UNICEF Case Study: Read and post a reflection about the use of Data and Tracking in the nations discussed. Create 2-3 questions to be discussed in class. 200-250 words? cgh_annualrepo

GLOBAL CENTER FOR

HEALTH Making an impact through global partnerships

Annual Report 2022Accessible version: https://www.cdc.gov/globalhealth/resources/reports/annual/2022/index.html

Founded as part of the U.S. Public Health Service in 1942, CDC’s predecessor, the Office of Malaria Control in War Areas, focused on malaria control in the southeastern United States, a major health problem in the region at the time. Since its inception in 1946, CDC carried the work of malaria prevention forward, and by 1951

when malaria was eliminated in the U.S., CDC’s mission had expanded.

Though 2021 marked 70 years since malaria was eliminated from the U.S., CDC continues to monitor malaria in the U.S., where there are still approximately 2,000 cases each year, mostly related to international travel. Today, CDC

also helps health care providers promptly and correctly diagnose and treat malaria in the U.S. and educates U.S. citizens traveling abroad about malaria prevention. As with other infectious diseases, continued vigilance at home and abroad is needed as long as malaria remains present in the world.

Since it was established more than 75 years ago, the Centers for Disease Control and Prevention (CDC) has focused on issues of global health significance.

in Public Health

75 YEARS CDC’s

CDC’s predecessor—the Office of Malaria Control in War Areas (MCWA)—was created to control malaria around military bases in the Southeastern U.S. Malaria was eliminated in the U.S. 1951

1942

CDC’s Center For Global Health In 2010, CDC established the Center for Global Health, recognizing that domestic and global health are indivisible and that no country can protect the health of its citizens in isolation from the rest of the world.

CGH’s Organization

Division of Global Health Protection

Division of Global HIV and TB

Division of Parasitic Diseases and Malaria

Global Immunization Division

CDC’s Global Health Mission

CDC improves the health, safety, and security of Americans while reducing morbidity and mortality worldwide.

CDC’s Global Health Priorities

Health Impact: Save lives, improve health outcomes, and foster healthy populations

Health Security: Strengthen global public health prevention, detection, and response to protect Americans and populations worldwide

Public Health Science Leadership: Lead and influence the advancement of global public health science and practice

CDC established the Center for Global Health (CGH) in 2010 to focus on important synergies across the global health portfolio, drawing on CDC’s unique expertise in global health security, epidemiology, surveillance, laboratory systems, emergency response, and workforce development. The Center for Global Health leads CDC efforts to work with U.S. government agencies, multilateral partners, and ministries of health in Africa, Asia, Latin America, Europe, and other regions. The Center is a steward of the agency’s domestic and global malaria and parasitic disease activities that date back to CDC’s origins, is a co-implementer of the President’s Malaria Initiative (PMI), along with the United States Agency for International Development (USAID), and is a key implementer of the U.S. President’s Emergency Plan for AIDS Relief (PEPFAR). In addition, the Center for Global Health oversees the implementation of programs to address leading causes of death worldwide, including tuberculosis, and implements prevention and vaccination activities across the globe. Through leveraging CDC’s longstanding partnerships and the agency’s unique scientific and technical capacities, CDC’s Center for Global Health works closely with ministries of health and other partners to implement programs and tackle profound health threats, including COVID-19.

True global health security requires equity in public health across the globe.

No community, district, or province within a nation will be truly safe and healthy until all are. No nation, including the United States can be truly safe until all nations have the core public health capabilities and the health systems in place to protect the most marginalized. This is why the Center for Global Health works on behalf of the American people to save lives around the world, partnering with other nations to prevent, prepare for, and respond to infectious disease threats. This work is integral to the CDC’s mission to protect Americans from health, safety, and security threats.

CDC sent a team of Epidemic Intelligence Service Officers to Southeast Asia to work on smallpox and cholera outbreaks. This was CDC’s first technical support mission to Southeast Asia.

The Foreign Quarantine Service joined CDC.1967

1958

As the nation’s lead public health agency, CDC is uniquely positioned and leads many critical aspects of the U.S. Government-wide effort to address the world’s leading global health challenges. Drawing on the CDC’s skilled workforce, and the decades of experience and lessons learned from addressing some of the world’s toughest global health challenges, CGH uses data-driven, locally appropriate approaches that are constantly informed by and adapted based on the latest innovations and the best science available.

From its inception, CGH has supported infectious disease outbreak response, elimination, and eradication efforts in the U.S. and across the globe. Through partnerships, CDC enhances country capacity in key areas—addressing the

leading causes of death and disease worldwide, including HIV, TB, malaria, and vaccine preventable diseases, and working with countries to respond to and better prepare for outbreaks and pandemic threats.

In all aspects of our global work, CGH proactively partners with ministries of health, local implementing organizations, and multilateral partners. Today, CGH has more than 1,700 in-country staff around the world working directly with ministries of health, local partners, WHO, and others to maximize global health impact—saving lives, improving health, and addressing disease outbreaks at their source.

All of CDC’s global work prioritizes country ownership, and CGH deliberately works to strengthen core public health capabilities and services around the world. Led by

country offices, CGH provides peer-to- peer support to ministries of health and others on the ground, strengthening governments’ public health systems and response to health threats. CDC also provides support from headquarters to partner countries on a wide range of shared priorities.

CDC’s Technical Expertise and Partnerships Promote Health Security and Global Good CDC’s Center for Global Health works through CDC Country Offices in more than 60 countries, and with CDC experts from across the agency to provide specialized scientific and program support to bilateral country partners, the World Health Organization and other multilateral institutions, and to other U.S. government agencies.

CDC supports Mozambique laboratory capacity for TB diagnosis. Credit: Ricardo Franco/CDC

CDC began regularly responding to public health crises abroad by providing famine assistance in sub-Saharan Africa.

CDC sent disease detectives to investigate two large outbreaks of an unknown, deadly hemorrhagic fever in Zaire (DRC) and Sudan. This disease is now known as Ebola.

1973 1976

CDC’s country-focused technical assistance is:

• Driven by science, data, and what works

• Done by working closely with in-country partners who can own the capacity gains achieved

• Designed to address needs identified by collaborators and in-country partners

Drs. Juliana de Fatima da Silva, CGH Division of Global HIV and TB, (left) and Roberto Jorge Freire Esteves, CDC Regional Office in Brazil, (right) stand near a U.S. Air Force plane used during a COVID-19 outbreak investigation in remote parts of Brazil. Credit: Juliana de Fatima da Silva/CDC

CDC established the WHO Lassa fever Collaborating Center in Sierra Leone.

CDC supported the launch of the Field Epidemiology Training Program (FETP) in Thailand, the first one outside of North America.

1980

1979

“My global work with the U.S. President’s Emergency Plan for AIDS Relief prepared me to deal with the nuances and sensitivities of scientific and international collaborations. Building relationships and trust with local partners and authorities, who ultimately have ownership of the situation, is essential to be welcomed and successful.”

-Dr. Juliana de Fatima da Silva, CGH Division of Global HIV and TB

CDC Experts Hunt for COVID-19 in the Rain Forest of Brazil

CDC launched an agency-wide response to the COVID-19 pandemic on January 21, 2020. Since the earliest days of the pandemic, CDC has been supporting prevention, preparedness, and response efforts globally, in partnership with public health agencies, ministries of health, and multilateral and non-governmental organizations worldwide. CDC’s work helps frontline healthcare workers, communities, and the public protect themselves and save lives. CDC has supported well over 60 countries in their efforts to prevent, detect, and respond to COVID-19 in collaboration with other U.S. government agencies and international partners. CDC activities are designed to enhance COVID-19 response capabilities, while simultaneously building longer-term, sustainable capacity for countries’ response to highly communicable diseases that we know will continue to threaten health outcomes well into the future.

The first wave of COVID-19 in early 2020 overwhelmed the health system in Manaus, the capital of Amazonas, Brazil’s largest state. The second wave, which started in December 2020, was even worse. By January 2021, there were not enough hospital beds, medicine, or oxygen for those who needed it. To support the Ministry of Health’s efforts in Brazil, CDC, sent a team of Portuguese-speaking epidemiologists and laboratory experts to work with local partners there. Their goal was to learn what was fueling the rapid spread of COVID-19 and conduct a public health investigation.

Initially, the CDC team faced many challenges, including getting personal protective equipment and testing supplies and getting into the community where they could begin the investigation. After meeting with local health officials, the team planned a journey to the remote city of Parintins, located on an island in the middle of the Amazon rain forest.

In Parintins, the team went to the houses of recently diagnosed people to interview and test their families to find out whether a new strain of coronavirus (referred to as P.1.) was fueling the new outbreak. In less than 72 hours, CDC and local partners talked to and tested 90 people. Fifty-four tested positive for SARS CoV-2, the virus that causes COVID-19. Of the 45 samples that underwent genetic sequencing, 31 (69%) had P.1.

Analyses of the investigation in Parintins is ongoing as of January 2022, but through this work, CDC helped to establish that the P.1. variant spread rapidly there.

BRAZIL

Since the earliest days of the pandemic in 2020, CDC country offices have pivoted available personnel, existing relationships, and critical resources and on-the- ground assets to support partner countries’ COVID-19 responses in a variety of ways. CDC’s country offices rapidly and effectively leveraged investments to respond to the pandemic, most notably from the U.S. President’s Emergency Plan for AIDS Relief (PEPFAR), Global Health Security, as

well as polio, measles and influenza relationships and platforms that were already in place before the pandemic. CDC’s long-standing partnerships and investments in supporting enhanced global surveillance systems, improving disease detection capacity, expanding adaptable laboratory networks, strengthening emergency management, and developing a well-trained workforce are key cornerstones of the global pandemic response.

Global Programs Help Countries Adapt to COVID-19

CDC’s decades old collaborations with WHO and partner countries on global health security and other shared priorities have helped to build strong foundations for COVID-19 pandemic response efforts around the world.

Three female students at the Juba Primary School in Dagahaley camp, inside Kenya’s Dadaab refugee camp, wash their hands at a washing station built with support from CDC and CARE International. Proper hand hygiene was a key recommendation early in the COVID-19 pandemic when masks were not always available and vaccines had not been developed. Credit: Peter Mndanyi/CARE Kenya

CDC joined the global campaign to eradicate Guinea worm disease.

The 33rd World Health Assembly declared the world free of smallpox, marking a landmark achievement in global health.

1980 1980

PARTNERSHIP IN ACTION: HAITI Healthcare access challenges and the recent earthquake resulted in decreased COVID-19 testing throughout Haiti. To address this issue, CDC developed additional COVID-19 testing sites, using the same model as the HIV and tuberculosis programs. As a result of this technical assistance to the Ministry of public Health and Population (MSPP), citizens can get tested for COVID-19 at pharmacies, private sector labs, and at both international airports. CDC also facilitated the donation of 500,000 Moderna COVID-19 vaccine doses a week in July. CDC continues to support the MSPP in identifying ways to increase vaccine uptake in the population.

Côte d’Ivoire Reference Laboratory Now Serves West Africa with CDC Support

One of CDC’s accomplishments in Côte d’Ivoire was the establishment of the Retro-Côte d’Ivoire (Retro-CI) laboratory in Abidjan with collaboration from the Ministry of Health and Public Hygiene (MSHP) and the Pasteur Institute of Côte d’Ivoire.

In November 2021, Retro-CI was designated by WHO as a prequalification site for HIV serology and nucleic acid testing. It is one of only 14 such laboratories worldwide, and the first in West Africa. Retro-CI’s international accreditation allows it to serve as a reference center for the West African region.

Before this designation, Retro-CI was already a recognized reference center for the country’s laboratory network. Retro- CI is a leader providing life-saving HIV diagnostics support to hundreds of thousands of people in Côte d’Ivoire each year.

In 2019, with support from PEPFAR and a goal of long-term sustainability, CDC initiated a five-year transition process for the Retro-CI laboratory. During this period, MSHP will gradually assume operational responsibilities for routine activities, and CDC will continue to provide support for more complex work.

Retro-CI works on COVID-19

Leveraging the gains and experience from the PEPFAR program to support the national COVID-19 response illustrates the adaptive and innovative approach that CDC uses to support national public health programs. In countries around the world, CDC’s support for a specific disease serves as a foundation for broader gains across the public health spectrum.

Retro-CI supported COVID-19 response activities in Côte d’Ivoire at the start of the pandemic. In March 2020, when the Pasteur Institute diagnosed the country’s first COVID-19 case, Retro-CI performed COVID-19 testing.

CDC and Retro-CI staff provided technical assistance to the broader laboratory network across the region on testing protocols and international guidance for biosafety and waste management.

The work CDC began in Côte d’Ivoire in 1988 has developed critical laboratory capacity in response to the HIV epidemic and emergent infectious diseases.

CDC supported EIS officers at COVID-19 first-line treatment centre at Poonthura, Kerala, 2020. This site used to be a school before it was converted into a treatment centre during COVID-19 outbreak investigation. Credit: CDC India Office

CDC MMWR published a report of Pneumocystis carinii pneumonia in five previously healthy young men in Los Angeles, California. This would later become known as the first published scientific account of human immunodeficiency virus (HIV).

The worldwide Polio Eradication Initiative launched, spearheaded by WHO, Rotary International, CDC, and UNICEF.

1988 1981

CDC Country Offices respond to COVID-19 around the world

Decades of collaboration between CDC and the Government of India have built strong foundations for India’s response to COVID-19. The Government of India reported its first case on the same day that WHO first declared COVID-19 a Public Health Emergency of International Concern. CDC’s country office in India mobilized immediately, establishing teams that aligned closely with Government of India response efforts across the country. CDC efforts helped to control cases and deaths by leveraging existing collaborations that strengthened India’s core public health capabilities such as disease surveillance, infection prevention and control, emergency response, public health laboratories, and a well- trained public health workforce. CDC supported efforts to establish a fully functioning Government of India Incident Management System and assisted with response and mitigation efforts, including COVID-19 clinical management, risk communication, hospital and community mitigation activities, and a tiered training program to establish a specialized cadre of epidemiologists in India.

Through CDC’s field epidemiology training program and in close collaboration with India’s Epidemic Intelligence Service program, CDC-trained public health experts are fully incorporated into the Government of India’s public health workforce, including many who have had critical roles in outbreak investigation and overall response efforts throughout the pandemic. CDC supports pandemic response efforts at the national and subnational level, providing direct support to some of the highest priority, hard-to-reach, and most vulnerable states identified by the Government of India. In addition, throughout the pandemic, CDC has provided critical support for outbreak response and contact tracing efforts within the U.S. Embassy.

CÔTE D’IVOIRE INDIA

CDC’s country offices have been critical to supporting the COVID-19 vaccine rollout, leveraging existing relationships, preparedness, response, and capacity investments, and ensuring quick access to response funds in country.

CDC collaborates with ministries of health, partner organizations, and multinational entities, including WHO and COVID-19 Vaccines Global Access (COVAX), the global collaboration to accelerate progress towards the development, production, and equitable access to COVID-19 tests, treatments, and vaccines. These collaborations work to plan, implement, and evaluate national COVID-19 vaccination programs.

CDC Provides Technical Assistance to COVID-19 Vaccine Rollout

CDC’s global COVID-19 activities enhance response capabilities and simultaneously build longer- term, sustainable capacity for response to future highly communicable diseases, including the vaccine rollout for COVID-19.

Colombia FETP COVID-19 field investigation with the Amazonas State Department of Health in San Juan de Atacuari on the Brazilian border. Credit CDC Global

CDC established the Stop Transmission of Polio (STOP) program to train and deploy international public health field staff to assist national immunization programs with polio investigation, surveillance, and planning of vaccination activities.

CDC established the Global AIDS Program. 1999 2000

CDC works with partners to:

• Ensure low and middle-income countries (LMIC) are ready to deploy and evaluate COVID-19 vaccines.

• Reduce disease burden and transmission in LMIC, which in turn reduces the threat of COVID-19 globally and the threat of new variants.

• Participate in safety monitoring guidance development, and works to ensure appropriate vaccine safety monitoring is established and maintained.

• Provide technical expertise to gather and synthesize evidence to support new policy and global guidance.

• Develop strategies for responding to public concerns about vaccines and guidance on countering common myths and rumors.

• Ensure the rapid distribution and administration of COVID-19 vaccines is taking place with appropriate health equity considerations wherever feasible.

CDC works to help ensure that LMIC can implement and evaluate the available COVID-19 vaccine campaigns. The broader aim of this effort is to establish and strengthen sustainable immunizations programs.

Taking on COVID-19 in Zambia

CDC’s Global Rapid Response Team (GRRT) is a unique resource that can rapidly respond to global public health concerns, both within the U.S. and abroad.

Since its inception in 2015 and through 2020, GRRT staff have spent more than 61,800 person-days deployed in over 1,450 total mobilizations.

GRRT has responded to multiple emergencies including cholera outbreaks, COVID-19, dengue, Ebola, hepatitis A, measles, polio, yellow fever, Zika, famine, mass gatherings, and natural disasters.

In April 2021, Kerton Victory, PhD, joined the CDC team in the southern African nation of Zambia for a 90-day assignment through CGH’s GRRT program. Kerton is a senior CDC epidemiologist working in the Center for Global Health’s Division of Global Health Protection; he is a disease detective and a member of CDC’s Global Rapid Response Team.

CDC Zambia works with the Ministry of Health (MOH) to support the country’s efforts to contain the spread of COVID-19.

“We are currently working with the MOH and local health officials to develop a national tracking system so that we can see if people have any adverse reactions to the COVID-19 vaccine and how we can go about documenting that,” Dr. Victory explained while he was in Zambia.

“CDC Zambia and I worked with the Ministry of Health to create messages and communication strategies to explain the benefits of vaccines,” Dr. Victory said.

CDC Zambia and local health officials also set up focus groups in different communities to learn more about how to increase COVID-19 vaccine demand. Social media was used as a strategy to convey and reinforce prevention messages. Showing people getting vaccinated could help encourage others to get the vaccine, too.

“We worked with religious leaders and people who are famous, like movie stars and local celebrities, to get the message out about the importance of getting the vaccine,” Dr. Victory said.

CDC launched DPDx—an online resource for diagnostic assistance and training in laboratory identification of parasites.

H5N1 influenza started spreading among humans in the late 1990’s, with several outbreaks occurring around the world throughout the 2000’s.

2000 2000s

U.S. CDC’s Kerton Victory, PhD., and colleagues from the MOH, conducted a COVID-19 vaccine readiness assessment at a Hospital in Lusaka, Zambia. Credit: Champo Chola/Zambia MOH

PARTNERSHIP IN ACTION: ZAMBIA CDC established an office in Zambia in 2000. CDC works with the Ministry of Health and provincial health offices to address HIV, tuberculosis, malaria, and other infectious diseases. CDC supports international and local organizations that help build the capacity of the ministry of health and to provide health services at the national and community level. CDC also supports national program efforts in workforce development and health systems strengthening.

ZAMBIA

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CDC’s Global Presence

Global Partnerships Save Lives CDC has over 60 country offices that work with ministries of health and other partners on the front lines. Although CDC’s overseas offices include staff assigned to the country office from CDC Headquarters in Atlanta, most of its overseas workforce are locally employed staff from the countries in which it works. CDC only works in countries that request our technical assistance and collaboration. CDC’s capacity development work is uniquely designed to be owned by partner countries.

United States

Chagas disease is an underrecognized parasitic infection that affects approximately 300,000 people in the United States. The disease can be passed from mother to baby, with as many as 300 babies born with Chagas disease every year. Tragically, most of these infections are undiagnosed. When left untreated, Chagas disease can cause heart failure, stroke, and even death. The key to preventing these outcomes is to educate healthcare providers to diagnose and prescribe treatment before patients develop problems with their hearts. Since 2015, CDC has funded partners to develop new strategies, educational tools, materials, and guidelines to improve awareness and prevention of Chagas disease. CDC improves diagnosis and treatment of Chagas disease through continuing medical education materials and patient and provider educational information.

Central America

Acute Febrile Illness (AFI) is an acute fever that can be caused by multiple pathogens. Substantial knowledge gaps exist regarding underlying etiologies and causes and patterns of AFI, particularly in lower and middle income countries. CDC Central America Region (CAR) works with countries to better understand causes of fever, to strengthen surveillance and laboratory capacities, to develop prevention and control measures, and to inform clinical management. CDC CAR helped to create a network to develop the first multi-country platform that identifies causes of illness not previously recognized in the region. CDC’s AFI work extends beyond CAR to more than 20 countries worldwide.

West Africa

CDC Nigeria’s remote COVID-19 training success led to an expansion of the Extension for Community Healthcare Outcomes (ECHO) concept. In February 2021, the University of New Mexico, U.S.CDC, CDC Nigeria, and the Nigerian government launched the West Africa Regional ECHO knowledge sharing platform for the COVID-19 Response. By mid-July 2021, thousands of West Africa healthcare workers had received COVID-19 case management and vaccination training. The West Africa Regional ECHO also serves as a platform for addressing misinformation across the region.

Philippines

At the end of 2020, Philippines ensured that over 9 million at-risk children received protection against measles and rubella, and nearly 7 million children received protection against polio. CDC supported this national, two-phased integrated campaign by providing remote technical assistance from CDC headquarters. CDC also deployed 12 Stop Transmission of Polio (STOP) program experts to assist with vaccine campaign implementation, monitoring and evaluation, and to strengthen routine immunization.

Pakistan

CDC supported polio, measles, and rubella campaigns, reaching over 90 million children in Nov. 2021. Pakistan and partners delivered the multi-antigen campaign to close gaps widened by the COVID-19 pandemic.

Vietnam

CDC Vietnam and partners implemented the Double X diagnostic strategy and tripled tuberculosis (TB) diagnoses and improved access to TB treatment for people living with HIV (PLHIV). The proportion of antiretroviral therapy (ART) patients who received TB treatment increased from 0.2% to 0.7%. The results helped inform the revision of Vietnam’s national guidelines for diagnosing and treating TB among PLHIV. The Double X strategy enhances case finding by using both a chest X-ray and a rapid molecular diagnostic test. The Double X diagnostic strategy was implemented in three provinces from July to September 2020. A total of 6,389 PLHIV were screened for TB symptoms. Of the PLHIV screened, 1,479 (23%) had a TB-like symptom.

Progress in Addressing Leading Causes of Death and Disability

CDC’s Central America Regional office partners with ministries of health to build a sustainable, high-impact national HIV response programs funded by PEPFAR. Pictured are staff of Colectivo Amigos Contra el SIDA (CAS), a free HIV and sexually transmitted disease prevention cl

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