New Initiatives Step Up Global Outbreak Preparedness: Public Health Watch Report

Everyone knows the scout motto: “Be prepared.”

What fewer people may realize, though, is that the same credo applies to public health professionals.

After the Centers for Disease Control and Prevention (CDC) was caught out a bit following the identification of 3 domestic cases of Ebola virus—resulting from travel to the affected region of West Africa—in 2014, far more attention has been paid to preparation for both “naturally occurring” infectious outbreaks and diseases brought on by, well, “other means” (we’ll explain) on the part of state and local health departments, particularly those overseeing heavily populated areas. Indeed, as Contagion^® reported recently, it seems the New York City Department of Health and Mental Hygiene has taken its “best-laid plans” approach a step further, using a series of “mystery patient drills” in the emergency departments (EDs) of city-run hospitals through late 2015 and early 2016.

The performance of the EDs in these drills was chronicled in the September 15, 2017 issue of the CDC’s Morbidity and Mortality Weekly Report (MMWR). However, as quick as some media outlets were to report failings in the public health system within the context of the Ebola “scare”—an infectious disease specialist described it to us as “the outbreak that never happened,” at least in the United States—few if any have highlighted the solid performance of the 49 public hospitals in the MMWR analysis.

Perhaps the fact that the facilities passed 78% of the 95 drills in which they participated isn’t considered “click bait.”

On the other hand, the lack of media attention paid to such preparedness drills may be a good thing. As an expert in the field of “health security” told us recently, public health officials run the risk of being the proverbial “boy who cried wolf” if they highlight too many potential risks and constantly have their local communities on high alert for outbreaks and other forms of public health emergencies—namely, bioterrorism (as we alluded to above).

“It’s a problem if you have the public continually stirred up that there are all sorts of diseases and chemicals that could spread across the country,” the expert, who spoke to us on the condition of anonymity, notes. “Having said that, there are legitimate concerns, and our infrastructure needs to be prepared in the event an outbreak does occur.”

In fact, according to our expert, since the September 11, 2001 terrorist attacks, the United States has made significant improvements to its healthcare and communications infrastructure in order to manage a potential act of bioterrorism as well as a large-scale disease outbreak. “An important consideration with… any outbreak is getting information on cases—who is getting sick and where the disease is coming from—and communicating it to the relevant people across the country,” our expert explains. “We have the capacity to do better, but there is a network in place for rapid response. The change that has taken place since 2001 has been remarkable.”

And, of course, as illustrated by the recent MMWR analysis, most large US hospitals and health departments in major cities across the country regularly conduct drills for emergencies involving mass casualties, including disease outbreaks and acts of bioterrorism. Now, it seems, the officials who spearheaded many of these changes domestically are seeking to import them overseas, to places where they are needed most.

According to September 13, 2017, report in the Chicago Tribune, it seems that former CDC director Tom Frieden, MD, MPH, is hoping to assist “low- and middle-income countries [in the] fight infectious disease epidemics by strengthening laboratory networks so emerging threats are identified promptly, and training disease detectives to track and investigate disease outbreaks, including those that circulate in animals and jump to humans.” The efforts are part of a $225 million funding initiative he is overseeing called Resolve, which will partner with the World Health Organization, the Bloomberg School of Public Health at the Johns Hopkins University, the CDC, and the World Bank, among other organizations.

“The fact is, most countries are still not prepared and there is limited progress in closing the gaps that have been identified,” Dr. Frieden, who led the CDC through the 2009 global H1N1 swine flu pandemic, MERS, Ebola, and Zika, tells the Tribune. “The world now needs to step up and accelerate these countries to close those gaps.”

No mystery there.

Brian P. Dunleavy is a medical writer and editor based in New York. His work has appeared in numerous healthcare-related publications. He is the former editor of Infectious Disease Special Edition.