CDC Strategy for Global Response to COVID-19 (2020-2023)

Goals

The goals of CDC’s strategy for global response to COVID-19 include:

1. Reduce transmission of SARS-CoV-2 (the virus responsible for COVID-19) and impact of COVID-19 globally;
2. Expand scientific knowledge of SARS-CoV-2 and strengthen global public health leadership; and
3. Improve long-term health security in low- and middle-income countries.

Key Principles

As the lead U.S. public health agency, CDC achieves these global goals by relying on key principles to guide our work and leveraging our expertise in collecting data (disease surveillance and laboratory), analyzing data (analytics), and making public health decisions using data (outbreak response).

• Serve as credible scientific and technical experts with international partners and partner country governments for COVID-19 science and public health practice:
  • Serve as a global reference laboratory for SARS-CoV-2 surveillance, diagnostics, and strain monitoring;
  • Serve as a global leader in developing sound, evidence-based recommendations for the control of COVID-19;
  • Support science-based policy at international, regional, and country levels.
• Promote and ensure health equity among all populations, especially children and disproportionately affected groups, as a central tenet to the global COVID-19 response.
• Provide technical support in coordination with other USG agencies and stakeholders, including multilateral organizations, to reduce the impact of COVID-19 on groups disproportionately affected groups.
• Establish, maintain, and expand new global (multilateral), regional, and local (country-specific) partnerships to enhance and create networks and systems to detect and respond to potential pandemics.
• Work as part of a unified USG response to COVID-19, including working closely with the Department of State (DoS) to protect U.S. citizens and American assets at home and abroad.
• Encourage and facilitate bi-directional learning between the U.S. and international partners, sharing scientific knowledge and best practices with collaborators participating in the U.S. domestic and global COVID-19 response.
• Establish and strengthen sustainable country, regional, and international public health systems, ensuring that COVID-19 specific systems build on, or link to, existing public health systems.
• Leverage CDC’s existing global health programs, partners, international footprint and infrastructure.
• Work with key partners and ministries of health to protect critical public health programs.

Strategic Objectives

1. Strengthen capacity to plan for and deliver COVID-19 vaccines and therapeutics and to evaluate vaccines and vaccination and treatment programs using timely and accurate data.
2. Strengthen capacity at country and regional levels to prevent, detect, and respond to COVID-19 cases and future pandemic threats by strengthening the global public health workforce; supporting approaches to prevention and treatment; strengthening surveillance and laboratory systems for SARS-CoV-2, other respiratory viruses, and emerging threats; and modernizing data systems to ensure that timely and accurate data are available to inform public health decision-making.
3. Prevent and mitigate COVID-19 transmission across borders, in communities, in healthcare facilities, and among healthcare workers, and minimize disruptions to essential health services to protect critical public health programs.
4. Contribute to the scientific understanding of COVID-19, other pandemics, and emerging threats, and address critical unknowns regarding mutations, clinical severity, modes of transmission, and long-term sequelae and immunity.
5. Strengthen the global health architecture working with multilateral and multisectoral partners to augment surveillance, laboratories, alert systems, and capacities for early and effective prevention, detection, and response to potential health emergencies.

Annex: Key Activities

Note: This list demonstrates examples of activities for each strategic objective. The list is not comprehensive and does not imply funding support for any specific activity.

1. Strengthen capacity to plan for and deliver COVID-19 vaccines and to evaluate vaccines and vaccination programs using timely and accurate data.
   • Accelerate global COVID-19 vaccinations through Global VAX, a whole-of-U.S. government effort to turn vaccines in vials into vaccinations in arms around the world.
   • Support and strengthen national immunization advisory groups in evidence-based policy making.
   • Support vaccine program planning, including microplanning.
   • Provide technical expertise and resources to strengthen the capacity of the immunization workforce to deliver COVID-19 vaccines.
   • Strengthen systems for reporting data on vaccinations and for detecting, reporting on, and responding to adverse events following immunization.
   • Improve vaccine confidence and demand for COVID-19 vaccines.
   • Evaluate the effectiveness of vaccines, including in different combinations and in different contexts and as viruses evolve and mutate.
   • Evaluate the quality and effectiveness of vaccination programs.
2. Strengthen capacity at country and regional levels to prevent, detect, and respond to COVID-19 cases and future pandemic threats by strengthening the global public health workforce; strengthening surveillance and laboratory systems for SARS-CoV-2, other respiratory viruses, and emerging threats; and modernizing data systems to ensure that timely and accurate data are available to inform public health decision-making.
   • Increase capacity to detect, investigate, report, and respond to COVID-19 transmission.
     • Provide technical support to partner governments through their Ministries of Health, other relevant ministries, international or national organizations and agencies responsible for human health, animal health, and public-health emergency preparedness to reduce the impact of COVID-19 on groups disproportionately affected.
     • Increase the capacity of national and local level surveillance and laboratory systems, including strengthening existing respiratory disease surveillance platforms, to detect and report priority pathogens and perform appropriate genetic sequence analysis.
     • Support countries’ development and deployment of health information systems to facilitate the timely collection, management, and analysis, and sharing of critical public health data.
     • Support training of critical field epidemiologists to analyze and interpret surveillance data and to investigate, track, and contain outbreaks.
     • Support critical training of laboratorians to ensure timely and accurate laboratory diagnosis and reporting.
     • Support training and capacity building of data scientists who can analyze and interpret epidemiology and laboratory data to inform decision-making.
     • Support countries’ timely sharing of surveillance and epidemiologic data across all relevant sectors to rapidly identify and disseminate knowledge and build upon the evidence base for successful intervention.
     • Support country capacity to prioritize, administer, and monitor adverse reactions to and efficacy of therapeutic agents.
     • Strengthen border health security, planning, and surveillance at ports of entry.
     • Support countries to develop and implement public health policies, laws, and regulations necessary—including quarantine, isolation, and mitigation measures—to prevent, detect, and respond to health threats.
     • Promote international coordination as regulatory frameworks are evaluated to ensure responsiveness to emerging and re-emerging infectious diseases.
     • Improve coordination and management of the COVID-19 response through a One Health approach that strengthens preparedness activities across human, animal, and environmental health sectors.
       • Strengthen animal health surveillance systems, including reporting and linkage to human health programs to prevent unnecessary spillover.
       • Identify risks associated with zoonotic disease transmission (e.g., occupation, animal ownership, livestock, place of residence near wildlife).
       • Collaborate with international partners to identify animal species involved in COVID-19 spillover to humans (reservoir host or intermediate host).
       • Assess virus prevalence in various species of animals (reservoirs(s) and possible intermediate host(s)).
       • Identify and describe possible transmission modes of COVID-19 between animals and humans.
       • Develop risk reduction strategies for preventing disease transmission between animals and humans, as well as between different animal species.
       • Support global animal health partners for the development of animal diagnostic tests, including serological tests for animal population screening.
       • Support development and use of integrated One Health surveillance systems for reporting and responding to animals infected with SARS-CoV-2 (and with other pathogens).
       • Support global One Health partners, including: the Food and Agriculture Organization (FAO), the World Organization for Animal Health (OIE), and the World Health Organization (WHO) Tripartite in developing guidance and building capacity on the human-animal-environment aspects of COVID-19 and other zoonotic diseases.
       • Support training and capacity building in the animal health workforce and strengthen linkages with the human health sector.
3. Prevent and mitigate COVID-19 transmission across borders, in the community, in healthcare facilities, and among healthcare workers, and minimize disruptions to essential health services to protect critical public health programs.
   • Mitigate COVID-19 transmission in communities.
     • Facilitate activities to reduce spread of COVID-19 within communities.
     • Support contact tracing activities.
     • Support mitigation activities that address those at higher risk for serious illness from COVID-19.
     • Support risk and media communications addressing mis- and dis-information, particularly reaching populations with low adherence to mitigation recommendations.
     • Support water, sanitation, and hygiene activities, targeting groups experiencing limited access to clean water.
     • Support the development and implementation of appropriate mitigation activities for refugees, displaced persons, and other under-resourced communities.
     • Provide direct assistance to country governments to support screening operations and bolster border health systems at priority points of entry (POE).
     • Map and analyze trends in population mobility to anticipate and respond to COVID-19 and other infectious disease outbreaks through targeted interventions.
     • Evaluate the impact and adherence levels of recommended mitigation measures and share lessons learned across countries.
     • Evaluate the impact of non-pharmaceutical interventions to support development of evidence-based recommendations.
       • Support critical needs of healthcare facilities, healthcare workers, and public health personnel and minimize disruptions to essential health services.
     • Develop and implement approaches to rapidly identify, triage, and isolate suspected and confirmed COVID-19 among patients, healthcare workers, and visitors to reduce healthcare-associated virus spread.
     • Provide practical laboratory platforms, including for genetic sequencing, and point-of-care/point-of-need diagnostics to improve the detection and differential diagnosis of SARS-CoV-2 infection and other respiratory viruses.
     • Strengthen infection prevention and control policies and procedures in rural and urban healthcare settings.
     • Build on existing infection prevention and control to coordinate and accelerate implementation.
     • Improve situational awareness of critical information in the healthcare system, such as preparedness, supplies, equipment, and capacity.
     • Facilitate the safe and respectful management of human remains.
     • Support and evaluate clinical mitigation activities to keep health services from being overwhelmed by COVID-19 patients.
     • Develop operational guidance for maintaining essential health services and public health activities during the COVID-19 pandemic.
     • Communicate with essential public health service recipients about the safety and importance of continuing to seek and receive health services.
     • Secure commodities including personal protective equipment (PPE) and laboratory diagnostics to maintain health services and public health programs.
     • Coordinate closely between essential health services—such as diagnostic and curative services for malaria and neglected tropical diseases, immunization services, HIV/TB programs, and maternal and child health programs, and COVID-19 programs—during activity planning to modify strategies that ensure COVID-19 precautions, implement protocols for protecting health workers, and apply mitigation measures for targeted communities.
     • Develop infection prevention and control guidance for healthcare providers, including vaccinators and TB service providers on how to safely undertake patient-centered work in the COVID-19 environment.
     • Expand differentiated service delivery models to increase access to lifesaving medical countermeasures — such as antiretroviral treatment for people living with HIV or combination antibiotic regimens for people with active TB cases — through multi-month medication dispensing, community-based delivery options, and increasing clinic hours.
     • Use effective online modules to continue workforce training and expand telehealth services.
   • Develop and implement strategies to ensure access to critical health services (multi-month dispensing, passes that allow attendance at clinic appointments).
   • Promote vaccination and provide training and supplies to health care workers to reduce the occupational risk of COVID-19.
   • Support clear health communications that facilitate appropriate care seeking.
   • Monitor progress in critical health programs and the impact of the COVID-19 pandemic on such programs.
4. Contribute to the scientific understanding of COVID-19, other pandemics, and emerging threats and address critical unknowns regarding mutations, clinical severity, modes of transmission, and long-term sequelae and immunity.
   • Collaborate with partner countries and organizations to study transmission and conduct modeling to guide prevention and control measures and build research capacity.
   • Conduct and participate in therapeutic and vaccine clinical trials as appropriate.
   • Collect and report data to provide critical information on the clinical course and outcomes of COVID-19 and use that information to improve clinical care.
   • Support countries’ timely sharing of research data.
   • Evaluate and assess mitigation measures, strengthen surveillance, and use evaluations to improve programs and surveillance systems.
   • Evaluate impact of preventive or protective interventions.
   • Improve pathogen identification and characterization using next-generation sequencing and other advanced molecular technologies.
   • Monitor long-term impacts for people infected with SARS-CoV-2.
   • Collaborate with partner countries and organizations to identify approaches to minimize the impact of COVID-19 on critical public health programs.
   • Contribute to the scientific understanding of COVID-19 and address crucial unknowns regarding clinical severity, extent and pathways of transmission, and infection with support for special investigations.
   • Minimize or mitigate misinformation and disinformation that undermines scientific evidence, understanding, and trust between communities and local public health authorities.
5. Strengthen the global health architecture, working with multilateral and multisectoral partners to augment surveillance, laboratories, alert systems, and capacities for early and effective prevention, detection, and response to potential health emergencies.
   • Broaden global respiratory surveillance activities by building on and enhancing the Global Influenza Surveillance and Response System (GISRS) in collaboration with WHO.
   • Address gaps in core public health systems by developing sustainable, systems-based approaches through National Public Health Institutes.
   • Support WHO and other international organizations as they provide guidance for building International Health Regulations (IHR) core capacities.
   • Participate in the development of a new pandemic preparedness instrument and strengthen IHR reporting to improve early and effective prevention, detection, and response to health emergencies.
   • Support development and implementation of tools to assess health security gaps and plans/approaches to address gaps following the assessment.
   • Provide technical expertise through bilateral partnerships and international efforts that support country efforts to build health security capacity.