The U.S. Approach to Global Health Challenges: Confronting Pandemics, Bio- and Natural Disasters

Assistant Secretary for Health Admiral John O. Agwunobi
U.S. Department of Health and Human Services
Tokyo American Center
July 25, 2006

A/S AGWUNOBI: Good afternoon, everyone. I bring greetings from my immediate supervisor, Secretary Michael Leavitt, the secretary for the Department of Health and Human Services. I also bring greetings from President George Bush, who runs our administration.

It is absolutely an honor to be here today to address this distinguished group. I recognize that there are many individuals from many different backgrounds, and I also recognize that your being here is recognition of the fact that the subjects of avian influenza, pandemic influenza, and the need to prepare are very important to many of us. From the US government's perspective, domestic and international health are closely linked. Coordinated efforts in disease surveillance, outbreak investigation, research, prevention, and disease control activities are all very important. They are priorities for our respective governments. The fact is, that no single nation can go at it alone as we address these challenges.

And it's also not just about governments; it's about involving the private sector, nongovernmental organizations, intergovernmental organizations, and of course, public-private partnerships. A united approach is required to address and mitigate the effects of the highest-priority disease threats, and I appreciate this opportunity to discuss some of these things with you.

I've spent two or three days here visiting with some of the finest scientists and leaders in this part of the world. And I have come to realize that the partnership between the US and Japan, between Japan and the US - that that partnership is a very valuable partnership. Our nations have worked together for many years through the US-Japan Common Agenda. The Common Agenda - a bilateral partnership to address critical global challenges - has been highly successful. Projects under this agenda include or embrace: global health, overpopulation, environmental degradation, and of course, reductions in damage to the many natural disasters that have occurred.

Since 1999, the US Centers for Disease Control and Prevention, which is within the Department of Health and Human Services in the US, has collaborated with the Japanese Ministry of Health to strengthen infectious disease surveillance, outbreak response, and other public health interventions. And one of those significant outcomes from that partnership is the Japanese field epidemiology training program. I visited today and found it to be a wonderful program. I visited with many of the leaders in the institute, and we're very proud of the work that they do. We recognize that that course has trained many epidemiologists to work in the field. And they are some of the finest in the field of epidemiology. We share a common mission: to improve the health and safety of all our citizens. Together we can and must find sustainable solutions to the health challenges that we face together. For example, the United States supports a strong, unified G-8 leadership role, and as I've said, we recognize that the unique partnership that exists between Japan and the US within the G-8 leadership is a very critical and important part of that.

Our strategic objectives are many, but some of the main ones include: our recommitment to existing international goals on HIV/AIDS, tuberculosis, malaria, polio, and measles. As we take on these newer challenges of SARS and avian influenza, we have to be sure not to forget that there are many diseases today that ravage many parts of the world, and they are not insignificant and require our unwavering commitment. An endorsement of voluntary, early adoption of the revised International Health Regulations is an important part of our strategy. And we believe that universal adherence to the international standards on the surveillance of and response to infectious disease is very important. A strong coordinated international effort against the new threat of avian and pandemic influenza is something that I think we share with you, and we'll talk a little bit more about avian influenza in just a second.

Now, Mr. Jamison mentioned that prior to joining the federal government, I served as a state health officer in Florida, which is a small state in the United States of America. In that position, which I served in from October 2001 until September 2005, I faced a number of public health crises. Those included, if I recall properly, anthrax. The first intentional anthrax attack in the United States was discovered in Palm Beach, Florida, when I was the state health officer. In fact, it was identified the day after I started that job. I also faced during my tenure there, a number of other disease situations. SARS was first identified while I served in that capacity. Hurricanes, we had quite a number. You call them typhoons here. I remember 2004, we had four hurricanes that swept across that state while I served as the secretary, and as you can imagine there were a number of health and medical requirements that I had to help lead and arrange for. I learned a number of experiences. I learned that you have to prepare ahead of time. You have to exercise those plans ahead of time, if you ever hope to be able to respond to severe crises. I learned that even though we hope for the best, that hope is not a strategy. Hope and prayer are not plans. You have to be willing to think about the worst-case scenario, the unthinkable, if you ever hope to be ready for crises.

As we prepare for the crisis, the next disaster, as we look out into the future, it's quite clear to many of us in this room and back home, that biodisasters and natural disasters - hurricanes earthquakes, floods, fires - that they all differ even as they share the similarity of the need for planning and preparedness. They all have essential differences. Pandemics, for example, are somewhat different than hurricanes, as you can imagine, but not just in terms of the source of the threat, but also because of a few unique characteristics that I want to go into.

Most natural disasters are confined, like a hurricane, a typhoon, confined to a particular region or to a particular time. Pandemics, on the other had, can last a year, a year-and-a-half. Pandemics have a tendency to affect many communities simultaneously. A pandemic could have happened in Miami, in London, in Brasilia, in Moscow, in Bangkok, and in Tokyo all at the same time. It is therefore important, that we not build into the strategy - the response, the plan, the notion - that somebody will come to our rescue. A pandemic would be happening in thousands of communities across the world simultaneously.

As I travel the United States, I often deliver a message that is not meant to be depressing, but it is meant to inspire preparation, and that message is that any community that fails to prepare with the expectation that a government will be able to step in and save them - rush to their aid at the last moment - will be sadly disappointed. And the reason I say that is because I want every community in the United States - every local community, every state, every business - to have their own plan, their own preparation coordinated by the government, resourced by the government, supported by the government. But no community can afford not to have a plan. There's no way that any government will be able to reach out to every community at the same time simultaneously. Thousands of communities? There's just no way. It's not because we don't have the money. It's not because we don't have the will. It's because there's just no way. It's impractical. So local preparedness, individual preparedness, are all an important part of our strategy.

A pandemic occurs over a prolonged period of time, so every plan has to have the ability to sustain for a year or for two. As you prepare for a pandemic, it's important that we recognize that business, and life, and the ongoing needs of a society have to be provided and continued through a pandemic. You can't turn everything off while you respond to the challenge a pandemic brings. You have to be able to continue and sustain your societal needs.

Pandemics are a fact of life and I think it's important that, as we go about our planning and our preparedness for pandemics, that we recognize that they are as natural as many other natural disasters. Earthquakes and hurricanes occur because of nature. Pandemics and the evolution of viruses that result in pandemics are also a natural part of living on this planet. It's therefore important that planning and preparedness becomes a natural part of living on this planet.

Pandemics are a part of our history, and I think we're guaranteed that they will be a part of our future. There's no reason to believe that the next century will be any different than the last, and as you know, we've had three pandemics in the last 100 years. It's entirely likely that we will have pandemics in the future. It's obviously impossible to predict when. I've been asked often what I sense are the challenges that we face, what worries me the most about our preparedness. Two things come to mind. Number one, will we be ready in time? Will we have the ability to quickly be able to sustain the increase in demand for health services and medical services? Will we get to that point of readiness fast enough? My other concern is will we be able to sustain that readiness for a long period of time into the future as we rush to prepare. When we get there, will we be able to maintain that state of preparedness into the future? There are many things that are associated with pandemic influenza preparedness: border closures, quarantines, vaccines, stockpiles. When we get there, will it be a state of preparedness that we can maintain into the future?

H5N1 is here today, and we are worried about it. In the United States, a lot of time and energy, a lot of science and investment, has been placed into pandemic preparedness because of our worries about H5N1. The virus raises concerns for a number of reasons. The fact that it's especially virulent is one. The fact that it spreads so easily in birds is another. We're worried by the fact that it seems to transmit from birds to other mammals, and we're worried by the fact that the virus continues to evolve. We're saddened by the tragedy and the loss that we see in terms of human cases that occasionally occur. As we see the growing number of H5N1 cases, we realize that although avian influenza is not a pandemic, it is a significant source of public health worry. There hasn't been, as you know, sustained human-to-human transmission. And we are concerned that if H5N1 continues to evolve, that it could one day become a virus capable of efficient human-to-human transmission.

The entire world faces these challenges together, and it's clear that nations must join together to ensure our ability to prepare. We must join in scientific cooperation, we must join in our rapid reporting of cases. It's important that we be transparent with the information and the data that we gather in surveillance. It's important that, as a global community, that we prepare together. To prepare on a global level, President Bush launched the International Partnership on Avian and Pandemic Influenza at the United Nations General Assembly in September 2005. Japan was one of the founding members and has remained a strong and committed partner in this particular initiative. The partnership is designed to increase cooperation and participation amongst its partner countries, and it includes the World Health Organization, the FAO, and of course the World Organization for Animal Health. IPAPI, the International Partnership on Avian and Pandemic Influenza, agreed at its very first meeting in Washington, DC, in October 2005, to elevate pandemic influenza on the national agendas. Japan has done that, and so has the US. Many nations have followed your lead - our lead. We agreed to coordinate efforts amongst donor and affected nations to mobilize and leverage resources globally to increase transparency, as I've said, in disease reporting and surveillance, and to build lab capacity around the world.

We've done an awful lot since then, since October 2005. I know Japan works diligently and hard to prepare not only its nation but the entire region in preparation for pandemic influenza. President Bush recently invested $1 billion through the US Department of Health and Human Services in the accelerated development of cell-based production, a new technology for influenza vaccine production. Other investments were placed in a way that will help modernize and strengthen the nation's egg-based influenza vaccine production.

You know, but when all is said and done, it'll be about individual preparedness, it'll be about regional preparedness, it'll be about international cooperation. These are all essential pillars in the preparation for a pandemic. We must continue to commit to transparency, scientific cooperation, and the rapid reporting of human and animal cases. The sharing of data is a critical part of our ability to respond to global crises.

One of the duties of my office, and one of my greatest challenges, is to help the American people understand not just the critical nature of public health issues but also how our nation is linked to all of the others around the world. Global health and international health issues are critical to everyone at home. Our world is more interdependent, and illness abroad is so much more easily transmitted into our nation than it was hundreds of years ago. With international travel, with viruses in birds flying over borders, the diseases of today know no boundaries. Our human population is so mobile and interacts so frequently with the animal kingdom that we can expect future emerging diseases. It's a small world, after all.

Now technology has enabled mankind to reach places around the world that perhaps we couldn't have gone before. The fact that we travel so quickly around the planet helps facilitate the spread of disease, but it also helps facilitate our response. It's important that we recognize that, as we are developed, and as science is something we've come to learn and harness, that we remember to take it to those nations that don't have resources, to the poorest communities around the world. As public health professionals and journalists and policymakers, we know that the great impact of global health needs to be translated into global action. We need to inform our citizens and to serve as partners. With cures on the horizons for many diseases that were once thought to be incurable, we must provide the necessary incentives to spur innovation and to make these solutions happen.

Today, we stand together at the edge of a new frontier. The distance perhaps seems daunting, and some of the obstacles may seem insurmountable. The challenges that await will test our resources and try our resolve, but I am persuaded that we will have the will, that we have the way, and that together, we can make health and safety a reality for all. I'll end by saying this: I have learned so much during my two or three days here in Japan. I've learned about the technological advances that are being made in clinical science. I've learned about the depth and the strength of the scientists. I've learned about the commitment and the passion of Japanese policymakers and leaders. But I've also learned about the importance of the partnership that exists between Japan and the US. And as I return to my homeland in the coming days, I will be sure to urge our leadership to do everything in its power to support you in your efforts to be the leaders that you are in this region. I'm proud and honored to have made your acquaintance. Thank you.