Although modern advances have conquered some diseases, infectious diseases continue to threaten the Nation’s health. Outbreaks of Severe Acute Respiratory Syndrome (SARS), avian influenza, West Nile Virus, and monkeypox are recent reminders of the extraordinary ability of microbes to adapt and evolve to infect humans. Earlier predictions of the elimination of infectious diseases often did not take into account changes in demographics, migration patterns, and human behaviors, as well as the ability of microbes to adapt, evolve, and develop resistance to drugs. Infectious disease can have significant medical and economic consequences. Addressing foodborne illnesses, vectorborne pathogens, viral hepatitis, HIV/AIDS and other sexually transmitted infections, tuberculosis, antimicrobial resistance, and a possible influenza pandemic is a significant priority for HHS. Although these diseases affect all Americans, many often hit hardest the most vulnerable populations—the low-income population, minorities, children and youth, immigrants, persons who are incarcerated, and other disenfranchised populations. The selected performance indicators at the end of this chapter were chosen to reflect the impact HHS has on these populations.
HHS has identified several key strategies for addressing the threat of infectious diseases. One of the primary strategies is the use of vaccines. HHS’s vaccine enterprise includes outreach activities and funding support for childhood and adult immunization. HHS, through CDC, will protect Americans from vaccine-preventable diseases by providing health communication messages about vaccination and supporting efforts to increase immunization coverage rates for both children and at-risk adults. OPHS coordinates and ensures collaboration among the many Federal agencies involved in vaccine and immunization activities. The Assistant Secretary for Health (ASH) provides leadership and coordination among Federal agencies, as they work together to carry out the goals of the National Vaccine Plan. The National Vaccine Plan provides a framework, including goals, objectives, and strategies, for pursuing the prevention of infectious diseases through immunizations. In 2007–2008, HHS will review and revise the existing National Vaccine Plan to ensure that it addresses new scientific and safety issues that have emerged since the first plan was developed. HHS also will continue existing efforts to increase immunization rates for vaccine-preventable illness. Specifically, HHS, through CDC, will develop and disseminate health communication messages about vaccination and support efforts to increase immunization coverage rates for both children and adults.
The Vaccines for Children Program (VFC), which provides immunizations for eligible children6 at their doctors’ offices, will continue to be a cornerstone of the HHS infectious disease prevention strategy. VFC also helps children whose insurance does not cover vaccinations when they receive them at participating Federally Qualified Health Centers and Rural Health Clinics. HHS also will work to increase rates of vaccination against influenza and pneumococcal viruses through its National Influenza and Pneumococcal Vaccination Campaign. This joint initiative involves CDC, CMS, FDA, HRSA, IHS, and NIH along with State and local health departments, Medicaid agencies, tribal representatives, health care providers, and the National Coalition for Adult Immunization. It aims to provide vaccinations for influenza and pneumonia to beneficiary populations.
OPHS coordinates all HIV/AIDS-related scientific and policy matters, such as new developments and program activities within the areas of research, HIV prevention, HIV care and treatment, and budget development. OPHS also ensures the effective and accountable management of the Department’s HIV/AIDS programs.
Building on its existing surveillance, research, and screening activities, CDC applies well-integrated, multidisciplinary programs of research, surveillance, risk factor, and disease intervention to prevent and control the spread of HIV infection. For example, CDC is the source of national data on the epidemic and supports prevention programs in every State, guided by community planning. These programs reach those at highest risk for acquiring or transmitting infection with effective interventions to reduce their risk and protect their health. CDC and HRSA will support efforts to increase knowledge of community capacity to respond to HIV and increase HIV testing status, focusing especially on groups and communities at the highest risk of infection. FDA is responsible for ensuring the safety of the Nation’s blood supply by minimizing the risks of infectious disease transmission and other hazards while facilitating an adequate supply of blood and blood products.
Routine and targeted HIV testing will be key strategies for preventing new HIV infections and improving outcomes for those who test positive. Individuals infected with HIV who are aware of their infection are less likely to engage in risky behaviors and are more likely to take steps to protect their partners. Additionally, individuals infected with HIV who are aware of their infection can take advantage of the therapies that can keep them healthy and extend their lives.
Additionally, FDA will continue its work with international drug regulatory authorities to promote expedited review of generic antiretroviral drugs under the President’s Emergency Plan for AIDS Relief (PEPFAR). HHS, through its operating divisions, especially CDC and HRSA, is one of the major implementing partners for PEPFAR, and manages prevention, treatment, and care activities in the 15 focus countries of the Emergency Plan and more than 20 others. HHS also provides part of the Federal Government’s financial contribution to the Global Fund to fight AIDS, tuberculosis, and malaria, and is part of the interagency team that guides U.S. policy toward the fund.
To address zoonotic and vectorborne diseases, HHS will develop plans to respond to a disease outbreak that encompasses animal, vector, and human experts working in synergy. CDC will develop disease surveillance systems that incorporate animal, vector, and human data to provide an effective public health response that will mitigate the impact of a multispecies outbreak. CDC will develop, test, and deploy improved methods for the detection and control of insectborne viruses and bacteria and will improve the capacity to detect the intentional release of plague, Rabbit Fever (tularemia), and other agents with bioterror potential. FDA will foster the development of preventive vaccines for malaria, dengue fever, and other vector-borne and zoonotic diseases by working with industry and academia. In addition, surveillance, detection, and response systems will be developed and tested to address domestic and international epidemics of vectorborne pathogens with the potential to harm the U.S. population.
To combat foodborne illness, FDA and CDC will work together to protect public health through preventive strategies that improve surveillance, inspection, tracking, detection, investigation, control, and prevention of foodborne outbreaks and disease; strengthen the enforcement of regulations; and broaden education about these problems. HHS will improve the important national collaborative surveillance and response networks of the FoodNet, PulseNet, and OutbreakNet to make them faster, more responsive, and capable of more detailed investigations. FDA and CDC, along with the U.S. Department of Agriculture, and other organizations, will continue to participate in the Council to Improve Foodborne Outbreak Response, a group created to develop tools that facilitate the investigation and control of foodborne disease outbreaks. Over the next several years, the Council will develop multistate outbreak guidelines, a repository for resources and tools, and performance indicators for the response to enteric disease.
To address waterborne diseases, CDC will continue to partner with EPA to fill critical data gaps by providing improved disease surveillance data, creating evidence-based guidelines and training for investigations, expanding access to water-related information, collecting data to define the magnitude and burden of waterborne illness, evaluating water-related interventions to improve public health, and developing laboratory sampling and detection methodologies. As part of its preparedness effort, CDC will also develop, improve, and deploy rapid sampling and detection methods for potential waterborne threats. Providing comprehensive public health protection to all community users of water will create a more effective Federal response aimed at reducing the burden of waterborne disease in the United States.
One key strategy for preventing the spread of infectious disease is preventing it from reaching the United States. HHS will collaborate with the World Health Organization (WHO) and other international partners to provide epidemiologic and laboratory support to assist countries in addressing disease threats through improved disease detection. HHS also will provide programmatic expertise, training, and funding support to assist with surveillance, control, elimination, and eradication activities for diseases such as measles, polio, avian influenza, and HIV/AIDS, as well as the provision of technical assistance with safe and healthy water and improved sanitation.
Immunization has revolutionized child health in countries throughout the world. WHO estimates that almost 40 percent of child deaths for children younger than 5 years of age are potentially preventable by vaccines.xxi HHS has been a major supporter of global initiatives to eradicate polio; control measles; and introduce new vaccines for pneumoccocal diseases, rotavirus, and possibly in the near future, malaria and even HIV. HHS remains committed to achieving global polio eradication and meeting the global target to achieve a 90 percent reduction in measles mortality by 2010 as compared to 2000. Efforts to combat vaccine- preventable diseases overseas not only assist global efforts at lowering child mortality, but also help to protect U.S. children from susceptibility to these debilitating diseases.
One specific set of activities that HHS will continue in support of its global health strategy is in the area of malaria prevention. CDC supports prevention and control of malaria throughout the world in partnership with local, State, and Federal agencies in the United States; medical and public health professionals; national and international organizations; and foreign governments. Specific strategies include conducting malaria surveillance, prevention, and control activities in the United States; providing consultation, technical assistance, and training to malaria-endemic countries to change and implement proven policies to decrease malaria burden; conducting multidisciplinary research in the laboratory and in the field, to develop new tools and improve existing interventions against malaria worldwide; and translating research findings into appropriate global policies and effective practices through the Roll Back Malaria Partnership and other international partners.
HHS will continue to work with other Federal partners to control malaria through participation in the President’s Malaria Initiative (PMI), an intergovernmental initiative led by the United States Agency for International Development (USAID), CDC, NIH, the U.S. Departments of State and Defense, and the National Security Council. The goal of PMI is to reduce malaria deaths by half in each target country after 3 years of full implementation. The initiative helps national governments deliver proven, effective interventions—insecticide-treated bed nets, indoor residual spraying, prompt and effective treatment with artemisinin-based combination therapies, and intermittent preventive treatment to people at greatest risk, pregnant women and children younger than 5 years old. As of June 2007, work is ongoing in the first three PMI countries (Angola, Tanzania, and Uganda) as well as the four added in 2006 (Malawi, Mozambique, Rwanda, and Senegal). Later in 2007, activities will begin in the final eight countries (Benin, Ethiopia, Ghana, Kenya, Liberia, Madagascar, Mali, and Zambia), which will bring the program to its full complement of 15 countries with a high burden of malaria in Africa.
Additional information about HHS’s efforts in global health can be found later in this chapter in In the Spotlight: Global Health Initiatives.