[inaudiblele conversations] good afternoon, everyone. Welcome to this csis discussion. Im very pleased to honor our guests here today, and ill introduce them in a moment. But we are going to be discussing cdcs Global Mission and the integration of a more global strategy that the agency is leading. Im julie, i am currently the president and ceo of the foundation for the nih, but im wearing a different hat in this meeting as the cochair of the csis bipartisan alliance on Global Health securities. My cochair and i, i welcome you, and and i will make sure we have time for questions [inaudible] if prepared for that, and is well invite you to the microphone to participate in the conversation. We also welcome our online guests and hope that you enjoy this discussion. So why are we here . Well, were here because we are operating under the basic premise that biosecurity is National Security and that cdc has an absolutely critical troll play in that. Bipartisan a aligns [inaudible] in helping the cdc build its capacity in this regard and really look at what is necessary for the cdc to, in a sense, recover from some of the issues that emerged during the global pandemic. We had a wonderful working group under the auspices of the alliance led by Steve Morrison and tom ingles by from Johns Hopkins university that really examined what was going on at a cdc, what were the opportunities for improvement, what were the strengths, where wereim investments needed both actions by cdc, but actions on behalf of cdc to really respond to what i think was found by some of the working groups report, the cdc is in peril. And yet it isor so important to our i National Security that it was an urgent priority to step forward and try to understand what could be done. So in january of 2023, csis published a report building the cdc the country needs. There were many stakeholders and and experts who participated in this working group report, and one of the things that youll hear today if you saw that report is that our leaders from the cdc have already taken steps to respond to some of recommendations in the a report. Particularly two recommendations that specifically address Global Health issues. First and foremost, what really was the best way to integrate cdcs Global Health work with it domestic biosecurity agenda. And then second, what were the investments, the budget, the work force, the practical policy, etc. , that cdc really needed to acquire in order to successfully fulfill its Global Mission. In the time since that report, there has been significant progress. I just want to fake a moment to highlight taken a moment to highlight some of those areas of progress. In mar, the cdc director has been very visible globally as have some of the cdc leaders who are here today. Regional offices have been opened around the world to try to coordinate cdcs agenda, particularly its Global Security agenda. And specific investments have been made, but i think what is probably most exciting for us is really the recognition that the whole is greater than the sum of the parts. And by coming together as a whole of cdc, we can really build on the vertical strengths and capabilities of the agency but move them in a direction where we have a more powerful, a more visible and i think a more successful global agenda. So let me introduce our panelists. First, id like to start by introducing kayla whos the heae Global Health center at cdc. Sitting to her left is dr. Dan jump began whos the director of the zoo nottic and infectious diseases. And doas you pronounce that [inaudible] [laughter] [inaudible] [laughter] just checking. And then sitting next to dan, on dans left, is dmitri whos the director of the National Center for immunization and rest rah pa story can diseases respiratory diseases and a leader particularly in the hiv arena and someone who ive long held in highest esteem. And then finally at the other end of the panel is henry wok whos the director of the office of readiness and response, someone who was in the hot seat during covid but continues to provide a really unique frame of leadership for the cdc. So what id like to do is just maybe give our panelists a chance to say a few words really focusing not so much on whats ahead in the context of this strategy, but whats already been accomplished. What a actions have you taken since, maybe since january of 2023 when the report came out in but in the recent months that really are kind of moving us in a new direction. So, kayla, ill start with you because i know if you have probably the overview of the overall strategy. Great. Thank you so much. Can and thanks to everyone for being here and everyone whos online. Today we wanted to talk talk a little bit about a sort of a unifying strategy, unifying if framework for cdcs Global Health work. And it really fits in to the cdc directors 2024 prior des of readiness and response priorities to really look at a Data Infrastructure and modernization, lab quality and safety and overall riskbased pathogen priority station. So this global framework really fits into those larger 2024 priorities. And weve learned a lot other the last few years over the few years especially from covid both domestically and globally, and we wanted to put it all together in our global work. We know that in order to protect the u. S. , to protect the work and our lives here we need to be working globally to do that. And our global work leverages many of the platforms that we work in overseas, much of the work that we do with pepfar or the president s ma a lair ya malaria work or any of the work in influenza. All of that global work with leverage both for those vertical programs, but also horizontal ally to build systems to have system strength for our global work. And so when we work overseas, we have 20, we have over 60 Country Offices and 6 regional offices. And we really work shoulder to shoulder with ministries and with government and with the community in the countries where we are. And we really have is are a trusted pickup have a trusted partnership. And we are, for that reason, the first call when something happens. And weve seep that repeatedly and especially since covid. But that has been going on for decades. So its really important that we with frame our worth and so weve put together a global strategicc framework which its elements are are not new, and its core capacities and the mission have the and the vision is are not new. But the framework is a new way of frame thing, and its a way of insuring that across the entire agency, across all our different programs and centers, in our Country Offices and in our regional offices were all a working together kind of in the same, pushing in the same way, pushing in the same lanes to be the most effective, to be the most efficient and to have the most impact. And the framework really has four major goals to why were working overseas. The first goal is to stop health risks at hair source. And thats cdcs really fundamental goal,ir stopping outbreaks at their source so they dont move anywhere or to the u. S. The second is to prevent or contain disruptive outbreaks. This isth the dengue, this is te cholera that may not move, but its very disruptive to societies, to economies, to the health of nations. And its very important to work on that. The third goal is really around Global Knowledge and and how we can use it both globally and domestically, and thats Something Like our influenza strains that we know from around the world that help go into our vaccine. And that Global Knowledge of disease elsewhere and how we use it domestically is very important. Gl so thats the third goal. And the fourth and final goal is really the platforms that we built that really prevent morbidity and mortality. Again, thats the pepfar or the malaria or the flu or the antimicrobialresistant platforms that reduce morbidity and mortality but also serve as a platform where we build system strength so we can then respond to outleak breaks. We are working in clinics and training, and those help in all of our work overseas. And there are six pillars that get us to those goals, data and surveillance, laboratory, prevention and response, innovation and research, work force and institutions and communication, policy and diplomacy. So through all those pillars of work, we reach those goals. And so what we want to do today is to share with you some of the ways in which the most recent outbreaks are really showing how weree using that framework, were working within that a frame if globally and how it connects to our Domestic Work and vice versa. So, kayla, what im struck by in your conversation here is that none of this has a decide name, right . Thats right. Were talking about the costcutting capacities and capabilities that really distinguish cdcs expertise that you can apply to whatever the threat is whether its a domestic threat or a global threat. And we certainly have plenty of those in play right now. So i thought maybe i would ask dan to start by talking a little bit about [inaudible] and how thats playing out and and how this approach is illustrated in the context of this arguably primarily global outbreak but certainly with u. S. Implications as well. Sure. M poxox is one of the pathogens that sits within the National Center for and infectious diseases. But to your point, it requires the allagency activity force the really respond to it. We did have cases of the clay 32v which is the case we had previously, 30,000 in the United States. What we have right now is something happening in the democratic republic of the congo called clay 1m pox which has higher severity, higher transmissibility. Were seeing about 4,000 cases from the first part of this year. And p it really demonstrates the threats that we have with emerging infections. The world is more connected than it ever was, so you can get from democratic republic of congo anywhere inn the world within r incubation period. The worlds more crowded than ever before, and the worlds of animals and humans are really converging like they never have before. And right now m pox is showing that, row dents giving it to kids, kids getting it within the family, it can is sexual transmission outside the drc. So we will be able to have that capability within the United States to havee the diagnostic test,s to have the right and in this helpswo us to say what data do we need in the United States, in the dc, whats the coordination between the team, the folk ifs being deployed, the laboratories that we have in the United States. We need to think of this across the spectrum from domestic all the a way to global so that were not inhibited in one place or the other, but thinking across that spectrum and how do we use the full breadth of all the different capabilities we have across these different certains and across in order for us to have the most optimal response and keep m pox from coming in and causing another is set of cases in the u. S. Potentially even worse. Yeah. Of yeah. So in thinking about how you actually implement that response, one of our greatest strengths globally is the pepfar platform. So i dont know, dmitri, can you with say a little bit about how that vertical gets leveraged in the context of this new strategy . Sure. Ill say that, one, i think it was remarkable seeing pepfar in action in cambodia with when we went for to our visit there. It was really important to see sort of how that is leveraged globally. And really that was t also reflective of how the work happened domestically during the outbreak. And i think sort of thinking about that very clear equivalent is f ryan white. And so i think very sort of similar lessons from the sort of global and the domestics were converged and in that looking at the sort of hiv Platform Global arely and domestically to really reach communities that needed to be reached but also address some of the gaps that are the well known inss hiv treatment and prevention and how that would exactly sync to the populations that were having the worst outcomes for m pox. So i think it is sort of in the image of this framework where were in a diseaseagnostic way stepping back and saying what can be leveraged and how far can with we push it. And i think thats some of the great leadership sort of shown in bringing this all together to work onn this framework demonstrates the importance of really saying where can we leverage, where do we have sort of infrastructure like influenza which is now the center that i look over, how do you leverage that not only for our seasonal flu, but also more emergent pathogens that were seeing and also many a more panrespiratory fashion. So thinking about the lessons, it really is a pathogenagnostic strategy where how can you leverageag the platforms, look t the laboratories, the relationships, the diplomacy, you know, the data and make those systems Work Together to achieve a Better Public Health outcome. I think we all realized in covid how important the pepfar investmentsco were as well as Global Fund Investments mt. Countries in the countries that had an infrastructure for laboratory and surveillance and the capacity to understand and convert it into tools for covid, etc. Thats kind of a cult knowledge because most americans understand that that was incredibly important in supporting outbreak response many many countries. And it was a value from that investment c that i dont thinke predicted back when george bush invented pepfar. So or when that leveraging a capability really gets us far more than we bargained for. Well come back to this whole issue of funding and budgets where both verticals and horizontals. But i want to bring henry into this conversation a little bit. So we have another very worrisome situation emerging in the u. S. , and that, of course, is the Avian Influenza. If youre a bird, it is a pandemic e, right in. [laughter] right . And certainly even this week we learned that pigeons, which were thought not to be susceptible to h5n1 now at least, i think, in michigan have been shown to have been infected. But i want to talk a little bit about dairy cattle, because i know thats whats on peoples minds. Youre the head of the i preparedness and Response Center at cdc. Whats going on in your center domestically and internationally in this context of this outbreak . Right. Well, you know, domestically we, cdc, are trying to coordinate together across multiple certains. Stood up, actually, it was in dmitris center where we stood the up a Management System to help coordinate if all the activities. There has been one case in texas, human case, so far. Certainly, were detecting it in multiple herds across the u. S. Which requires that collaboration with other sectors, usda a, basically, and fta within hhs to make sure that milk is safe. So this is an interagency collaboration ase. Not only an hpai, this particular outbreak, but as it was in ebola, as informs zika, as it was it was in zika, as it was in m. Pock, its not just cdc coordinating within it, but across hhs and coordinating across the interagency. If so domestically usda has the lead on the animal if side. Wele obviously have a lead, a competing role on the domestic side. We continue to try to investigate if potential cases on farms, but its actually been quite difficult to get access to some of those farms and understand understand the epidemiology and where the missing is. So we are risk is. So we are supporting the states, supporting this migrant population thats actually working on the farms. Its a difficult population to reach, so were working with various Partner Organizations to try to gain that type of trust. So with we actually can do more ofs those epidemiological investigations. Fda is responsible for the milk, for the quality of the mil, and so were working quite closely with fda. And youll see a lot of information coming out around pasteurization of milk. Yes, the milk is safe. Dont drink raw milk. Its not just h5 you have to be concerned doesnt ash a. [laughter] thank you. So i think within cdc certainly we have multiple groups engaged in including dmitris center. We have our one health group is dans center thats e engaged. And we have, actually, a forecast in analystics as well to try to predict if this does take off, you know, what does the future hold. Fortunately, now our vaccines, candidate vaccines will work, our anti our laboratory testing, we can pick up this particular strain of h a 5, and our therapeutics as well also work. So its very reassuring at the moment. We are we need to learn more about where the risk is on these farms. If then lock term long term is our sur vale lance in these cattle. Is it milk if surveillance, is it herd surveillance, theres a number of or wastewater. And, of course, theres wastewater. And youll see some more results coming out, actually fairly sooa dmitri [laughter] around waste water. So, kayla, or right now were kind of managing this as a u. S. Centric situation although h5n11 is not just a u. S. Sent reck problem. Centric problem. But yet communication has to be relevant globally. And im sure theres a lot of anxiety on the part of the Food Production industry in terms of trade and the Global Impact of concern about the safety of our cattle industry, etc. So how are you managing the Global Communication around this kind of unfolding . This is the hardest part of an outbreak, is the early days when theres soth much uncertainty. How bad is it, how bad will it be, whos affected, how far will it go . You just dont know. How areu you handling that tha . Yeah, thank you. So a couple things weve done so far, obviously we have, you know, everything we have on cdc, you know, web sites are pushing out to all of our partners, all of w our Global Parking lotter ins, but also we