House of Lords - Intergovernmental Organisations Committee

CDC's vision for the Global Disease Detection (GDD) Program is to protect the health of Americans and the global community by developing and strengthening public health capacity to rapidly detect and respond to emerging infectious diseases and bioterrorist threats. The GDD program was built from CDC's existing international expertise in public health surveillance, training, and laboratory methods, bringing together three established, proven programs:

— Field Epidemiology Training Program (FETP), which trains scientists and public health workers on field epidemiology and laboratory methods;

— International Emerging Infections Program (IEIP), which integrates disease surveillance, applied research, prevention, and control activities; and

— Influenza activities related to influenza surveillance and detection.

The GDD program effectively coordinates these existing CDC resources to build in—country capacity and enhance rapid response capacity for emerging infectious diseases.

GDD Centers

The central focus of the GDD program is the establishment and expansion of GDD Centers. Strategically positioned around the world, the Centers are CDC-funded international centers of excellence in emerging infectious diseases that focus on five key activities: (1) outbreak response, (2) surveillance, (3) research, (4) training, and (5) networking.

CDC currently operates GDD Centers in Thailand, Kenya, Guatemala, China, and Egypt. Each Center serves as a regional resource to assist the host country and neighboring countries that lack fully developed capacity of their own. Together with host and partner countries' Ministries or Departments of Health, GDD Centers provide support to national and regional laboratories and epidemiology programs. During emergencies, the Centers typically function as members of the Global Outbreak Alert and Response Network (GOARN) that is coordinated by the World Health Organization (WHO). In non-emergency settings, the Centers work with country partners to implement disease detection and response interventions.

Locations for GDD Centers are selected in consultation with invited countries, internal experts, and national and international partners, on the basis of these criteria:

— Public health significance: The country has a high population density or history of infectious diseases or expected potential for emerging diseases;

— Country commitment: The country supports and values partnership with CDC and will actively engage in collaborative activities and identify new partners with which to work;

— Established CDC presence: The country has an established, effective working relationship with CDC and supports CDC staff in-country;

— Established regional reach: The country has the infrastructure and regional structure to serve as regional resource, or is already acting as a regional leader in other arenas;

— International partner presence; The country has other US Government agencies and international partners operating in-country.

Global Disease Detection: A Public Health Issue

In June 2007, the revised International Health Regulations (IHR)—the international agreement designed to help contain or prevent serious risks to public health and discourage unnecessary or excessive restrictions on travel or trade—entered into force. The revised regulations acknowledge that public health incidents can pose threats beyond national borders and that Member States bear a responsibility to the global community to identify, report, and when possible, contain public health threats before they become "public health emergencies of international concern."

Building on CDC's existing emerging infectious disease strategies, using lessons learned from SARS, and driven by concern about the threat of avian influenza or another virus that could lead to the next pandemic, GDD represents a major U.S. contribution to this new system of global disease protection.

An Urgent Threat: Pandemic Influenza

GDD Centers help detect, confirm, and contain a variety of emerging infectious diseases that pose a substantial threat to the people of the affected country, its regional neighbors, and the world. Foremost among such threats is a pandemic influenza.

In FY2006, GDD Centers trained more than 230 participants from more than 32 countries in pandemic influenza response. In addition, the Centers collectively helped respond to and contain 28 human cases of highly pathogenic avian influenza H5N1; all responses were initiated within the goal of 48 hours.

When avian influenza was detected in Nigeria in 2006, the Kenya GDD Center—with CDC's Global AIDS Program and the Influenza Division—organized an international training for more than 40 lab technicians and public health staff from 14 African nations. The training included rapid response capacity for containment and hands-on diagnostic training and was modeled after a prototype training developed by the Thailand GDD Center in 2006. The Kenya Center continues to work with countries in sub-Saharan Africa to futher enhance this preparedness.

GDD Center Achievements

During FY2006, the GDD Centers and supporting programs at CDC Headquarters have conducted a variety of activities in support of the GDD mission.

Outbreak Response

During 2006, the GDD Centers collectively responded to more than 144 disease outbreaks, including avian influenza, hemorrhagic fever, meningitis, cholera, and unexplained sudden death. These responses resulted in measurable health impact, such as disease control efforts that led to an 83% decline (compared to the previous year) in Streptococcus suis cases in one region of China, delivery of botulism antitoxin that likely prevented multiple deaths in Thailand, and investigation and control measures that saved hundreds of people from methanol intoxication in Nicaragua.

Surveillance

GDD Centers are beginning to develop protocols and diagnostic standards for conducting surveillance:

— The Guatemala Center has provided technical assistance to Ministries of Health in Honduras and Guatemala to improve their national reporting systems.

— The Thailand Center expanded an ongoing, active, pneumonia surveillance system in two provinces by adding advanced microbiology diagnostic capacity. Within 10 months of implementation, they had begun to describe the bacterial causes of pneumonia and had identified 26 cases of pneumococcal disease (a greater than six-fold increase over the previous three years combined). This new capacity produces reliable information that can be used to treat patients and identify appropriate public health interventions.

— The Kenya Center is conducting sentinel surveillance for influenza and acute febrile illness, and conducted influenza A (H5N1) surveillance of migratory birds as part of multi-country collaboration.

Research

The Thailand Center discovered three new pathogens in pneumonia patients, including bocavirus and Legionella longbeachea for the first time in Thailand, and Bartonella tamii, identified for the first time anywhere in the world.

The Kenya Center established diagnostic testing for more than five pathogens and completed testing of 786 human and animal specimens. This capacity was previously unavailable in the region.

Training

Collectively, the Centers helped to strengthen in-country and regional public health capacity for outbreak detection and response by graduating 27 FETP fellows, and providing short-term training for more than 900 public health staff. In China alone, 20 FETP graduates now hold key positions in emergency response or infectious disease departments in 14 provinces and at China CDC.

Networking

The activities of individual GDD Centers can provide benefits to other Centers. For example, the Thailand Center developed and hosted rapid response training for avian and pandemic influenza that was attended by staff of other Centers. The participating countries were then able to provide in-country training to their colleagues and establish greater regional capacity for avian and pandemic influenza.

GDD Operations Center

The GDD Operations Center, located in the Emergency Operations Center at CDC Headquarters in Atlanta, serves as CDCs central coordination point for international outbreak information, and provides support to the GOARN. Information about outbreaks worldwide is collected from a variety of public and private sources, including GDD Centers, CDC programs, WHO, the US Department of State, the US Agency for International Development (USAID), the US Department of Defense (DOD), and the Global Public Health Information Network. Information is analyzed using the expertise of scientists across the agency to help determine the level of threat to public health posed by a given event and guide the appropriate level of response. When a CDC field response is indicated, the GDD Operations Center utilizes its resources to maximise response efforts.

CDC and its Partners: Building a Global Network

GDD represents a partnership between CDC, the host country, and participating neighbor countries. To implement the GDD program, CDC also works with other domestic and international partners, including WHO, the US Department of State, USAID, DOD, the Training Programs in Public Health Interventions Network, UNICEF, the World Bank and non-governmental organizations.

Future Directions

CDC aims to build a global network of strategically located GDD Centers, capable of effectively addressing emerging infectious diseases. Ongoing and planned activities include:

— Continued support of currently funded GDD Centers in Thailand, Kenya, Guatemala, China and Egypt.

— Expanded regional and global coverage through the strategic, incremental addition of new GDD Centers (as resources allow).

— Increased collaborations with WHO, DOD, and other key global and domestic partners.

— Continued monitoring and evaluation of GDD Center activities to measure progress and assess impact.