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THE CENTER FOR GLOBAL HEALTH, CDC

Friday, 30th of March 2012

• THE CENTER FOR GLOBAL HEALTH, CDC

www.thelancet.com Published online March 7, 2012

 

Responding to criticisms published in The Lancet, ( ‘Missed Opportunities,’ reference 1, below), CDC’s top management describes the work of CDC’s recently created Center for Global Health.

 

• The CDC’s Center for Global Health

 

The strategy of the recently established Center for Global Health (CGH) at the US Centers for Disease Control and Prevention (CDC) is to enhance the public health capacity of global partners, increase global health security, and maximise the health impact of specific programmes and interventions through a focus on scientific rigour, scalability, and sustainability. We welcome the opportunity to describe the work of CGH1 and are committed to continuing to increase our impact.

 

CGH builds on CDC’s 60-year history of evidence-based global health programmes. Previously, CDC had five large and many small programmes engaged in global health work; CGH was formed 2 years ago to draw together the large and coordinate the small programmes to enable more effective collaboration within CDC and with host country, bilateral, and multilateral partners.2

 

CDC’s most strategically important partners are hostcountry ministries of health and multilateral agencies,with which CDC works to strengthen epidemiological, laboratory, and programme implementationcapacity. CDC helped establish field epidemiology training programmes that have trained more than 2500 epidemiologists and laboratory workers, about 80% of whom work in public health in their home countries after graduation.3 Since CGH was established in 2010, we have improved the quality of these training programmes with the introduction of an accreditation process, expanded their breadth in non-communicable diseases and other areas, and increased the number of trainees and countries served.3 CGH also helped establish the African Society for Laboratory Medicine to enhance laboratory capacity, quality, and accreditation. CGH marshals all of CDC’s expertise to support countries and respond to country requests to foster national public health institutes that adapt the US CDC model.

CGH places about 400 long-term staff in 55 countries, including 41 assigned to international organisations such as WHO. All are supported by agency-wide expertise at headquarters, including CDC’s several dozen WHO Collaborating Centres. In 2011, CGH coordinated more than 2000 focused public health missions of experts from headquarters to more than 100 countries, including intensive technical and management reviews in more than 30 countries. In addition to embedding staff in ministries of health, CDC’s programmes under the US President’s Emergency Plan for AIDS Relief (PEPFAR) devote more than half of all resources to local partners, a proportion that has steadily increased and will continue to grow as additional programmes are transferred to host governments.

 

Places where public health is most needed often have fragile infrastructure and weak management systems. CGH has streamlined governance and intensified oversight of technical and operational management of CDC’s programmes in the field to ensure careful stewardship of resources spent in every country. Over the past year about three dozen multidisciplinary teams of finance, procurement, and technical experts from our headquarters in Atlanta visited CDC’s country offices to review finances and documents, conduct technical and administrative grantee site visits, and assess overall financial and administrative procedures.

 

CGH will continue to refine and improve systems and protocols for diligent oversight of global health funding mechanisms, including ongoing fiscal review at the partner and country level. CGH also works to improve health security, and has supported responses to literally hundreds of outbreaks and emergencies in dozens of countries since 2010.4 An early challenge for CGH was to support Haiti after the 2010 earthquake and subsequent cholera epidemic. CDC helped the Haitian Ministry of Health diagnose cholera promptly; integrate cholera prevention and oral rehydration therapy into HIV/AIDS programmes; and establish an exemplary surveillance system to track the epidemic and adjust its response.5 As a result, the cholera case fatality rate fell quickly to the international standard of less than 1%, preventing about 7000 deaths from cholera.5,6 More recent examples include investigating the severe epidemic of lead poisoning in northern Nigeria7 and identifying the environmental aetiology of an outbreak of cryptic liver disease in Ethiopia. In 2011, CGH mobilised 37 experts to the Horn of Africa to mitigate the humanitarian emergency resulting from severe drought; they provided expert advice on nutritional surveillance and immunisation and assured quality of data even when humanitarian workers were withdrawn for security reasons.8

CGH increases health security not only through outbreak assistance, but also by working with countries to enhancetheir capacity to implement the International Health Regulations (IHR), and houses a WHO Collaborating Centre for IHR Implementation of National Capacity for Surveillance and Response. CDC scientists also help develop and evaluate new technologies, such as low-cost, point-of-care tests for plague and cryptococcosis, and vaccines for dengue and Rift Valley fever.4

 

CGH has increased the health impact of many CDC programmes, including support for PEPFAR and thePresident’s Malaria Initiative. CDC partners with the US Department of State to provide a large proportionof services for HIV testing, treatment, and prevention of mother-to-child transmission of HIV in PEPFAR.9 In the past 2 years, there has been more than a ten-fold increase in voluntary medical male circumcisions in sub-Saharan Africa,10 with CDC providing substantial support for this expansion. CGH’s intensive focus on cost-effectiveness has helped reduce costs of comprehensive HIV/AIDS treatment, prevention, and other services.11,12 CGH also undertakes malaria research to inform policy, including on the efficacy of insecticide-treated bednets in reducing malaria mortality and the effectiveness of intermittentpreventive treatment in pregnancy and infancy.13,14

 

CGH programmes collaborate with partners in disease eradication and elimination efforts, including for measles, lymphatic filariasis,15 onchocerciasis,16 guinea worm,17 and polio.18 In Haiti, CDC works with partners to increase routine vaccination, including against measles, for which Haiti remains at high risk of importation and spread, and to accelerate introduction of pneumococcal and rotavirus vaccines that will save many thousands of children’s lives.

 

Global health is too complex and broad to be directed exclusively by any one entity; CDC has many partners including USAID and the US Departments of State and Defense. Although interagency work can bring challenges, improved indicators in HIV/AIDS, malaria, and maternal and child health19 indicate the quality of collaboration in the field.

 

CDC created CGH and additional offices 2 years ago and began a review of these new programmes last year to continuously identify and address areas for improvement. CDC’s greatest strength is our staff’s scientific rigour, programmatic expertise, and deep commitment to health and social justice. The establishment of CGH will, over the next 5 years, further strengthen public health infrastructure and capacity in low-income and middle-income countries; improve timeliness and effectiveness of responses to new and emerging health threats; and increase measurable effectiveness and efficiency of programmes addressing infectious and noncommunicable diseases for a fairer and healthier world.

 

*Thomas R Frieden, Kevin M De Cock

Centers for Disease Control and Prevention, US Department of Health and Human Services, Atlanta, GA 30333, USA

tfrieden@cdc.gov.

 

TRF is Director of the US CDC. KMDC is Director of the CDC’s Center for Global Health. We declare that we have no conflicts of interest

.

1 Horton R. Offline: missed opportunities. Lancet 2012; 379: 504.

2 DeCock KM. Trends in global health and CDC’s international role, 1961–2011.

MMWR Morb Mortal Wkly Rep 2011; 60: 104–11.

3 Schneider D, Evering-Watley M, Walke H, et al. Training the global public

health workforce through applied epidemiology training programs: CDC’s

experience, 1951–2011. Public Health Rev 2011; 33: 190–203.

4 Centers for Disease Control and Prevention. Global disease detection

program: 2010 monitoring and evaluation report. Atlanta: CDC, 2011.

http://www.cdc.gov/globalhealth/GDDER/pdf/mande2010.pdf (accessed

March 6, 2012).

5 Tappero JW, Tauxe RV. Lessons learned during public health response to

cholera epidemic in Haiti and the Dominican Republic. Emerg Infect Dis 2011;

17: 2087–93.

6 Tauxe RV, Lynch M, Lambert Y, et al. Rapid development of a nationwide

training program for cholera management, Haiti, 2010. Emerg Infect Dis

2011; 17: 2094–98.

7 Dooyema CA, Neri A, Lo YC, et al. Outbreak of fatal childhood lead

poisoning related to artisanal gold mining in northwestern Nigeria, 2010.

Environ Health Perspect 2011; published online Dec 21. DOI:10.1289/

eph.1103965.

8 Centers for Disease Control and Prevention. Notes from the field:

malnutrition and mortality, Southern Somalia, July 2011.

MMWR Morb Mortal Wkly Rep 2011; 60: 1026–27.

9 The United States President’s Emergency Plan for AIDS Relief. Seventh

annual report to Congress. Washington, DC: US Department of State, 2012.

10 World Health Organization. Global HIV/AIDS response. Epidemic update and

health sector progress towards universal access: progress report 2011.

Geneva: World Health Organization, 2011.

11 The United States President’s Emergency Plan for AIDS Relief. Report on

costs of treatment in the President’s Emergency Plan for AIDS Relief

(PEPFAR). Washington, DC: US Department of State, 2012.

12 Menzies NA, Berruti AA, Berzon R, et al. Cost of comprehensive treatment in

PEPFAR-supported programs. AIDS 2011; 25: 1753–60.

13 US Agency for International Development. The President’s Malaria Initiative:

fifth annual report to Congress. Washington DC: USAID, 2011.

14 Odhiambo FO, Hamel MJ, Williamson J, et al. Intermittent preventive

treatment in infants for the prevention of malaria in rural western Kenya:

a randomized, double-blind placebo-controlled trial. PLoS One 2010;

5: e10016.

15 Gass K, Beau de Rochars MVE, Boakye D, et al. A multicenter evaluation of

diagnostic tools to define endpoints for programs to eliminate Bancroftian

filariasis. PLoS Negl Trop Dis 2012; 6: e1479.

16 Lindblade KA, Arana B, Zea-Flores G, et al. Elimination of Onchocerca volvulus

transmission in the Santa Rosa focus of Guatemala. Am J Trop Med Hyg 2007;

77: 334–41.

17 Centers for Disease Control and Prevention. Progress toward global

eradication of dracunculiasis, January 2010–June 2011.

MMWR Morb Mortal Wkly Rep 2011; 60: 1450–53.

18 Centers for Disease Control and Prevention. Progress toward interruption

of wild poliovirus transmission—worldwide, January 2010–March 2011.

MMWR Morb Mortal Wkly Rep 2011; 60: 582–86.

19 Lozano R, Wang H, Foreman KJ, et al. Progress towards millennium

development goals 4 and 5 on maternal and child mortality: an updated

systematic analysis. Lancet 2011; 378: 1139–65.