Leaders have relied on data-driven weather forecasts to understand when to deploy resources in response to natural disasters and advise the general public on the level of risk so they understand whether to shelter at home, evacuate, or simply bring an umbrella when leaving the house.
The CDC’s new Center for Forecasting and Outbreak Analytics (CFA), aims to act in a similar way to guide decisions about broad public health needs like deploying antivirals or additional testing capacity and advising the general public on the level of risk for different behaviors like wearing a mask or attending large events.
This is a long-overdue element of infectious disease control that replaces a patchwork of mostly volunteer academic experts and institutions. Designing and implementing infectious disease policies and guidelines without a centralized reliable source for forecasting is challenging. The CFA could have a profound impact on how we approach and control this pandemic and inevitable future infectious outbreaks.
The CFA is intended to support federal, state, and local decision-makers with analyses at every stage of a health threat. The work will be focused on three main areas; predicting and modeling, informing, educating and communicating and innovation. This will allow the center to determine the outbreak risk and its potential to reach epidemic status, early on. There will be a strong focus on effective communication and how to translate the data into clear decisions, interventions, and resource allocation.
However, the system will only be as effective as the data it receives. There needs to be a clear, real-time, pipeline of anonymized infectious disease data identified via zipcodes from hospitals and primary care clinics to the CFA. We can not also ignore the use of open-source intelligence. Analyzing the data is just the first step.
A lack of general testing capacity or general ambivalence about testing amongst the public as Covid fatigue sets in could threaten the accuracy of the data. Recent cuts to federally subsidized testing programs will undercut the expansive data needed for this program to be successful. Antiviral drugs like Paxlovoid need to be stockpiled so they can be swiftly distributed free of cost to communities through programs like test and treat.
Egypt’s 100 Million Healthy Lives initiative provides a recent example of how universal disease surveillance, treatment, and eradication is possible. Egypt previously had the highest rate of Hepatitis C in the world. In 2018, Egypt launched the 100 Million Healthy Lives program. The goal was to screen all Egyptians over the age of 12 for active hepatitis C virus replication along with other chronic conditions such as hypertension, diabetes, and obesity. Treatment was offered for free in government clinics for those who tested positive for hepatitis C, hypertension, and diabetes; free counseling was available for those considered obese.
Approximately 4 million people with active hepatitis C were identified and treated with the antiviral medication Sovaldi (sofosbuvir), a nucleotide analog that inhibits the polymerase enzyme of hepatitis C and blocks its replication, effectively eliminating hepatitis C from Egypt. Once initiated, the program was completed in 18 months. Implementing this kind of program will not only improve our disease surveillance but allow us to work towards universal healthcare goals and emerge as a healthier society.
The CFA will hopefully begin to rebuild trust in the general public which has been eroded by conflicting and confusing guidelines that have been issued by various federal agencies. A centralized, data-driven source of guidelines will relieve the burden of risk assessment that has fallen heavily on the shoulders of the public and business owners for years.
The launch of the CFA puts us in a better position to assess the early risk of emerging Omicron subvariants and any new variants that are likely to occur as the virus evolves and responds more swiftly than we did with past devastating variants. But the center’s work needs to be funded sustainably for the long term and state and public health departments need a skilled workforce that understands methods for modeling diseases.
Funding for public health programs has always been fraught with difficulties. But we should look to the substantial investments made in HIV/AIDS as an example to follow. Within the US, we now have the tools to treat and significantly improve the quality and longevity of those living with HIV. It is no longer viewed as a death sentence and should be the standard we aspire to for treating all diseases.