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Sunday, February 5th, 2023

New model needed for public health response, former CDC director says

Julie Gerberding

The nation’s biodefense response to emerging diseases and outbreaks is on an endless loop that, without a proper foundation, is not allowing for progressive countermeasure operations, according to Merck Pharmaceuticals Executive Director Julie Gerberding, former director of the Centers for Disease Control and Prevention.

Gerberding recently led a presentation titled, “Combating Microbial Terrorists: How to End Our Preparedness Stalemate,” which was co-sponsored in part by the University of Minnesota’s Center for Infectious Disease Research and Prevention (CIDRAP).

Gerberding referenced a media search she conducted of crises in the country and the world, pulling topics like geopolitical concerns, financial struggles, technological developments and natural disasters. She then noted what was missing on the forefront of the media stage.

“From a Google [search] perspective we’re dealing with a number of local, regional and global crises simultaneously all in the news in just a few short days of time,” Gerberding said. “But I had to get to page 15 of the Google search response before I got an infectious disease outbreak listed as a crisis in the world.”

Through this, she argued that while high-profile disease outbreaks provokes increased media reaction, that short-term reaction, and non-reaction to “smaller” infectious diseases issues, fails to create a proper system that will actually achieve global health security.

“We must do more to focus on these threats, because, if anything, we are going to see more and more of them and the scale of their impact is going to get larger and larger,” Gerberding said. “We need to be prepared for the opportunity of devastating outbreaks.”

Indicators of increased global impact, she said, are macro trends occurring throughout the world; one of the most important being urbanization of global communities and the incursion of human populations into environments that had not previously been inhabited.

“Things circulating in a zoonotic, or even a plant world, environment were not coming in contact with people and were not becoming vulnerable to spread in rapid movement from one location to another,” Gerberding said.

Other macro trends are the acceleration of global travel and translocation, which continues the spread of incurred diseases and climate change, which exposes people and animals to reemerged as well as emerging illnesses and geological alterations in the ecosystem.

These macro trends, on top of the scientific challenges prevented by the pandemics and infectious diseases themselves, aided in a telescope response from the government that focused too much on individual issues and not the larger-scale picture, Gerberding said.

“After the anthrax outbreak in 2001, we [at the CDC] still had a lot to learn how to manage such a complex and international outbreak situation,” she said. “We initiated a whole set of after-action reviews, where we met with the FBI Disease Investigation Team, state health officers, hospital officials, all kinds of law enforcement agencies and really anyone who had anything to do with this to try and learn what we did right, what we didn’t do right, what we could do better.”

In those reviews, the after-action response team developed a list of key challenges that were met in the anthrax outbreak, which Gerberding also said are met each time an infectious disease situation occurs and/or is overlooked. The key challenges were coordination, collaboration, competency, capacity, communication, and countermeasures.

Gerberding said that not only are there tests within each listed point, but there are even bigger obstacles when one is missing all together.

“Health and Human Services and its agencies were not funded to sustain a prolonged public health emergency, overseas or at home,” she said. “We know the threats exist and we know that they are not going to go away. We know that we need to do something, but for this reason we’re just not getting it done. It is a cycle that repeats and not in a progressive way.”

Gerberding points out, however, that this is not how it has to happen. Science, government leadership and social mobilization have to work together, she said, to achieve the necessary plans of action and global health security measures, and create a case for health system reform.

Referencing “Deadliest Enemy: Our War Against Killer Germs” — a book written by Michael Osterholm, director for the Center for Infectious Disease and Policy at the University of Minnesota, and Mark Olshaker – Gerberding discussed an example of a recommended crisis agenda that would comprehensively cover aspects of long-term crisis management. Included in the agenda were tasks, such as development of a “Manhattan Project” for the flu vaccine, establishment of an international organization to address antimicrobial resistance, launch of the Global Alliance for Control of Aedes-transmitted diseases, anticipation of climate-change effects, and adoption of a one-health approach to human and animal disease.

“These are things that can be done to improve our preparedness,” Gerberding said. “These are the points that can address what we actually need to get done. And there’s not a lot of disagreement about what we need to do, but the question still remains: why aren’t we doing it?”

Gerberding said that complacency, competing priorities — such as geopolitical concerns, financial struggles and natural disasters — and confusion about risk are the biggest problems that cause a hindrance to successful engagement.

The only ways to make significant progress in the fields of outbreak and public health responses is to create an agenda, find ways to garner resources ahead of an emergency situation, motivating action by the government and researchers, and creating open, public-private discourse about the real threat of infectious diseases and pandemics. The conversation needs to include discussions with private sector developers and businesses, some of which create skepticism in the motives behind their influence and contributions. That, Gerberding said, needs to be moved beyond.

“In my career, I’ve kind of come full circle,” Gerberding said. “Having been an academician and a government worker and now being in the private sector, I’ve come to understand the power that businesses have in leveraging action. Whether it’s local action in a community or global action in something like taking on the agenda of the United Nations, business contributions to creating sustainable development goals are invaluable assets to successful implementation. We need the people who move economies and influence economic capital allocation in order to align what needs to get done sufficiently.”