November 17, 2018
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CDC to cut global disease outbreak prevention by 80 percent

David Goldman | AP
David Goldman | AP
This Nov. 19, 2013 file photo shows a Centers for Disease Control and Prevention logo at the agency's federal headquarters in Atlanta. The CDC has announced it will cut its global disease prevention outbreak program by 80 percent.

Four years after the United States pledged to help the world fight infectious disease epidemics like Ebola, the Centers for Disease Control and Prevention is dramatically downsizing its epidemic prevention activities in 39 out of 49 countries because money is running out, U.S. government officials said.

The CDC programs, part of an initiative known as global health security, train front-line workers in outbreak detection and strengthen laboratory and emergency response systems in countries where disease risks are greatest. The goal is to stop future outbreaks at their source.

Most of the funding comes from a one-time, five-year emergency package that Congress approved to respond to the 2014 Ebola epidemic in West Africa. About $600 million was awarded to CDC to help countries prevent infectious disease threats from becoming epidemics. That money is slated to run out by September 2019. Despite statements from President Donald Trump and senior administration officials affirming the importance of controlling outbreaks, the administration has not budgeted additional resources, according to global infectious disease experts.

Two weeks ago, the CDC began notifying staff and officials abroad about its plan to downsize these activities because officials assume there will be “no new resources,” said a senior government official speaking on the condition of anonymity to discuss budget matters. Notice is being given now to CDC country directors “as the very first phase of a transition,” the official said. There is a need for “forward planning,” the official said, to accommodate longer advance notice for staff and leases and property agreements. The downsizing decision was first reported by the Wall Street Journal.

The CDC plans to narrow its focus to 10 “priority countries,” starting in October 2019, the official said. They are: India, Thailand and Vietnam in Asia; Jordan in the Middle East; and Kenya, Uganda, Liberia, Nigeria and Senegal in Africa; and Guatemala in Central America.

Countries where CDC is planning to scale back include some of the world’s hot spots for emerging infectious disease, such as China, Pakistan, Haiti, Rwanda, and the Democratic Republic of Congo. Last year, when Congo experienced a potentially deadly Ebola outbreak in a remote, forested area, CDC-trained disease detectives and rapid responders helped contain it quickly.

In Congo’s capital of Kinshasa, an emergency operations center established last year with CDC funding is operational but still needs staff to be trained and protocols and systems to be put in place so data can be collected accurately from across the country, said Carolyn Reynolds, a vice president at PATH, a global health technology nonprofit that helped the Congolese set up the center.

This next phase of work may be at risk if CDC cuts back its support, she said. “It would be akin to building the firehouse without providing the trained firemen and information and tools to fight the fire,” said Reynolds, in an email.

If more funding becomes available in the fiscal year that starts Oct. 1, CDC could resume work in China and Congo as well as Ethiopia, Indonesia and Sierra Leone, another government official said, also speaking on the condition of anonymity to discuss budget matters.

In the meantime, the CDC will continue its work with dozens of countries on other public health issues, such as HIV, tuberculosis, malaria, polio eradication, vaccine-preventable diseases, influenza and emerging infectious diseases.

Global health organizations said critical momentum will be lost if epidemic prevention funding is reduced, leaving the world unprepared for the next outbreak. The risks of deadly and costly pandemic threats are higher than ever, especially in low- and middle-income countries with the weakest public health systems, experts say. A rapid response by a country can mean the difference between an isolated outbreak and a global catastrophe. In less than 36 hours, infectious disease and pathogens can travel from a remote village to major cities on any continent to become a global crisis.

On Monday, a coalition of global health organizations representing more than 200 organizations and companies sent a letter to Health and Human Services Secretary Alex Azar asking the administration to reconsider the planned reductions to programs they described as essential to health and national security.

“Not only will CDC be forced to narrow its countries of operations, but the U.S. also stands to lose vital information about epidemic threats garnered on the ground through trusted relationships, real-time surveillance, and research,” wrote the coalition, which included the Global Health Security Agenda Consortium and the Global Health Council.

The coalition also warned that complacency after outbreaks have been contained leads to funding cuts, followed by ever more costly outbreaks. The Ebola outbreak cost U.S. taxpayers $5.4 billion in emergency supplemental funding, forced several U.S. cities to spend millions in containment, disrupted global business, and required the deployment of the U.S. military to address the threat.

“This is the front line against terrible organisms,” said Tom Frieden, the former CDC director who led the agency during the Ebola and Zika outbreaks. He now heads Resolve to Save Lives, a global initiative to prevent epidemics. Referring to dangerous pathogens, he said: “Like terrorism, you can’t fight it just within our borders. You’ve got to fight epidemic diseases where they emerge.”

Without additional help, low-income countries aren’t going to be able to maintain laboratory networks to detect dangerous pathogens. “Either we help or hope we get lucky it isn’t an epidemic that travelers will catch or spread to our country,” Frieden said.

The U.S. downsizing could also lead other countries to cut back or drop out from “the most serious multinational effort in many years to stop epidemics at their sources overseas,” said Tom Inglesby, director of the Center for Health Security of the Johns Hopkins Bloomberg School of Public Health.

CDC spokeswoman Kathy Harben said the agency and federal partners remain committed to “prevent, detect and respond to infectious disease threats.”

The United States helped launch an initiative known as the Global Health Security Agenda in 2014 to help countries reduce their vulnerabilities to public health threats. More than 60 countries now participate in that effort. At a meeting in Uganda in the fall, administration officials led by Tim Ziemer, the White House senior director for global health security, affirmed U.S. support to extend the initiative to 2024.

“The world remains underprepared to prevent, detect and respond to infectious disease outbreaks, whether naturally occurring, accidental, or deliberately released,” Ziemer wrote in a blog post before the meeting. “We recognize that the cost of failing to control outbreaks and losing lives is far greater than the cost of prevention.”

The CDC has about $150 million remaining from the one-time Ebola emergency package for these global health security programs, the senior government official said. That money will be used this year and in fiscal year 2019, but without substantial new resources, that leaves only the agency’s core annual budget, which has remained flat at about $50 million to $60 million.

Officials at the CDC, HHS and National Security Council pushed for more funding in the president’s fiscal 2019 to be released in February. But the White House budget office rejected the request, according to one global infectious disease expert. Experts say they are hoping the administration will reconsider, and that Congress will ultimately provide funding for better disease preparedness.

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