World's CDCs Strengthening Global Defense to H1N1 Virus

Unlike previous outbreaks - such as SARS, mad cow disease and the flu pandemic of 1918 that took millions of lives - new and more robust national public health institutes have helped their own countries and countries around the world deal with the swine flu crisis with unprecedented global coordination and efficiency. 

The U.S. version of a national public health institute is the Centers for Disease Control and Prevention (CDC) in Atlanta and similarly there is the Health Protection Agency in the UK, the National Institute for Public Health and the Environment (RIVM) in the Netherlands, the China CDC and the National Institute of Communicable Diseases in South Africa. 

National public health institutes (NPHIs) are the first line of defense in diagnosing outbreaks, such as swine flu, and containing them. Strengthening public health systems and their functions is essential to global health. 

For the past few years, many of these institutes have been linked through the International Association of National Public Health Institutes (IANPHI), which was created in 2005 through support from the Gates Foundation. IANPHI’s international network is strengthening national scientific public health capacity, especially in low-resource countries, which often do not have the resources in place to effectively identify, monitor, evaluate and contain outbreaks. 

“The ability to share expertise, experience and current assessments among scientific institutes around the world is critical to saving lives,” says Jeffrey P. Koplan, MD, MPH, president of IANPHI, former director of the U.S. CDC, and director of Emory University’s Global Health Institute. “Many of IANPHI’s 63 member institutes are playing a prominent role in responding to the swine flu outbreak and working collaboratively with their sister institutes.” 

In countries where H1N1 has arrived or is threatening, these institutes have played a crucial role in identifying and combating this new influenza, and communicating health risks. Some examples of their active involvement in coping with H1N1 flu are: 

• In Mexico, the National Institute of Public Health is conducting real time analysis of the epidemic to predict the behavior of the outbreak, investigating the possible protective effect of the seasonal influenza vaccine given during the winter, and monitoring possible virus mutations leading to resistance to anti-viral drugs.
• Bangladesh’s Institute of Epidemiology, Disease Control and Research now has the capability to diagnose the virus and is prepared for its April-September influenza season. It has stockpiled drugs and masks, isolation units are being readied at 29 district hospitals, and immigration officials at Zia International Airport are being trained on the H1N1 influenza.
• South Africa’s National Institute of Communicable Diseases (NICD) hosts the country’s WHO National Influenza Laboratory and carries the national responsibility for surveillance and laboratory testing of suspected cases of novel influenza A through its fully equipped BSL-2 and 3 laboratories. It also provides laboratory support, guidance, and consultation to several countries in the southern African region.
• The Public Health Agency of Canada has identified more than 100 cases, and has uploaded to GenBank the full gene sequences of three source viruses from Ontario and Nova Scotia in Canada, and from Mexico.
• US CDC developed diagnostic reagents to the novel A (H1N1) within a week of first detection of the virus, and has now packaged and shipped reagents for testing to 237 labs in 107 countries, many to laboratories in their national public health institutes. CDC has deployed more than 100 staff to multiple areas of the United States heavily affected by H1N1 and to neighboring countries to carry out epidemiologic investigations.

IANPHI's Jeffrey Koplan says most directors of NPHIs are making progress against the virus. 

Barry Schoub, the executive director of South Africa’s NICD, says,  “the NICD, as a member of IANPHI, has received invaluable training and shared expertise through the public health institutional network established by IANPHI. IANPHI has played a major role in bringing together countries on the continent to enhance their preparedness for infectious diseases emergencies such as the present crisis.” 

Paulo Buss, director of Brazil’s FIOCRUZ Center for Global Health, says, “IANPHI has contributed meaningfully to strengthening the public health systems needed to identify, investigate and control disease spread around the world. In partnership with IANPHI, FIOCRUZ has been able to share our technical expertise with partner NPHIs in Mozambique, Guinea Bissau and Latin America. This unique South-to-South collaboration has laid the groundwork for putting in place effective and sustainable disease surveillance and response systems in the areas most in need of them.” 

“We are better prepared,“ adds Mohammed Hassar, director of the Institute Pasteur du Maroc (Morocco). “Since the start of IANPHI, links and cooperation have been established. We are no longer alone and isolated in our institutes. IANPHI has become a label for credible results and trust in local institutions as well as a code of ethical behavior. It has given a new stimulus to global health prevention and surveillance to our benefit because more threats are ahead of us. The risks are global, and so must be the answers.”