After Russian full-scale invasion in Ukraine the Russian propaganda and disinformation found special popularity in various countries of the world, including in Georgia, one of the key goals of which is to demonize the West in public opinion. They try to influence the public opinion in the context of the country’s strategic relations with a lot of anti-Western narratives. To fight against that effectively, it is pivotal to provide relevant information for society. At this point, we’d like to discuss the support which Georgia has received from the strategic partnership since it became independent and subsequent crisis as well as discuss its results. Let’s focus on the field of medicine that is so popular among citizens. "What is the role of the U.S. in supporting Georgian healthcare system?", "Why the Lugar Center is the target of Russian conspiracy theories?", "Which project is the one you are most proud of?", - with these and other questions the Accent addressed to the U.S. Embassy in Georgia. The answers were prepared by the Press Relations Department of the Embassy.

- Many people might not be aware that the U.S. is the very first supporter of Georgia since its independence in terms of financial, humanitarian, and technical aid. As we know, support consists of three components….

- Since the mid-1990s, the United States and Georgia have worked together to address public health issues, which has saved lives and protected the Georgian population. These efforts began with disease detection and prevention shortly after the formalization of U.S.-Georgia diplomatic ties. For example, the U.S. Centers for Disease Control and Prevention (CDC) and the Georgian national public health system first partnered in 1995 to jointly investigated a diphtheria outbreak. As a result of our decades-long partnership, the Georgian National Center for Disease Control and Public Health (NCDC) has developed to become the leading public health institution in Georgia and the South Caucasus region.

Our partnerships continually strengthen the Georgian public health system’s capacity to manage disease threats. The U.S. Centers for Disease Control and Prevention (CDC) and the Georgian NCDC have partnered since 1995 to prevent, detect and rapidly respond to infectious disease threats, the United States Agency for International Development (USAID) funded immunization of children in Georgia aged 0-12 months, and the Defense Threat Reduction Agency (DTRA) and Walter Reed Army Institute of Research work with partners in the Georgian health system to improve the health and safety of the Georgian people.

Capacity-building of health care professionals is a core component of the U.S. government’s support to sustain initiatives in the Georgian public health system. Between 2009 and 2018, the CDC more than trained 100 epidemiologists in Georgia, via a two-year Advanced Field Epidemiology and Laboratory Training Program (FELTP). These graduates investigated disease outbreaks, including COVID-19, in Georgia and across the region. In 2022, the CDC launched a 10-month intermediate Field Epidemiology Training Program (FETP), leveraging Georgia’s outstanding reputation, to train public health experts from Armenia, Azerbaijan, Georgia, Moldova, and Ukraine. Since 2017, with support from the CDC, the NCDC has opened a public health Emergency Operations Centers and trained Emergency Operations Center personnel; trained nearly 500 public health professionals to prevent the spread of infectious diseases, identify diseases through laboratory diagnostics, and rapidly identify health emergencies; established effective emergency operations, including training 90 responders for Public Health Emergency Management Rapid Response Teams across five regions.

- The aid programs for mothers and children, medical education, reform of primary health care, development of public health, fighting against infectious diseases… this is a brief but important list of the fields of health care which were supported by the U.S…. let’s discuss the support and its results.

Over the last quarter century, the U.S. government has cooperated with Georgian government stakeholders, across the political spectrum, to respond to health needs in Georgia. In the areas mentioned, U.S. government agencies have supported related efforts over the years, including:

• Improved outcomes in maternal and child health: USAID worked with Georgian partners to promote modern birth practices that reduced postpartum hemorrhage – the leading cause of death in delivering mothers– from more than 10% to less than 1%. Through a partnership with the Georgian Obstetricians, Gynecologists, and Perinatologists Association, USAID introduced maternal and childcare guidelines that have standardized maternity care and have been adopted in clinical practice nationwide. Additionally, USAID has supported the training of hundreds of Georgian health care professionals in Effective Perinatal Care (EPC). By 2014, more than half of maternity hospitals in Georgia were trained and equipped by USAID to provide EPC and family-centered maternity care, covering approximately 80 percent of the annual deliveries in Georgia. The U.S. government has also supported implementation of a routine immunization system for all children in Georgia from 0 to five years old.
• Modernized medical education: USAID has partnered with leading medical schools - Tbilisi State Medical University (TSMU), David Tvildiani (AIETI) Medical University, Batumi Shota Rustaveli University Medical School, Kutaisi Medical University, and Tbilisi Petre Shotadze Medical Academy - to update curriculum and pedagogy. As a result of this partnership, Georgia implemented the objective structured clinical examination (OSCE), internationally recognized as the most effective method to evaluate clinical skills of medical students and administered its first OSCE to more than 500 students in 2014. USAID forged a public-private partnership between Emory University, Tbilisi State Medical University, and Foresight Investment Group LLC, that opened the “Ken Walker University Clinic for Medical Rehabilitation” in Tbilisi in 2020. The clinic now serves as a main clinical training base for rehabilitation and physical therapy students.
• Strengthened health care management: USAID developed and institutionalized the National Health Management Information System covering all business processes of the Ministry of Labor, Health, and Social Affairs, serving as the primary instrument in administering the Universal Health Care Program. More efficient and effective processes have improved health outcomes for all citizens of Georgia.
• Upgraded capacity for tuberculosis (TB) management: USAID-supported programs have strengthened case finding and improved the quality of TB treatment, as well as training for thousands of physicians and nurses. USAID support led to the adoption of a TB control law to ensure access to and quality of TB services. Additionally, USAID introduced an e-TB health management tool that enabled real-time tracking of TB data and facilitated decision-making. USAID also helped introduce up-to-date TB management guidelines and supported the implementation of new TB drugs and schemes to manage drug-resistant forms of TB.
• Launched the world’s first Hepatitis C elimination project: NCDC, in partnership with CDC and Gilead Sciences established this program 2015, which has since facilitated over 2.3 million screening tests and treated over 80,000 people in Georgia. Today, over 98% of patients who have completed treatment have been cured of this life-threatening disease. In 2022, the NCDC was designated as a World Health Organization (WHO) Collaborating Center for Viral Hepatitis Elimination, which means the Georgian NCDC will contribute to national hepatitis elimination plans, including testing strategies and diagnostic laboratory capacity in the region. CDC continues to provide support to Georgia, which is now providing technical guidance on implementation of similar programs across the region. Most recently, NCDC has hosting learning tours from Azerbaijan, Moldova, and Turkmenistan. In early 2022, CDC funded NCDC experts to guide elimination efforts in Uzbekistan.
• Strengthened pandemic preparedness capabilities in Georgia: The Hepatitis C Elimination Program helped Georgia implement high-volume testing for COVID-19 early in the pandemic and to detect COVID-19 variants with little additional international assistance. During the COVID-19 pandemic, Georgia established requirements to report and test suspected cases. With most of the laboratory system being private, an important task was ensuring that the testing was accurate. With support from CDC, Georgia established a PCR testing quality assurance and quality control (QA/QC) system for Hepatitis C virus, as part of the CDC contribution to the Hepatitis C Elimination Project, that was implemented at private laboratories across the country. NCDC adapted the hepatitis QA/QC system for COVID-19 testing throughout the country. This allowed for accurate testing at rates greater than most other countries throughout the pandemic. The results were reported transparently and in full to the WHO and the Georgian public.
• Improving detection and control of antibiotic resistance pathogens: Quality-assured laboratory diagnostics is essential for addressing the threat of antimicrobial resistance (AMR) in Georgia and across the region. Emergence and spread of AMR – the ability of pathogens to change over time and defeat medicines designed to kill them – is a major global health security threat. In May 2023, with support from the U.S. Centers for Disease Control and Prevention (CDC), the General Bacteriology Laboratory of the Richard Lugar Center for Public Health Research (GBL-LCPHR) obtained international accreditation to serve as an external quality assurance (EQA) provider for AMR detection in Georgia and across the Eastern European and Central Asian (EECA) region under the (International Organization for Standardization (ISO) ISO and International Electrotechnical Commission (IEC). This recognition is a testament to the high quality and competence of the LCPHR and its staff, and positions the national GBL-LCPHR as a top-tier multi-laboratory support facility for Georgia and across across the EECA region.
• Strengthening the public health workforce: In 2022, the Ministry of Labor, Health and Social Affairs of Georgia requested CDC assistance with developing a strategy to strengthen its public health workforce. The strategy is expected to be finalized by early 2024, with implementation occurring over the next five years.

- We should especially emphasize the Lugar Center which as specialists consider is one of the successful projects within Georgian-American partnership. Citizens may not realize its importance in daily life, but its role got especially important during pandemic when it was the only research center against the Covid. How important do you think it is and what are your thoughts about the reasons of it being a target of the Russian conspiracy theories for so many years?

DTRA completed construction of the Richard Lugar Center for Public Health Research in 2011 and after Georgia’s NCDC assumed ownership of the facility in 2014, the Lugar Center continues to improve and save lives through its work. During the COVID-19 pandemic, the Lugar Center’s nimble pivot to COVID-19 diagnostic testing and management, including contact tracing, isolation recommendations, and monitoring of confirmed cases, empowered Georgian public health institutions’ rapid response. The Lugar Center shared technical expertise with Georgia’s National Food Agency and the State Laboratory of Agriculture, to help neighboring countries like Armenia and Azerbaijan, to tackle COVID-19.

More broadly, the Lugar Center has supported laboratories across Georgia that work on disease prevention and management. The Lugar Center is a global leader in detection of antimicrobial resistance, a WHO-declared global threat which spreads drug-resistant pathogens and threatens the ability to treat common infections. It supports a process called genomic sequencing to decipher the genetic material found in an organism or virus. Sequences from specimens can be compared to help scientists track the spread of a virus, how it is changing, and how those changes may affect public health, which has strengthened Georgia’s response to disease outbreaks. In addition to COVID-19, the Lugar Center slashed hepatitis C prevalence in Georgia to under 2 percent and contributed to reaching the European regional hepatitis B control target and the target for elimination of mother-to-child transmission of hepatitis B set forth by the WHO.

Thanks to the hard work of its public health professionals and scientists, the Lugar Center is a modern facility that aligns with international standards on key operational measures. For example, they have improved safety and security for specimen storage for Georgian use in health research. To ensure stable operations, they created a sustainable procurement system for laboratory supplies. To empower its personnel, they instituted training for its cadre of Georgian laboratory scientists, physicians, and public health specialists.

Misinformation maligns the dedication of the Lugar Center’s professionals, Georgian government, and public health workers who peacefully serve the public health interests of Georgians and the global community.

- We’ve already discussed some fields. And still how specific fields are differentiated when the decision of support is made and how the monitoring process is implemented?

DTRA has supported 21 Georgian-owned and operated laboratories, which comprise Georgia’s national animal and human disease surveillance network that tracks disease outbreaks. Since 2018, the Government of Georgia has successfully funded and operated this national network. Working with the Ministry of Health and public health institutions like NCDC, the U.S. government continues to partner on efforts to strengthen Georgia’s biosafety, biosecurity, and biosurveillance. Biosafety and biosecurity efforts help the Georgian government ensure laboratories are equipped with the trained personnel and infrastructure to meet international guidelines. Biosurveillance empowers Georgia to mitigate biological threats, particularly disease outbreaks.

Over three decades, the U.S. and Georgia have cooperated to improve monitoring, particularly on endemic diseases in Georgia and the region, like plague. Thanks to this robust partnership, the people of Georgia benefit greatly in health outcomes, and Georgia is globally recognized for its technical leadership and project management. In three of the 11 studies the U.S. government currently partners on with Georgia, Georgian institutions - National Centers for Disease Control and Public Health (NCDC), State Laboratory of Agriculture (SLA), National Food Agency (NFA) – applied for U.S. government funding and work with international partners.

Recent notable examples of cooperation also include:

• In 2014, Georgia was one of the first countries to join the Global Health Security Agenda (GHSA), a global effort to prevent, detect, and respond to infectious disease threats. To date, more than 70 countries have joined the GHSA and Georgia is a leader in the biosurveillance technical area.
• In 2019, Georgia conducted its first Joint External Evaluation (JEE). The public results of this evaluation identified gaps in Georgia’s public health system, to develop a national action plan for health security. This plan addresses these gaps and reaches full compliance with international health regulations.
• In April 2023, the Georgian government committed to serving with the U.S. as an intensive support partner country for health security. This designation represents another step towards cooperation in managing infectious disease, in line with national commitments under international health regulations and commitment to the GHSA 2024 goals.
• In September 2023, the U.S. CDC and WHO supported Georgia’s first Policy Dialogue for Health Security. This is a critical step in convening Georgian ministries and other partners to initiate the development of Georgia’s National Action Plan for Health Security. We look forward to Georgia hosting its first workshop with key Georgian ministries to start developing a National Action Plan for Health Security.

DTRA continues to partner with Georgia on monitoring via activities such as regional engagement in studies, international conferences, and cross-border collaborations. Georgia is a regional leader that shares its technical expertise with the international scientific community and the U.S. government is proud to stand with Georgian partners.

- Considering long-term partnership and invested resources, specifically which project (or projects) you are mostly proud of and why?

Many wonderful examples highlight the U.S.-Georgia health partnership. During the COVID-19 pandemic, the greatest health threat of the modern era, Georgia mounted a strong response to the pandemic, which underscored the success of Georgian institutions supported and continually advanced through our bilateral partnership.

The CDC facilitated the U.S. government donation of 500,000 doses of Pfizer vaccine in July 2021, leading to a substantial increase in vaccination. USAID provided emergency assistance to Georgia, beginning in the first months of the pandemic in 2020 as it mobilized 5 million USD to address immediate needs in diagnostics, raising awareness, and prevention, followed by a second tranche of 5 million USD in 2021 to support the Georgian government’s PROVAX campaign that messaged about how to access vaccines, and challenged myths about the COVID-19 vaccine that stunted Georgia’s vaccination rate. USAID’s assistance also strengthened rollout of the COVID-19 vaccine in Georgia by increasing public access to vaccination services across the country, including by supporting the operation of two mass vaccination centers in Mtskheta and Rustavi, establishing a primary healthcare clinic-level vaccination unit in Mukhrani village; and supporting the operation of two mobile vaccination clinics to reach patients in inaccessible areas.

Throughout the pandemic, the CDC supported COVID-19 monitoring and research that guided decisions about public health and social measures, including vaccination strategies​. Georgia’s FETP graduates participated in contact tracing activities and household transmission investigations.

COVID-19 pushed the public health system in Georgia to further improve its approach to public health detection and response. COVID-19 related efforts have led to the use of new processes for detecting future acute respiratory and influenza-like illnesses. Another innovative example of this has been the CDC’s support of the Lugar Center in streamlining its processes and workflows to provide faster analysis of genomes and high-quality sequencing data, allowing experts to track changes in infectious disease threats to better identify approaches and tools, including applications of wastewater surveillance systems. Today, the U.S. government and its Georgian partners are applying the lessons learned during the pandemic to establish a Genomic Sequencing Center of Excellence within the Lugar Center, which will provide trainings, mentorship and technical support across the region.

Similarly, the ongoing USAID-WHO COVID-19 Response Program is focused on safety, data privacy, and real-time data analysis. The activity improves waste management procedures at vaccination sites and introduces safe injection programs in Georgia to reduce injuries associated with improper waste handling and management. The program distributed 600,000 USD worth of equipment and supplies to more than 1,100 clinics nationwide to ensure safe medical waste practices. The program also optimizes Georgia’s Health Information System (HIS) by expanding the Geographic Information Systems (GIS) and data visualization capacities of the Ministry of Health and National Center for Disease Control and strengthening the cybersecurity of the HIS system.

Whether it is establishment of the Lugar Center and seeing our Georgian partners lead its continued development and expansion as a cornerstone of Georgia’s public health system, saving lives by launching the world’s first hepatitis C elimination program, or steering a strong response to the COVID-19 pandemic, we can all be proud of these efforts.