FY 2017 Annual Performance Plan and Report - Goal 2 Objective E

Topics on this page: Goal 2. Objective E | Table of Related Performance Measures | Analysis of Results | Plans for the Future | FY 2014 Strategic Review Objective Progress Update Summary

Goal 2.  Objective E:  Improve laboratory, surveillance, and epidemiology capacity

Three critical elements that underpin public health and regulatory practice — laboratory, surveillance, and epidemiological services — enable the public health field to detect emerging threats, monitor ongoing health issues and their risk factors, and identify and evaluate the impact of strategies to prevent disease and promote health.  Carrying out these activities requires quality data and specimen collection, evidence-based epidemiology, and accurate and reliable laboratory services across the departments and organizations that make up the nation’s public health infrastructure.

To this end, HHS is working to strengthen surveillance systems, including the monitoring of health care quality to ensure that best practices are used to prevent and treat the leading causes of death and disability.  CDC works to ensure a prepared, diverse, sustainable public health workforce through experiential fellowships and high-quality training programs in many areas, including epidemiology, preventive medicine, and program management.  This fills critical gaps in workforce needs at CDC and in the field, including global Ministries of Health (MOH).

HHS is building a robust data system that provides data, feedback, and tools directly to health agencies and health care facilities to improve practices and, ultimately, health.  A data system for public reporting and using electronic data sources for data collection and prevention will enhance the nation’s ability to monitor trends in critical health measures among priority populations; monitor health status, health care, and health policy concerns; and conduct in-depth studies of population health at the community level and for specific subpopulations.

ASPR, CDC, FDA, and SAMHSA will have roles in implementing the following strategies to achieve this objective.  The Office of the Secretary led this Objective’s assessment as a part of the Strategic Review.

Objective 2.E Table of Related Performance Measures

Increase epidemiology and laboratory capacity within global health ministries through the Field Epidemiology Training Program (FETP).  New Residents (Lead Agency - CDC; Measure ID - 10.F.1a)

Increase epidemiology and laboratory capacity within global health ministries through the Field Epidemiology Training Program (FETP).  Total Graduates (Lead Agency - CDC; Measure ID - 10.F.1b)

Increase the number of CDC trainees in state, tribal, local, and territorial public health agencies.  (Lead Agency - CDC; Measure ID - 8.B.4.2)

Increase the number of states that report all CD4 and viral load values for HIV surveillance purposes (Lead Agency - CDC; Measure ID - 2.2.4)

Analysis of Results

The current ease and frequency of long-range travel can make previously regional diseases and infections local risks.  Therefore, HHS supports a number of initiatives to develop local and international workforce to improve public health both at home and abroad.  In FY 2014, CDC did not meet its target for new residents.  However, the number of new residents increased by more than 33% over FY 2013 results.  Since 1980, CDC has developed international Field Epidemiology Training Programs (FETPs) serving more than 60 countries that have graduated over 3,600 epidemiologists, exceeding its cumulative target for FY 2014.  On average, 80 percent of FETP graduates work within their Ministry of Health after graduation and many assume key leadership positions.  Their presence enhances sustainable public health capacity in these countries, which is critical in transitioning U.S.-led global health investments to long-term host-country ownership.  In FY 2014, FETP graduates and residents participated in approximately 424 outbreak investigations, over 340 planned investigations, and approximately 500 surveillance activities.  CDC is planning for a level number of new residents in FY 2017 based on current participation and funding considerations.  FETP activities are supported by funding from CDC appropriations and inter-agency agreements with the Department of Defense, Department of State, and USAID.  Policy changes within those agencies may affect the future number of FETPs supported, which may require adjustments to targets.

The detection and monitoring of pathogens and infections is a key component of HHS’s strategic plan to enhance public health.  State health departments report shortages of critical disciplines such as epidemiologists, public health nurses, managers, disease investigation specialists, laboratorians, environmental scientists, sanitarians, and informaticians.  CDC’s fellowship programs promote service while learning; fellows fill critical workforce needs at CDC and in the field while they are in-training for careers in the field of public health.  Targets are set based on the typical, annual class size for each of the fellowship programs included in the measure.  CDC’s Public Health Associates Program (PHAP) transitioned from a summer start date to a fall start-date for the incoming FY 2014 class, creating a "gap-year" that resulted in fewer PHAP trainees reported for FY 2014.  The PHAP "gap year” also affected the 2015 class because of the later start date, Therefore, only the 2014 class that started in October 2014 is reflected in the results.  CDC will report two PHAP classes in the FY 2017.  Therefore, CDC expects performance levels to increase in FY 2016 and increase in FY 2017.

The spread of infectious diseases continue to be a national and international concern, requiring a robust system of detection, monitoring, and prevention.  CD4 and viral load reporting provide the fundamental data for four of the National HIV/AIDS Strategy Goals.  These goals are to increase the proportion of newly diagnosed persons linked to clinical care, and reduce the proportion of three populations diagnosed with HIV who have undetectable viral loads.  Routine reporting of CD4 and Viral Load data to surveillance programs facilitates case finding and follow-up on new cases.  These data help to ensure the timeliness, accuracy, and completeness of the national HIV surveillance system.  CDC works in collaboration with state and local health departments to better monitor the effects of HIV medical care through expanded reporting of CD4 and viral load test results.  For FY 2015, 42 states and Washington, D.C. required reporting of all CD4 and viral load values, an increase of two states from FY 2014, exceeding the FY 2015 target while continuing a steady increase in states meeting reporting requirements (Measure 2.2.4).

Plans for the Future

In response to the Ebola epidemic, in 2014/2015, CDC initiated the FETP Surveillance Training for Ebola Preparedness (STEP) program in several countries in West Africa.  Community health workers participating in the STEP program were trained in basic principles of disease epidemiology and reporting and have served as an important node in supplying local data to national networks, enabling quicker response in these countries, and faster recognition and resolution of community outbreaks.  CDC is now implementing a shorter FETP Basic Level Training for surveillance personnel at the lower levels of the health system in nearly 25 new countries in order to build surveillance response capacity more broadly.  This work should significantly improve countries’ ability to detect the next important disease outbreaks within their borders as well as developing common surveillance epidemiology skills across borders to improve information sharing and earlier disease reporting and control.  CDC is also working closely with Training Programs in Epidemiology and Public Health Interventions Network (TEPHINET) to implement the accreditation process for the FETPs, which will help maintain the quality of FETPs globally.

FY 2014 Strategic Review Objective Progress Update Summary

Please note that this section summarizes the result of the FY 2014 HHS Strategic Review process, limiting the scope of content to that available prior to spring of 2015.  Due to this constraint, the following may not be the most current information available.

Conclusions:  Progressing

Analysis:  Progress has been made in a variety of surveillance and epidemiologic areas which are clearly tied to public health outcomes.  The National Healthcare Safety Network continues to demonstrate how surveillance can drive prevention at the facility, state, regional and national levels.  CMS is using National Healthcare Safety Network data in its pay for performance programs and posting data on the Hospital Compare website.

In 2014 a “Mini-Sentinel” pilot program demonstrated proof of principle in conducting 17 medical product assessments across multiple vaccine classes.  The now-established full Sentinel System uses innovative electronic methods to rapidly assess the safety of drugs and other medical products.

Progress has been made in the laboratory sphere, especially with respect to outbreak detection including incorporating new tools like Advanced Molecular Detection.  In the area of Food Safety Advanced Molecular Detection methods of whole genome sequencing have improved the laboratory-based foodborne outbreak detection system, PulseNet.  A successful pilot project involving Listeria samples has resulted in detecting outbreaks faster and savings lives.  Food safety experts within HHS are building on this success to extend to other pathogens and to the states.  Advanced Molecular Detection also achieved improvements in the high priority area of antibiotic resistant Neisseria gonorrhea that have the potential to lead to the development of point of care tests, providing real time results and revolutionizing gonorrhea treatment. 

There were numerous outbreaks where laboratory testing and new diagnostics played a pivotal role.  The Novel Coronavirus RT-PCR assay for the presumptive detection of Middle Eastern Respiratory Syndrome (MERS) and its dissemination to qualified laboratories in the US and around the world formed a cornerstone of efforts to control the spread of MERS.  In another example, laboratory analysis was critical in investigating multiple clusters of infections from multidrug resistant E. coli infections from duodenoscopes.

Training at the state and local level is focused on filling gaps and creating the next generation of public health specialist.  Recent efforts include building IT capacity in states, utilizing e-learning, and informatics training.  Building electronic laboratory capacity is bearing fruit with a steady increase in the proportion of laboratories that report nationally notifiable diseases electronically.

Further, HHS is exploring options for harmonizing electronic health record systems with public health surveillance systems as well as continuing to expand public health applications of Advanced Molecular Detection methods.