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Indonesia Takes a Leadership Position in the Global Health Security Agenda

Categories: global health security

Maluku mom and kid with mosquito bed net (Photo courtesy of Edi Purnomo, UNICEF)

Photo courtesy of Edi Purnomo, UNICEF

Dr. William Hawley, Country Director for CDC-Indonesia

Dr. William Hawley, Country Director for CDC-Indonesia

As the world’s fourth most populated country, Indonesia plays an important strategic role in protecting the global community from infectious disease threats. As one of the early countries to take a leadership role in the Global Health Security (GHS) Agenda, the Government of Indonesia will welcome senior health and agricultural leaders from 36 countries and 12 international organizations for the next commitment meeting August 20-21. The meeting, “Building Global Commitment to Multisectoral Approaches to Manage Emerging Zoonotic Diseases in Support of the Global Health Security Agenda within the Framework of Public Health”, demonstrates the progress and growing momentum of the GHS Agenda.

CDC has collaborated with Indonesia for more than fifty years. Short- and long-term technical assistance from CDC staff has helped the Indonesian Ministry of Health (MoH) address a wide range of high-priority public health needs, including communicable diseases, noncommunicable diseases, injuries, and strengthening surveillance. As CDC Country Director in Indonesia for the last three years, it has been an honor and privilege to work alongside our Indonesian counterparts to advance public health and the GHS Agenda.

Recent CDC and Indonesia MoH collaborations include support for maternal and child health and malaria control and elimination, surveillance for influenza and respiratory diseases, immunizations, enhancing laboratory-based early warning surveillance systems, and the Field Epidemiology Training Program. CDC works closely with the World Health Organization (WHO), UNICEF, and USAID in supporting collaborations with the MoH.

IndonesiaThe GHS Agenda is a WHO Member State-driven effort to accelerate progress toward global implementation of the International Health Regulations (IHR), building on the IHR obligations of all Member States to collaborate in the development, strengthening, and maintenance of IHR core capacities. Participation in the GHS Agenda is open to all Member States who can make a specific commitment to accelerate measurable progress toward the GHS Agenda objectives.

Through focused leadership and high-level political will, the GHS Agenda aims to bring together other sectors in addition to health (including agriculture, security, development, and foreign affairs) in a whole-of-government—as well as a whole-of-society—approach to address infectious disease threats.

As we look ahead to the next GHS Agenda event at the White House on September 26, when nations around the world will present their comprehensive and integrated commitments, the meeting this week in Indonesia underscores Indonesia’s commitment to global health security and its important role in the international community and the Association of Southeast Asian Nations (ASEAN).

Learn more about CDC’s work in Indonesia.

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The High Stakes in Fighting Ebola: Leave One Burning Ember and the Epidemic Could Re-Ignite

Categories: Ebola, global disease detection, global health security, health systems strengthening, infectious disease


This blog was originally posted on the Huffington Post on August 7, 2014.


A banner encouraging people suffering from Ebola to go immediately to a health center for treatment is seen on a sidewalk in the city of Freetown, Sierra Leone, Thursday, Aug. 7, 2014. While the Ebola virus outbreak has now reached four countries, Liberia and Sierra Leone account for more than 60 percent of the deaths, according to the World Health Organization. The outbreak that emerged in March has claimed at least 932 lives. (AP Photo/Michael Duff)

(AP Photo/Michael Duff)

CDC and our partners are currently fighting the biggest and most complex outbreak of Ebola virus disease ever recorded.

CDC Director Dr. Tom Frieden

CDC Director Dr. Tom Frieden

There are hundreds of cases in West Africa and now a new cluster of cases in Nigeria is very concerning. The spread of Ebola shows what happens if we don’t have meticulous infection control, contact tracing, and proper isolation of those with symptoms of the disease.

There are two things that are very important to understand about how Ebola spreads.

The evidence suggests that Ebola only spreads from sick people—not from people who have been exposed to the disease but haven’t yet become sick from it. The illness has an average 8-10 day incubation period, although in rare instances the incubation period may be as short as two days or as long as 21 days, which is why we recommend monitoring for 21 days after any potential exposure.

People are not contagious during that incubation period; they become contagious only when they start having symptoms.

Second, the evidence shows that Ebola outbreaks aren’t propagated by casual contact or through the air or in water.

Ebola is transmitted through direct contact with body fluids of an infected, symptomatic sick person, or exposure to objects such as needles that have been contaminated.

This is a disease that has been hard to stop in Africa, but if it were to show up here, we can stop in the United States.

Ebola virus disease spreads in Africa through inadequate infection control in hospitals as well as through traditional burial ceremonies that directly expose people to body fluids. We can avoid those problems here.

The standard, rigorous infection control procedures used in hospitals in the United States will prevent spread of Ebola.

The problem isn’t that Ebola is highly infectious—it’s not.

It’s that the stakes are so high.

So the key to contain the virus is to have meticulous, rigorous procedures in place to ensure adherence to scrupulous infection control.

Ebola in West AfricaIn the past decade, the United States has had five imported cases of hemorrhagic fevers—one of Marburg and four of Lassa, both viruses that are similar to Ebola. Each time, the American public health system identified the cases and through scrupulous infection control procedures prevented any one else from becoming ill.

The best way to protect Americans is to stop the outbreak in West Africa.

We know how to control Ebola. Previous outbreaks of Ebola virus disease have been contained by patient isolation, rigorous use of infection control measures in hospitals, intensive and thorough contact tracing in affected communities, and community education.

CDC, the World Health Organization, and our partners are committing to deliver a surge of resources and expertise to help end this outbreak. Far too many lives have been lost already. We have a difficult road ahead, which will take many months, but we must redouble our efforts to bring this terrible outbreak under control.

CDC is sending at least 50 public health staff to West Africa in the next few weeks. These staff members include epidemiologists, data managers, health educators, and other specialists who can assist with efforts to control the outbreak.

We have stopped every previous outbreak of Ebola in Africa, and CDC is ready to help the World Health Organization stop this one, too.

As part of the Global Health Security Agenda, a partnership of the U. S. government, WHO and other multilateral organizations and non-government actors, the President’s FY 2015 budget includes $45 million for CDC to accelerate progress in detection, prevention, and response and potentially reduce some of the direct and indirect costs of infectious diseases. Improving these capabilities for each nation improves health security for all nations.

It’s like fighting a forest fire.

Leave behind one burning ember and the epidemic could re-ignite.

That ember could be one case undetected, one contact not traced or health care worker not effectively protected, or burial ceremony conducted unsafely.

Our efforts will not only stop these outbreaks, but we are working to leave behind stronger laboratories, emergency operations centers, and trained public health staff who can prevent, detect, and stop future outbreaks of Ebola and other diseases before they spread.

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Global Health Security in Africa: Collaborations Between CDC and African Partners

Categories: global health security

2012 investigation of Ebola virus in Uganda

2012 investigation of Ebola virus in Uganda

Thomas Kenyon, MD MPH, Director of CDC Center for Global Health

Thomas Kenyon, MD MPH, Director of CDC Center for Global Health

The ambition and scope of the Global Health Security Agenda are clear. Its reach can be discerned from the very first word: global. The Agenda’s overarching goal is just as expansive—making the world safer and more secure by preventing epidemics and outbreaks, detecting them more rapidly, and responding effectively to lessen the health, economic, and societal consequences from disease threats.

Less obvious, but no less true, is that African ownership will be central and fundamental in shaping the way the Global Health Security Agenda evolves worldwide, the way it is enacted and refined, and to a large extent, how it succeeds.

CDC and African nations have been close and successful partners for many decades in the battle to protect and improve public health. In many ways, the concepts, practices, and tools that are central to the Global Health Security Agenda are drawn from experiences honed with our partners in Africa over many years.

The needs—and justification—for this enhanced approach are beyond dispute. New diseases are occurring and spreading, drug resistance is rising, and more laboratories are working with dangerous bacteria and viruses. In today’s compressed world, it’s no exaggeration to say the next disease threat is only a plane ride away. It’s also true that there are dangerous gaps in detection, response, and prevention that must be closed.

The lessons from our collaborative work in Africa illuminate and inform our thinking and actions. It’s also true that accomplishments have already been achieved as a result of strong and longstanding partnerships between the U.S. and African nations to prevent the spread of diseases. In 2013, for example, CDC collaborated with partners in Uganda to strengthen lab systems, improve the capacity of emergency operation centers, and work toward real-time data sharing in health emergencies.

For years, CDC has worked with many partners and countries across Africa to develop Field Epidemiology Training Programs (FETP) to train field epidemiologists. These programs are very important in building capacity for detecting and responding to health threats and developing systems that can help quickly detect diseases and prevent them from spreading. CDC’s Sub-Saharan Africa FETPs have responded to outbreaks ranging from polio in Cameroon and Nigeria, monkeypox in the Democratic Republic of the Congo, and Lassa fever in Nigeria.

More needs to be done however.

An Ebola isolation ward in Conakry, Guinea

An Ebola isolation ward in Conakry, Guinea

With the current Ebola outbreak in Guinea, Liberia, and Sierra Leone and diseases like cholera and typhoid affecting thousands in Africa, it is more important than ever to improve public health systems through a coordinated surveillance and effective response.

It’s fair to ask: Would a fully realized and implemented Global Health Security Agenda have prevented the Ebola outbreak in West Africa, which now is the largest in history? Probably not. Would it have made a difference? Most would say yes in terms of saving lives, through earlier detection, an early alert and communication system, and a more coordinated response by a wider collection of nations equipped with Emergency Operations Centers operating with more universal rules and standards. Each of those goals is a central element of the Global Health Security Agenda.

Enhancing global health security is a priority for the U.S. government and for CDC. Yet the U.S. government cannot achieve global health security alone. It needs to be a priority for every nation because we all share common risks. Global health security is a shared responsibility as well. Just as it’s been for years with our partners in Africa and we look forward to making that partnership even stronger in the years ahead.

See also

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World Cup serving as real-world test for new disease detection technology

Categories: global disease detection, global health security, health systems strengthening, infectious disease


World Cup soccer ball


With the World Cup underway in all its frenzied glory, you can be forgiven for missing another major effort currently underway in Brazil that represents the first large scale, real-life, real-world test of important new technology.

And no, it’s not the goal-line technology that’s being used for the first time at soccer’s biggest competition.

This technology uses computer tablets, sophisticated software designed by CDC and public health experts from Brazil’s Ministry of Health (MOH) trained in the Field Epidemiological Training Program (FETP) to provide the most complete, detailed and timely information about disease threats and other public health concerns.

Communication Matters in Global Health Deployments

Categories: global health security, infectious disease

During the simulation exercise, ECN trainees deployed to the site of a mock disaster in Avully, Switzerland.

During the simulation exercise, ECN trainees deployed to the site of a mock disaster in Avully, Switzerland.

Communication matters.

Gaya Gamhewage, MD, Coordinator, WHO Communication Capacity Building Team; Founder, WHO Emergency Communication Network

Gaya Gamhewage, MD, Coordinator, WHO Communication Capacity Building Team; Founder, WHO Emergency Communication Network

That’s not a new idea. Many of us have learned this the hard way. This concept is being applied in a new, more comprehensive way for a key purpose—to help the World Health Organization (WHO) communicate more effectively, with more clarity and purpose during humanitarian and public health emergencies.

The idea is to better integrate communications specialists from WHO, CDC, ministries of health and a wide array of other humanitarian and global health organizations into a cohesive, specially trained team that can be dispatched on short notice when public health or humanitarian emergencies occur.

The logic is based on the idea that communications is part and parcel of emergency health response. Communicating in a crisis not only provides the public and policy maker clear and critical information, it also can help the technical side of the response. It connects those affected with those willing to help and can make sure that resources are aligned to the most important needs.

Public Health Informatics in Action in Malawi: Making life easier for healthcare workers and patients while improving quality through an innovative national Electronic Medical Record System

Categories: child health, global health security, HIV/AIDS, women's/maternal health

Instituting an Electronic Medical Record System reduces the need to manage and store growing volumes of patient charts, a major challenge in resource-limited settings.

Instituting an Electronic Medical Record System reduces the need to manage and store growing volumes of patient charts, a major challenge in resource-limited settings.

Denise Giles, M.P.H., Health Scientist, CDC-Malawi

Denise Giles, M.P.H., Health Scientist, CDC-Malawi

Keeping track of even one patient undergoing treatment for HIV/AIDS can be complicated enough.

Doing it for over 472,865 patients when you’re a low income country coping with high demand and a sputtering economy magnifies the complexity.

Which is why Malawi’s story – and its solution – is attracting attention and praise. It’s a story of how Electronic Medical Record System (EMRS) technology is being used and the foresight needed to bring it to reality.

You don’t have to look far to see the positive results.

FETP Work in South Sudan Benefits the Whole World

Categories: global health security, health systems strengthening

I’ve been with the Field Epidemiology Training Program (FETP) for 2.5 years now, where I am currently the resident advisor (RA) in South Sudan. My epidemiology training has provided me with the opportunity to gain a wide variety of experiences; prior to joining FETP, I served as an epidemiologist with Médecins Sans Frontières-Switzerland (MSF-CH), working in the refugee camp in Dadaab, Kenya, and have also worked in Dawei (Tavoy), Burma . I am glad to be able to pass on my knowledge about epidemiology to future leaders in the field. As an RA I assist with basic FETP implementation for county and state surveillance officers as well as immunization managers and supervisors. I also advise on outbreak response for priority diseases as well as assist with cascade training for the health facility staff who provide immunization services.

Helsinki, Finland – The Next Step in Accelerating Global Health Security

Categories: global health security

The Global Health Security Agenda Commitment Development meeting is being hosted by Finland, May 5-6, 2014 at Finlandia Hall in Helsinki.

The Global Health Security Agenda Commitment Development meeting is being hosted by Finland, May 5-6, 2014 at Finlandia Hall in Helsinki.

When senior leaders from more than 30 countries and 4 international organizations converge on Helsinki on May 5th for two days of intensive discussion, the over-arching topic will be one that is closely associated with Finland’s capital city – security.

CAPT (USPHS) Eric Kasowski, DVM, MD, MPH – Chief, CDC Global Health Security Branch

CAPT (USPHS) Eric Kasowski, DVM, MD, MPH – Chief, CDC Global Health Security Branch

But this time, unlike 1975 when Helsinki hosted the Conference on Security and Cooperation in Europe, or 1990 when President George Bush met President Mikhail Gorbachev met in the same city for a path-breaking U.S. – Soviet summit, the leaders arriving in Helsinki will be working on a new aspect of security, one that will better protect the world from infectious disease threats.

The Helsinki meeting is the next major step in a historic partnership unveiled Feb. 13 in Washington, D.C., called the Global Health Security (GHS) Agenda. This effort is aimed at improving our ability worldwide to prevent, detect and respond to infectious disease outbreaks at a time when diseases of all types can travel greater distances in less time than ever before and potentially threaten a larger number of people no matter where they live.

DPDx: 15 Years of Strengthening Laboratory Capacity for Parasitic Disease Diagnosis

Categories: global health security, parasitic diseases


CDC’s DPDx helps labs around the world identify parasites like Taenia saginata. (Photo courtesy of David Snyder/CDC Foundation)

CDC’s DPDx helps labs around the world identify parasites like Taenia saginata. (Photo courtesy of David Snyder/CDC Foundation)

The inquiries and images come from almost every state in the United States, and often with a sense of urgency. Still others arrive from Argentina and Germany, Italy, Japan, China, New Zealand, India—and dozens more countries around the globe. Each time the question for CDC’s parasite identification laboratory, known as DPDx, is the same: What is it?

Alexandre J. da Silva, PhD, CDC DPDx

Alexandre J. da Silva, PhD, CDC DPDx

The diagnostic parasitology experts on CDC’s Division of Parasitic Diseases and Malaria’s DPDx team provide answers.

DPDx is the effective merger of technology, laboratory science, and CDC’s unparalleled expertise in parasite identification and the diseases they cause.

DPDx is a unique online educational resource that includes visual depictions of parasite lifecycles, a reference library of free images of parasites, and guidance on proper laboratory techniques for diagnostic parasitology. But it is much more than a Web site.

The primary role of DPDx is reference diagnosis, wherein CDC laboratory scientists confirm diagnoses or discover that the diagnosis is something altogether different from what was originally thought. In both cases, but especially in the latter cases, DPDx impacts treatment. For example, Babesia microti is one of the parasites that cause the tick-borne disease babesiosis; it can be misidentified as Plasmodium falciparum, which causes malaria. The two diseases require different treatments and on many occasions, the DPDx team has corrected a misdiagnosis, ensuring that the patient is appropriately treated.

Strengthening Global Health Security Protects Americans

Categories: flu, global health security, HIV/AIDS, infectious disease, malaria, parasitic diseases


This blog was originally posted on on February 13, 2014.


The 5 Ways Diseases in Other Countries Can Kill You

The world is smaller and people are more mobile than at any time in history. This makes it easier than ever for what’s happening anywhere on the globe to harm Americans’ health. 
Here are five ways diseases in other countries pose a threat:

1) The flu could threaten millions. Even in a mild year for flu, in the United States alone, there are thousands of deaths, hundreds of thousands of hospitalizations, and billions of dollars in productivity losses.
In a pandemic, millions of people worldwide could be killed. H7N9 influenza, also known as bird flu, is spreading in China, though fortunately it has not mutated to become an infectious disease outbreak that could threaten the health of people around the world.

CDC Director Dr. Tom Frieden

CDC Director Dr. Tom Frieden

2) Antibiotic resistance is on the rise. Antibiotic resistance just might be the most urgent health threat facing us now.

The nightmare strain of bacteria known as CRE, carbapenem-resistant Enterobacteriaceae, arose abroad and was introduced to one state in the United States. Now it’s in at least 44 states. It can resist all or almost all antibiotics, kills many of the people who get it in their blood, and spreads its resistance capabilities to other bacteria.

The World Health Organization estimates multidrug-resistant tuberculosis already has infected a half a. million people across the globe.

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