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Protecting Our Nation's Health in an Era of Globalization: CDC's Global Infectious Disease Strategy
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Executive Summary
It is not possible to adequately protect the health of our nation without addressing infectious disease problems that occur elsewhere in the world. In an age of expanding air travel and international trade, infectious microbes are transported across borders every day, carried by infected people, animals, and insects, and contained within commercial shipments of contaminated food. “Old” diseases such as malaria, measles, and foodborne illnesses are endemic in many parts of the globe, and new diseases such as acquired immunodeficiency syndrome (AIDS; caused by the human immunodeficiency virus [HIV])—as well as new forms of old diseases such as multidrug-resistant tuberculosis (TB)—can emerge in one region and spread throughout the world.

Moreover, unforeseen disease problems continue to appear. Recent examples include vancomycin-resistant infections of Staphylococcus aureus in the United States and Japan, avian influenza in Hong Kong, a new disease called Nipah virus encephalitis in Malaysia, and outbreaks of dengue fever in Texas and West Nile encephalitis in New York. Increased CDC engagement in efforts to improve global disease surveillance and outbreak response will help us detect new or unusual diseases of any kind and respond to health emergencies of any kind—including both naturally occurring and intentionally caused outbreaks.

Left unchecked, today’s emerging diseases can become the endemic diseases of tomorrow. This is what happened with HIV/AIDS, which spread from a remote part of Africa to all other continents 20 years ago, and is now entrenched all over the world, necessitating a major international control effort.

Because U.S. and international health are inextricably linked, the fulfillment of CDC’s domestic mission—to protect the health of the U.S. population—requires global awareness and strategic thinking. This document, Protecting the Nation’s Health in an Era of Globalization: CDC’s Global Infectious Disease Strategy, describes how CDC and its international partners can collaborate to prevent the emergence and spread of infectious diseases.

U.S. Investment in Global Public Health

The United States must participate more fully in combating infectious disease threats around the world. These efforts will yield multiple benefits:

  • Protecting the health of U.S. citizens at home and abroad. Controlling disease outbreaks as well as dangerous endemic diseases wherever they occur prevents those diseases from spreading internationally, saving lives and dollars. U.S. citizens cannot be adequately protected from diseases such as measles, HIV/AIDS, and tuberculosis if our public health efforts are restricted to persons residing within our borders.
  • Furthering U.S. humanitarian efforts. The potential for saving human lives by preventing infectious diseases overseas is tremendous. Every year, an estimated three million infant and child deaths are prevented by vaccination and other preventive health measures. Many families and communities, including refugees and displaced people, also benefit from international investigations that lead to prompt control of outbreaks.
  • Providing diplomatic and economic benefits. Because health is an area of concern for all nations, international projects that address infectious disease issues can open avenues of communication and ease tensions between the United States and other nations. Improvements in global health will also enhance the U.S. economy and contribute to global prosperity. Reductions in disease burden will promote economic growth in nations that represent growing markets for U.S. products. Investments in global health will also reduce U.S. healthcare costs by decreasing the number of cases of imported diseases and by eradicating diseases currently included in childhood vaccination programs.
  • Enhancing security. Slowed economic growth fueled by poor health and disease can impede democratic development and political transitions in poor and former communist nations, contributing to military conflicts and humanitarian emergencies. The HIV/AIDS pandemic is already destabilizing poorer nations, damaging their economic, social, political, military, and educational infrastructures, and creating vast numbers of orphans. The recent intentional releases of biologic agents in the United States have also intensified international concerns about bioterrorism. Due to the ease and frequency of modern travel, an intentionally-caused outbreak that begins anywhere in the world can quickly become an international problem. A contagious bioterrorist agent such as smallpox can spread rapidly from person to person and from country to country. A noncontagious agent such as anthrax can be spread by unexpected methods, including international mail. The United States must be prepared to work with other nations to prevent illness and deaths caused by acts of bioterrorism.

Although the United States participates in health projects in many parts of the world, much more can be done, at relatively low cost, with political will, national leadership, and a clearly articulated global strategy.

CDC’s Role in Promoting Global Public Health

CDC, which is dedicated to the prevention and control of disease and the promotion of health, works by invitation in many different jurisdictions, including U.S. states and cities and other nations. Throughout its history, CDC has provided international leadership in public health, serving as a technical consultant to the World Health Organization (WHO) and ministries of health on projects that address infectious disease problems related to endemic diseases, wars, famines, or other disasters. Many of these projects have been funded and coordinated by the U.S. Agency for International Development (USAID). CDC has also supported research and public health education on diseases of regional or international importance, provided resources and leadership for the smallpox eradication effort, and established long-term collaborative research partnerships with several developing nations. While considerable effort has been devoted to these international activities, CDC’s primary focus has remained on domestic health.

In recent years, however, CDC’s overseas role has expanded rapidly. Global polio eradication and HIV/AIDS control programs have led to substantial investments of CDC personnel and financial resources, as have a succession of complex international emergencies. Between 1990 and 2000, CDC provided outbreak assistance on an ad hoc basis to nations in Asia, Africa, Europe, and Latin America to help investigate outbreaks of unknown, highly dangerous, and highly infectious diseases, and provided diagnostic support for hundreds of local investigations around the globe.

Although there are no formal structures and designated resources for international outbreak response, U.S. citizens—as well as foreign governments—have come to rely on CDC to provide outbreak assistance and public health information whenever a new or reemerging disease threat is detected anywhere on the globe. Oubreak assistance by CDC would also be required if an intentionally caused outbreak occurred at home or abroad.

CDC’s growing presence overseas presents new opportunities and new challenges. This document—developed in consultation with public and private sector partners, at home and abroad—represents an active effort to further define CDC’s evolving global mission. It considers how CDC and its international partners can work together over the long term to improve the capacity to detect, control, and prevent infectious diseases. CDC’s ongoing efforts to strengthen U.S. domestic public health infrastructure are critical to the success of these international collaborations.

Six Priority Areas

Protecting the Nation's Health in an Era of Globalization: CDC’s Global Strategy for Addressing Infectious Diseases defines CDC’s global infectious disease priorities in six areas, selected in consultation with global public health partners. In looking towards the future, CDC envisions increased activity and progress in each area:

  1. International Outbreak Assistance.
    An underlying principle of the global strategy is the recognition that international outbreak assistance is an integral function of CDC. Supporting this function will require augmenting, updating, and strengthening CDC’s diagnostic facilities, as well as its capacity for epidemiologic investigation overseas. In the future, CDC must also be prepared, as a matter of routine, to offer follow-up assistance after each acute emergency response. Such follow-up will assist host-country ministries of health to maintain control of new pathogens when an outbreak is over.
  1. A Global Approach to Disease Surveillance.
    In the years ahead, regional surveillance networks should expand, interact, and evolve into a global “network of networks” that provides early warning of emerging health threats and increased capacity to monitor the effectiveness of public health control measures. CDC will help stimulate this process by providing technical assistance, evaluating regional progress, and working with many partners to strengthen the networks’ telecommunications capacities and encourage the use of common software tools and harmonized standards for disease reporting.
  1. Applied Research on Diseases of Global Importance.
    A research program on diseases that are of global importance, including some that are uncommon in the United States, is a valuable resource, both for humanitarian reasons and because of the dangers represented by some imported diseases. CDC’s laboratorians, epidemiologists, and behavioral scientists will maintain an active research program to develop tools to detect, diagnose, predict, and eliminate diseases of global or regional importance. When a new disease threat is reported anywhere in the world, CDC’s laboratorians and field investigators will be available to help answer questions about disease transmission, treatment, control, and prevention.
  1. Application of Proven Public Health Tools.
    There is often a long delay between the development of a new public health tool and its widespread use. CDC will intensify efforts to couple applied research with research on ways to promote the use of newly developed tools for disease control (“implementation research”). CDC will help identify the most effective tools and actively encourage their international use, applying expertise and resources in laboratory research, public health policy, program management, and health communications to overcome scientific, financial, and cultural barriers.
  1. Global Initiatives for Disease Control.
    CDC will make sustained contributions to global initiatives to reduce the prevalence of HIV/AIDS in young people by 25% and reduce deaths from tuberculosis and malaria by 50% by 2010. CDC will also work with the Global Alliance for Vaccines and Immunization to reduce infant mortality through enhanced delivery and use of new and underutilitzed vaccines against respiratory illnesses and other childhood diseases. CDC and its partners will also consult on future international priorities for disease control, elimination, and eradication efforts—as well on monitoring for antimicrobial resistance and planning for pandemic influenza—and help evaluate progress through the collection and analysis of disease surveillance data.
  1. Public Health Training and Capacity Building.
    CDC will encourage and support the establishment of International Emerging Infections Programs (IEIPs) in developing countries—centers of excellence that integrate disease surveillance, applied research, prevention, and control activities. The IEIP sites will partner with Field Epidemiology Training Programs (FETPs) and other institutions to strengthen national public health capacity and provide hands-on training in public health. Over time, they may help to strengthen capacity in neighboring countries as well as within the host country.

Implementation of specific objectives in these six areas will help realize CDC’s vision of a world in which U.S. citizens and people throughout the world are better protected from infectious diseases.

Partnerships and Implementation

CDC's global infectious disease strategy was prepared by the National Center for Infectious Diseases, in collaboration with other CDC centers and offices, including the Office of Global Health, the National Center for HIV, STD, and TB Prevention, the National Immunization Program, the Epidemiology Program Office, and the Public Health Practice Program Office. Many global health organizations and agencies provided consultation and assistance during its development.

  Box 1
  Implementation Priorities, 2001-2002

The strategy will be implemented incrementally over the next five years, as funds become available, beginning with the highest priorities for 2001-2002 (Box 1). As CDC carries out this strategy, it will coordinate with foreign governments, international organizations (including WHO, the Joint United Nations Programme on AIDS [UNAIDS], and the United Nations Children’s Fund [UNICEF]), other U.S. agencies (including USAID, the National Institutes of Health [NIH], the Food and Drug Administration [FDA], the Department of Defense [DoD], the Department of State, the Department of Veterans Affairs [DVA], the U.S. Department of Agriculture [USDA], the National Oceanic and Atmospheric Administration [NOAA], and the National Aeronautics and Space Agency [NASA]), professional societies, research institutions, and schools of public health, medicine, nursing, and veterinary science. CDC will also participate in international coalitions that support disease eradication efforts and other regional and global health initiatives. These coalitions may include national and local nongovernmental organizations, community-based and faith-based organizations, and communities of color. Other implementation partners will include pharmaceutical and biotechnology companies, nongovernmental organizations that address health problems, and development agencies, development banks, foundations, and other organizations that aim to reduce poverty by reducing the incidence of endemic diseases. Web site addresses for selected organizations and health publications and reports referred to in this document are provided in Appendix A.

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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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