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Volume 28, Supplement—December 2022

Global Responses to the COVID-19 Pandemic

Cynthia H. Cassell, Pratima L. RaghunathanComments to Author , Olga Henao, Katina A. Pappas-DeLuca, Whitney L. Rémy, Emily Kainne Dokubo, Rebecca D. Merrill, and Barbara J. Marston
Author affiliation: Centers for Disease Control and Prevention, Atlanta, Georgia, USA

Cite This Article

Confronted with a novel coronavirus, countries worldwide were forced to rapidly adjust their public health systems, platforms, and tools to respond to COVID-19. The US Centers for Disease Control and Prevention (CDC) and its global partners adapted health systems and programs originally developed for other purposes, such as controlling the HIV/AIDS pandemic through the US President’s Emergency Plan for AIDS Relief (PEPFAR), Global Health Security Agenda implementation, influenza surveillance, and vaccine-preventable disease elimination and eradication. This special supplement of Emerging Infectious Diseases highlights responses to the early phases of the COVID-19 pandemic from >80 countries, spanning 6 continents and representing >130 organizations. This article summarizes global adaptations of core public health functions during COVID-19: surveillance, information, and laboratory systems; workforce, institutional, and public health capacity; and clinical and health services delivery.

Surveillance, Information, and Laboratory Systems

CDC has provided longstanding support to strengthen surveillance, health information, and laboratory systems globally. Examples of such platforms used during the COVID-19 pandemic include the early warning and response surveillance system (1); respiratory (2), influenza (3), and acute febrile illness surveillance systems (4); global health security–supported information systems (e.g., District Health Information Software, version 2 [DHIS2]) (5); and PEPFAR-supported HIV and tuberculosis (TB) information systems (6,7). Respiratory disease surveillance guidance was developed for COVID-19 in 9 temporary camps for displaced persons along the Thailand–Myanmar border, showing that such systems can be effective during pandemics (2). Countries’ ministries of health (MOH), the World Health Organization (WHO), CDC, academic institutions, and nongovernmental organizations adapted international influenza surveillance systems for SARS-CoV-2 infections (3). CDC collaborated with MOH and partners to leverage existing acute febrile illness surveillance systems in 5 countries to collect and generate COVID-19 data needed for action (4). Kinkade et al. described 3 countries’ experience strengthening surveillance systems and reporting using DHIS2 for COVID-19 (5). Mirza et al. showed how health information systems for HIV and TB were modified for COVID-19 (6). PEPFAR-supported HIV and TB information management systems and diagnostic networks were adapted for SARS-CoV-2 testing in 16 low- to middle-income countries during the pandemic (7). Surveys provided key data on SARS-CoV-2 cases in Pakistan (8) and Malawi (9). Ohlsen et al. found international disparities in SARS-CoV-2 sequencing capacity and timeliness while viral genomic surveillance coverage increased globally (10). Smith-Sreen et al. compared 3 waves of the pandemic in 10 countries in southern Africa (11). Three neighboring countries in Africa used toolkits to analyze population movements and prioritize surveillance, cross-border collaboration, and communication strategies (12). Kenu et al. explained how geographic information systems were used for contact tracing to identify COVID-19 cases in Ghana (13). Chiou et al. developed a COVID-19 infodemic surveillance system to produce actionable insights to help address misinformation (14).

Workforce, Institutional, and Public Health Capacity Development

CDC-supported Field Epidemiology Training Programs (FETPs) (15,16), Public Health Emergency Management (PHEM) Fellowships (17), and national public health institutes (NPHIs) (18) have contributed to leadership, disease detection and surveillance, and response and workforce capacity during the pandemic. Bell et al. described contributions to COVID-19 preparedness and response from 32 FETPs with 2,300 trainees and ≈7,400 graduates, representing >80 countries and 3 regions (15). Since 2013, CDC has offered the PHEM Fellowship to develop an international emergency response workforce; an assessment examined PHEM graduates’ roles during the pandemic (17). Zuber et al. reviewed the pivotal role NPHIs have played in pandemic response and identify gaps and priorities for further research (18).

Longstanding partnerships with MOH and other governmental bodies helped strengthen COVID-19 response capacity in Kenya (19), Nigeria (20), South Africa (21), and Cameroon (22). In Kenya, COVID-19 helped advance establishment of NPHIs and national and county-level emergency operations centers, workforce development and deployment, and training in surveillance, laboratory diagnostics, and infection prevention and control (IPC) (19). The Nigeria Presidential Task Force on COVID-19 worked with partners to develop a comprehensive National Pandemic Response Plan (20). In Cameroon, CDC’s global health programs were leveraged to respond to COVID-19, helping ensure continued delivery of HIV services and other health programs (22). Through PEPFAR, CDC used HIV Project Extension for Community Healthcare Outcomes programs, a model for virtual clinical mentorship, to address and assess healthcare workers’ response to COVID-19 (23). In 2021, the Public Health Center of Ukraine, Ukraine’s NPHI, engaged with faith communities to address public health measures during religious gatherings (24).

Clinical and Health Services Delivery and Impact

The pandemic also affected clinical and health services delivery. This supplement describes impacts on vaccine-preventable disease surveillance (25), expansion of COVID-19 vaccinations (26), and the effects of decreased hepatitis B immunization coverage (27). In the WHO Africa region, more than 200 Stop Transmission of Polio (STOP) Program consultants were surveyed to clarify how vaccine-preventable disease surveillance systems were disrupted during the pandemic (25). CDC’s COVID-19 International Vaccine Implementation and Evaluation program applied lessons learned from Ebola, influenza, and meningococcal serogroup A conjugate vaccine introductions for the delivery of COVID-19 vaccines (26). Experiences from past rubella vaccination programs (28), yellow fever and polio immunization campaigns for COVID-19 vaccine deployment and safety monitoring in Ghana (29), and the effectiveness of inactivated whole-virus COVID-19 vaccine among healthcare personnel in Peru (30) can also inform future responses. Zambia integrated COVID-19 vaccination at HIV treatment centers and combined activities planned for 2021 World AIDS Day to help increase vaccination outreach (31). Kimani et al. assessed IPC strategies and health facility readiness for responding to COVID-19 in Kenya, providing important data to guide IPC improvements (32). Gomes et al. described initiatives to strengthen IPC in healthcare facilities in 4 countries for the prevention of healthcare-associated transmission of SARS-CoV-2 (33).

COVID-19 affected other clinical services, including male circumcision for HIV prevention in sub-Saharan Africa (34) and care offered to survivors of sexual violence in Kenya (35). COVID-19 also caused clinical and socioeconomic impacts on agricultural workers in Guatemala (36). Protocols on community-based management of acute malnutrition in Uganda, Ethiopia, and Somalia needed modification to continue essential feeding services during the pandemic (37).


International responses to COVID-19 demonstrated diverse adaptations, effects, and some improvements to public health systems and institutions; long-term global partnerships and collaborations across technical domains were central. The articles in this supplement issue contribute to ongoing efforts to stop outbreaks at their source and advance health equity to make the world safer, healthier, and more prepared for future public health emergencies.

Dr. Cassell was recently Applied Research Lead, Division of Global Health Protection, Center for Global Health, and is currently the Pregnancy Risk Assessment Monitoring System Team Lead, Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion, both with the Centers for Disease Control and Prevention, Atlanta, GA. Her research interests include surveillance, maternal and child health, global health, and health services research.

Dr. Raghunathan serves as Accelerated Disease Control Branch Chief, Global Immunization Division, Center for Global Health, Centers for Disease Control and Prevention, Atlanta, GA. Her public health interests include global health, immunization, outbreak response, and health equity.

Dr. Henao serves as the Global Epidemiology, Laboratory, and Surveillance Chief, Division of Global Health Protection, Center for Global Health, Centers for Disease Control and Prevention, Atlanta, GA, and helped coordinate internationally focused activities in the CDC COVID-19 response. Her public health interests include global health, integrated and laboratory-based surveillance strategies, and epidemiologic methods.

Dr. Pappas-DeLuca is the Associate Director for Prevention Science and the Scientific Publications Unit Lead, Division of Global HIV and TB, Center for Global Health, Centers for Disease Control and Prevention, Atlanta, GA. Her public health interests include global health, sexuality and health, risk communication, and behavior change communications.

Ms. Rémy is a research epidemiologist with RTI International providing technical support for developing and implementing applied research and evaluation studies to the Division of Global Health Protection, Center for Global Health, Centers for Disease Control and Prevention, Atlanta, GA. Her research areas of interest are related to global health security, implementation science, infectious disease, and public health surveillance.

Dr. Dokubo is the CDC Country Director in Jamaica/Caribbean Regional Office, Center for Global Health, Centers for Disease Control and Prevention, Atlanta, GA. She served as CDC Country Director in Cameroon during 2018–2022, where she led the agency’s COVID-19 response efforts. Her primary research interests are HIV, global health security, and disease outbreak preparedness and response.

Dr. Merrill is the Team Lead of the Global Border Health Team, Division of Global Migration and Quarantine, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, GA. Her primary research and program interests include transborder communicable disease surveillance, migration, and outbreak preparedness and response.

Dr. Marston recently retired from a position in the Center for Global Health, Centers for Disease Control and Prevention, Atlanta, GA, where she helped coordinate CDC’s support for the response to the COVID-19 pandemic globally.



We acknowledge the support and effort from other CDC Global COVID-19 Supplement Planning Group members in the concept proposal process and prioritization of supplement articles: Joanne Andreadis, Eduardo Azziz-Baumgartner, Stephanie Bialek, Eric Gogstad, Michael Lynch, Nadia Oussayef, Benjamin Park, Laura Porter, Sandra Romero-Steiner, Bryan Shelby, and Sara J. Vagi. We also thank Apophia Namageyo with CDC’s COVID-19 Response International Task Force and other Task Forces’ Clearance Teams for their assistance in reviewing these articles. Last, we thank Adaeze A. Ogee-Nwankwo for her insight and assistance in budgetary and contractual matters.



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Cite This Article

DOI: 10.3201/eid2813.221733

Table of Contents – Volume 28, Supplement—December 2022

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Pratima L. Raghunathan, Centers for Disease Control and Prevention, 1600 Clifton Rd NE, Mailstop H24-3, Atlanta, GA 30329-4027, USA

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Page created: December 01, 2022
Page updated: December 13, 2022
Page reviewed: December 13, 2022
The conclusions, findings, and opinions expressed by authors contributing to this journal do not necessarily reflect the official position of the U.S. Department of Health and Human Services, the Public Health Service, the Centers for Disease Control and Prevention, or the authors' affiliated institutions. Use of trade names is for identification only and does not imply endorsement by any of the groups named above.