On Global Health and Being “Prepared”

What does it mean to be “prepared?” And, more to the point, what does it mean for working in global health?

For some, being “prepared” means setting aside cash for emergencies and keeping their insurance up-to-date. For others, it means a plan of action or even a fresh supply of duct tape, a list of important phone numbers, and a supply of bottled water – just in case.

As director of CDC’s Center for Global Health, I spend my time understanding and planning for what it means to be “prepared” to keep Americans safe here in the U.S. and abroad. CDC works with other governments and global partners by strengthening detection and response systems to combat diseases at their source, building a global safety net to detect diseases once they are on the move, and responding rapidly to threats that can impact the health of the American people. Many infectious diseases are the ultimate opportunistic creatures, taking full advantage of gaps in the global safety net.

Being prepared is a critical watchword in global health, and we draw lessons from our battles against HIV, TB, Ebola, Zika, and the only human disease the world has eradicated: smallpox, to name a few. All of them provide critical real-life examples of what works and what doesn’t, what it means to be prepared and what happens when we are not. Those lessons tell us what is needed for an effective response that saves lives and better protects not just people in the country where the disease is found, but the global community – all of us. That’s the definition of preparedness.

We must learn from the experiences and wisdom of those who have led the fight before us and succeeded, such as the late D. A. Henderson. D. A. Henderson directed the global smallpox eradication effort from 1967-1977 at the World Health Organization (WHO). The eradication of smallpox led to the launch of the Expanded Program on Immunization in 1974, with the goal to deliver childhood vaccines to all children everywhere to prevent vaccine-preventable diseases globally.

The global fight against measles offers particular clarity for what preparedness means when a disease is imported into the United States. The U.S., as part of the WHO Region of the Americas (AMR), documented measles elimination in 2000. However, AMR and the U.S. must have public health systems prepared to respond to the importation of measles from other geographic locations.

It’s a lofty goal, but what does this mean? It means we work closely with other countries and partners in every region of the world to monitor measles outbreaks. It means maintaining and even expanding our detection systems, which include a strong global and national laboratory and reporting network to identify and rapidly test individuals who may be infected. The systems need to be sensitive to detect when the measles virus takes hold and the number of cases spikes, whether it happens in the U.S. or somewhere else.

We need a strong and skilled public health workforce that is able to surge to investigate and to follow-up and notify anyone and everyone who may have come in contact with an infected person – you can imagine what is required when this happens on an airplane. Lastly, we need to be able to alert local, state, and national public health systems, as well as hospitals, clinics, schools, and universities, and vaccinate against measles to prevent further spread, stop the outbreak, and prevent future ones.

There is a strong role for community engagement in preparedness. As we have seen with measles outbreaks, the vaccine is effective and of high quality, but if people and entire communities decide not to get vaccinated, the outbreak can spread and there will be hospitalizations due to complications such as pneumonia. Deaths will occur.

The public health system in the U.S. has worked with religious and other communities to identify trusted leaders so that the lifesaving vaccine can be provided. From 2008 through 2011, France experienced one of its largest measles outbreaks, with over 23,000 people getting measles. I worked extensively on this outbreak with the country while based in the WHO European Regional Office, and France launched a nationwide communication campaign to recommend that adolescents and adults get vaccinated.

The recent multi-state outbreak in the U.S. linked to an amusement park in California was related to measles virus originally detected in the Philippines in 2014. It is estimated that, in the U.S., it can cost nearly $11,000 for public health officials to investigate one person with measles. This adds up quickly as an outbreak spreads. The characteristics of the measles virus create a lot of work for public health officials, so being prepared is critical.

Being “prepared” can be defined as having the right tools and the right workforce in place to respond and adapt effectively to any threat. That’s certainly the definition I use for our work in global health. It certainly describes sustaining measles elimination in the U.S.

The need for health programs to deliver preventive services – such as vaccines – based on strong science, combined with real-time accurate data to act and make hard decisions and the sheer determination of public health professionals is the essence of “preparedness” in today’s world, a circumstance that saves lives and improves the human condition everywhere.