1. CDC Strategic Health Engagements in Africa: Capacity Building for the Future
Mr. Dave Kennedy
Plans and Exercise Branch
Division of Emergency Operations
Office of Public Health Preparedness and Response
April 23, 2015
Division of Global Health Protection

2. Landscape of CDC Investments in Africa
Platforms
Integrated Disease Surveillance and Response (IDSR)
WHO International Health Regulations (IHR, 2005)
Global Health Security Agenda
Activities
Trainings
Technical Assistance
Disease Investigation & Response
Programs
HIV/AIDS
Influenza
Malaria and other Parasitic Diseases
Emerging and Zoonotic Infectious Diseases
Global Disease Detection
Work Force Development (FETP)
Immunization

3. Existing CDC Investments
Cote d’Ivoire
Influenza
HIV/AIDS
Ethiopia
FETP Influenza
HIV/AIDS
Malaria
Immunization
Kenya
FETP
Global Disease Detection
Malaria
Influenza TB
HIV/AIDS
Immunization
Ghana
Influenza
FETP
HIV/AIDS
Nigeria
Influenza
HIV/AIDS
FETP
Malaria
OneHealth
Immunization
Uganda Malaria
FETP
HIV/AIDS
Influenza
Bacterial/ Viral pathogens
Angola FETP
Influenza
HIVAIDS
Malaria
GID
Rwanda Malaria
FETP
HIV/AIDS
Influenza
Now establishing CDC Country offices in Ebola affected countries (Sierra Leone, Liberia, Guinea)
What about ring countries? Ghana, Cameroon etc?
DRC
Influenza
HIVAIDS
Malaria
Immunization
Namibia
HIV/AIDS
Tanzania Influenza
FETP
HIV/AIDS
Zambia
HIV/AIDS
Malaria
Influenza
South Africa
FETP
Global Disease Detection
Influenza
HIV/AIDS
Madagascar Influenza
Malaria
Mozambique FETP
HIV/AIDS
Malaria
Botswana TB
HIV/AIDS

4. Longstanding Partnership with DTRA’s Cooperative Biological Engagement Program
CDC and CBEP in partnership since 2004
Mitigating risk of emerging infectious disease threats
Foundational support for Global Health Security concept
Currently partnering in over 20 countries, with potential to expand in West Africa and South East Asia in FY16

5. Early Global Health Security FY 13’ CDC Demonstrations Projects
Objectives
Produce visible results in 7 months
Select from on-going activities in Uganda and Vietnam
Focus
Lab – Strengthen the nationwide capacity for detection, specimen referral, and laboratory confirmation of 3 priority pathogens
Information Technology – Integrate data sources from disease surveillance, laboratory and EOC dashboards to guide public health decisions during a crisis
Emergency Operations Center – Provide a central point for epidemic response coordination and information exchange

6. GHS Demonstration Project Uganda Successes
Emergency Operations
Established an EOC of appropriate size and scope with four full-time staff
EOC has been successfully activated for meningitis outbreak, monitoring of Ugandans returning from Hajj and other events of public health importance.
Laboratory
Ebola: Suspect specimens collected and transported via the PEPFAR hub network to CDC/Uganda Virus Research Institute for testing  
Cholera: Rapid diagnostic tests pre-positioned at 17 district health facilities with specimen referral to National Health Laboratory for culture
TB: Sputum transported to a GeneXpert site via hubs; drug-resistant TB specimens sent to National TB Lab for culture
Information Systems
Improve real-time detection, transport and confirmation through new DHIS-2 disease specific modules
Lab results interlinked via EOC through SMS; online reporting and tracking via DHIS-2
Building an integrated data system using the EOC as the hub

7. The Global Health Security Agenda
Accelerating Progress through a new International Partnership
Launch Event 13 February countries with WHO, OIE, FAO acknowledged need for concerted global action to enhance Global Health Security
Commitment Development Meetings (3)
Washington Ministerial Event
26 September 14 – 44 countries and leading international organizations met to discuss commitments made during 2014 and the course forward

8. GHSA directly supports the establishment and maintenance of the “Core Capacities” stated within the WHO International Health Regulations (IHR, 2005).

9. Global Health Security Agenda: Objectives
Goals
Objectives
Prevent avoidable epidemics
Prevent the emergence and spread of antimicrobial drug resistant organisms
Prevent spillover of zoonotic diseases into human populations
Promote national biosafety and biosecurity systems
Ensure that 90% or more of 1 year old population has received measles- containing vaccine
Detect
threats early
Launch, strengthen and link global networks for real-time biosurveillance
Strengthen the global norm of rapid, transparent reporting and sample sharing in the event of health emergencies of international concern
Develop and deploy novel diagnostics and strengthen laboratory systems
Train and deploy an effective biosurveillance workforce
Respond rapidly and effectively
Develop an interconnected global network of Emergency Operations Centers and multi-sectoral response to biological incidents
In the event of a suspected or confirmed biological attack, have the capacity to link public health and law enforcement for the purpose of attribution.
Improve global access to medical and non-medical countermeasures during health emergencies

10. Prevent | Detect | Respond Highlights for Uganda, Vietnam, India, and South Africa
Conducted a biothreat and vulnerability assessment at the biobank/laboratory in Skukuza to identify opportunities for biosafety and biosecurity upgrades
South Africa
Established a regional animal zoonotic disease station in a rural province north of Hanoi, which will serve as the hub for all animal rabies surveillance activities in the Phu Tho province.
Vietnam
Uganda
Provided microbiological lab training for detection of selected priority enteric pathogens in 4 districts of 2 states.
Immediately following training, interventions to improve cholera diagnostics
Surveillance that covers all reportable diseases in >50% of districts
Upgrade public health labs to meet accreditation
Improve EOC with staffing and technology
In 2014, in the spirit of the demonstration projects and to showcase the potential of GHS, CDC partnered with DOD on specific GHS “Quick-win” activities with additional partner countries. These activities focused on key areas to strengthen country’s capability to prevent, detect and respond to infectious disease threats.
India

11. Ebola Response and GHSA

12. 2014 Ebola Outbreak in Sierra Leone, Guinea and Liberia

14. Ebola Preparedness – WHO Checklist
Country X
Country Y
WHO Visit Date (2014)
10/20-
10/27-
10/24
10/31
WHO Preparedness Components
Overall Coordination
Rapid Response Team (RRT)
Public Awareness & Community Engagement
Infection Prevention and Control
Case Management
Ebola Treatment Center
Safe Burials
Epidemiological Surveillance
Contact Tracing
Laboratory
Capacities at Points of Entry
Overall Budget for Outbreak
Available
(All Tasks in Component are available)
Partially Available
(≥ 50% of tasks in component are available)
Not Available
(< 50% of tasks in component are available)
20 November 2014

15. Global Health Security Stopping the Ebola Epidemic
PREVENT
Promote bio-safety
Infection control training and supplies for health care facilities
Reduce outbreaks
Safe body collections and burials
Reduce spillover of zoonotic diseases into human populations
Reduce contact with bats and unsafe handling of bush meat
DETECT
Disease surveillance
Improve suspect, probable and laboratory- confirmed case reporting
Laboratory testing
Specimen transport and diagnostics
Trained workforce
Contact tracing and data management staff to conduct outbreak detection and response (e.g., Field Epidemiology Training Programs; trained, supervised and paid public health workforce)
RESPOND
Emergency Operations Center(s)
Emergency Operations Center in each country and each area within the country experiencing Ebola outbreak
Receive and deploy countermeasures
Isolation units with trained staff and an uninterrupted supply of personal protective equipment and commodities

16. Expanding FETP in West Africa
The West Africa FETP will launch in January 2015 and will include the French speaking nations in the region:
Benin
Burkina Faso (program HQ)
Côte d’Ivoire
Guinea
Mali
Niger
Senegal
Togo
FETPs previously or currently supported by CDC in Africa

17. Way Forward

18. U.S. Commitment to the Global Health Security Agenda
By 2020: 30 countries covering approximately 4 billion people
Over the next five years the United States commits to working with at least 30 partner countries to prevent, detect and respond to infectious disease threats, whether naturally-occurring or caused by accidental or intentional releases of dangerous pathogens.
Building off experiences from initial GHS Pilot Projects in Uganda and Vietnam

19. Expanding Our Global Reach
What does color code mean?

20. Global Health Security
Agenda
“…the good news is today, our nations have begun to answer the call. Together, our countries have made over 100 commitments both to strengthen our own security and to work with each other to strengthen the security of all countries’ public health systems.”
President Barack Obama, 2014
GHSA Summit Greeting Ebola Survivor Dr. Melvin Korkor from Liberia