Diseases do not respect borders: A conversation with the CDC’s Dr. Rebecca Martin on the economic case for preventing disease outbreaks

30 April 2018
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Dr. Rebecca Martin is a fixture in the global health community. As director of the CDC’s Center for Global Health, Dr. Martin’s leadership has been a driving force in engaging the public and private sectors to accelerate progress towards disease prevention, detection and response around the world. Dr. Martin and her colleagues at the CDC are also important partners to the Global Health Security Agenda (GHSA) Private Sector Roundtable (PSRT), a coalition of companies that acts as a central touchpoint for industry to mobilize efforts to protect against, detect and respond to disease threats.

PSRT members generate private sector insights to address specific health and development risks and vulnerabilities, identify opportunities to apply the unique expertise and resources of its members, and facilitate industry engagement to strengthen health systems and outbreak preparedness. The CDC provides technical support to the PSRT to ensure alignment with country priorities.

“Pathogens exploit gaps in the world’s ability to prevent, detect, and respond to existing or emerging diseases, and in today’s interconnected world, diseases can spread from a remote village to major cities in as little as 36 hours. We must all work together to close those gaps to protect the health and safety of Americans and U.S. interest.” — Dr. Rebecca Martin, Director of the Center for Global Health at the U.S. Centers for Disease Control and Prevention

Tina Flores, who leads the PSRT’s secretariat at Rabin Martin, talks with Dr. Martin about some of CDC’s recent research on the effects of pandemic outbreak on the U.S. economy and the organization’s relationship with industry, and gets Dr. Martin’s take on why an ounce of prevention is indeed worth a pound of cure.

Tina Flores: The CDC recently published a series of studies that explore the economic impact of pandemic outbreaks on the U.S. What was the impetus for the studies and why was the focus on impact to the private sector, specifically? 

Dr. Rebecca Martin: We have to start by acknowledging a reality of our world today, that disease knows no borders. Pathogens exploit gaps in the world’s ability to prevent, detect, and respond to existing or emerging diseases, and in today’s interconnected world, diseases can spread from a remote village to major cities in as little as 36 hours.

These studies help make a clear business case for investing in public health capacity building around the world.

The first economic impact study, for example, Relevance of Global Health Security to the U.S. Export Economy, depicts the extent to which the U.S. economy is affected by infectious disease outbreaks in other countries.

• Using 2015 U.S. Department of Commerce data, CDC assessed the value of U.S. exports and the number of U.S. jobs supported by those exports to a set of countries where CDC supports health security activities.

• U.S. exports to the countries where CDC is partnering to strengthen and improve health security exceeded $308 billion and supported more than 1.6 million jobs across all U.S. states in agriculture, manufacturing, mining, oil and gas, services and other sectors.

• These exports represented 13.7% of all U.S. export revenue worldwide and 14.3% of all U.S. jobs supported by all U.S. exports.

The economic linkages between the United States and these global health security countries illustrate the importance of ensuring that countries have the public health capacities needed to control outbreaks at their source before they become pandemics. We must all work together to close these gaps to protect the health and safety of Americans and U.S. interests.

Tina: How can these studies help policymakers, at home and abroad, make decisions about resource allocation and further the discussion of how health, finance, trade, and agriculture can work together to prevent and minimize threat of outbreaks?

Dr. Martin: These studies demonstrate and quantify that even in a country where a disease outbreak does not spread to U.S. shores, it can trigger direct and measurable economic fallout in communities in the United States. Global health security is important for us all, and we are only as strong as our weakest link.

For example, the CDC study, Impact of a Hypothetical Infectious Disease Outbreak on U.S. Exports and Export-Based Jobs, predicted that the hypothetical outbreak would carry a cost inside the United States of between almost $13 million to $64 million if only one country was affected, and that it would quickly escalate as the epidemic spread to more counties, peaking at about $8 billion to $41 billion, if the outbreak were to spread to nine countries.

These results demonstrate that there is value in investing in systems to strengthen the tools and policies in countries for detecting disease at the earliest possible moment, and for responding decisively when an outbreak occurs—value for the country facing the disease threat, and for preventing potential disruptions to markets and associated economic and job losses in the U.S.

The U.S. government strongly supports the Global Health Security Agenda (GHSA) as a mechanism to focus the world on the capacities to prevent, detect, and respond to human and animal infectious disease threats, whether they are natural, accidental, or deliberate.  U.S. government support of the GHSA is truly a whole-of-government effort and is a model for program coordination of health security activities. For example:

• CDC remains committed to supporting the U.S. Government’s July 2015 pledge of $1 billion to support GHSA capacity building in 17 partner countries over five years.

• In addition to the $1 billion investment in 17 countries, the U.S. continues to partner with 14 additional countries and the Caribbean Community to make progress toward GHSA targets.

• As highlighted in the U.S. government’s GHSA Annual Report, published in March 2018, we have shown measurable progress from our investments in global health security, including demonstrated improvements in partner country capacity to detect and respond to health threats faster and more effectively.

Tina: What are the implications for industry – for health care companies as well as other sectors?

Dr. Martin: In our increasingly interconnected world, outbreaks can destabilize countries, disrupt economic forces, and affect businesses no matter where they are located.

We know that successful businesses need healthy, productive employees and the presence of disease threats can diminish that essential need. We also know that a disease outbreak—and in some cases even the threat of a disease outbreak—distorts the economy in powerful ways that can touch both global and domestic businesses.

During the Ebola outbreak, for example, imports to the three affected countries—Liberia, Guinea and Sierra Leone—plummeted.  The number of commercial airline flights to the region decreased, providing further disruption to travel and trade. All three countries had rapidly growing economies before the Ebola outbreak, and even into the first half of 2014. By the end of 2014, the World Bank reports that the total fiscal impact felt by the three countries was over half a billion dollars, nearly 5 percent of their combined GDP.

Tina: For many people, global health security is quite amorphous. But disease detection, infection prevention and control, vaccines and supply chains are such a critical part of the global health security equation. What are some of the ways the CDC collaborates or can collaborate with companies and organizations that do this work?

Dr. Martin: No single country, sector or organization can achieve global health security alone. Multi-sectoral collaboration and public-private partnerships are critical to ensure the world will be ready to prevent, detect and respond to the next inevitable infectious disease outbreak. Businesses and NGOs have a stake in the success of these endeavor―their investments, workforce, and mission are affected positively or negatively by the capacity of a country’s public health system.

For more than 70 years, CDC has worked in partnership around the world to protect the health, safety, and security of the American people, to protect U.S. interests and save lives. We have seen examples of synergies in expertise, knowledge, and technologies―most recently partnering in the Global Health Security Agenda―and for many years in HIV, malaria and immunization.

For example, in the area of vaccines, CDC is working with Gavi, The Vaccine Alliance and public and private sector partners on vaccine delivery technologies. These innovations are addressing some of the major hurdles to vaccine delivery, so that we can eliminate barriers and reach at-risk populations faster and more efficiently than we do today.

Tina: How can investments in global health security strengthen health systems, and especially the health workforce?

Source: CDC

Dr. Martin: More than anything else, stopping disease outbreaks early and decisively takes capable, well-trained frontline personnel that can spot, identify and respond to threats correctly. These facts underlie much of CDC’s work abroad, helping train “disease detectives” in countries, and improving the knowledge and capabilities of laboratory technicians, as well as an array of other health care officials ranging from policy makers to those involved in immunization campaigns and other disciplines.

We have to protect our frontline workers, as they are at increased risk and play a vital role in detecting and rapidly responding to disease. For example:

• During the Ebola 2014 outbreak, ExxonMobil partnered with CDC Foundation to support improvement to healthcare worker safety and infection prevention and control (IPC) at Nigerian healthcare facilities through the Field and Epidemiology Training Program (FETP).

• In December 2016, CDC provided technical assistance to Nigeria’s African Field Epidemiology Network as a pilot with 34 Field

Epidemiology Training Program (FETP) residents. Shortly thereafter, a health worker at a hospital in southwestern Nigeria died after being admitted with Lassa Fever. Six of the residents who participated in the training investigated this outbreak, helping to prevent the spread of Lassa Fever to any further health workers at the medical center.

• In 2017, through FETP, CDC trained nearly 2,000 “boots on the ground” disease detectives in partner countries around the world. These disease detectives were among the first on the scene to identify and contain outbreaks of international concern like yellow fever, Ebola, and Marburg virus. FETP graduates form the backbone of the public health effort in many countries, with a high percentage also moving into leadership positions in their respective ministries of health and related organizations. Since 1980, FETPs have trained more than 10,000 disease detectives in more than 70 countries.

Tina: Let’s talk regionally. The recent CDC study exploring the impact of a hypothetical outbreak on the U.S. economy focused on Southeast Asia. What was the thinking around focusing on this region?

Dr. Martin: There are two reasons that Southeast Asia is a fitting region for illustrating the potential economic impact on the U.S. economy:

• Risk – CDC tracks many disease outbreaks that start in Southeast Asia, from SARS to avian influenza. One reason is that animals and humans live in close proximity to one another and a virus that infects wildlife or farm animals can more easily spread to humans.

• Trade ties – Southeast Asia is an important economic partner for the U.S. A large-scale infectious disease outbreak in the region presents one of the biggest risks of significantly disrupting the U.S. export economy.

Tina: Africa is a big focus of global health security. In terms of public-private engagement, how does the post-Ebola landscape different from the pre-Ebola environment? Do you see more openness to industry collaboration?

Dr. Martin: CDC has always worked strategically with industries from many sectors. It is clear that the private sector, and especially businesses, can offer a great deal during an emergency response.  For example, The Paul G. Allen Ebola Program, the William and Flora Hewlett Foundation, and Mark Zuckerberg and Dr. Priscilla Chan (through their donor-advised fund at Silicon Valley Community Foundation) provided financial support to help build, furnish, and supply temporary and permanent emergency operations centers in Guinea, Liberia, and Sierra Leone during the Ebola epidemic in West Africa.

All of the emergency structures stood up during the Ebola response, contributed significantly to the control of this epidemic and have been activated for subsequent responses such as measles, vaccine-derived poliovirus, and the recent meningococcal disease outbreak in Liberia.

There is no doubt that in the aftermath of Ebola, the desire to find additional ways to work with industry to advance mutual goals and priorities has expanded. Private sector partners have been some of the most important champions for global health security—and it is a win-win partnership, with countries and companies both benefiting. Private sector expertise, innovation and capabilities are critical in logistics and supply chain, diagnostics, drugs and vaccines, health, technology, data management and financial services. In addition, companies often have great connections with local communities and their respective workforces, which can play an important role in moving public health goals forward through community engagement.

Finally, it is important to emphasize that partnership opportunities need not be limited to financial support or public health emergencies. Our work with partners―both government and private―have repeatedly demonstrated this point and the mutual benefits, such as in our work related to HIV, malaria, vaccine preventable diseases and global health security.

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