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CDC Foundation CEO warns of 'Disease X,' cites donor-research 'firewall'

? CDC Foundation President and CEO Judith Monroe sees global public health threats from long-standing sources, chronic illnesses and as-yet-unknown diseases.

? Getting the U.S. to devote more resources to illness prevention than to healthcare is like swimming "upstream."

? Increased buzz around environmental, social and governance investing principles suggests new opportunities to finance public health research.

? The CDC Foundation stands behind its donation and disclosure practices.

It has been 100 years since the global influenza pandemic of 1918. With that grim milestone in mind and facing many old and new public health threats, CDC Foundation President and CEO Judith Monroe is focused on developing public-private partnerships that advance the mission of the U.S. Centers for Disease Control and Prevention. But the foundation is not without critics, some of whom question the transparency of the nonprofit organization's funding and donors' influence on scientific research at the CDC.

A guest at the annual gathering of economists, investment managers and market observers known as Camp Kotok, Monroe, who is also a physician, sat down with S&P Global Market Intelligence on Aug. 4 at Leen's Lodge in rural Maine. The following is an edited and condensed version of that conversation, which took place just ahead of the release of the latest "CDC Vital Signs" report.

SNL ImageCDC Foundation President and CEO Judith Monroe visiting Camp Kotok at Leen's Lodge in Maine.
Source: S&P Global Market Intelligence

S&P Global Market Intelligence: What do you consider the biggest public health crisis the U.S. is facing right now, and what do you see affecting the world at large?

Judith Monroe: There's no doubt that the opioid crisis is a major problem here in the U.S. that we're not seeing to the same extent in other countries. A lot of attention is being paid to it now.

We are always at the threat of the infectious diseases that may come to our borders. They might emerge here, but they are more likely coming in. If you look at the largest threat to mankind at large, probably a pandemic influenza still ranks as the highest because of the ability for the influenza to spread so rapidly and because of the emerging strains.

Zika is an example of a disease that we've known about for a while, but we had no idea of the consequences. Zika has been around since 1947, that we've known about, and it's only with the 2015-2016 epidemic that we've realized the birth defects. With the changes taking place in climate and the warming of the earth, we're seeing mosquito- and tick-borne diseases and other things in regions where we've not seen them before.

It's that emerging unknown disease that is going to be a threat. The World Health Organization calls it Disease X. The WHO has a list of diseases that are rich for research and development. They're on the list because they have a high potential for epidemic or pandemic, and we don't have the tools to fight them. There are known diseases like Lassa fever, Ebola, Zika, a lot of the hemorrhagic diseases.

Monroe emphasized the need to have global systems in place to deal with unknown health threats along with the "strongest public health system possible" in the U.S.

There are fundamentals that we know make a difference: having strong surveillance with data coming in so the epidemiologists can see whether there's a blip on the screen that we need to be paying attention to. Having really strong laboratory capacity is important. Look at, as an example, Puerto Rico or the U.S. Virgin Islands in the face of the hurricanes. They already had systems that weren't nearly as strong as you'd want to have, but when something devastating comes in, you really realize how important laboratory systems and epidemiologists and all of that are.

In the U.S., we invest a lot less in public health than we do in healthcare. Chronic disease in the U.S. is a big challenge because it's high-cost and high-burden. Preventing diabetes, preventing heart disease, preventing those things so people can live long, healthy lives is moving upstream, but we don't put nearly the resources into that that we should.

Do you see that changing? Are there any political winds that suggest that we could improve, or does anything from the private sector suggest that we are going to move in the right direction?

There was a prevention and public health fund that the CDC received funding for in past years. There have been efforts to move upstream. There are certainly businesses that understand. You've got businesses that do worksite wellness as an example. Insurance companies are very interested in this.

Let's take hypertension as an example. It's relatively easy to manage if you diagnose it and you get folks on medication or lifestyle changes. But we fall short in the United States. Less than 50% of people with hypertension are treated effectively. Look at the burden of the heart attacks and the heart disease that could be prevented. Systems like Kaiser Permanente do a nice job. I think they've attained maybe up to 90% effectiveness, but that's not widespread. If we're really going to make a difference in the big problems, we need everybody to come to the table. Quite frankly, we all own a part of the problem or could do something about it.

With the increasing prevalence of environmental, social and governance principles in investing, do you see any more appetite from the private sector for public-private partnerships?

We're hearing more about it. I'm excited because I do think we need to be looking at different financial models and different ways of thinking. There are some opportunities on a global scale, with pandemic influenza being probably the greatest threat. There might be investment bonds and things that would look differently. I'm excited about what's possible, but at the foundation, we haven't had any partnerships like that just yet.

Suspicious of ties to Coca-Cola Co., CrossFit Inc. has claimed that the CDC Foundation is not in compliance with laws governing its donation disclosures. And legislators from the U.S. House appropriations committee recently emphasized to the foundation its legal responsibilities with respect to such disclosures.

There has been some scrutiny of your foundation over the disclosure of donors. What's your response?

The foundation has a report that goes to Congress each year. We've reported for 23 years. We've never had any concerns from Congress about the report. We actually put out a lot of information about our donors. We have a website that talks about our projects and who the donors are and so forth. There's something called a donor bill of rights that we have subscribed to under which individual donors can remain anonymous. We've done that just with individuals and on a small scale. Quite frankly, some of the individuals do that for religious reasons. They feel that giving is something that should be anonymous. They don't want any fanfare.

Monroe said the CDC Foundation has honored the wish of other donors to remain anonymous because they do not want to end up on a list and get "hammered" by other organizations in search of funding. The foundation has received $259,000 in anonymous donations over the last five fiscal years, averaging about $300 per donation. Nearly 90% of that amount came in during fiscal 2015 and 2016 for emergency responses to Ebola and Zika.

Some folks have taken issue with some particular donors. Donors know if they donate to the foundation for any purpose, especially if there's research involved, that the CDC is controlling the science, and there's an absolute firewall. We stand ready to do whatever we need to, and we have full transparency.