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

Robert R. Redfield, MDDirector, Centers for Disease Control and Prevention

Global Health Security and Domestic Preparedness Priorities

CDC is Science-based, Data-driven, Service-oriented

Pandemic Flu

Antimicrobial Resistance

Outbreaks Global

Domestic

Pandemic Flu Is Still Our Greatest Threat

Four Pandemics 1918-2018

1918 Pandemic

H1N1

1957 Pandemic

1968 Pandemic

H2N2

2009 Pandemic

H1N1

H3N2

Burden of Influenza During the 2017-2018 Season

CDC estimates during the 2017–2018 influenza season that influenza was associated with:

>49 million illnesses

>22.7 million medical visits,

960,000 hospitalizations

79,400 deaths

Peak U.S. Influenza Activity for 2017-2018 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 years Trivalent Adjuvanted for ≥65 years

Recombinant Protein Vaccine Quadrivalent for ≥18 years

Live Attenuated Vaccine Quadrivalent for 2-49 years Recommended again for 2018-19 season

Vaccination Rates Dropped for Adults in 2017-18 Season

Vaccination Rates Dropped for Children in 2017-18 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 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

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

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

What we don’t expectOpioids Infectious Diseases

We Have to Respond Before Health Threats Spread

History of Ebola in Democratic Republic of Congo

1976 318 280 2 months

1977 1 1 2 days

1995 315 250 3 months

2007 264 187 4 months

2008-09 32 15 3 months

2012 36 13 6 months

2014 69 49 4 months

2017 8 4 3 months

2018 54 31 3 months

2018 442 210 4 months

Year Cases Deaths Duration

and ongoing

DRC Ebola Outbreak: Responding Amid Insecurity

Ebola Areas and Road Security Status Armed Group Areas of Activity

HEALTH

programmeEMERGENCIES

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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

Current Outbreaks and Instability Worldwide 2018

Ongoing Conflicts and Extreme Security Risks

Source: CDC, Council on Foreign Relations, Control RisksHigh Security Risk Areas

What we don’t expectOpioids Infectious Diseases

October 26, 2017Opioid 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

Domestic Preparedness: Fighting the Opioid Crisis

U.S. Opioid-related Deaths Soar, 1999-2016Non-opioid Deaths Also Increasing

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Non-Opioid Deaths Opioid Deaths

Over 600,000 people have died from overdose since 2000

Rapid Increase in Drug Overdose Deaths

Rates by County

SOURCE: NCHS Data Visualization Gallery

What we don’t expect Infectious DiseasesOpioid Use Condition Rates

Per 1,000 People Ages 12 and OlderDrug Overdose Death Rates

Per 100,000 People Ages 12 and Older

State Rates of Opioid Use Condition and Drug Overdose Deaths

Source: Jones CM Analysis of 2015-2106 NSDUH, 2016 National Vital Statistics System

CDC. US State Prescribing Rates 2016.

Number of opioid prescriptions dispensed per

100 persons between 2006–2016

Opioid Prescribing and Rogue PharmaciesThe Role of the 5th Vital Sign

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

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

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

What we don’t expectOpioids Infectious Diseases

President’s 2018 Biodefense StrategyAssess, 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

CDC Priorities

CDC is Science-based, Data-driven, Service-oriented

Responding to Outbreaks (Opioid Crisis)

Disease Elimination

Global Health Security and Domestic Preparedness

What we don’t expectGlobal Health Development

Global Health Security

2003: President George W. Bush authorizes PEPFAR

Key U.S. Target Global Health Programs

U.S. President’s Emergency Plan for AIDS Relief

2018: PEPFAR reauthorized

CDC and Our Partners Are Driving PEPFAR Results

2008: President George W. Bush authorizes PMI

Key U.S. Target Global Health Programs

President’s Malaria Initiative

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

Global Health Security Agenda Countries Supported by CDC

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 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.

Never Underestimate the Possible

July 20, 1969:

“…that’s one small step for a man, one giant leap for mankind.”

September 12, 1962:

“We choose to go to the Moon in this decade…”

We Must See the Possible and Lead the Nation to Act