WASHINGTON, DC — Recently named director of the US Centers for Disease Control and Prevention (CDC) Robert Redfield told a gathering of global health experts this week that the most critical investment that can be made is in global health security, with the recent fast response to the Ebola outbreak in the Democratic Republic of the Congo setting the example.  

Redfield addressed a reception at international health organisation PATH on 11 June.

Steve Davis, president and CEO of PATH, opened by talking about how much is going on. “And it’s both the good and the bad, right?” For instance, he pointed to the recent Ebola outbreaks, and said, “we are watching the world have to step up again and again.” And yet, he said, “the innovation that continues to be in the pipeline … is across the board some of the most exciting stuff.”

He mentioned just as an example blockchain and health systems and said it “bodes well for the future.”

In a question and answer format, Redfield said what has surprised him most in his first three months at the CDC is how much he has missed working with people committed to public service, while he has been in academia.

He has been impressed by the labs, the people and the data-driven approach at CDC, but he said he was to put more emphasis on getting in the next generation of young people working as civil servants.

On his global health vision, he said Health and Human Services (HHS) Secretary Alex Azar was at CDC a few days ago and talked about the importance of the global health security agenda. The US and the world need to be better prepared for pandemic influenza, he said. “Pandemic is the global health threat,” he said.

The other biggest threat is antimicrobial resistance (AMR), said Redfield, stressing that the world needs to “keep its eye on the ball” especially on pandemics and AMR.

With global health security “first and foremost on the agenda,” there is also “space to improve” on seasonal flu, and there, vaccination has “enormous impact.” The efficacy of this year’s vaccine may be only about 37 percent efficacious, but of the 172 children who died this flu season, 80 percent were not vaccinated, he said. But more research can be done on how people might need slightly different vaccines depending on their bodies and history.

Asked how to get more support for global health security, he said the CDC needs long-term, sustainable, “proportional” funding for this.

He pointed to Ebola as a good example of what can happen, and what the consequences of investing or not investing are. With the recent outbreak in the Democratic Republic of Congo (DRC), the local health authorities recognised it was Ebola, and even figured out it was the Zairean strain, which put a vaccine produced by Merck Sharp and Dohme into play. Different groups were on the ground, such as the World Health Organization and CDC (and PATH).

Unlike the last outbreak in that region, this time, the response has been quick and effective, because of 16 years of investment. Now the world needs to replicate that investment, to build the local capacity to detect, understand the epidemiology, have the lab capacity to identify it correctly, have a workforce to respond, understand emergency operations, and they control the outbreak. The experience of the last Ebola outbreak led to long-term investing that now is paying off, he said.

Davis said the DRC was an example of difficult case given its circumstances, and that PATH seconded a health adviser to the DRC health ministry.

Another question Davis asked was whether there is “over-architecting” for diseases that might occur at the expense of those that already are taking many lives, such as malaria and tuberculosis, taking our eye off the ball for diseases that are killing hundreds of thousands of children every year.

Redfield agreed, and reflected on his experience early in his career as a doctor working on HIV/AIDS, and how he became friends with many of his patients who were lost as he cared for them after several years. Now, “we’re seeing the power of science,” he said, and today a person with AIDS can live close to a natural lifetime.

The AIDS epidemic can be ended, he said, adding, “We have the tools, let’s get it done.”

He gave some perspective when he said that one of the prices paid for the 9/11 attack was that a lot of biomedical research talent got “sidetracked” into bio-defense issues like plague, developing innovations they hoped would never be used.

He pointed to the positive aspect of developing innovations to be used. “I was so happy I wasn’t a nuclear physicist,” he said of his younger years, “working on something I hope to god is never used.”

So, he said, we do need to focus on what’s killing people now. What is killing more children than anything else, he asked, pneumococcus – “and we have a vaccine.” Maybe we need to figure out an innovation for getting it to them, he said.

“Vaccination is the most important tool that we have to confront infectious disease,” said Redfield, and the most critical tool if one talks about eradication.

And he noted that infrastructure for one purpose can be “dual” infrastructure used for another purpose.

On innovation, Redfield said it does not help to have innovations that do not go to scale, but that sometimes it is not a question of innovation but of finding the right technology for the circumstances, sometimes it’s an old technology. For instance, early in the AIDS epidemic, while caregivers were waiting scanning machines and local expertise to meet national guidelines in countries for identifying T-cells for AIDS that would take months, he figured out that basic microscopes could be used to identify the T-cells for AIDS, so lives could begin to be saved right away.

But for innovation, if could choose, he would put the most focus on vaccines, since they have the ability to save millions of lives.

To another point, he mentioned polio and said it is “still a heavy lift,” but it has to get done. There have just been three more cases bringing the total up to 11. First there has to be no more cases for 3 years, and then all active viruses need to get out of the environment, which he guessed would take another 10 years of using an active vaccine, so it would likely be some 13 years overall to finally be able to take polio vaccines off the world market and saying ‘we have a polio-free world’.

Image Credits: William New.