Telebriefing on launch of global health security agenda

OPERATOR: Welcome, and thank you for standing by. I'd like to inform all parties your lines have been placed in a listen only mode until the question and answer session of today's conference. At that time, if you would liking to ask a question, please press star 1 on your telephone keypad, and be sure your phone is unmuted and record your name and affiliation at the prompt. This call is also being recorded. If you have any objections, you may disconnect at this time. I would now like to turn the meeting over to Mr.Tom Skinner. Sir, you may begin.

TOM SKINNER: Thank you all for joining us today for this telebriefing where we'll be discussing the launch of a new global health security initiative which we all hope will make the world a safer place. With us today is three speakers, Laura Holgate who is the Senior Director, for Weapons of Mass Destruction Terrorism and Threat Reduction at the National Security Council, Dr.Tom Frieden who is the director of the CDC, and Andrew Weber who is the Assistant Secretary of Defense for Nuclear, Chemical and Biological Defense Programs. Each will provide some opening remarks and then we'll get to your questions. Please identify yourself when you ask your questions, and please identify the person whom you'd like to respond to your question. So without further ado, I’ll turn the call over to Miss Holgate who will provide some hoping remarks.

LAURA HOLGATE: Before we get to that, can you say a couple words about the embargo please, Mr.Skinner.

TOM SKINNER: Absolutely, yes. For all reporters on the call, we need to make sure you're aware the information on this call is embargoed till 9:00 a.m. tomorrow morning, February 13th. Thank you.

LAURA HOLGATE: Thanks. Hi, folks. This is Laura Holgate. Just a few words by way of overview. The first thing we want to talk about when talking about the global health security agenda is what we're talking about is making the world safer and more secure by strengthening our ability as an international community to prevent, detect and respond to infectious disease outbreaks. This includes diseases such as Ebola, other hemorrhagic fevers, obviously flu is a lot in the headlines these days with the H7N9 outbreak. We've all experienced challenges with the flu over the last few years. Dengue fever continues to be a problem in terms of infecting at many as 400 million people each year and other diseases like the Middle East Respiratory Syndrome or MERS and also SARS that got a lot of public attention ten years ago. This is the kind of challenge that we're trying to prepare our own countries and the international community to work together to be able to deal with.

The U.S. has been a leader on this issue for a number of years, and we've worked internally to create a strong capacity for our own resources but also have the ability to work across sectors within the security sector, the health sector, ag sector, agricultural sector, veterinary sector and so on to prevent, detect and respond to infectious disease threats. This is something where we've been investing hundreds of millions of dollars a year to support activities with our partner countries around the world, as well. We've already seen a lot of benefits in the work that we've been doing and when you look at, for example, the progressing that SARS-- that China has made since the SARS outbreak and also with Indonesia in recent years, we can see countries are investing in their own capacity building and also working with other countries to increase their ability to hold up their end of the stick in terms of the global standards for infectious disease management.

In our interconnected world, we are all vulnerable. And this is something that we've been doing because these are threats to the United States. We've got an increased global travel, the trade connectivity around the world means that disease threats spread faster than ever before and this causes not only loss of life but also serious economic losses and you know, ultimately instability from a security perspective. We know that outbreaks anywhere in the world are only a plane ride away. So that's the challenge we're trying to deal with. Even though the U.S. has done a lot and other countries have done some important progress, there's more to be done. That's what we're looking at. When we saw in 2012, we were really struck by the reality that 80% of the countries did not meet the World Health Organization deadline to be prepared for disease threats. This is a really critical number. And we looked around the world and said this is not something the U.S. can do alone. We really need to be working more closely and more collaboratively with other countries and need to increase the focus and participation of other countries in addressing these challenges. We also know that each-- that the disease threats do threaten other countries, as well. And that no one can-- no one country can manage this problem on their own. And so this is truly a global agenda. And we really want to try to develop a sustained engagement from partners across sectors and with the resources that are needed. We saw this highlighted yesterday when president Obama spoke of it in his press conference with the visiting French President Hollande. France is an important partner for the U.S. in this area. Finland is also doing important work. But what we want to do tomorrow at the event is really demonstrate in a very visible way that we are working with other countries, 30 partners in terms of countries as well as international organizations from around the world to launch this global health security agenda. Really step up our global game and make a difference that is meaningful in our global ability to manage infectious disease challenges. Countries such as China, India and Indonesia will be joining had international launch. They will announce commitments to accelerate progress in some very specific areas. We're also co-hosting this with the World Health Organization and there will be a node in Geneva linking in electronically with a number of countries from participating from Geneva and most importantly, with Director-General Chan from the World Health Organization. We also have a node in Rome that will be linking in the international veterinary and international ag organizations, as well.

From the U.S. point of view, we're going to be putting out there four key deliverables. We'll be announcing first of all, a commitment that we're going to partner with at least 30 partner countries to meet new specific milestones in the pursuit of the global health security agenda. That will be over a five-year period. The down payment on that, if you will, are is a specific focus in 2014 between our Centers for Disease Control and on our Department of Defense, to partner with up to 10 countries to begin implementing and accelerating successful efforts on field epidemiology, new diagnostic tests and so on. I'll let my other briefers on this line say more about that specific effort that they'll be leading. Then looking forward, we'll also be announcing that a previewing component of the President's budget for fiscal year 2015 that will announce a specific-- a specific increase of $45 million within the Centers for Disease Control and Prevention's budget explicitly for global health security. And that's one of the first times we've seen that kind of specific increase dedicated to this mission space. Then finally, the fourth point we'll be announcing is that we will be convening from the White House a forum in the fall to bring additional nations back together and really highlight progress, talk about how specific commitments have been achieved and what progress has been made and then set a path to the work over the next years after that. So I think we've got an exciting conversation to be had tomorrow. And we're really looking forward to powering through the snowstorm that may be coming to make this event a real success. So I will look to hand over now to Tom Frieden, and I’ll let Mr.Skinner introduce him.

TOM SKINNER: Thank you. Next is the director of the Centers for Disease Control and Prevention, Dr.Tom Frieden.

TOM FRIEDEN: Good afternoon, everyone. The bottom line here is that we have the ability to make both our country, the U.S. and the world substantially safer from infectious threats. We face a real storm of vulnerability. There are new risks from new infections like H7N9. There are resistant organisms, and we're now seeing some microbes that resistant to all our treatments and unfortunately there is the possibility of the spread of intentionally created organisms either through a bioterrorist attack or through the inadvertent release of organisms. With our globalized world, a threat anywhere is a threat everywhere. If there is the emergence of a disease in any part of the world, it could be in any other part of the world within a day. Fortunately, we have three real opportunities, one, there is a tremendous commitment and the fact that 25 countries are participating tomorrow, that there's immense interest is evidence of that. The fact that the SARS epidemic a decade ago caused $30 billion of economic damage is something that leaders all around the world have seen and that the World Health Organization has something called the International Health Regulations which 194 countries have committed to, but as senior director Holgate said, less than 20% of countries have actually met means we really do have the opportunity to make rapid progress. In addition to that commitment, there are new technologies that are very exciting and that includes laboratory technologies and we're testing one now in the field in Uganda that can diagnose plague in 20 minutes at the patient's bedside and has already been used to save lives and stop outbreaks, and communications technologies, for example, using remote printing or cell phones or data collection through handheld devices. And perhaps most importantly, success leads to success. A much safer world is really within our reach. We know that new organisms will continue to emerge, but we can prevent outbreaks and epidemics. The good news is that where we've moved on this as in Uganda, we've been able to make very rapid progress. The bad news is that there are too many blind spots around the world. Too many places where a disease may emerge and we may be at risk because it's not recognized, found and stopped there. So the three priorities of this initiative are prevention, detection, and response. And for each of those, we have measurable concrete, ambitious targets that countries will be able to meet.

Just to give you an example, in prevention, we'll make sure that if they're growing dangerous organisms in laboratories they're kept securely so the people working in those laboratories aren't harmed and so they don't get out. We'll also work to strengthen immunization programs to prevent deaths today but also to establish the infrastructure if it were needed in the future. On detection, countries will detect at least five of the most deadly organisms in at least 80% of their country, and on response, countries will have emergency operation centers which can marshal a response within 120 minutes with rapid response teams to quickly control an outbreak and prevent it from becoming worse. The future is pretty clear here. In 2013, we did two pilot projects, one in Uganda and one in Vietnam, and showed that very rapid progress was possible. In 2014, working in partnership with the Department of Defense, we'll be committing $40 million to 10 additional countries to make this kind of initial rapid progress toward global health security [Editor’s note: CDC and Department of Defense are committing a total of 40 million in 2014.] In 2015, as senior director Holgate just said, there will be a proposal in the President's budget to add $45 million to the CDC budget to further expand the initiative toward the goal of within five years, making sure that at least 30 countries not currently protected with at least 4 billion people are well protected and really to call on the world and our partners and that's what tomorrow is about to step up to the plate and make sure that we can protect all people in all countries. I'll turn it over now back to Tom Skinner.

TOM SKINNER: Okay, thank you, Dr.Frieden. Next is Andrew Weber who is the assistant secretary of defense for Nuclear Chemical and Biological Defense programs. Mr.Weber?

ANDREW WEBER: Thank you, Tom. The global threat that Laura and Tom described requires the Department of Defense to innovate, especially for confronting biological terrorism. This requires the defense community to work closely with domestic and international health emergency response and agricultural organizations in unprecedented partnerships. The Department of Defense's global presence with our service members and families posted around the world make us particularly concerned about natural and deliberate infectious disease outbreaks. This is just one reason we need to work with partners to boost global capacity to prevent, detect and respond to disease outbreaks. We're bringing Department of Defense resources to the global health security agenda. Through our effective programs, through collaborative investment with the Centers for Disease Control and international partners, and by leveraging the department's long history of medical and health innovation.

For just one example, the Department of Defense Cooperative Threat Reduction program has partnered with the Georgian Ministry of Health to create the Lugar Center for Public Health Research in Tbilisi, Georgia. The Lugar center is a state-of-the-art laboratory for Georgia’s public and animal infectious disease surveillance system. So thank you very much. And I’ll turn it over to Tom. I think we're ready to answer some questions.

TOM SKINNER: Calvin, I believe we're ready for questions. Again, if you could give instructions for asking questions and I would like for our reporters when they ask questions to please identify the person for whom they had like to answer the question. So with that, Calvin, I believe we're ready.

OPERATOR: Thank you, sir. Once again, if you would like to ask the question, please press star 1 on your telephone keypad. That is star 1 to ask a question. One moment, please, for our first question. One moment please. Our first question comes from Michael Smith with MedPage Today your line is open.

MICHAEL SMITH: Good morning, thank you. This question is for Dr.Frieden. Dr.Frieden, you mentioned in 2014, spending $40 million in projects similar to those in Uganda and Vietnam. And then $45 million in 2015 to additional countries. How much of that is new money is the first question?

TOM FRIEDEN: So the $40 million in '14 is existing resources that are being aligned to this focused approach on prevention, detection, response and are being added to other resources already going into the space. The proposal from the president for 15 would be additional dollars.

MICHAEL SMITH: Okay. And then a second question if I may. Perhaps to Miss Holgate and that is, you mentioned three sort of developing countries, if you will, although I guess China is a pretty major developing country. Are there any other of the developed world involved in this project? Will we see near Great Britain or France or Germany at this meeting?

LAURA HOLGATE: Yes, you'll be seeing all of those countries at this meeting. I also mentioned Finland is a major donor. Germany has put resources against this effort. So we're-- we've also got strong partners in Canada. And as well as you mentioned the UK. And the Netherlands and Norway have also been big participants and coordinators of some of the work that we've done. So it's important that the mix that we've developed is both regionally diverse but also diverse in terms of development status and diverse in terms of countries that can help and countries that may need some help and then countries that may just need technical advice and support for activities that they actually carry out with their own funding.

TOM FRIDEN: This is Tom Frieden. Just to add to that exactly as senior director Holgate says, one way to think of it is for upper income countries OECD countries we're asking that they, of course, get their own systems well run. And that they consider development assistance or technical cooperation on this area. For middle income countries, the approach has generally been one of technical cooperation, for example, we worked with China and provided technical input and that enabled the Chinese government to greatly strengthen their system so they could rapidly identify the H7N9 influenza virus when it emerged and share it openly with international partners so could rapidly make a diagnostic test and begin work on a vaccine. So for larger income countries, it's largely a technical cooperation. For lower income countries, there may be some assistance in strengthening laboratory networks or establishing a cadre of disease detectives or securing some of their dangerous materials or establishing emergency operation centers as examples.

LAURA HOLGATE: I should also mention Japan and Republic of Korea as excellent partners in this realm, as well.

TOM SKINNER: Next question, Calvin?

OPERATOR: Our next question comes from Brian Bennett with the LA Times, your line is open.

BRIAN BENNETT: Hi, this is Brian Bennett. I think this is a question for Dr.Frieden. How will the ten additional countries be chosen? And the project in those countries and for the $40 million to be spent? Are these countries that have, say, the most frequent flights coming to the United States or the most-- the largest risk of an infection spreading to the United States? How is that selection process handled?

TOM FRIEDEN: These would be low and middle income countries in which in collaboration with a country they have an interest and a willingness to make rapid progress and a clear need. I don't think we can say that any country is a country where there's not going to be an emerging it infection. None of us would have predicted, for example, that H1N1 influenza would emerge from Mexico. We expected it, frankly, from Southeast Asia. So it's not so much the geographic as the ability to make rapid progress as we did in and are doing in Uganda and Vietnam.

TOM SKINNER: Next question, Calvin.

OPERATOR: Our next question comes from Andre Sitov with the TASS Russian News Agency. Your line is open.

ANDRE SITOV: Thank you for the call, and I guess my question goes to the White House. I have not heard Russia mentioned among the participants. Please correct me if Russia does take part and my question is about the G-8. Russia chairs the G-8 this year. I know that this particular issue is high on the agenda for the G-8. So how does this new initiative square with the efforts that we already know about that have been going on for a number of years at the G-8 initiative? Thank you.

LAURA HOLGATE: Thanks so much for that question. And for the chance to point out that yes, in fact, we're very thrilled that we have Russian participation in tomorrow's launch. We've been working closely with Russia in the G-8 planning for this year's submit and the whole process throughout the year and we welcome that this has been identified by the Russian organizers of the G-8 as a priority for them. It's a great opportunity to work closely under Russian leadership to advance this concept within the G-8 community and to partner with other G-8 countries. I think all of the G-8 are part of the launch tomorrow and so it will be an opportunity for everyone to kind of be on the same page with that. And more broadly, I just want to say that we're-- that the-- there are many different existing mechanisms that we will be using to develop the actions and the commitments that will underpin this global health security agenda and the nine objectives that are identified in there. The g-8 as such is one and another key, key portion and another reflection of the Russian leadership is the global partnership which as many of you know, was spawned under the G-8, but it now grows to 25 different countries, and is much broader than the G-8 and has been working on issues of biosafety, biosecurity, global health security for a number of years, and so there again, we're really pleased that the Russian leadership of the global partnership is also looking to continue that focus area of work under that set of funding initiatives. So we have a lot of different ways including through the World Health Organization and other existing structures to really enhance and elevate the work that's been done with a little bit more political oomph and a little bit more focus to these nine objective areas.

TOM SKINNER: Next question, Calvin.

OPERATOR: Our next question comes from Clara Richter with National Journal. Your line is open.

CLARA RICTHER: Hi, yes, thank you for taking my call. This question is for Tom Frieden. You had talked briefly about the two pilot projects and how you're going to work or the response and can you talk a little bit about some of that progress and how that's going to be applied on a more global scale?

TOM FRIEDEN: Thank you. We wrote these up two weeks ago in our bulletin Morbidity and Mortality Weekly Report. And we can get you a copy. From Uganda, there were existing networks to diagnosis patients, for example, children born to HIV positive mothers but those networks were operating in only part of the country and only for one disease. We were able with this project to establish a system that starts with sample collection where patients are sick all over the country, goes to taking those samples to a motorcycle courier who brings them to the provincial capital where they're overnighted to the country capital where they're tested with state-of-the-art high quality laboratory testing safely and the results are then delivered to the remote areas by a GSM enabled printer to enable both patient management and care of the individual and outbreak prevention and control. That was initially expanded to cover Ebola and other hemorrhagic fevers, cholera, and drug resistant tuberculosis but has since been used to identify and help stop many different outbreaks including Zika virus, hemorrhagic fever and others. So it's an example of being able to expand the infrastructure so that we can rapidly detect, respond and therefore, prevent health threats.

TOM SKINNER: Next question, please.

OPERATOR: Our next question comes from Lena Sun with the "Washington Post." Your line is open.

LENA SUN: Hi, this is a question for all three of you. But anyone can answer. Given the fact that there are already global efforts under way and national efforts under way in the United States to fight infectious disease, what is there special about this initiative that makes you think that countries will, you know, do better since they haven't even met the standards that the World Health Organization had wanted them to?

LAURA HOLGATE: This is Laura. I'll start off with that and invite others to join. I think what we're looking at really here is a chance to put some political highlight on it by convening a ministerial level meeting and to really put a focus on these nine particular activities and to highlight that these are areas where the U.S. Is going to be focusing its own significant resources and where others can also bring resources to bear. And so if we make progress on these nine arenas, we will make a big dent in the international health regulations compliance that we're all aiming for and that the World Health Organization has prioritized. And we'll also be more explicit about applying some of the measures that you heard from Dr.Frieden in terms of how will we know if we've made a difference and how can we visibly and meaningfully move the needle on these various objective arenas. Tom, Andy, do you want to add to that?

TOM FRIEDEN: I'll just comment that I think this is not something that's brand new and never started. In fact-- the good news is where countries have focused; they've made a lot of progress. The bad news is that by 2012, the initial deadline, less than 20% of the world's countries and even self-reported to the world health organization that they were fully compliant with the international health regulations, and what we have done is to identify these nine specific areas that countries can working in, move toward, and this allows us within the U.S. Government to focus our attention and assistance in technical cooperation and also to work with high, middle and low income countries, in the high income countries to encourage them to help other middle and low income countries to come up to that mark as well as their own populations in middle income countries to focus their attention so they can address these nine areas and in low income countries, again to focus and to think of how they can marshal support for this through bilateral or multilateral assistance. This is something that really is jumpstarting global progress toward keeping each country safe and keeping the world safer. Because what we've learned from the progress so far is that a much safer world is within reach. And we need to move forward to get there.

ANDY WEBER: And let me-- this is Andy Weber. Let me add in strong agreement to what Tom and Laura said, that this is intended to be a shot in the arm that will energize and elevate the global health security agenda. And by making it deliberately multispectral, by bringing the security sector into this partnership, we hope to bring new resources to bear in the way that the departments of defense and the CDC have been working together for quite a few years to combine our resources and to make the whole bigger than the sum of the parts.

TOM SKINNER: Next question, Calvin.

OPERATOR: Our next question comes from Jeff Cowen with Science Magazine. Your line is open.

JON COHEN: Hi, thanks for taking my call. John Cohen. A question I have is about enforcement, the international health regulations call for enforcement. How does this new agenda factor in with enforcement?

TOM FRIEDEN: This is Tom Frieden. I'll start with that and others may want to join. Currently, the focus of this is for the countries of the world to achieve compliance with the international health regulations. And that will be assessed by the World Health organization. One of the things that we'll be looking at going forward is, what are ways in which we can ensure that there also an objective assessment of each country's readiness in each area. We have been able to do that collaboratively with the World Health Organization and individual countries in areas such as influenza where we've been moving countries further and further along on the look of preparedness spectrum and in laboratory networks where we've worked in several continents with establishing and accrediting qualified laboratories. And so this is an area that we will certainly be focusing on in the time to come. I don't know if others want to comment further.

TOM SKINNER: I think Calvin, we'll move to the next question.

OPERATOR: Thank you. This question comes from Susan Scutti from Medical Daily. Your line is open.

SUSAN SCUTTI: Thank you very much. How would you characterize the condition of our strategic national stockpile of vaccines, anti-toxins and other drugs?

TOM FRIDEN: CDC maintains for country a strategic national stockpile. It includes vaccine, diagnostics, medications and other supplies. We continuously look at the need for different interventions and our supplies whether that's biological or other, and we have the ability to deploy that within hours to any part of the United States. This is the type of facility that other countries may wish to consider establishing at least so that they can continue core services in the case of an outbreak. We have not included it in the nine key areas because it's a decision that we believe each country needs to make for itself, as the U.S. has made a decision to do this. We also are looking where possible to do global collaboration from the stockpile or other U.S. Resources, but this is an area I think for each country to consider and look at.

TOM SKINNER: The next question, Calvin.

OPERATOR: I'm showing no further questions at this time. Once again, if you would like to ask a question, please press star 1 on your telephone keypad. One moment for our next question.

TOM SKINNER: Calvin, I think we're good to conclude the call.

OPERATOR: No questions. Wait we do have some questions coming in.

TOM SKINNER: Okay, we'll take one or two more questions and then we'll conclude the call.

OPERATOR: Okay. First question comes from Bob Roos from Cidrap News. Your line is open.

BOB ROOS: Hi, thanks for taking the question. This question is for any of the three speakers I guess. I wondered if you could tell us what will be happening at the event tomorrow.

LAURA HOLGATE: Well, I can just sketch it for you briefly. We'll have a few-- an opening presentation from Secretary Sebelius and then—that’s Secretary of Health and Human Services Sebelius, obviously. And then Lisa Monaco, the President's Advisor for Homeland Security will also be giving a brief opening remark and then we'll have a number of other presentations thematically grouped by other countries who are participating. The event itself will be off the record but those countries may choose to characterize their inputs later afterwards. And then the-- there will also be an opening presentation from Deputy Secretary Higgenbotham from the State Department, as well. And Deputy Secretary Fox from the Defense Department, as well as our Chief Veterinary Officer. Those are kind of the U.S. Participants and we'll-- they'll be engaging throughout the day.

BOB ROOS: Thank you.

TOM SKINNER: Calvin, I think we need to conclude the call. I want to remind everyone on the call that the information shared today during the call was embargoed till tomorrow morning at 9:00 ET. That would be February 13th. If you have additional questions or need additional information, you can call the HHS Press Office at 202-690-6343 or you can e-mail the HHS Press Office at media@hhs.gov. So thank you once again for joining us. And this concludes our call. Thank you.

OPERATOR: That concludes today's conference. You may disconnect at this time. Thank you for your participation.

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U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES