congress rerntuesday for legislative business and boats. the house is back at no eastern. later in the week, lawmakers will vote on legislation to reauthorize the faa proamfor five years. current programsreet to expire friday at midnight. winners will also consider retiring event ticket sells to disclose total ticket prices, including fees. the soonest back at 3:00 p.m. eastern. send will vote on execute and judicial nominations for u.s. district and cir courts. watch veoverage of the house on c-spa t senate on c-span2 , and you can watch all of our coressional coverage with our free video app, c-span now, or online at c-span.org. >> next, look at current health threats and lessons learned from the covid-19 pandemic.

we will hear from senior cdc officials and agencies former director. the center for strategic international studies hosted this event. >> welcome to this discussion. i'm very pleased to introduce our guest in a moment. were going to be discussing the

evolution of our integrated strategies. i'm wearing a different hat in the context of this meeting as the cochair of the bipartisan alliance on global health security. i welcome you and i will make sure there is time for questions at the end of our discussion, so be prepared for that as well if you'd like to participate in the conversation. we also welcome our online guests to this discussion. so why are we here? we are operating under the basic premise that cdc has a critical role to play in international security.

we try to be productive in helping the cvc build its capacity in this regard and really look at what is necessary for the cvc two 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 from johns hopkins university that really examines what was going on at cvc, what were the opportunities for improvement, what were the strengths, where investments needed, both actions by cdc but actions on behalf of cvc to really respond to what i think was the soundbite from the working groups report that cdc is in peril, and yet it is so important to our national security that it was an urgent priority to step forward and try to understand what can be done.

a report was published on building the cdc the country needs. there were many stakeholders and experts who participated in this working group report. one of the things you will hear today if you saw that report is that our leaders from the cvc have already taken steps to respond to some of the recommendations in the report, particularly two recommendations that specifically address global health issues. first and foremost, what really was the best way to integrate cdc's global health work with its domestic bio security agenda. and second, what were the investments, the budget, the workforce, the practical policy authorities, 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 take a moment to highlight some of those areas of progress. in particular, the cdc director has been very visible globally as have some of the cdc leaders who are here today. regional offices have been open around the world to try to coordinate cvc's agenda, particularly its global security agenda, and specific investments have been made. what was probably most exciting for us was the recognition that the whole is greater than the sum of its parts. we can move them in a direction where we have a more powerful, a more successful global agenda. let me introduce our panelists. i like to start by introducing the director of the global health center at cdc. sitting to her left is the

director of the national centers for emerging infectious diseases. how do you pronounce that? [laughter] she is checking. to the left is the director of the national center for immunization and respiratory diseases, and a leader in the hiv arena, and someone i have long held in highest esteem. finally at the other end of the panel is the director of the office of readiness and response , someone who is in the hot seat during covid but continues to provide a really unique frame of leadership for the cvc. i like to maybe give our panelists a chance to say a few words, really focusing not so

much on what is ahead in the context of the strategy, but what has already been accomplished, but actions have you taken maybe since january of 2023 when the report came out, but in the recent months that really are moving us in a new direction. kayla, i will start with you because you probably have the view of the overall strategy. >> thank you so much, and thanks to everyone for being here and everyone online. today we wanted to talk a little bit about sort of a unifying framework for cdc's global health work. really fits into the cvc directors 2024 priorities of readiness and response, to look at data infrastructure and modernization, quality and safety and overall prioritization. so the global framework with

those larger priorities. we have learned a lot from covid, both domestically and globally. 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. our global work leverages many of the platforms that we work in overseas, much of the work we do with the president's malaria initiative or the work with influenza, all of that global work we leverage both for the vertical programs, but also horizontally, to have system strengths for our global work. when we work overseas, we have over 60 country offices and six regional offices. we really work shoulder to shoulder with ministries and governments and with the community in the countries where we are, and we really have a

trusted partnership and for that reason we are the first call when something happens. we've seen that repeatedly, and especially since covid. but that has been going on for decades. so it is really important that we frame our work. what we have done is put together a global strategic framework, its elements are not new and the capacity and mission and vision globally or not new. but there is a new way of framing and ensuring that across the entire agency, across all of our different programs and in our country and regional offices, we are all working together, pushing in the same way to be the most effective, the most efficient and you have the most impact. the framework really has four major goals to why we are working overseas. the first goal is to stop health risks at their source.

that is cdc's really fundamental goal, stopping outbreaks at their source so they don't live anywhere, or to the u.s.. the second is to prevent or contain disruptive outbreaks. it's very disruptive to societies, two economies, to the health of nations, and it's very important to work on that. the third goal is really around global knowledge and how we can use it both globally and domestically. that something like our influenza strains that we know from around the world that go into our vaccines, and that global knowledge of disease elsewhere and how we use it domestically. the fourth and final goal is really the platforms that we build that really prevent mortality. that's the pep far, the malaria, the flu, to reduce morbidity and

reduce mortality, but also serve as a platform where we build system strength so that we can then respond to outbreaks, that we give clinics and training and that helps with all our work overseas. there are six pillars that get us to those goals. data and surveillance, laboratories, prevention and response, innovation and research. workforce and institutions, and communication, policy, and diplomacy. through all those pillars of work, we reach those goes. we want to share with you the ways the recent outbreaks are showing how we are using that framework, working within that frame globally, and how it connects to our domestic work and vice versa.

>> when i am struck by in this conversation is that none of this has a disease name. you are talking about the crosscutting capacities and capabilities that distinguish the cdc's expertise that you can apply to whatever the threat is, domestic or global. we certainly have plenty of those in play right now. i thought maybe i would ask dan to start talking about mpox and how that is playing out and how this approach is illustrated in the context of this arguably primarily global outbreak, but certainly with u.s. implications as well. >> sure. mpox is one of the pathogens that requires the all of agency activity forced to be able to respond to it. we did have cases previously, 30,000 in the united states. but we have right now is

something happening in the democratic republic of congo which has a higher severity and higher transmissibility. we are seeing about 4000 cases from the first part of this year. it really demonstrates the threats we have with emerging infections. the world is more connected than ever. you can get from the democratic republic of congo just anywhere in the world within the incubation period. the world is more crowded than ever before, and the worlds of animals and humans are converging like never before. right now, mpox is showing that come rodents getting it to kids, kids getting it within the family. you can have sexual transmission and then get outside the drc. we want to have that capability inside the united states to have diagnostic tests, to have the right surveillance in place. this framework really helps us see what data we need both in

the united states and for the things in the drc. both the coordination between the country teams, the experts that are being deployed, the laboratories we have in the united states. we need to think of this across the spectrum, domestic all the way to global so that we are not thinking in one place or another, but thinking across the spectrum, and how do we use the breath of all the capabilities we have across these different centers and across the usg in order for us to have the most optimal response had keep mpox from coming in and causing another set of cases in the u.s. >> potential even worse. and in thinking about how you actually implement that response , one of our greatest strengths globally is deplatform. dimitri, can you say a little bit about how that vertical gets leveraged in the context of this new strategy? >> sure, and i will say it was remarkable seeing it in action

for mpox in cambodia. i thought it was really important to see how that was leveraged globally. it was reflective on how the work happened domestically during the outbreak. still thinking about cap far -- about pepfar, looking at the hiv platform globally and domestically to really up reach communities that need to be reach, but also address some of the gaps that are well-known in hiv treatment and prevention and how that speaks to the populations that were having the worst outcomes for mpox. it is in the image of this framework where we are, in a disease agnostic way, stepping back and saying what did you leverage and how far can we push it.

that is some of the great leadership michaela has shown. it demonstrates the importance of saying where can we leverage, where do we have infrastructure like influenza, which is now the center that i work over. how can we leverage that not only for our seasonal flu but also our more emergent or urgent passages we are seeing, and also in a more pan-respiratory fashion? it really is a package in agnostic strategy. how can you leverage the platforms? how can you look at the laboratories? and really make those systems work together to achieve a better public health outcome? >> i think we all realized in covid how important the pepfar assessments were as well as the global fund investments in countries that did not have infrastructure for laboratory and surveillance and the

capacity to understand pcr and convert it into tools for covid, etc. that is kind of an occult knowledge, because not most americans understand that was incredibly important in supporting the outbreak response in many countries, and it was the value from that investment i don't think we predicted back when george bush implemented pepfar. sometimes that leveraging capability gets is far more than we bargained for. we will come back to the issue of funding and budget. what i want to bring henry into this conversation a little bit. we have another very worrisome situation emerging in the u.s., the avian influenza. if you are a bird, it is a pandemic. certainly, even this week, we learned that pigeons, which were thought not to be susceptible to h5n1, now, at least in michigan,

they have been shown to have been infected. but i want to talk about dairy cattle, because i know that is what is on people's mind. you are the head of the preparedness and response center at cdc. what is going on in your center, both domestically and internationally in this context of this outbreak? >> domestically, we at the cdc are trying to coordinate together a us multiple centers -- across multiple centers. it was actually in dimitri's center we re-stood up a management system to coordinate all the activities. there has been one case in texas, a human case, so far. it is detected in multiple herds across the u.s. it requires collaboration with other sectors to ensure that milk is safe. this is an interagency collaboration. not only this particular

outbreak, but as it was in ebola, in zika, and mpox. it is not just the cdc coordinating within itself, but it is also the cdc coordinating across hhs and across interagency. domestically, the usda has the lead on the animal side. we obviously have a leading role on the domestic side. we continue to try to investigate potential cases on farms, but it has been quite difficult to get access to some of those farms and understand the epidemiology and where the risk is. we are supporting the states, supporting this migrant population that is working. the farms are a difficult population to reach, so we are working with different organizations to gain that trust so we can actually do more epidemiological investigations. the fda is responsible for the quality of the milk.

we are working quite closely with fda. you will see a lot of information coming out around pasteurization of milk. yes, the milk is safe. don't drink raw milk. so, i think within cdc, certainly we have multiple groups engaged, including dimitri's center. we have our one health group that is in dan's center, and we have forecasts as well to try to predict, if this does take off, what the future holds. fortunately now are vaccines will work. our laboratory testing can pick

up this particular strain. and therapeutics as well also work. it is reassuring at the moment. we learned -- we need to learn more about where the risk is. and our surveillance with these cattle, is it milk surveillance, heard surveillance, among dairy farm workers? >> wastewater. >> and of course wastewater. you will see more results coming out fairly soon, i'm looking at dimitri come around wastewater. dr. gerberding: kayla, right now we are kind of managing this as a u.s. centric situation though h5n1 is not just a u.s. centric problem. communication has to be relevant globally. i am sure there is a lot of anxiety as far as the food production industry in terms of trade and the global impact of the safety of our cattle industry, etc.. how are you managing the global communication around this unfolding?

this is the hardest part of the outbreak, when there is so much uncertainty, how bad is it, who is effected, how far it will go. you just do not know. how are you handling that? kayla: a couple of things we have done so far. everything on the cdc websites we are pushing out to all of our global partners, but also we just did a webinar with our country and regional cdc teams to make sure everybody was fully informed, had a chance to ask questions. we just met with the state department and talked about ways we can push out another seminar and webinar to get everybody up-to-date on what is happening and to make sure questions are answered, keeping awareness very high. if countries are interested in getting engaged and looking at surveillance, we want to support that. right now it is mostly domestic, but we are insuring all of our

partners are aware and ready and watching so that in case anything is needed, we are right there. for avian influenza in cambodia, our team is there. we are right on those cases. it just happened recently. a couple have been right as we were there. our teams are well trained and ready to respond and did respond quite quickly. with the capacities they have from the work we have been doing there for years, and also in the whole region. that was the u.s. global link between all of this. >> one of the strengths of the cdc is the international workforce. that would is not as optimized as i think it could or should be , and that was one of the findings of the commission report, that this incredible investment in talent and public-health capacity in over

100 countries is still not managed as a global asset, it is managed as a therapeutic area or an assignment on a temporary basis. there is no real career development or planning. will this strategy be able to interrupt that opportunity to really strengthen the workforce internationally? >> one of the starkest parts of ac/dc workforce is the staff around the world. we have spent a lot of energy and investment to ensure great training amongst the staff, whether they are trained in epidemiology or laboratory response. now we are having more and more opportunities for the staff to move from country to country, so the development of the locally employed staff is extremely important. on top of that, we have the

field epidemiology training programs and we have emergency management training, laboratory management training. we are building the workforce overseas, bringing people to atlanta for training, for rotations throughout the cdc, throughout washington sometimes. we are really trying to build up that workforce and also have cross communication across the workforce overseas. dr. gerberding: can, prior to your current role as the, i'm not going to try to say it -- [laughter] you had responsibility for data modernization efforts and were very much involved in that effort. tell us where that plays into this global strategy? dr. jernigan: there were multiple frameworks listed, the first being data and surveillance. we see that as an interoperability component.

we want the data to be shared so that if you are collecting information, it is able to be shared with other countries also with the u.s. and other partners as well. we want that information to be used for making decisions too. having that data available so that you can get the right policies developed from that quickly is an important part of the data and surveillance part as well. other things we want our the ability to have the data available to inform people. right now we have an emerging problem with dengue in the united states -- excuse me, and puerto rico, which is part of the united states, as well as in central and south america were lots of dengue cases are likely to occur. we want to have the data for -- from el salvador be able to be presented so people around there can see it is increasing, we need to take care for how

they're looking out for those cases and that we can monitor then in the united states to see what is happening. interoperability so it can be seen and lead people to do the right thing. >> could you look at the strategy in the six pillars, who could argue with the importance of the six pillars? but they cost money. we are dealing with a very difficult situation across the board and the u.s. government, but particularly as it pertains to the cdc and some of our other agencies. when you think about the pepfar reauthorization challenge and that pepfar was only reauthorized for one year, it felt ominous to me. what is it saying about the perspective of our government on our global health investments and the long-term values we have been able to deliver not only in terms of human health and the

incredible impact, but also on diplomacy and the respect and trust that the united states has earned internationally in many countries as a result of those investments. here we are now. we've got bold ideas about how to do a better job with our global bio security, and yet i do not think we have a big budget line for this particular effort. so how are you going to get the story out there? maybe i will ask all four of you to answer that because you are probably all playing a role in that. but what can be done to make sure people understand the value and importance but also the opportunity that this strategy really presents for the u.s. government and our national security? i will start with you. >> i will probably use influenza as a great example. the seasonal preparedness we do every year lines up with the

preparedness for pandemic and unexpected events like the transmission of h5n1. i think that is part of the storytelling. i think we can tell the story of cambodia, the work that happens, and really, remarkably, these businesses it up being really important because i think our director can speak about it in clear terms and we can speak about it in clear terms. back to cambodia, you actually saw the cdc infrastructure in action and how that action mattered much later when we had the outbreak of 85. i think seeing what happened in the village where we have the case and how that moves into the clinical arena, and then moved

it to the laboratory where after identification of that case, you had sequence and then told you exactly what you are dealing with, let you assess what the risk is, think about antiviral and also think about the vaccine candidates we have. sort of thinking that is far away. but we did the same thing in texas, making the point that that trained the system that global work that was not only creating the security and understanding of what is circulating in the world for flu so we can build better vaccines and also have better vaccines in the bank in case we have surprises, but the other piece was we were able to go from there is a human with conjunctivitis in texas to 24 or 36 hours later having risk assessment of the sequence available for the world to see, really creating both of her.

concern and adequate reassurance of where we were that day. part of it is making sure how we tell that story and we convert the domestic into the global and the global into the domestic. the way we are acting at cdc is for that flow from domestic to global and global to domestic in that seamless way within that barrier. dr. jernigan: maybe if i could jump in, a couple of examples, what comes to mind was with mpox, the work that was done in a couple of past decades with the vaccine. the translation of that work led to the use of the vaccine in the u.s. but that story is not told, so telling that story and the word we are doing internationally -- the work we are doing internationally with other

countries where the disease is endemic, mpox for example, i am telling that story and translating it for the american people and congress. i can think of the work on ebola in uganda. a lot of work done in uganda. we have been working with the ugandan public health for the last three years, and they had the capability. the government stood up and contained the outbreak, based on the work we had done in the lab in uganda for a decade prior, the work that was done in equatorial guinea, that was a nice collaboration with the usa and the cdc getting people on the ground in a very difficult environment to contain that outbreak. but part of the issue here is that we invest in laboratories, in people, in surveillances, in early detection and containment. it is hard to describe prevention, hard to show the success of what we have

prevented, by talking more about it, talking about the counterfactual, for example, of what would have happened if we did not have the training, the laboratory testing, had not done the workforce training, i think that is important as well. dr. gerberding: we are in an environment right now we are trusting in the institution is not high but trust in the cdc is probably still on the low side, from everything i have read, though there are partisan dimensions to that, of course. you have been at the cdc for a long time. you were there when trust was very high and very low. when you are thinking about how to get the word out about the value of the cdc, who are you going to talk to, and what do you think is the most important thing for a budget decision to understand? >> is a great question, and there are several angles to that, but in terms of us

speaking more, when to -- we need to commute again more clearly and often and be more transparent in what we are saying -- communicate more clearly and often and be more transparent and what we are saying. there are things that we say that individuals out there, they don't cure it the way i think i am saying it. it really is on us to be able to understand where people are coming from, listen to them, and adapt that message to get the highest amount of people being able to do the right thing to protect their own health. that kind of communication is needed if we are going to build that trust back. dr. gerberding: if there is one story you would like to tell, what would be the story? >> from a global standpoint? sure, one thing that comes to mind is the antimicrobial resistance. this is an issue that you think of as a hospital thing or a long-term care facility thing,

but it is emerging across the globe as well as in health care facilities to the point where we will not have any antibiotics to treat people. in the united states, to your point about having networks and laboratory capability and epidemiologic capability, we were able to pick up cases of infection in the eyes of some long-term care facility residents where we are actually getting pox in their eyes and having really bad infections. they would send that off to a laboratory that got to a public health laboratory where, because of the support, they were able to actually see that that was a student no mess, kind of a soil bacteria that was resistant to 12 different antibiotics. that is a really bad bug. we also found that there were several other cases in the united states. it turned out those individuals

had all been using artificial tears that you used to wet your eyes when you have a problem with your eyes. it was a kind of bacteria we had not seen in the united states. that particular pattern of that resistance had only been seen in india. we were able to note that it was coming from there, but we were able to find it and stop it at the source so it does not come in, and then prevent that transmission from happening in the united states. but we still have this bacteria periodically showing up in some places. it just shows you that domestic and global are highly connected, converging all of those things that are happening now, and we have to work together for us to be able to address those problems. dr. gerberding: kayla, i know you served in india for many years and had a pivotal role

they are in terms of building a partnership and alliances with public health in india and the cdc perspectives. that kind of diplomacy is really critical for health but also critical for broader national security, global security issues. can you talk a bit about how the strategy reinforces that? kayla: when you look at the last pillar, which has diplomacy in its name, communication policy and diplomacy, really the fundamental backbone of everything we do is diplomacy, and health is diplomacy. working in government, working next to somebody, often our offices are actually in the ministry of health, so we are working really closely with the ministry of health. that creates the partnerships, the trust you are asking about, and it means that we can bring in scientific expertise. we can support. we work together.

when something happens and we are not there or not in that place at that time, we are the first call. if something like this could happen, we get that call first. we could either have people in the country or go there, and we are trusted to go there, to support or help. that diplomacy is really the backbone of all of the work we do. going back to your question about pepfar, pepfar built that over decades, that kind of relationship, that kind of trusted partnership, and all of the examples we just heard about, all of those different outbreaks, all built on pepfar, on the platform of pepfar and all that laboratory surveillance data. those platforms are what allow those outbreaks to get identified and then responded to. it is both diplomacy and also just system strengthening that gives us our ability to respond.

dr. gerberding: we also have to think if we are not they are doing this, who will be there, and will they have the same relationship with the u.s. government that we would like to have with our allies? there is a global competition for allies at the moment, as we all know, and that is another dimension of this that does not really seem like a public health issue, but when you step away from it, it is. in a couple minutes, i am going to open it to questions from the audience, so be thinking about your question. i think the microphone is in this corner, so we will ask you to step to the microphone and leaves just maybe line-up so we can go quickly through the questions. we will probably ask a few questions and give the panel a chance to respond. i want to remember that a strategy is a ground thing -- grand thing. it has to be socialized, and that is what we are doing today,

getting input and feedback. but it also has to have measures of success. in one short kind of soundbite, how will you know you are successful, and say three years, what do you want to make sure has gotten accomplished? i will start with henry. >> first of all, let me say that we do need to measure our accomplishments, and we are working on performance measures as part of the strategy, trying to dig deep into the six pillars and four goals. i think one of the ways for me at least is stopping outbreaks at the source. that is a fundamental piece of this, helping countries where we are seen as an emerging threat, how are we able to contain that within the country and region very quickly? that is going to be one of our successes. >> i would say to build on that,

measuring get us to those goals. how do we identify gaps and intervene? so those pillar metrics are important. dr. gerberding: do you have a favorite pillar? >> data and surveillance. dr. gerberding: i knew it. >> for me, i think if we have in place in strategic locations capable laboratories that can do genomic sequencing quickly, that will be a success we can identify -- that will be a success and that we can identify emerging pathogens. they get the information quickly. we will have it and act on it quickly as well. >> it's foundational. >> i will echo what dan said, which is about how the laboratory interacts with

surveillance to accelerate what happens on the ground, so that for me would be probably the strongest metric. it frankly blends into the pillars, the surveillance piece, the lab piece, and efficiency. you go from someone who is sick to we have a problem to we have a response. >> so building the capacity locally. it's one thing to set up a lab and another to be able to operate it and maintain it. it gives us hope. those are concrete things. let's move to the microphone and have a q&a. >> hi. my name is jerry martin. i'm currently at a school of veterinary medicine, but prior to that, i ran a series of control programs funded by usaid called community-based avian

influenza control in indonesia, and other programs, including the preparedness and response program. the purpose for that context is you talk about how we can learn from our global work and bring it back to the u.s. h5n1 here in the u.s. is a serious issue now. there's a lot of lessons that were learned through the funding of aig programs and one of the big ones was the establishment of the national one health platforms. i know there's a one health office within cdc. it was mentioned earlier. but i understand, at least in the united states now, there's no national one health platform that includes usda, includes fda and cdc. i would like your opinion about the feasibility of establishing that type of entity so that you would not have this issue where we cannot necessarily get to test farmworkers because there's

all this extra coordination and rules and regulations you have to deal with. >> you're asking a question i asked about 25 minutes ago. >> i am asking it specifically about whether establishing a national one health platform is a mechanism that is needed beyond what you already have at cdc. >> yes. the one health office -- that group has been tasked by the federal government to run the one health consortium. that's a group of usda, fda, epa and others within the united states government in order for us to have an ongoing dialogue, rules of interacting with each other on outbreaks, etc. so it is intended to get to that. is that a platform that is specifically stood up for that?

it could be overtime. this was an authorizing language last year. we have now instantiated with -- i do know if we have had the first meeting or not but they are working on that. that is something the government wants. we have been tasked with helping to bring it together but it's something that has to work across all the different partners. globally, we also work with a number of the international parties as well. we do the one health zoonotic prioritization activities. important -- we have to take one of the most important pathogens in that country. the animal husbandry people and of the human health care people so they have each other's telephones, they know each other's phone numbers. standard operating procedures they know. that thing we are helping countries to do we are trying to do in the united states as well. >> helps us to move that

forward. >> thank you for your question. >> thanks very much. my name is andrew mack. i'm representing biosafety engineering, a company that deals with biomedical waste and the treatment of it. you talked an awful lot about trying to knock down an epidemic before gets out of hand. one of the things that was interesting to me, we have a lot of technology coming out of the u.s. one of the biggest challenges is getting into the hands of people are the world so we don't -- so we can track the data, prevent the spread, hospital waste, biomedical waste. when things start to go bad, you don't want to wipe out the whole herd in botswana or tanzania or any number of countries where we have interests both national security, bio security and just friends of ours.

so one of the things i did not hear was we talked about the challenges of finding budgets. it's cheaper to solve the problem at the source early by pre-positioning goods that will allow us to treat the problem but i have not heard anybody talk about jobs in trade and the fact that the u.s. is one of the countries that produces the best solutions for a lot of these problems. perhaps we should try to wrap in other parts of usg in the trade promotion business taken together with what you are doing and talk about that. most of this i think would have gone over the head of a typical person who does not have a lot of time or background in the field and we want to engage in the public. future risk is hard to engage them about but current and future is easy. >> let's hear the question so i can -- the questions so i major

we can get them all out. >> hello. i have two questions. one is very specific and one is more general. the specific one i direct to dimitri and dan since you are supposed to be overseeing age -- overseeing h5. there are finally incentives to encourage more testing of animals and workers because as we know what we don't know is how much of his this that how much of this virus is transmitting -- don't know is how much of this virus is transmitting asymptomatically? how any companies would take up your offer and why is it only now being allowed for infected herds? would you not want to know whether workers also have antibodies? the second question, thinking about november and a particular scenario, what kind

of measures can you put in place now foundational he to protect cdc from some of the things that happened last time around. you recall that under the trump administration, you know, there was all this funding cut for cooperation with w.h.o.. it's fine to have these pillars and metrics but it will not mean anything if you are not allowed to do that work, so is there anything being put in place now you can share in public with some specifics other than collaborating with each other? thank you. dr. gerberding: thank you. >> thank you. i'm chief policy officer at the association of public health laboratories. obviously learning about the role and importance of laboratories and data is music to my years. as we think about how we are going to tell these stories and connect dots, let's remember

there are state and local public health laboratories that are involved not just domestically but globally. apho has 50 staff in 10 countries helping to build lab systems. so again, a fuller, more robust accounting of the role of partners, i think, will also be critical in telling the story to preserve the funding and may be future years increase it. thank you. >> thank you. >> good afternoon. i'm the president and ceo of trust for america's health. good to see you. henry, you noted in one of your responses what was learned specifically on the continent of africa, what could be applied in the u.s., making that connection between global and domestic preparedness and response, and yet you said the story is not being told.

could you share with us the approaches of how we can tell that story more and is that part of the communication policy and diplomacy pillar and perhaps elaborate on how that will be elevated to speak about these stories that are not being told as much as they should be. >> thank you. so we have a good and robust set of questions. i think we can start with the first comment about the export. dimitri? >> the export of -- again, part of the diplomacy and relationship building is making sure we know what the gaps are in thinking creatively about what our partnerships are. so one of the really exciting things about cdc is the willingness to engage more deeply with private entities. we have seen it a lot in other areas so as we sort of understand that global situation

and identify those gaps, those relationships may end up being important to leverage in other spaces. most important piece of that is we agree. that component of our partnerships is critical not only in our borders but beyond. >> you are developing an intra-agency strategy to bring the cdc together in an integrated way. you are working interagency across usg to build those partnerships but then there's the intersectoral aspects of this with private sector and broader state and local public sector engagement and then of course the international. so as is typical in public health, it's a ripple of interrelated relationships, but clearly the nongovernment sectors are going to be particularly to go -- particularly critical here. in an environment where some of them are nonsupportive of

spending taxpayer dollars in some of these areas, the ability to leverage private sector investments and partnerships will be particularly strategic, so that makes sense to me. dan, questions about -- from the washington post. you wanted to tackle those? >> yeah. i can try and address those in terms of what might happen in november, cannot speculate, but i can say we need to focus on core public health activities. that's what we are trying to get at here. what is it we have to do? what is the important thing that protects americans from these emerging threats? so focusing on those fundamentals i think will be key for whatever happens in november. >> did you want to comment on personal protective equipment? >> i can do that. thanks for the question.

about 75. >> yeah. >> great. the most important answers we are putting all our eggs in one basket, thinking about not only how can public health get there but partnering with academic workers to see if we can get to the same question. one of the conversations the cdc is excited to have, like lab support, even if we are not principally doing that, as we are chipping at different aspects of the problem, can we partner with academics who potentially have better access? can we work deeper with veterinarians who could ease access? and if necessary, how are we able to provide some incentive? we are looking to understand this not only with what's happening today on the farms but what's happening globally in

that situation. it's really about what are the mechanisms we can use to get there? in terms of how long, as long as it takes to make sure we actually get the data we need and actually access for folks to understand what exposures are like. the goal is not only to understand how the virus is moving but give appropriate guidance about how people can protect themselves and we need that information to fill that out from the perspective of ppe and other strategies. so lots of different things. >> i would also go back to the csis report because there are authorities the cdc does not have in terms of gathering state health data in the context of a public health event, a bona fide public health emergency. it gets easier but not in -- not entirely.

maybe would like to comment on the importance of the engagement, not just u.s. but internationally, as part of our front line of preparedness? >> absolutely. when you said labs are music to my years i wrote that down. i appreciate the engagement among a number of different partners who are supporting our laboratory work overseas. we were recently in the middle east and met with one of your staff there and learned about the work that was going on there as well, but i wanted to also into the question related to telling stories. and we need help, because we come at it from a public health standpoint of. this is wonderful. we stop the outbreak at its source. but converting that into a conversation or story, we can utilize the partners in this room to help us. also there's potentially an opportunity to think more of it

as a national security threat. covid was not just about public health with the impacts on our economy, for example, the impact on our schoolchildren. and so framing this potentially in a larger context around a national security threat. isaac we have done some work in the space. we need to do more, thinking about different types of fumigation with different audiences -- of communication with different audiences. >> i will add to that. just to build on that, we talk a lot at the level of the hill and those stories and we need those. we also need to talk to the community and make sure that our stories are actually reaching all ears and hits all the right tones for all the different audiences that we have.

so we need that help because sometimes it is too technical or just not being heard. you think you are saying what you think you are saying that you are not being heard that way. so again, telling our story to everyone is important. these outbreaks that we are finding and stopping, it's important to everyone, but we have to tell the story better. >> i think it's also important to communicate the innovations we are having tebow. we were just in el salvador looking at a bacteria that can infect mosquitoes and prevent dengue. that could be used in multiple places around the globe. so we are doing things people probably don't know about from a global spectrum. also looking at genomic sequencing, where we are taking wastewater from planes coming in from areas around the globe to see if there's something we need to know about and if it's coming to the u.s., so with wastewater,

sequencing, the innovations . >> you learned about covid variants three or four weeks ahead of them being noticed in clinical settings, which is really a huge advance warning. >> so we really need an inside story. >> yes. >> in our public health system. this is a cdc issue but it's also a local and state public health issue as well. we just don't have insight and visibility. when something goes wrong it is visible but when something goes right or why something did not go wrong is part of the story that does not get told. those of us who have been insiders know every single day something happens or does not because of the cdc work. but i think you have done a fantastic job of sending -- of presenting the framework or strategy. i will go back to the csis

statement. we looked at the cdc and how we can strengthen the cdc and that -- there are things the cdc must do and those things are underway and it's encouraging to see the commitment, particularly in the global space, but i know there are other things going on. there are also things that need to be done on behalf of cdc. and those of us who are here trying to be advocates for science-based policy and security based policy, we really understand that not everything that needs to happen at the agency is within the agency's control. we need allies and advocates and people who can speak up and speak out about what a vital resource you are, not just the national treasure but the global treasurer, and stand strong on your behalf. >> thank you for sharing this.

>> before we close, i would like to thank some people. first and foremost, steve morrison, who is the genius behind the csis bipartisan alliance for global health security and has been an incredible advocate for all things bio security and cdc. i also want to thank sophia and michaela, who have been the people who pulled this together and guided us and put all my talking points together. thank you for being here. thanks to our audience and advocates. stand strong for public health. thank you. thank you. [applause]

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