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Protecting Our Nation's Health in an Era of Globalization: CDC's Global Infectious Disease Strategy
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Priority Area 6: Public Health Training and Capacity Building
Training workshop in Vietnam

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.

Photographer: Nguyen Thi Thu Hong, HHS/CDC/Hanoi

  Box 22
  USAID and CDC: Collaboration on Capacity Building
  Box 23
  The World Bank and CDC Sign A Memorandum of Understanding
  Box 10
  Examples of CDC's Long-term Research Collaborations Overseas

CDC’s 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 CDC’s Epidemic Intelligence Service and the Emerging Infectious Disease Laboratory Fellowship Program, which is a joint effort between CDC and the Association of Public Health Laboratories (APHL).

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 efforts—which included training courses, research collaborations, program evaluations, health education campaigns, and the provision of laboratory reference support—were 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 countries—centers 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 NIH’s Tropical Medicine Research Centers or DoD’s 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).

  Box 24
  Applied Field Epidemiology Programs

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 United States.

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.

  Box 16
  A Growing Community of International Public Health Leaders

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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Booklet Contents
item Contributors
item Table of Contents
item Preface
item Executive Summary
item Introduction
item International Cooperation To Combat Infectious Diseases
item U.S. Investment in Global Public Health
item Protecting the health of U.S. citizens at home and abroad
item Furthering U.S. humanitarian efforts
item Providing economic and diplomatic benefits
item Enhancing security
item CDC's Role in Promoting Global Public Health
item An evolving mission
item Vision for the Future
item Partnerships and Implementation
item Priorities and Objectives
1. International Outbreak Assistance
item Objectives
2. A Global Approach to Disease Surveillance
item Objectives
3. Applied Research on Diseases of Global Importance
item Objectives
4. Application of Proven Public Health Tools
item Objectives
5. Global Initiatives for Disease Control
item Objectives
6. Public Health Training and Capacity Building
item Objectives
item List of Boxes
item Acronyms
item Appendix A
item Appendix B
item Appendix C
item Appendix D
item Appendix E
item Acknowledgments
item References

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Date published: 2002

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