01/27/2010As CDC continues its public health mission in Haiti, we take a look at its role, the priorities of the mission, and the public health dangers. Here is an interview with CDC's incident manager for Haiti, Scott Dowell, M.P.H., M.D. (CAPT, USPHS), medical officer with the Global Disease Detection and Emergency Response Branch, Office of Global Health.
What is CDC's role in the Haiti relief effort?
CDC in Atlanta is gearing up to become a fairly large part of the Haiti relief effort in the upcoming weeks and months. CDC's public health role was small and back-seat in the initial three or four days of search and recovery after the earthquake, but has become much more prominent as attention turned toward potential public health disasters that are looming in the weeks and months ahead. Our role is to help prevent tropical diseases, airborne and waterborne, from spreading through the population.
The key point is that this earthquake struck what was the most precarious public health system in the entire hemisphere. So even before the earthquake hit, Haiti had the lowest rate of immunization of infants, had the highest rate of mortality during childbirth, and had other serious public health problems. When you add the earthquake disaster to that, you have the potential for outbreaks of disease and other public health problems in the coming weeks. So one of the first priorities that we're focusing on is public health information because it's the quality of that information that's going to guide the response and sort of avert these more predictable mortality risks.
What are the public health dangers that you foresee developing in Haiti in the coming weeks and months?
CDC's Incident Manager for Haiti
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|There's a long list of potential problems, and the public health information, along with surveillance that we will be conducting, will help us identify the priorities more precisely as they unfold. Part of what we're putting in place is a rapid assessment of the current situation and a surveillance system that will identify problems as they arise. But we can predict from past disasters the ones that are of greatest concern. Problems that result from the lack of clean water are the first ones. Outbreaks of diarrheal disease have struck populations in this kind of circumstance in the past and could be disastrous. After water, we'll focus on food. We knew that malnutrition was already a severe problem in Haiti, and people are going to need to have adequate supplies of safe food.
In the first days after the earthquake there are continued concerns about trauma and injuries. As time unfolds and that concern will decrease, there will be outbreaks of infectious disease. Measles is one of the classic ones that infect populations like the one in Port-au-Prince. Fortunately, measles has been all but eradicated as an endemic problem in the western hemisphere. But there are periodic re-importations and the fact that Haiti's measles vaccination coverage was so low to start with — about 50 percent — puts them at risk for even more importations of disease like that, in addition to the normal vaccine-preventable diseases that are already there. Part of what we're putting in place is a rapid assessment of the current situation and a surveillance system that will identify problems as they arise.
How many CDC people are working on Haiti now?
CDC now has 17 full-time US citizens on the ground in Haiti (as of Monday, January 24), plus 35 local CDC staff. Supporting them are 235 CDC staff members at the Centers' headquarters in Atlanta, two liaison officers in Washington, and one in Miami. That number will increase and fluctuate as CDC becomes more involved in addressing the long-term public health challenges facing Haiti. Most CDC staff members are assigned to work with the Centers' partner organizations — the UN organizations, the U.S. military organizations, the U.S. aid organizations, and the Haiti Ministry of Health. The exact numbers that CDC will eventually deploy to Haiti will depend on what these organizations identify as their public health needs, but I anticipate two or three dozen CDC staff in Haiti in the coming months.
Will CDC be establishing camps for the displaced Haitians?
Tent cities already have been established in informal ways across the city of Port-au-Prince, and part of the job in the coming days is going to be to move the people in these camps into more formally organized settlements. Various international organizations probably will take charge of those settlements on a temporary basis.
Who's the overall international coordinator of the Haiti disaster relief response?
Ultimately, the international response is coordinated by the United Nations, which has delegated the Pan American Health Organization (PAHO) as the public health lead, with the US response coordinated by US Agency for International Development (USAID).
How does CDC become involved in such operations?
PAHO, USAID and other coordinating agencies ask for CDC experts in a variety of areas — epidemiologists, environmental health specialists, technical advisors, veterinarians, sanitarians, nurses and information specialists — to handle information flow.
Is Atlanta particularly well-positioned to become a staging point for long-term assistance to Haiti?
We are at an advantage because Atlanta is a transportation hub. For example, the large group that the US government HHS sent down at the very beginning was staged out of Atlanta. So people can gather here or get down there very quickly. Through all these partnerships, CDC is well positioned to respond with agility to these kinds of crises. CDC does this a lot. We have a plane available to us that can get our people and supplies in and out very quickly. And we're able to be quick in responding when people ask us for help.
What do you see as the top priority in the next seven or eight days?
CDC has two immediate tasks that I will be concerned with: