Secure Funding for Disease Prevention & Public Health Initiatives

1. Rabies Elimination: In 2016 CDC, Humane Society International, and Christian Veterinary Mission trained 55 vaccinators on alternative vaccination methods (capture-vaccinate-release & door-tO-door), and conducted a 10,000 dog vaccination campaign to evaluate their ability to conduct these methods. The results were encouraging, with post-campaign vaccination coverages measured at 65% - 80%. Data collected during this evaluation has been used to develop an excel-based program-planning tool that is currently being evaluated in 5 countries.

The previous three years of evaluation and training have prepared Haiti for implementation of effective mass dog rabies vaccination campaigns. There is a reliable dog population (available down to a community-level). It has been proven that vaccination coverage of >70% are achievable, and the capacities of Ministry of Agriculture (MARNDR) vaccinators can plan cost-effective campaigns. MARNDR has procured 800,000 canine rabies vaccine doses for use in 2017; but funding for logistical implementation and vaccinator's salary had not been secured.

CDC conducted a global feasibility assessment for the elimination of canine rabies (accepted for publication 11512017). In this analysis, assuming continued progress, Haiti is estimated to achieve elimination of canine rabies in under 7 years. To ensure that Haiti continues to progress towards the WHO goal of rabies elimination by 2030, international support is being requested to assist in these final steps towards national rabies elimination. CDC and PAHO will provide assistance to MARNDR to in the vaccination of up to 300,000 dogs as part of a national rabies vaccination program.

MARNDR has requested assistance in evaluating the vaccination program and identifying barriers to achieving adequate vaccination coverage. MARNDR will conduct household surveys after the vaccination campaign to assess barriers to dog vaccination. CDC and PAHO will provide technical assistance for questionnaire development and interpretation of findings. MARNDR will collect programmatic data during the vaccination campaign, such as ‘dogs vaccinated per hour’ and ‘vaccination coverage’ to determine the program’s success.

CDC and PAHO will provide technical assistance for evaluation criteria and interpretation of findings. c) Mission Rabies-Jed Vaccination Program: CDC, PAHO, and Mission Rabies will plan vaccination campaigns in the same manner as logistical approach 2, however in this approach vaccination teams will be equipped with mobile phones pre-loaded with a mobile application that helps to track vaccination activities and locations. The outcome of a successful 2017 mass vaccination campaign is likely to have an impact broader than just within Haiti. The World Health Organization has declared a goal to eliminate dog-mediated human rabies deaths by 2030.

Per the CDC global assessment, there are few countries better-prepared to achieve this goal than Haiti. No country has declared canine rabies elimination in over a decade (the United States was the last to do so in 2007). The global community needs more success stories to rally behind, and Haiti is on the precipice of being that global focal example. Lastly, proving that Haiti can rally support to conduct an effective campaign (evaluated by CDC), will hopefully provide evidence for donors to continue to support this effort for the 5 - 7 years required to achieve the goal of elimination.

Data collection will help design future vaccination campaigns in Haiti and similarly affected countries. If not funded, dog-mediated human rabies deaths will increase in Haiti. The WHO goal of eliminating rabies - not only in Haiti, but other countries will not be realized.2. Zika: Laboratory and Surveillance Enhancement: Additional Zika funding will expand/enhance PAHO's current Zika project activities for PAHO member countries to support surveillance and diagnostic capacity for arboviral diseases.

Specific activities will include the following: a) Provide technical assistance to develop standard operating procedures for diagnostic and integrated surveillance activities; b) Distribution of arboviral reagents to support diagnostic testing; c) Training and consultative support for arboviral surveillance and diagnostic activities; d) Provide technical assistance for arboviral outbreak response; e) Collaborate with WHOCC to provide technical consultation and training and support for national reference laboratories; and D Support the development, implementation and evaluation of diagnostic and surveillance guidelines. PAHOIWHO works through a permanent contract between s Country Office and the Ministry of Health. If PAHO does not receive this funding, arboviral surveillance and diagnostic testing capacity in the Americas will be severely curtailed, putting the public health of the United States citizens at risk for the importation of exotic arboviruses. In the recent past, the Zika virus rapidly swept through South America (21 countries) and has now been identified in specific areas of the continental United States.

There have been reports of a serious fetal malformation called rnicrocephaly (a condition in which a baby's head is smaller than expected when compared to babies of the same sex and age) and other poor pregnancy outcomes in babies of mothers who were infected with Zika virus. Zika virus is the only known arbovirus to be sexually transmitted as well as transmitted via mosquitoes, compounding the ability for this disease to spread rapidly. Anticipating increased cases of local transmission leading to an increased risk to pregnant women and their developing babies, (CDC) activated its Emergency Operations Center and mobilized an extensive emergency response to Zika virus disease. Given the devastating impact of Zika virus and its potential to spread throughout the continental US, and the impending threat of the importation of other exotic arboviruses, it is critical to fund these diagnostic training and surveillance activities to better prepare the US to respond to critical vector-borne disease outbreaks of this nature.