Press Briefing with Dr. Rebecca Martin, Director, Center for Global Health, U.S. Centers for Disease Control and Prevention Via Teleconference, Kigali, Rwanda

June 28, 2017

Africa Regional Media Hub

Press Briefing with

Dr. Rebecca Martin, Director, Center for Global Health,

U.S. Centers for Disease Control and Prevention

Via Teleconference,

Kigali, Rwanda

June 28, 2017


Audio links








MODERATOR: Ladies and gentlemen, thank you for standing by. Welcome to the African Health Forum. I'd like to turn the conference over to your moderator, Ms. Tiffany Jackson-Zunker. Please go ahead.

MODERATOR: Good afternoon to everyone from the U.S. Department of State's Africa Regional Media Hub. I would like to welcome our participants who have dialed in from across the continent and media gathered at our various missions in Africa. Today we are joined by Dr. Rebecca Martin, Director of the Center for Global Health at the U.S. Centers for Disease Control and Prevention. Dr. Martin has just participated in the World Health Organization Regional Office for Africa's first ever Africa Health Forum. She is speaking to us from Kigali, Rwanda. We will begin with remarks from Dr. Martin, and then we will open it up to your questions. For those of you listening to the call in English, please press *1 on your phone to join the question queue. If you are using a speaker phone, you may need to pick up the handset before entering *1. For those of you listening to the call in French and Portuguese, we have received some of your questions submitted in advance by email, and you may continue to submit your questions in English via email to If you would like to join the conversation on Twitter, please use the hashtag #AHFLaunch and follow us on @AfricaMediaHub and @CDCGlobal. Today's call is on the record and will last approximately 45 minutes. And with that, I'll turn it over to Dr. Martin.

DR. MARTIN: Thank you Tiffany, and thank you for the opportunity to speak with all of you today. As Tiffany noted, I am here in Kigali, Rwanda, attending the first WHO Africa Health Forum, which is a two-day meeting. The plan is that these would be held biannually going forward. The theme of the current meeting is "Putting People First," and this is the first ever Africa Health Forum that they've held to address the opportunities and challenges for effective health service delivery, and policy priorities within the region.

My first impressions of this Africa Health Forum are it's a very valuable opportunity, because it is bringing together multiple stakeholders across multi-sectoral areas and also different line ministries within government. We have some Ministers of Finance, there are some Ministers of Health attending, but it's really a wonderful opportunity to discuss about the health issues in Africa, and the partnerships that are needed to be able to achieve the goals and to address the morbidity and mortality on the continent. It is also a really wonderful opportunity to come together to talk about how to engage youth also in public health efforts on the continent.

Yesterday I had the opportunity to participate in a panel addressing global health security and protecting the people of Africa, and I wanted to just maybe make a few notes about this. Next year, 2018, will be 100 years since the Spanish flu epidemic. And that epidemic killed 50-100 million people, which was actually more people than died during World War I, and the equivalent of comparing people who died in 24 weeks due to Spanish flu is comparable to the number of people who have died in 24 years due to HIV, just to put that in perspective. There was, at that time, no vaccine. The diagnostics were not good, many people first thought the outbreak was due to dengue, to typhoid, to cholera. But quickly after that, it was diagnosed. But again, it took a long time for diagnosis, a long time to implement prevention measures, to keep people away from crowded areas if they were infected, and it also required that people report diseases. And I mention this because the name it got, Spanish flu, is because Spain was actually reporting cases. The UK, the U.S., Germany, and France did not report their cases as robustly as Spain did.

And all of these points I bring up, the opportunities to have vaccines and diagnostic tests, the importance of reporting diseases as soon as they occur and where they occur, and the importance of implementing preventive measures as soon as possible, are all still challenges we are dealing with today, and that need to be addressed in any outbreak that we see. The Ebola outbreak that started in 2014 in West Africa - in Sierra Leone, Liberia, and Guinea - shows us another example of when a perfect storm occurs, bringing together potential geopolitical conflicts or crises that are occurring. Public health infrastructure and health systems that are not as strong as they should be. And then you have the crowded cities which have opportunities for global air transport, to be able to spread the disease. All of these came together for a perfect storm that happened with the Ebola outbreak we saw in West Africa. After that, we had a window of opportunity open, and we recognized that only one in three countries - or 30% of the world's countries - are prepared to be able to respond to public health emergencies.

These public health emergencies, they are disruptors to local, regional, and global markets. They affect economies, and the importance of people to understand that health security is national security. And this is something that we were able to discuss at the Africa Health Forum, about how to share best practices, how to make sure that it really does take everybody, from civil society up to global level, to be able to make sure that the world is prepared, to keep everybody safe, and to make sure that outbreaks don’t spread. I’ll stop there. Thank you.

MODERATOR: Thank you very much. We will now begin with the question and answer portion of today's call. For those asking questions, please state your name and affiliation and limit yourself to one question related to the topic of today's briefing, the first Africa Health Forum and U.S. support to address the opportunities and challenges for effective health service delivery in Africa. To begin, I would like to ask the operator to open the line for a question from our embassy in Windhoek, Namibia.

MEDIA: Good afternoon and thank you so much for this time and also for your information. My name is Bianca Gowases, I'm from Radio Current Affairs, the Namibia broadcasting corporation. And my sole question, really, is what is the CDC’s view on efforts by the Namibia Center for Disease Control, that is now looking at whether Namibia is successfully managing to contain diseases and if their preparedness system is efficient enough to detect, diagnose, and treat possible outbreaks, be it communicable or non-communicable diseases. Thank you.

DR. MARTIN: Tiffany, this is Rebecca. I'm sorry, I missed the first part of the question.

MEDIA: My first part of the question is, what are the CDC's views on efforts by Namibia’s Center for Disease Control? Can you determine whether Namibia is successfully managing to contain diseases, and if their preparedness system is efficient enough to detect, diagnose, and treat possible outbreaks, be it communicable or non-communicable diseases. Thank you.

MODERATOR: Was that clear?

DR. MARTIN: Yes, thank you very much for the question. One of the ways that we have, working with the World Health Organization and other key partners, is what is called the Joint External Evaluation. And what countries do is they conduct an external assessment where a team comes in and looks at 19 technical areas to see whether a country is, as you’re saying, prepared, needs improvement, or a certain activity may not exist. For example, looking at the surveillance system, looking at the laboratories, the ability to diagnose rapidly and be able to share results. Is there the trained workforce that's needed, both in the health facilities but also at the front lines, what we call the 'disease detectives,' to be able to conduct the surveillance? And also, we look at their response for antimicrobial resistance, just to name a few areas. When a country conducts a Joint External Evaluation, they are given a score for each of these areas, in prevention - ability to prevent diseases - also then the ability to detect and the ability to respond if an outbreak occurs. This score then shows where there are still gaps, and where there are the strengths, and what areas will need improvement. When a country goes through this process, then we can be able to see if the country has the ability and is prepared and will be able to respond rapidly. There's also, within this ability, is what WHO conducts, which are assimilation exercises. So, actually pretending that an event has occurred, and how well the system responds to the event. When a country goes through this, then there is a measured score that can be used to be able to determine if a country is prepared.

MODERATOR: Alright, thank you very much.

MEDIA: Could I ask a follow-up question, please. I just need you to speak specifically to Namibia's situation.

DR. MARTIN: Yes, I am not exactly familiar right to date at this point on if Namibia has conducted a Joint External Evaluation, but if so, there is a public website where those data are shared in a very transparent and open way, and we can make sure that we can get you that website so you can take a look at those results, if they have conducted one. We do know that many countries to date, actually, on the African continent, 15 have conducted Joint External Evaluations and there are 11 more scheduled for this year, so we can look and make sure and give you the website link.

MODERATOR: Great, thank you very much. Our next question comes from Rosária Fortunato from ANGOP News Agency in Luanda, Angola. She asks, how many and which countries already have a Regional Collaborating Centre in Africa, and what are the criteria for the setup of a center?

DR. MARTIN: Thank you for that question. I think that this question is related to the establishment of the Africa CDC, which currently has its headquarters in Addis, in Ethiopia. When it was established, it was also agreed by the Heads of State within the African Union community that there would be five regional collaborating centres established. And their review was done by the African Union, the Africa CDC, and experts from around the world. The five countries that are currently having regional collaborating centres are Egypt, Nigeria, Zambia, Kenya, and Gabon. Within each of these countries, they have the capacity to host a regional collaborating centre. Currently, the roles and responsibilities of the regional collaborating centres are still being developed in relationship to the Africa CDC, but the goal is really to focus on countries first. That is, the importance that is the country's responsibility to protect its people, and within that, when capacity is not able to met to be able to respond, to be able to protect, or to detect, there's the opportunity and the need for a regional response, and to have that ability to surge. So this is the goal of the regional collaborating centres, is to support countries' ability to be able to be prepared and to be able to respond. And if they cannot, that there's the laboratory capacity to help the diagnosis, there is the surge of the needed workforce to be able to respond. Thank you.

MODERATOR: Thanks. Our next question will go to the listening party at the United States Embassy in Accra, Ghana. Operator, can you open the line, please?

MEDIA: My name is Goodwill Arthur Mensah, I come from the Ghana News Agency. Currently I'm in the U.S. Embassy in Ghana. One issue that Ghanaians are facing is their health medication. Most of the people want to take health medication without going to hospital for diagnosis. And I think that Ghanaians authorities should look at this by really attending educational - like, increasing education, especially people who are not educated, because people prefer to undertake self-medication and then take medicines, sometimes will have future consequences on their health, and I think Ghanaian authorities look at this by really educating the public to go to the available health facilities for proper diagnosing instead of taking self-medication.

DR. MARTIN: Thank you for your question. I think this is a very important issue, and we see this in many situations, where the importance of the consumer to have the information that's needed to be making the right decisions about his or her health, and to your point, I think the value that we see and the way forward that's currently being thought about in many countries here on the continent is how to engage communities in an appropriate way, creating what they're calling 'Community Health Workers' and also key stakeholders in the community who can be given the information and then who can help educate in their communities. And I also know in the private sector, with many of their businesses, they have a strong communication program, where they have used their workers, that when they go back to the communities, that they help educate, they train them on self-issues, on water and sanitation, that can then be shared with the community. So the importance of this is that the work starts at the community level, and to make sure that people are educated, as you're saying, using the means that are appropriate. As you said, many people may not be able to read, but how can you provide information in pictures or in visuals or in oral stories as well. So these are some of the efforts under way, but your points are very important to the efforts to date. Thank you.

MODERATOR: Thank you. Our next question will go to the listening party at the U.S. Embassy in Addis Ababa. Operator, can you open the line, please?

MEDIA: Hello. Hi, good afternoon. My name is Samuel Getachew, I'm from The Reporter Newspaper, a weekly paper in Ethiopia. My question is, from afar we see the U.S. removing itself from the ideas of the Canadian-style universal health care. And we see the U.S. removing itself from international institutions, and its role in Africa. So, is this commitment that is made, provided, this an idea - what you’ve told us today - is this something that has been endorsed by the Trump administration or is it just an idea? Will there be no firm commitment to act on the idea of universal health care in Africa? Thank you.

DR. MARTIN: Thank you for your question, and I can only speak to our current efforts and the current funds we have for those efforts, and I can assure your our Secretary of Health, Secretary Price, before going to the World Health Assembly, made a visit to Liberia to see the reconstruction work after the Ebola outbreak there. He then went on to participate at the G20 Ministerial Health Meeting and then to the World Health Assembly in May. And in many public fora at different meetings where he was presenting, he talked about the importance and the value of the global health security work, which is part of what is in the efforts of making sure that populations are safe and have access to care, ensuring that no one becomes ill and that people are protected by the rights of their country. So with the global health security work, this work is able to be continued currently with our current funds and our current mission, and ensuring the work that we're doing to keep people safe here and abroad, and making sure that we can detect things and stop things rapidly before they become either regional or national or global outbreaks. Thank you.

MODERATOR: Thank you. Our next question was sent in by Sumba Nansil from Guinea-Bissau. He asks, to what extent can the opportunities and challenges for effective health care delivery and health policy priorities have an immediate effect on health in Africa?

DR. MARTIN: Tiffany, could you repeat that once more, please?

MODERATOR: Certainly. To what extent can the opportunities and challenges for effective health care delivery and health policy priorities have an immediate effect on health in Africa?

DR. MARTIN: Thank you for that question. We have seen - I wanted to use the example of looking at Cameroon, where we have seen the ability of the government in responding to events, not only communicable disease events, but also when there was a train crash, by establishing their emergency management system, that they were able to bring together the different sectors and the different line ministries that were needed to be able to come together and have one approach with a very strong message about the leadership and who was doing what and their roles. And they have moved from being able to respond to events - from eight weeks - down to 24 hours, of being able to bring their needed governments, their partners, and stakeholders together to be able to respond. And this was done very quickly. Now, in doing so, Cameroon then put in place their policies and their laws to be able to use this sort of mechanism, the incident management system, to be able to respond to other events. They're now using it to improve their HIV program, to make sure that they're reaching everybody, making sure that tests are being offered and those who are found to be HIV-positive are being put on treatment. So we see that with the policies, they can be done very quickly, and importantly, have major impact.

We also see countries establishing what are called 'National Public Health Institutes', and this requires, in many countries, to institutionalize this, that there be a law for this. And countries are now going through - for example, Mozambique recently finished their process to set up their National Public Health Institute, through setting regulations and laws. So we see that with that, you can easily make sure that things can be put into place and be sustainable and be put in place for long-term. As you know, I'm currently here in Kigali, and at the session I was just attending, the mayor of Kigali was asked, "Why do you have such good health systems here? How are you doing this?" And the true answer is, it came right top from the leadership, from the President, that they have been able to put in structural changes. They have built sidewalks, so more people are walking. They have no-car zones, so people are able to come out and play, and smoking areas where people cannot smoke. And so these opportunities, and putting policies and laws into place, can quickly change the health of many people in a very fast way, to prevent long-term non-communicable diseases and also to be able to respond rapidly to infectious diseases. Thank you.

MODERATOR: Thank you. Our next question will come from the listening party in Windhoek, Namibia. Operator, can you open the call, please?

MEDIA: Good afternoon, my name is Dorcus from Namibian Sun. The question that I wanted to pose to you is, can you comment on the dynamics that African countries get where other social issues do have a negative impact on the initiatives that are provided, for instance by CDC? Of particular reference is a case that occurs here in Namibia where, in malaria-prone areas, where some people have sometimes droughts, and when they have floods, the mosquito nets that are used to protect them from malaria, they end up using them to catch the many fish that come with flood. Maybe you can comment on how best they can benefit.

DR. MARTIN: I'm sorry, I apologize, I did not quite catch the question on the second part. The areas that are malaria-prone, if you could just repeat that second part, please.

MEDIA: Okay, they do get floods during the rainy season. And the same nets that they are supposed to use to protect them from mosquito bites, they will use to catch fish, because they need - I mean, fish is food.

DR. MARTIN: I understand your question.



MEDIA: Obviously it will have an impact on the initiative that the CDC is working on.

DR. MARTIN: Thank you for that question. The most important thing in all of this is, as interventions are put in place, to make sure that communities and people are empowered to understand the importance of the intervention and why it's being recommended. With that, then, comes the importance of being able to monitor, in a positive way, to understand what could be done if things are not going the way that they're supposed to, as you're saying, in this example. But then to have the accountability so that there could be some correction, and when - as you've mentioned - when there's a health issue that comes in, also, with a natural disaster or with a natural environmental issue or with another social issue, it’s important that the approach to solve the problem is taken with a multi-sectoral approach. It's not only for health to solve this, but it's also to understand what the other line ministries need to be doing. Also, how to bring in - if there are potential opportunities for private sector, for non-governmental organizations or civil society to help solve these problems. It's not just a health problem. And we see that even with health problems, that there are many determinants about why a disease may occur, and we have to have a multi-disciplinarian approach to solving these problems. Thank you.

MODERATOR: Thanks. Our next question comes from the listening party in Accra, Ghana. Operator, can you open the line, please?

MEDIA: My name is Gideon Ahenforah I’m reporting for the Ghana News Agency. I'm calling from the U.S. Embassy. My question is, we know in the case of Ghana, most of the health problems we are facing now come from poor sanitation and the inadequate access to potable drinking water, as well as food. Which, of course, has appeared to have an impact on water, sanitation, and hygiene. I believe that there is a need to solve the grassroots causes of health problems in Ghana if we are to help improve the health [UNCLEAR] of our people. I'm asking that, how would this help health forum, ensure our [UNCLEAR] help our health problem?

DR. MARTIN: Thank you. Thank you very much for that question. The biggest thing about this African Health Forum is it has brought together stakeholders from many different areas, and I think this is the largest issue is we recognize, and I think the world recognizes, that to solve problems, it takes everybody nowadays. It's not just for health to solve the issue, or for water and sanitation, but really, as we see when there are floods, when there are food shortages or food security issues or no access to potable water, as you mentioned, diseases will come. And it's a matter of working together to address this problem and address this issue. And this is something that we have heard at the African Health Forum in the last two days.

The other important thing, I think, that I appreciated from this forum was the focus on youth and the true need to engage youth now, to address the importance of what is needed and to engage them in these efforts in a formalized and standard way so that their voices are heard, they help with the peer-to-peer education, and they are the future of the work and the success of Africa itself. So the importance of engaging the youth has been a very important issue. We've also heard - in the last few days we've heard from private sector, we've heard from civil society, and we heard also from the importance of the military being engaged in these efforts. Security in making sure that food could be safely transported; if there are things that could be built or wells that need to be drilled, how can the military be involved? So the importance that it takes all to do the work and that youth are really the future of how we're going to be doing this on the continent. Thank you.

MODERATOR: Thank you. Our next question has come from Mr. Joachim Neto from Radio Nacional de Angola, in Luanda. He asks, in light of the Forum's theme of “Putting the Person First”, what system should African countries adopt to have more flexible responses to health issues, and what is your assessment of the Angola health system?

DR. MARTIN: Thank you for that question. I'm going to answer the second part first. As you know, as I mentioned with Namibia, and I know that Angola has not conducted the Joint External Evaluation, but I think it would be a good internal and external assessment to do this, and I know that there may be some discussions ongoing to be able, with WHO, to do this. But I do know with the recent yellow fever outbreak last year, there was the response put in place to quickly be able to vaccinate most of Luanda and then to be able to be sure that the borders were protected as well. So I know that there are efforts, but I don't have the full capacity or knowledge to be able to comment on the full health system in Angola right now.

With the theme of “Putting People First”, it really is - and I appreciated your point about the need for flexibility - because what needs to be done, needs to be tailored or needs to be adapted from the lowest level up, because it does require the population that you're serving, how you provide health services to them. And it is for them to help define how they can best receive and access services. So it does take that community engagement, it does take that involvement of the different sectors, as I talked about, to be able to make sure that the systems can be flexible and to meet the needs. And this requires a discussion and a review in each country of what is working best and how to meet the needs of the people. Thank you.

MODERATOR: Thanks. Our next question comes from the listening party in Addis Ababa. Operator, can you open the line, please?

MEDIA: I'd like to know about the new leadership of WHO. Have you met with the - the new head of WHO, who happens to be an African - Ethiopian - Tedros Adhanom, and what has been your impression on some of his ideas going forward? Thank you.

DR. MARTIN: Thank you very much. I did have the opportunity to meet Dr. Tedros a couple weeks ago, and then also during the World Health Assembly in May. As you know, the process for the selection of the Director-General for WHO changed this year for the first time, and the current incoming Director-General only had about six weeks to stand up his transition team before actually taking office on July 1. And with that has been a very short time. And the previous incoming Director-General had up to six months. So I know that he has been working furiously to ensure that he has a very strong and competent transition team, bringing in new voices, as well as the importance of the old voices of people there. I know from talking with him that he has been traveling around the world and listening to different member states to hear about their health issues, their priorities, and I know he's very, very interested in ensuring that how and what WHO does and works on going forward are the priorities of the member states and that they have to be very focused.

Beyond that, I don't want to comment on his next steps until he's done them, but I can say that he has definitely been listening and hearing and he has recognized that there are common themes from member states about the health issues that are needed, but everybody wants to have a strong health system. Everybody wants to make sure that their people are protected and that they have access to good medical care. Thank you.

MODERATOR: Thank you very much. Our next question will come from the listening party in Maseru, Lesotho, at the U.S. Embassy in Maseru. Operator, can you open the line, please?

MODERATOR: I think what I will do is I will read a question that's just come in from Nigeria. The News Agency of Nigeria asks, is the CDC or the World Health Organization considering increasing their intervention efforts in Nigeria, in view of the health conditions produced by the Boko Haram insurgency in the northeast of the country? This question comes from Isaac Aregbesola.

DR. MARTIN: Thank you. As you know, WHO a while back declared a public health emergency with the Nigerian government in the Northern State of Borno State, the northern area. CDC as well as the U.S. government have been providing support for responses as well and in addressing, as I mentioned, in these types of conditions, the infectious diseases that can occur. There has been a meningitis outbreak occurring, there have been wild polio virus that has been discovered, now over 12 months ago, but still making sure that children are vaccinated. And in addition, the Office of Foreign Disaster Assistance with USAID has been working on the humanitarian response very closely with WHO as well. So there has been much effort and the importance of ensuring that Nigerian people, led by the Nigerian government, that the people are protected and are ensured that there is food and safety. But this is an ongoing effort, and we are following the lead of the government of Nigeria. Thank you.

MODERATOR: Thank you very much. I would like to now go to the U.S. Embassy listening party in Windhoek, Namibia for the next question. Operator, can you open the line, please?

MEDIA: Hi, Bianca again from the Embassy. I just wanted to find out whether - generally in Africa there are always a number of outbreaks. We have malaria, we have Ebola, measles polio, as you have mentioned. But what I want to find out is how spontaneously can the CDC supply vaccination or medication, including expertise, should the countries run out of such medications.

DR. MARTIN: So your question - and I think this is where we want to make sure first that countries are being able to prepare and being ready to respond to events so they do not get as big as they could if they are allowed to continue to spread - so the importance of detecting them early and stopping them as efficiently as possible.

Now, on your point, it is through the World Health Organization, mainly through their - depending, but the importance of being able to find vaccine if it's needed to be brought in - it is mainly through WHO that this initial work happens. And the U.S. Centers for Disease Control and Prevention works very closely and works through the World Health Organization in this type of situation. But with the access to the medicines and vaccines, we rely on the leadership of the World Health Organization, and here with the African regional office in Brazzaville, to be able to start the work on that, and we would take the lead to be able to support how we could do that in the best way. But it is very, very important, as you noted, that there is a response quickly, rapidly, and swiftly. This is one of the reasons for the creation, I believe, of the Africa CDC, where it really is about Africans helping Africans. And to be able to ensure that within 24 to 48 hours there can be a response mounted, if needed, if a country needs support, and then have on the continent virtual stockpiles of vaccines or medicines that may be needed in collaboration with the World Health Organization. And this is the plan for the future going forward. Thank you.

MODERATOR: Thank you very much. We are going to try again the U.S. Embassy in Maseru. Operator, can you open the line, please?

MEDIA: Thank you very much. This is [UNCLEAR] from The Post Newspaper based in Lesotho, Maseru. I'd like to know, based on your discussion these past two days with various stakeholders, how valuable will the African Health Forum be in the fight against HIV in sub-Saharan Africa, moving forward?

DR. MARTIN: Thank you for that question. We just had a panel today entitled "Old Foes" or enemies, and HIV, TB, and malaria were discussed. And through the efforts of the universal healthcare coverage, WHO and stakeholders are working to make sure, first of all, that there is access to services, that there is, ensuring that there are the health resources and health financing to sustain efforts once people are on treatment. So with this, there is a strong effort to make sure that people are getting tested for HIV, and if they're positive, that they're put on treatment and that they're monitored, then, for suppression of the virus through laboratory testing. These efforts are ongoing, and the U.S. government is supporting these efforts through the President’s Emergency Plan for AIDS Relief on the continent in many countries.

But at the African Health Forum, the importance, again, as I mentioned, of having the different sectors present, the value of looking at how countries will be able to have innovative financing to sustain and keep people on antiretrovirals will be critical, and then lastly, the value of making sure that everybody has access to being able to be tested and then started on treatment. Thank you.

MODERATOR: Thank you very much. Our next question will go to the listening party at the U.S. Embassy in Addis Ababa, Ethiopia. Operator, can you open the line, please?

MEDIA: Good afternoon, this is Bahiru Yidnekachew from Fana Broadcasting Corporate, a radio station here in Addis Ababa. My question is what is the U.S. CDC lean toward with African Centre for Disease Control and what is the effort of the U.S. from the African CDC so far, and what will be the U.S. CDC's next response to the health situations in South Sudan?

DR. MARTIN: I - I believe the first question was asking about the U.S. Centers for Disease Control relationship with the Africa CDC. Is that correct?


DR. MARTIN: Thank you for that question. To date, we have been supporting the Africa CDC. We have put two of our technical staff in Addis, who are working with the leadership at the Africa CDC in setting up what's called 'event-based surveillance'. And what that means is people are scanning the radios, scanning newspapers, looking at what's happening on the internet and social media, looking for different words or different topics to see if there may be rumors of an event, a public health event or emergency occurring. Maybe somebody says, 'my friend was not feeling well and went to the pharmacy' or 'we have' - you know - 'multiple cases of acute watery diarrhea,' and to be able to use this information, then, to do a proper surveillance investigation before things are - or may not have been - reported to a health facility. So we are working with the Africa CDC in setting up this type of surveillance across the borders of the countries and on the continent.

We also have been supporting through providing funds. Through the year October of 2019 we have committed 10 million U.S. dollars to support the hiring of key staff that will be important for conducting investigations and for surging, when there’s an event, to help countries. The other area that we have been supporting is working on sharing some of our technical knowledge and what can be adapted, both in the laboratory and diagnostics. Thank you.

MODERATOR: Our next question will go to the listening party in Accra, Ghana - the U.S. Embassy in Accra. Operator, can you open the line, please?

MEDIA: Yes, my name is Goodwill Arthur Manesah, I work for the Ghana News Agency, that’s a news agency in Ghana. When the Ebola outbreak occurred in West Africa, even though Ghana did not experience the outbreak, the Ghanaian authority wanted to share the Ebola vaccine in our community, to help [UNCLEAR] so that [UNCLEAR] to be implemented in other regions. But the Ghanaian community, the people were not happy with that because of lack of education among the public. People thought when the vaccination was implemented, that people would be infected with the Ebola virus, so people were kicking against its implementation in that community. So I think - I want to find out - how CDC will help in educating the public regarding this vaccine, because the purpose of this project is to prevent outbreaks, and so if the Ghanaian authority want to prevent future occurrence of disease and they want to carry out this, and I think it's in the right direction, but how to get the people to support it is a problem. So I want your comment on this.

DR. MARTIN: You brought up a very good point. You can have the best intervention, such as a vaccine or medicine, but it is up to a person to take that, and it is up to a community to decide that they want to implement, and so the role of the individual and the engagement of community is so critical, both in prevention, and also when there’s an outbreak or an emergency occurring. We saw this also very clearly with burial practices in the three countries, which was not going along with tradition, and so then they started to hide information, and there was more disease spread. So the importance of really talking to the community, finding out who are the key influencers, how to make sure that people understand, and then can translate that to their communities about the information, about why this is important, why it is of value to them, and to find ways not to disrupt cultures or traditions, but to see ways that you can still work with this but recognizing the value of the intervention.

With vaccines, this is always an issue, especially, as you said, there was no Ebola in Ghana. So the importance of understanding why a vaccine may need to be tested in terms of a trial to get data to understand how the vaccine works, how it can protect. All of this requires much planning in terms of the communication component. Working with the communities and the people beforehand, answering questions, and making sure that they understand the value of this, as well, in the way that they’re able to comprehend, and to assert in their values of what they're doing with their lives. So the communications piece cannot be left until the end, it needs to be started at the same time when you want to look at vaccine introduction, and it requires ongoing information, being very open and developing that trust so that there can be future engagement and being accepting of different interventions. Thank you.

MODERATOR: Thank you very much. We have time for only one last question, I'm sorry, there are a few more on the line, so I would encourage you to submit your questions and we will send them to Dr. Martin via email and get a response. Our last question comes from Nigeria, from Isaac Aregbesola from the News Agency of Nigeria. He asks, how was the response to the reports of Ebola in the DRC some months ago? Was it sufficient to curb the outbreak, and did the response utilize lessons learned from the outbreak in West Africa?

DR. MARTIN: That's a really good question, because I think one of the most important things is that we do make sure countries share best practices and lessons learned, and as you may know, DR Congo has had many outbreaks of Ebola before the outbreaks that occurred in West Africa. And most of the knowledge that we had was from outbreaks in Uganda and in DR Congo, and the assumption had been - most of these outbreaks had been in very rural areas, and there was always a way to prevent and then finally stop them. When we saw Ebola get into crowded cities, and the continual spread, and then, as I mentioned, the opportunity for air travel to multiple countries, this is when the threat becomes quite large.

DR Congo was able to send some of their - and I’ll call them - they definitely aren’t experts - but people from health facilities and from communities, who knew how to deal with this, in terms of the prevention measures - of the burial, of the Ebola treatment unit, about when a patient comes in, how to handle a patient, and making sure that the personal protective equipment is worn. Also, the laboratory diagnostics and getting specimens. So, much of the things that then happened in West Africa were actually learned from DR Congo. But I think when it came time now, when this outbreak occurred most recently in the northern part of DR Congo, within five days - it was in a very remote area - and it took them five days to get specimens and to get the results that it was Ebola virus. But within ten days, they had a team from the national center and from the province, go to this area and from Bas-Uele, and they were able to go in there and be able to set up a system and to help the community. So the more rapid response that they had, having to be able to put a team together, they moved in mobile laboratories, which were learned during the Ebola outbreak in West Africa, how we could set up mobile laboratories to do the testing on site, because as I said it took five days to get the specimens to Kinshasa for testing. So one of the things learned was the mobile laboratories, and then the lessons learned that they had from their previous outbreaks, they put in place rapidly. Thank you.

MODERATOR: Thank you very much, and I appreciate an extra few minutes you've provided to us for all the questions, and we did not even get to the bottom of the well. But with that, Dr. Martin, do you have any final words to close today’s call?

DR. MARTIN: I again just want to thank all of you for your interest in this very important topic of what's happening in health in Africa and protecting Africans. I did want to mention a few statistics, because I think it’s important to recognize that every year, the estimated, that we have a U.S. 60 billion dollar loss due to outbreaks that occur or public health emergencies. And for only U.S. 65 cents - less than a dollar - if we spent that money in prevention, we could make sure that outbreaks would not occur. So comparing a 60 billion dollar loss in economies and in deaths, to a 4.5 billion investment annually - and that’s every individual in the world, that prevention is much more efficient and cost-effective than being able to respond to outbreaks, which cost a lot more money.

And lastly, just to note that we do not know where, when, or how the next large epidemic may occur, but we do know that there will be one. And we need to make sure that every country is prepared and can respond rapidly. And this is the important work that we are doing with U.S. Government, with many countries of the world, with World Health Organization, and it will take everybody to be able to meet this, from civil society and community up to international organizations, to do this. Thank you so much for your time today, I really appreciate it.

MODERATOR: Great, and thank you. That concludes today’s call, and I want to thank Dr. Rebecca Martin, Director of the Center for Global Health at the U.S. Centers for Disease Control and Prevention for joining us, and to thank all of our callers for participating. If you have any questions about today's call, you may contact the Africa Regional Media Hub at Thank you.