Global Health Security and Domestic Preparedness:

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1 Centers for Disease Control and Prevention Robert R. Redfield, MD Director, Centers for Disease Control and Prevention Global Health Security and Domestic Preparedness: Public Health in an Insecure World A Domestic Threat: The Opioid Crisis Global Partnerships Final Thoughts

2 Global Health Security and Domestic Preparedness Priorities Pandemic Flu Antimicrobial Resistance Outbreaks Global Domestic CDC is Science-based, Data-driven, Service-oriented

3 Pandemic Flu Is Still Our Greatest Threat

4 Four Pandemics Pandemic 1918 Pandemic H1N Pandemic 1957 Pandemic H3N2 H2N2 H1N1

Burden of Influenza During the 2017-2018 Season CDC estimates during the 2017 2018 influenza season that

5 Burden of Influenza During the Season CDC estimates during the influenza season that influenza was associated with: >49 million illnesses >22.7 million medical visits, 960,000 hospitalizations 79,400 deaths

6 Peak U.S. Influenza Activity for Season January 20, 2018 February 10, 2018

Vaccine Formulations Available for 2018-19 Inactivated Vaccine Trivalent for 6 months Quadrivalent for 6 months Quadrivalent Cell-Culture-Based for 4 years Trivalent High-Dose for 65

7 Vaccine Formulations Available for Inactivated Vaccine Trivalent for 6 months Quadrivalent for 6 months Quadrivalent Cell-Culture-Based for 4 years Trivalent High-Dose for 65 years Trivalent Adjuvanted for 65 years Recombinant Protein Vaccine Quadrivalent for 18 years Live Attenuated Vaccine Quadrivalent for 2-49 years Recommended again for season

8 Vaccination Rates Dropped for Adults in Season

9 Vaccination Rates Dropped for Children in Season

Antimicrobial Resistance: Every Country and Industry Has to Step Up AMR Challenge is the most ambitious campaign ever to combat antimicrobial threat Marshalls global stakeholders AMR Industry

10 Antimicrobial Resistance: Every Country and Industry Has to Step Up AMR Challenge is the most ambitious campaign ever to combat antimicrobial threat Marshalls global stakeholders AMR Industry Alliance partners with world s largest pharmaceutical companies to curb discharging antibiotics and residues into environment If we don t all act fast together, we will see global progress quickly unravel. Antibiotic resistance isn t slowing down. Every country and industry has to step up. - HHS Secretary Azar

11 Antimicrobial Resistance Threatens health care, food production, and life expectancy around the world AMR Strategy 5-year commitment from global health leaders to share data, improve how antibiotics are used, develop new vaccines and drugs, and improve infection prevention

and U.S. Travel advisory on risk of typhoid fever in Pakistan U.K.

12 Drug-resistant Outbreaks Pose Threats Worldwide Pakistan: Ongoing XDR typhoid fever outbreak Spread to U.K. and U.S. Travel advisory on risk of typhoid fever in Pakistan U.K.: Super Gonorrhea outbreak started in England in 2014 Emergence of cephalosporin-resistant gonorrhea will significantly hinder ability to treat infection U.S.: Nightmare Bacteria ~50% of cases are fatal 2011: serious outbreak in NIH Clinical Center killed 11 patients 221 instances identified nationwide just in 2017 Containment strategy is critical

13 We Have to Respond Before Health Threats Spread What we Opioids don t expect Infectious Diseases

History of Ebola in Democratic Republic of Congo Year Cases Deaths Duration 1976 318 280 2 months 1977 1 1 2 days 1995 315 250 3 months 2007 264

14 History of Ebola in Democratic Republic of Congo Year Cases Deaths Duration months days months months months months months months months months and ongoing

17 DRC Ebola Outbreak: Responding Amid Insecurity Ebola Areas and Road Security Status Armed Group Areas of Activity

18 Insert maps by: 1. ZdeS (external map) 2. Quartier (all areas) 3. Quartier (Beni) 4. AdeS (Beni) 5.. Note: To insert blank like this one, copy-paste this slide, or from New slide dropdown, select Title slide HEALTH EMERGENCIES programme

Recent Responses in Insecure Areas Polio in Syria: Active conflict, chronic insecurity, and large-scale displacement of people made wild poliovirus outbreak possible Multiphase outbreak response

Yemen: Largest and fastest cholera outbreak in modern history CDC provided technical assistance and funding 3+ years of conflict caused closure of half of all health facilities Polio

19 Recent Responses in Insecure Areas Polio in Syria: Active conflict, chronic insecurity, and large-scale displacement of people made wild poliovirus outbreak possible Multiphase outbreak response involved 8 countries focused on improving surveillance and vaccination helped contain and interrupt outbreak within 6 months Lessons learned could help other responses amid insecurity Cholera in Yemen: Largest and fastest cholera outbreak in modern history CDC provided technical assistance and funding 3+ years of conflict caused closure of half of all health facilities Polio (Afghanistan/Pakistan/Nigeria): Vaccination access increasingly hampered by bombings, attacks, active conflicts in Afghanistan Regional insecurity, forced displacement cut off 60% of settlements from vaccination in northeastern Nigeria in 2015

20 Current Outbreaks and Instability Worldwide 2018 Ongoing Conflicts and Extreme Security Risks High Security Risk Areas Source: CDC, Council on Foreign Relations, Control Risks

Domestic Preparedness: Fighting the Opioid Crisis What we Opioids don t expect Infectious Diseases October 26, 2017 Opioid Crisis declared Nationwide Public

21 Domestic Preparedness: Fighting the Opioid Crisis What we Opioids don t expect Infectious Diseases October 26, 2017 Opioid Crisis declared Nationwide Public Health Emergency by Trump Administration I am directing all executive agencies to use every appropriate emergency authority to fight the opioid crisis. - President Trump

22 Number of deaths Number of deaths U.S. Opioid-related Deaths Soar, Non-opioid Deaths Also Increasing 45,000 Non-Opioid Deaths 45,000 Opioid Deaths 40,000 35,000 30,000 25,000 20,000 15,000 Psychostimulants with Abuse Potential Cocaine 40,000 35,000 30,000 25,000 20,000 15,000 10,000 5, ,000 5,000 0 Over 600,000 people have died from overdose since 2000 Year Year

23 Rapid Increase in Drug Overdose Deaths Rates by County SOURCE: NCHS Data Visualization Gallery

Infectious Diseases Drug Overdose Death Rates Per 100,000 People Ages 12 and

24 State Rates of Opioid Use Condition and Drug Overdose Deaths What we don t expect Opioid Use Condition Rates Per 1,000 People Ages 12 and Older Infectious Diseases Drug Overdose Death Rates Per 100,000 People Ages 12 and Older Source: Jones CM Analysis of NSDUH, 2016 National Vital Statistics System

25 Opioid Prescribing and Rogue Pharmacies The Role of the 5 th Vital Sign Number of opioid prescriptions dispensed per 100 persons between CDC. US State Prescribing Rates 2016.

26 W. Virginia Leads U.S. in Resident Drug Overdose Death Rate Infants Born with Opioid-related Condition Increase

27 Opioid Crisis: the Public Health Crisis of Our Time Opioid use is a medical condition, not a moral failing Stigma is the enemy of public health

28 CDC s Approach to Fighting Opioids: Science-based Data-driven Service-oriented Syndromic surveillance Prescription Drug Monitoring Program Chronic and acute pain management Outreach to public

29 What we Opioids don t expect Infectious Diseases

bio incidents Ensure biodefense preparedness to reduce impact of bio incidents Rapidly respond to limit

30 President s 2018 Biodefense Strategy Assess, Prevent, Detect, Prepare for, Respond to, and Recover from Biological Threats Enable risk awareness to inform decision-making Ensure biodefense capabilities to prevent bio incidents Ensure biodefense preparedness to reduce impact of bio incidents Rapidly respond to limit impact of bio incidents Facilitate recovery to restore the community, the economy, and environment after a bio incident

31 CDC Priorities Responding to Outbreaks (Opioid Crisis) Disease Elimination Global Health Security and Domestic Preparedness CDC is Science-based, Data-driven, Service-oriented

32 What we Global don t Health expect Development Global Health Security

33 Key U.S. Target Global Health Programs 2003: President George W. Bush authorizes PEPFAR 2018: PEPFAR reauthorized U.S. President s Emergency Plan for AIDS Relief

34 CDC and Our Partners Are Driving PEPFAR Results

35 Key U.S. Target Global Health Programs 2008: President George W. Bush authorizes PMI President s Malaria Initiative

36 Global Health Security: U.S. Needs Long-term Footprint

37 Global Health Security Agenda Countries Supported by CDC

security Defense and security sectors are a key partner

38 We Need a Game Plan for Outbreak Response Amid Insecurity More outbreaks will occur in areas of compromised security Defense and security sectors are a key partner in advancing Global Health Security Agenda and outbreak responses

The Dream of Preventive Medicine Preventive medicine dreams of a time when there shall be no unnecessary suffering and no premature deaths; when the welfare of the people shall be our

39 The Dream of Preventive Medicine Preventive medicine dreams of a time when there shall be no unnecessary suffering and no premature deaths; when the welfare of the people shall be our highest concern; when humanity and mercy shall replace greed and selfishness; and it dreams that all these things will be accomplished through the wisdom of man. - Milton J. Rosenau, M.D.

40 Never Underestimate the Possible September 12, 1962: We choose to go to the Moon in this decade July 20, 1969: that s one small step for a man, one giant leap for mankind. We Must See the Possible and Lead the Nation to Act

Center for Global Health. CDC Global Health Saving Lives Overseas, Protecting Americans at Home

Center for Global Health. CDC Global Health Saving Lives Overseas, Protecting Americans at Home Center for Global Health CDC Global Health Saving Lives Overseas, Protecting Americans at Home CDC Overview Part of the U.S. Department of Health and Human Services, CDC is the nation s leading public