Action Plan developed

Costed Plan developed and resources identified

Plan implemented and evaluated over time

*Joint: country and external experts

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Aligning gaps and resources through the JEE process

JEEs Scheduled for February:ZimbabweJapan

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Role of Joint External Evaluations in accelerating progress and sustainability

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Decades of civil unrest in all 3countries

Weak public healthinfrastructure/Lack of IPCin health facilities / Unrecognized cases incrowded cities

Spotty border control

Aperfect stormfor the Ebola

outbreak in West Africa


The Impact of Ebola

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Ebola and the Economy

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Global safety net and surge capacity are critical

Global health security starts at the country level• Country action is quicker, more efficient, and more cost-effective• Global action must strengthen and work through national systems to the

greatest extent possible

The international community is also responsible – epidemics are the world’s problem, not only the problem of individual countries or regions• Rapid Response Teams• Access to medical countermeasures (PPE, drugs, vaccines, diagnostics)

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Need for research – more to learn Accelerating the development of vaccines

• Discovery research (universities, pharmaceuticals)• Development (industry, governments, CEPI) • Manufacturing (industry, regulators, governments)• Delivery (GAVI, WHO, UNICEF, PAHO, governments)

Studies and research during outbreaks

Developing of diagnostics• Point of care • Rapid tests

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Public health advocacy, partnerships, and multi-sectoral interventions to enhance impact and sustainability UN General Assembly

• Non-communicable disease• HIV• Ebola• Antimicrobial resistance • Tuberculosis (2018)

WHO and African Union declarations and resolutions Public-private partnerships Multi-sectoral approach

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1 2

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Health security: Protecting populations from Disease Outbreaks

Health System Strengthening: Promoting Stable Societies

Share Best Practices in Program Implementation, Research, and Policy

Stable Societies Can Provide Economic Growth Opportunities

Save Lives and Prevent the Spread of Disease

REASONS TO INVEST IN HEATH GLOBALLY

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37Emerging Infections Factors of Emergence Global Health Security:Prevent, Detect, Respond Minding the Gaps Moving forward

House on Fire

“He was shaking as he described himself as just a poor village man. But, he said, when he was growing up,

there were things you could depend on. For example, if a house is on fire in a village, no one wastes time

putting water on the other houses, just in case the fire spreads…Instead…they rush to pour water where it will

do the most good – on the burning house.”

38House on Fire – The Fight to Eradicate Smallpox. William H. Foege. 2011. University of California Press, Berkley CA.


Thank you

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EMERGING DISEASES

Looking forward based on past...

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