Foa_Content_of_CDC-RFA-JG-24-0131 revised(2).pdf

Signature Date

Centers for Disease Control and Prevention

Global Health Center

Public Health Partnerships to Accelerate Prevention and Control of Infectious Diseases and Emerging Public Health Threats in China and Globally

CDC-RFA-JG-24-0131

06/10/2024

Table of Contents A. Funding Opportunity Description

B. Award Information

C. Eligibility Information

D. Application and Submission Information

E. Review and Selection Process

F. Award Administration Information

G. Agency Contacts

H. Other Information

I. Glossary

Part I. Overview Applicants must go to the synopsis page of this announcement at www.grants.gov and click on the "Subscribe" button link to ensure they receive notifications of any changes to CDC-RFA-JG- 24-0131. Applicants also must provide an e-mail address to www.grants.gov to receive notifications of changes.

A. Federal Agency Name:

Centers for Disease Control and Prevention (CDC) / Agency for Toxic Substances and Disease Registry (ATSDR)

B. Notice of Funding Opportunity (NOFO) Title:

Public Health Partnerships to Accelerate Prevention and Control of Infectious Diseases and Emerging Public Health Threats in China and Globally

C. Announcement Type: New - Type 1:

This announcement is only for non-research activities supported by CDC. If research is proposed, the application will not be considered. For purposes of this NOFO, research is defined as set forth in 45 CFR 75.2 and, for further clarity, as set forth in 42 CFR 52.2 (see eCFR :: 45 CFR 75.2 -- Definitions and https://www.gpo.gov/fdsys/pkg/CFR-2007-title42-vol1/pdf/CFR- 2007-title42-vol1-sec52-2.pdf. In addition, for purposes of research involving human subjects and available exceptions for public health activities, please see 45 CFR 46.102(l) (https://www.ecfr.gov/current/title-45/subtitle-A/subchapter-A/part-46/subpart-A/section- 46.102#p-46.102(l)).

New Type 1 https://www.grants.gov/ https://www.grants.gov/ https://www.gpo.gov/fdsys/pkg/CFR-2007-title42-vol1/pdf/CFR-2007-title42-vol1-sec52-2.pdf https://www.gpo.gov/fdsys/pkg/CFR-2007-title42-vol1/pdf/CFR-2007-title42-vol1-sec52-2.pdf https://www.ecfr.gov/current/title-45/subtitle-A/subchapter-A/part-46/subpart-A/section-46.102#p-46.102(l) https://www.ecfr.gov/current/title-45/subtitle-A/subchapter-A/part-46/subpart-A/section-46.102#p-46.102(l)

D. Agency Notice of Funding Opportunity Number:

CDC-RFA-JG-24-0131

E. Assistance Listings Number:

93.318

F. Dates:

1. Due Date for Letter of Intent (LOI):

06/09/2024

2. Due Date for Applications:

06/10/2024 11:59 p.m. U.S. Eastern Standard Time, at www.grants.gov.

3. Due Date for Informational Conference Call:

N/A

G. Executive Summary:

1. Summary Paragraph This 5-year project’s purpose is to continue collaboration with counterparts in China to reduce the threat of infectious disease transmission in China, the U.S., and the world. This collaboration contributes to enhancing the technical collaboration, scientific exchange, and effective communication to promote health through trusted and robust partnerships between CDC and counterparts in China. The project has three broad goals: 1) strengthen public health systems and workforce capacity; 2) decrease the burden of TB; and 3) reduce influenza morbidity and mortality and enhance preparedness for pandemic threats. Activities may include joint investigations and monitoring of disease outbreaks, piloting innovative public health interventions, translating programmatic success to practice and policy, working in third countries to jointly respond to a public health emergency, and promoting rapid and transparent dissemination of public health data. This collaboration strives to leverage the expertise in China to share knowledge and evidence-based science for a bi-lateral exchange that mutually benefits the U.S. and China through partnership that builds sustainable expertise and capacity in global health security and public health systems. Depending on funding availability and priorities, the specific infectious disease entities to be addressed can change over the period of performance.

This NOFO has a required component funding structure. Please refer to Funding Strategy section.

a. Funding Instrument Type:

CA (Cooperative Agreement)

b. Approximate Number of Awards

c. Total Period of Performance Funding:

$5,000,000

d. Average One Year Award Amount:

$1,000,000

e. Total Period of Performance Length:

5 year(s)

f. Estimated Award Date:

September 30, 2024

g. Cost Sharing and / or Matching Requirements:

No Cost sharing or matching funds are not required for this program. Although there is no statutory match requirement for this NOFO, leveraging other resources and related ongoing efforts to promote sustainability is strongly encouraged.

Part II. Full Text

A. Funding Opportunity Description

1. Background

a. Overview For the past 40 years, CDC has collaborated with China on public health priorities that affect China, the U.S., and the world. This collaboration has helped build the public health system in China, address health issues of importance to both countries, and build a strong partnership between the U.S. and China on public health. This is an opportunity to continue strengthening that partnership through the exchange of knowledge, expertise, and science that can support both countries' public health systems and contribute to improving public health globally.

As witnessed from the COVID-19 pandemic, disease threat anywhere is a disease threat everywhere. But any disease outbreak can devastate economies, destabilize political environments, and impact national security. China is at special risk for outbreaks of emerging and re-emerging infections, in part because its large population of both people and livestock result in significant human-animal interface and increased spread of zoonotic disease. China has the third-highest number of tuberculosis (TB) cases globally with an estimated 30,000 cases of drug-resistant TB. Moreover, China is linked to the world through international trade and air travel, increasing the risk for infections spreading from China to the U.S. and the rest of the world. Thus, it is in the interest of both the U.S. and China to collaborate to reduce the threat of infectious diseases in China that have pandemic potential.

CDC has been partnering with China to build its public health capacity by strengthening public health surveillance, preventing disease transmission, and improving laboratory detection of infectious diseases, such as influenza, acute respiratory infections, food-borne infections, vaccine-preventable diseases, HIV, and drug-resistant TB. CDC has supported workforce development in strengthening disease surveillance, epidemiology, and capacity to respond to infectious disease outbreaks and other public health emergencies to develop future public health leaders. CDC has advised China on science-based communication strategies to mitigate public health threats and address public health priorities.

China demonstrated its growing capacity to improve public health systems in other countries during the 2014 Ebola outbreak in West Africa. Continuing to improve workforce and systems through Emergency Operating Center and establishing processes to set up an Incident Command

Structure are global priorities to effectively prepare and respond to a public health emergency.

This has resulted in China and U.S. commitments to collaborate closely on global health threats, such as joint support in third countries during a public health emergency.

Continuing close relationships between the U.S. and China built through decades of public health collaboration provide a foundation essential to work together to respond to future global pandemics and other public health emergencies. The technical expertise in China offers an opportunity to exchange the lessons, knowledge, and evidence-based science that will mutually benefit both the U.S. and China. The purpose of this cooperative agreement supports the technical collaboration to continue to build multi-sectoral partners to prevent, detect, and rapidly respond to emerging infectious diseases and strengthen collaboration with CDC.

In addition to core Components 1 - 3, this NOFO will support additional activities when funding is made available for a moderate (Component 4) or substantial (Component 5) response to a public health emergency. Applicants must apply for all five components.

b. Statutory Authorities This program is authorized under Section 307 of the Public Health Service Act [42 USC 242l] and Section 301 (a) [42 USC 241(a)] of the Public Health Service Act.

c. Healthy People 2030 This project supports the following Healthy People 2030 topic areas:

• Global Health

• Public Health Infrastructure

• Health Care Access and Quality

• Infectious Disease

• Emergency Preparedness

This NOFO aligns with CDC’s current Global Health Strategy including: protecting Americans and populations across the globe by strengthening global public health prevention, detection, and response; saving lives, improving health outcomes, and fostering healthy populations globally;

and leading the advancement of global public health science and practice and serving as a leading source of credible scientific information.

d. Other National Public Health Priorities and Strategies Activities funded through this cooperative agreement must align with the following United States Government (USG) and HHS/CDC strategies and policies:

CDC's strategy for improving global health security (GHS), based on three concepts embedded in the agency's mission to protect public health worldwide: 1) Prevent 2) Detect 3) Respond

CDC and the Global Health Security Agenda | Global Health | CDC

The Department of Health and Human Services' (HHS) Global Health Strategy

HHS Global Strategy | HHS.gov

International Health Regulations (2005)(IHR) and supporting policies and frameworks

International health regulations (who.int) https://health.gov/healthypeople/objectives-and-data/browse-objectives/global-health https://health.gov/healthypeople/objectives-and-data/browse-objectives/public-health-infrastructure https://health.gov/healthypeople/objectives-and-data/browse-objectives/health-care-access-and-quality https://health.gov/healthypeople/objectives-and-data/browse-objectives/infectious-disease https://health.gov/healthypeople/objectives-and-data/browse-objectives/emergency-preparedness https://www.cdc.gov/globalhealth/security/index.htm https://www.hhs.gov/about/agencies/oga/about-oga/why-hhs-works-globally/hhs-global-strategy/index.html https://www.who.int/health-topics/international-health-regulations#tab=tab_1

In an effort to ensure maximum cost efficiencies and program effectiveness, HHS/CDC also supports coordination with and among relevant partners. Recipients may be requested to participate in the following programmatic activities:

• Scale-up evidence-based programs to identify and close the major TB gaps among all populations at risk of TB infection and all forms of drug-sensitive and drug-resistant TB disease, including but not limited to household contacts of people with TB, children and adolescents, people living with HIV (PLHIV), health care workers, migrants, mobile/displaced populations, and those who work in crowded/congregate settings (criminal justice facilities, mines, etc.);

• Increase impact through strategic coordination and integration;

• Strengthen and leverage key multilateral organizations, global health partnerships, and private sector engagement;

• Encourage country ownership and invest in country-led plans, putting our national and local partners in the lead and actively enabling their growth through design of the program at all phases;

• Build sustainability through investments in health systems;

• Enhance health equity and reduce disparities in access to and uptake of TB services;

• Improve performance metrics, monitoring and evaluation and the quality of related data;

and

• Promote research, development, and innovation to develop a body of knowledge, enhance awareness and increase the skills and abilities of stakeholders (research is not supported by this NOFO).

Geographic prioritization may change over the course of the period of performance based on the burden of disease and evolving program priorities.

Any Personally Identifiable Information (PII) collected should be managed in a manner that ultimately protects individual-level data to the extent allowed by applicable law.

This NOFO is only for non-research activities supported by CDC. Recipients may not use funds for research. Certain activities that may require human subjects review due to institutional requirements but that are generally considered not to constitute research (e.g., formative assessments, surveys, disease surveillance, program monitoring and evaluation, field evaluation of diagnostic tests, etc.) may be funded through this mechanism. If research is proposed, the application will not be reviewed. For the definition of research, please see the CDC Web site at the following Internet address: https://www.hhs.gov/ohrp/regulations-and-policy/regulations/45-cfr-46/revised-common-rule-regulatory-text/index.html#46.102

e. Relevant Work This NOFO builds upon the long-term relationship between CDC and public health institutions in China. Important areas of this collaboration over the past decades have been in the areas of infectious disease prevention and control, public health capacity building, and scientific knowledge and information dissemination. This NOFO also builds on specific collaborations with China in HIV, influenza, TB, vaccine-preventable diseases, and global health security. In particular, this NOFO builds on and expands on previous non-research cooperative agreements (RFA-GH18-1855) and research cooperative agreement (RFA-GH17-05).

2. CDC Project Description

a. Approach

Bold indicates period of performance outcome.

CDC-RFA-JG-24-0131 Logic Model

Component 1: Strengthen Public Health Systems and Workforce Capacity

Strategies and Activities

Short-Term Outcomes

Intermediate Outcomes

Long-Term Outcomes

Strengthen public health systems and workforce to prevent, detect, and respond to emerging public health threats

• Strengthen local workforce capacity to rapidly detect, report, and respond to disease clusters of known and unknown etiology and other emergency events, with a focus on early detection and development and deployment of rapid response teams

• Build workforce capacity and establish protocols and procedures within the incident

Health systems are functional and available to prevent, detect, and respond to public health emergencies

Increased capacity among local surveillance staff and community health centers to detect and report emerging public health threats

Increased multi-sectoral collaboration to address emerging and re-emerging infectious diseases and coordinate public health emergencies

Strengthened workforce capacity to conduct innovative and quality health studies and to report timely, accurate, and relevant information for decision-making

Achieve IHR (2005) goal of 1 epidemiologist per 200,000 population

Strengthened local level capacity to control outbreaks

Capacity to deploy collaborative and multi-sectoral teams to infectious disease emergencies that arise in other countries

• Sustained partnership between the U.S. and China that contributes to the public health protection of both countries command structure

• Enhance the reporting and dissemination of timely, accurate, and relevant public health information

• Jointly respond to international public health emergencies

Component 2: Decrease the Burden of TB

Strategies and Activities

Short-Term Outcomes

Intermediate Outcomes

Long-Term Outcomes

Implement performance quality management interventions in health care settings

• Implement infection prevention and control interventions in health care settings

• Strengthen laboratory systems to improve diagnosis

• Develop core indicators for the performance of the quality management interventions

Increased implementation of appropriate infection prevention and control measures in health care settings

Improved quality of laboratory systems to diagnose TB cases

Reduced TB transmission in health care settings

Scale up to additional sites in China

Established performance quality management practices and policies in all local healthcare settings

Component 3: Reduce Influenza Morbidity and Mortality and Enhance Preparedness for Pandemic Threats

Strategies and Activities

Short-Term Outcomes

Intermediate Outcomes

Long-Term Outcomes

Facilitate the prevention and detection of influenza

• Establish multi-sectoral partnerships for early detection and timely investigation of avian and novel influenza

• Promote the use of vaccines, antivirals, and non-pharmaceutical interventions in high-risk groups

• Conduct surveillance for detection and control of influenza viruses and other respiratory pathogens

• Optimize surveillance data for public action for seasonal and novel influenza

Working groups developed for multi-sector collaboration

Training/workshops on avian influenza with multi-sector partners

Detect and characterize influenza viruses and other respiratory pathogens

Improved data analysis and utilization

Surveillance for avian and novel influenza conducted with participation of multi-sectoral partners

Assess lessons learned and best practices in China based on global standard or practices of neighboring countries

Monitor, detect and report influenza viruses and other respiratory pathogens

Develop evidence-based risk communication strategies and technical guidelines to reduce influenza morbidity and mortality

Improved multi-sectoral detection and timely investigation of novel influenza

Strengthened data sharing and information exchange between multi-sectoral partners

Early detection and rapid response to influenza viruses and other respiratory pathogens with pandemic potential

Improved utilization of surveillance data and evidence-based policy and/or practice

Components 4 and 5: Rapid Response to Small-scale and Large-scale Public Health Emergencies

Strategies and Activities

Short-Term Outcomes

Intermediate Outcomes

Long-Term Outcomes

Intensify active surveillance, case finding, contact tracing, monitoring and other outbreak response measures at local levels

Strengthen capabilities for epidemiologic and laboratory analysis and program evaluation

Intensify social mobilization, community and professional education and engagement

Improve outbreak case management and infection control

Strengthen non-outbreak related public health activities that are impacted by the outbreak

Increase security and logistics for local responders

Strengthen capabilities for preparedness and response to highly infectious diseases

Improved time to deploy healthcare workers to respond and control the spread of infectious diseases

Strengthened coordination and robust emergency preparedness and response capacities

Improved disease outbreak case management and infection control

Shortened time to detect highly infectious disease outbreaks through active surveillance and case finding

Reduced transmission of highly infectious diseases in clinical and community settings

Increased awareness, knowledge, and support for local disease outbreak response and prevention efforts at the community level

Rapid identification and containment of highly infectious disease outbreaks

Reduced time to reinvigorated public health activities that have been interrupted or slowed due to outbreak response

Improved access to health services by individuals in outbreak affected areas

Increased capacity of countries for early warning, risk reduction and management of national and global health risks

Sustained improvements in timeliness of achieving outbreak/epidemic/pandemic control

Reduced morbidity and mortality attributed to disease outbreaks or other public health threats

Reduced spread of infectious outbreaks into other countries

Improved preparedness for potential future outbreaks and other highly infectious diseases

i. Purpose The purpose of this agreement is to enhance the collaboration with public health institutes in China that will be mutually beneficial through technical collaboration, scientific exchange, and effective communication to promote health. This will be done by 1) building stronger public health systems and workforce capacity, 2) reducing the burden of TB, and 3) reducing the morbidity and mortality of influenza and enhancing preparedness for pandemic threats.

ii. Outcomes Component 1: Strengthen Public Health Systems and Workforce Capacity

• Health systems are functional and available to prevent, detect, and respond to public health emergencies

• Increased capacity among local surveillance staff and community health centers to detect and report emerging public health threats

• Increased multisectoral collaboration to address emerging and re-emerging infectious diseases and coordinate public health emergencies

• Strengthened the workforce capacity to conduct innovative and quality health studies and to report timely, accurate, and relevant information for decision-making

Component 2: Decrease the Burden of TB

• Increased implementation of appropriate infection prevention and control measures in health care settings

• Improved quality of laboratory systems to diagnose TB cases

• Reduced TB transmission in health care settings

• Established performance quality management practices and policies in all local healthcare settings

Component 3: Reduce the Influenza Morbidity and Mortality and Enhance Preparedness for Pandemic Threats

• Working groups developed for multi-sector collaboration

• Training/workshops on avian influenza with multi-sector partners

• Detect and characterize influenza viruses and other respiratory pathogens

• Improved data analysis and utilization

• Surveillance for avian and novel influenza conducted with participation of multi-sectoral partners

• Assess lessons learned and best practices in China based on global standards or practices in neighboring countries

• Monitor, detect, and report influenza viruses and other respiratory pathogens

• Develop evidence-based risk communication strategies and technical guidelines to reduce influenza morbidity and mortality

Components 4 and 5: Rapid Response to Small-Scale and Large-Scale Public Health Emergencies

• Improved time to deploy healthcare workers to respond and control the spread of infectious diseases

• Strengthened coordination and robust emergency preparedness and response capacities

• Improved disease outbreak case management and infection control

• Shortened time to detect highly infectious disease outbreaks through active surveillance and case finding

• Reduced transmission of highly infectious diseases in clinical and community settings

• Increased awareness, knowledge, and support for local disease outbreak response and prevention efforts at the community level

• Rapid identification and containment of highly infectious disease outbreaks

• Reduced time to reinvigorated public health activities that have been interrupted or slowed due to outbreak response

• Increased capacity of countries for early warning, risk reduction and management of national and global health risks

• Sustained improvements in timeliness of achieving outbreak/epidemic/pandemic control

• Reduced morbidity and mortality attributed to disease outbreaks or other public health threats

• Improved preparedness for potential future outbreaks and other highly infectious diseases

iii. Strategies and Activities Component 1: Strengthen Public Health Systems and Workforce Capacity

Activities in this component aim to strengthen the public health workforce and related systems to effectively prevent, detect, and respond to emerging and re-emerging public health threats. All trainings, projects, and corresponding activities should be planned in coordination with CDC and include program/project monitoring and evaluation. CDC expects that resulting outputs (e.g., progress reports, abstracts, and publications) will meet high quality public health standards.

Provincial CDCs, academic institutions, and hospitals are encouraged to apply. Applications addressing multi-sectoral and cross-provincial activities are also strongly encouraged.

Successful applications will address one or more of the following:

• Strengthening local workforce capacity to rapidly detect, report, and respond to disease clusters of known and unknown etiology and other emergency events, with a focus on early detection and development and deployment of rapid response teams

• Building workforce capacity and establishing protocols and procedures within the incident command structure

• Enhancing the reporting and dissemination of timely, accurate, and relevant public health information

• Increasing coordination and collaboration between CDC and China CDC in jointly responding to public health emergencies in third countries, including the establishment of global rapid response teams and practicing through tabletop exercises

Component 2: Decrease the Burden of TB

Activities in this component implement performance quality management interventions in health care settings. In furtherance of the underlying purposes of this NOFO, recipients are expected to provide copies of and/or access to all data, software, tools, training materials, guidelines, and systems developed under this NOFO to Ministry of Health and other relevant stakeholders, including HHS/CDC, for appropriate use consistent with underlying authorities. Recipients are encouraged to exchange best practices, lessons learned, and evidence-based science with CDC.

Activities can include:

• Implementing infection prevention and control interventions in health care settings

• Strengthening laboratory systems to improve TB diagnosis

• Developing core indicators for the performance of the quality management interventions

Component 3: Reduce the Influenza Morbidity and Mortality and Enhance Preparedness for Pandemic Threats

Activities in this component facilitate the prevention and detection of seasonal and novel influenza. Recipients are encouraged to exchange best practices, lessons learned, and evidence-based science with CDC. Activities can include:

• Establishing multi-sectoral partnerships for early detection and timely investigation of avian and novel influenza

• Promoting the use of vaccines, antivirals, and non-pharmaceutical interventions in high-risk groups

• Conducting surveillance for detection and control of influenza viruses and other respiratory pathogens

• Optimizing surveillance data for public health action for seasonal and novel influenza

Components 4 and 5: Rapid Response to Small-Scale and Large-Scale Public Health Emergencies

Intensify active surveillance, case finding, contact tracing, monitoring, and other critical response efforts at local levels.

• Conducting and improving ongoing active surveillance, with laboratory confirmation to ensure rapid identification of missed, new or newly imported outbreak cases

• Strengthening capacity for general surveillance including support for personnel required for surveillance and epidemiology activities

• Strengthening surveillance at entry points (border posts, airports and maritime ports) from countries with ongoing transmission

Strengthen capabilities for epidemiologic and laboratory analysis and program evaluation.

• Improving operational and technical analysis, coordination and monitoring of interventions

• Assessing the impact of the epidemic on health care seeking and health care provision

Intensify social mobilization, community and professional education and engagement.

• Conducting intensified social mobilization and community engagement to enhance awareness and gather community support, acceptance, and participation in implementation of containment measures

• Providing psychosocial first aid training for community agents and their supervisors so they can provide direct psychosocial support to contact cases and their families

• Developing and conducting communications to contain the outbreaks and enforce the theme of "Staying at Zero Cases"

• Developing and disseminating key health risk communication messages

Improve outbreak case management and infection control.

• Developing plans for patient management as community and clinical settings

• Improving infection control practices, particularly in facilities that might receive outbreak cases for example, on a border with a country with ongoing transmission

Strengthen non-outbreak related public health activities that are impacted by the outbreak.

• Restoring priority aspects of the health/public health system, such as surveillance and assessment of vaccination coverage for epidemic-prone disease (e.g., measles), that are negatively impacted or stalled due to the outbreak.

Increase security and logistics for local responders.

• Strengthening field security to ensure operational security and protect national and international staff involved in the response

Strengthen capabilities for preparedness and response to highly infectious diseases.

• Developing/implementing partnership mechanisms for a more robust and responsive global health emergency workforce.

• Training front-line responders on emerging infectious diseases.

Strengthen critical International Health Regulations (IHR) and health systems capacities in affected region and elsewhere.

1. Collaborations

a. With other CDC projects and CDC-funded organizations:

Recipient(s) are required to work with other CDC implementing partners, including non-governmental organizations, universities, Ministry of Health and other host governmental bodies and multi-lateral organizations that receive CDC funds. Recipient(s) should ensure their proposed activities are not duplicating activities already implemented by other CDC-funded organizations. To be considered, applicants must submit a letter of support from China's national government (e.g. China CDC) and save the file "China Letter of Support," and upload it as a PDF file at www.grants.gov.

b. With organizations not funded by CDC:

The recipient(s) will work primarily and directly with partner governments specifically with the Ministry of Health and other government entities which are working towards the objectives of this NOFO. In addition, the recipient(s) will be expected to work with other in-country and global stakeholders, including but not limited to government entities, non-governmental organizations, universities, civil society, the private sector, and other USG agencies.

2. Population(s) of Focus http://www.grants.gov/

The target populations for this NOFO include but are not limited to those individuals infected or at risk for becoming infected by an infectious disease. The target population for this NOFO may also include at-risk populations for non-communicable diseases, humanitarian crises, and/or other public health emergencies.

The work under this NOFO will also target increased capacity at the national and sub-national level to implement and achieve outbreak/epidemic/pandemic control in line with USG and CDC strategy.

This NOFO, including funding and eligibility, is not limited based on, and does not discriminate on the basis of race, color, national origin, disability, age, sex (including gender identity, sexual orientation, and pregnancy) or other constitutionally protected statuses.

a. Health Disparities The goal of health equity is for everyone to have a fair and just opportunity to attain their highest level of health. Achieving this requires focused and ongoing societal efforts to address historical and contemporary injustices; overcome economic, social, and other obstacles to health and healthcare; and eliminate preventable health disparities.

Broadly defined, social determinants of health are non-medical factors that influence health outcomes. They are the conditions in which people are born, grow, work, live, and age, and the wider set of forces and systems shaping the conditions of daily life. These forces (e.g., racism, climate) and systems include economic policies and systems, development agendas, social norms, social policies, and political systems. See content below and in other sections (e.g., Approach, Collaborations, Populations of Focus) for information on how this specific NOFO affects social determinants of health.

A health disparity is a preventable difference in the burden of disease, injury, violence, or opportunities to achieve optimal health that are experienced by populations that have been socially, economically, geographically, and environmentally disadvantaged. Health disparities are inextricably linked to a complex blend of social determinants that influence which populations are most disproportionately affected by these diseases and conditions.

Recipients are expected to use epidemiologic, social determinants, and linked laboratory, epidemiological, and surveillance data to identify communities disproportionately affected by infectious diseases or non-communicable diseases in the target areas to ensure that program activities appropriately cover these populations. Recipients should ensure that supported services are accessible and available to all populations regardless of age, sex, race/ethnicity, sexual orientation, gender identity, or socio-economic status in order to achieve the outcomes of this

NOFO.

Global Tuberculosis Funding: In an effort to assure that activities funded through this NOFO: (1) affirm and advance, as appropriate, the role of health equity and an equitable, diverse, and inclusive workforce as core principles and (2) advance the reduction of stigma and discrimination through the promotion, consistent with applicable laws, of civil and human rights to improve the health outcomes of persons at risk of, or living with, HIV and/or TB infection, CDC/Division of Global HIV and TB (DGHT) awards resulting from this NOFO may address the following activities, where and when appropriate:

• Community involvement in the design, implementation, and monitoring of HIV and TB services.

• Training for implementing partners involved in the design, implementation, and/or monitoring of activities on stigma, discrimination, gender equitable norms, human rights, and community engagement to minimize the likelihood for activities to unintentionally increase stigma and discrimination directed towards PLHIV and all populations at risk of TB infection.

• Programs to address evidenced health disparities and social barriers (e.g., HIV-related stigma) to HIV and TB services.

• Use of data to monitor disparities and implement strategies to improve access, service use, and outcomes.

iv. Funding Strategy This NOFO is divided into three core components and two additional emergency components, in the event of a public health emergency. Applicants are required to apply for at least one core component and both emergency components and include a separate budget and work plan for each component. The application package should be inclusive of all component work plans and budgets; multiple applications will not be reviewed. Applicants are encouraged to submit component budgets toward the year one award ceiling for each component, detailed below.

However, budget proposals for year one may not exceed the year one award ceiling. Please note, these amounts are subject to the approval and availability of funds.

The emergency components (Components 4–5) follow the same logic model with identical overarching strategies and activities. However, Component 4 should support activities when funding is made available for a moderate response to a disease outbreak or other public health emergency. Component 5 should support activities when funding is made available for a substantial response to a disease outbreak or other public health emergency. Applicants are encouraged to use the strategies and activities of the logic model as guidance for developing activities relevant to their context and aligned with the outcomes included in the logic model.

Applicants are encouraged to consider the following in the development of their budgets and budget narratives:

Component 1: Strengthen Public Health Systems and Workforce Capacity

Activities in this core component are intended to be funded on an annual basis under Component 1. The estimated year one ceiling is $350,000. Future years’ funding levels will be dependent on funding availability. This component will support activities related to strengthening outbreak detection and response through multi-sector collaboration and coordination between public health systems, clinical care, and communities, particularly at the sub-national level. This component can also include activities to increase workforce capacity in epidemiology at the national, provincial, and local levels, strengthen existing emergency operation centers, and improve dissemination of public health information.

Component 2: Decrease the Burden of TB

Activities in this core component are intended to be funded on an annual basis under Component 2 related to reducing the burden of TB in China in health care and community settings. The estimated year one ceiling is $150,000. Future years’ funding levels will be dependent on funding availability.

Component 3: Reduce Influenza Morbidity and Mortality and Enhance Preparedness for Pandemic Threats

Activities in this core component are intended to be funded on an annual basis under Component 3 related to reducing the prevention, detection, and investigation of seasonal and novel influenza. The estimated year one ceiling is $500,000. Future years’ funding levels will be dependent on funding availability.

Component 4: Rapid Small-scale Response to Infectious Disease Outbreaks or Other Public Health Emergencies

This emergency component is intended to be approved but unfunded (ABU) as a baseline practice. Future years’ funding levels will be dependent on funding availability. This component would be funded to support additional activities needed within a budget period when funding is made available for a moderate response to a disease outbreak or other public health emergency. The estimated year one ceiling is $1,000,000.

Component 5: Rapid Large-scale Response to Infectious Disease Outbreaks or Other Public Health Emergencies

This emergency component is intended to be approved but unfunded (ABU) as a baseline practice. Future years’ funding levels will be dependent on funding availability. This component would be funded to support additional activities needed within a budget period when funding is made available for a substantial response to a disease outbreak or other public health emergency. The estimated year one funding is $3,000,000.

Applicants must specify a descriptive title for each corresponding column shown on the SF- 424A, followed by the total (cumulative) in the column to the far right of the SF-424A.

Additional Information

Emergency Management and Response: The ability to respond rapidly and effectively to public health emergencies is a key component of global health security. International public health emergencies, including humanitarian crises, are by nature unpredictable, requiring fulfillment of changing and often unpredictable needs that vary widely according to context.

Consequently, funding for public health emergencies is also unpredictable and based on external factors. In recent years, there has been a sharp rise in the number of people living in regions of the world affected by public health emergencies, including humanitarian emergencies, which has often led to additional funding resources from the USG to respond to these threats. Given this unpredictability and the resulting need for a rapid, flexible, and efficient process to award funding under an emergency situation, recipients that are selected for funding under this NOFO will be eligible to receive additional expedited supplemental funding when a public health emergency occurs to scale-up activities included within the scope of work of this NOFO.

Definition of Public Health Emergency:

In order to qualify for supplemental emergency funding, one of the following situations must apply:

When the UN or the WHO classifies the emergency as a Level 3 (L3)

When the U.S. Congress appropriates funding for an international response related to humanitarian or public health crisis with the words containing “emergency” in the program title.

The appropriated funding could be for CDC directly or is transferred to CDC through an Interagency Agreement (IAA) by HHS or another USG entity.

When the U.S. government (Congress, White House, National Security Council, etc.) declares a public health emergency as national security priority

When the CDC Director activates the Emergency Operation Center (EOC) in response to an international public health threat

When the U.S. Department of State or the U.S. Agency for International Development transfer funds to CDC to respond to an international disaster or humanitarian assistance under 2 FAM 060 (International Disaster and Humanitarian Assistance)

If a public health emergency situation meets one or more of the criteria listed above, then selected recipients under this NOFO will be eligible to receive supplemental emergency funding to scale up public health activities included in the scope of work of this NOFO on a single-source basis (i.e. without additional competition, within a 12-month budget period and throughout the 60-month period of performance). There is no limit on the amount of emergency supplemental funding that a recipient may receive within a 12-month budget period or the 60-month period of performance under a public health emergency. Recipients receiving funds under a public health emergency will be eligible to receive emergency funding without constraint to the period of performance funding ceiling, annual budget period ceiling, or lack of component funding. In addition, applications for funding under a public health emergency will not need a merit review and will only require approval from the CDC Project Officer and Grants Management Officer (GMO) in order to be funded.

All reporting requirements listed under this NOFO still apply to any emergency supplemental funding.

Component Funding: It is required that this cooperative agreement be formulated for component funding. A component is a discrete set of activities with an associated budget. CDC will use component funding to provide funding for activities proposed in an application that received merit review but were not selected for funding in the initial award (i.e., at the onset of budget period 1) but may be funded at a later point in the budget period as programmatically necessary and as funding becomes available. Please review the following key points about component funding:

Component funding must be setup at the time of the application. While preparing the application, applicants should review the expectations listed in the NOFO for Year 1 activities and group them under the anticipated components listed above. Only activities planned for Year 1 should be grouped into components; applicants do not need to group activities in the high-level plan for the subsequent years 2-5 of the award into components. Funding amounts and components for years 2-5 will be determined at continuation.

Each component must be a discrete set of activities with an associated budget. Distinguishable component budget narratives are required. Setting up components based on time (i.e., quarterly) is an appropriate distinction of activities, provided activities are clearly outlined.

Applicants should submit the anticipated components on an SF-424A form as part of their application which shows all components for the budget period. The amounts should exactly match what is being requested for funding. Each component has its own approved amount and cannot be funded above the established amount. The combined total of all components must total the requested amount.

If more than 4 components are proposed, multiple SF-424As will be needed. Applicants may include the first 4 components on one SF-424A form and the remaining components on a second SF-424A form. Applicants may download additional SF-424A forms and upload them as PDFs under “Budget Narrative Attachment Form” or “Other Attachments Form.” These should be clearly labeled for easy identification and included in the Table of Contents for the entire submission.

If possible, applicants are encouraged to submit a separate budget justification for each component, but it is not a requirement. Applicants will not be deemed incomplete if separate budget justifications are not provided with the submission. A separate budget justification will ultimately be required for all components that are funded.

Any component that is not funded at the time of a new award may be deemed “Approved but Unfunded” (ABU). There is no guarantee that all components will be funded in a budget period as ABU components are subject to the availability of funds and the underlying legal authority for the work.

Components may not be awarded in order. All ABU components are eligible to receive funding once (and if) funds become available.

If funding becomes available, multiple components can be funded through the same funding action (single NOA).

If funding is awarded for an amount less than the ABU component approved amount, it is not possible to fund the difference at a later time. Components can only be funded once.

If, during the funding confirmation, the Program Office approves a budget that differs from what was submitted at the time of application (reflected in the budget markup), a revised budget may be required in addition to the technical review responses. If required, the revised budget is due within fifteen (15) to thirty (30) days of the start of the budget period. If required, technical review responses will also be due within fifteen (15) to thirty (30) days of the start of the budget period and must be submitted separately from revised budget applications. Future funding for ABU components will not be awarded until a revised budget, if required, is submitted and approved by CDC.

Once components are awarded, funds cannot be redirected between components. However, funds may be redirected within a component between object class categories.

It is critical to ensure accountability, transparency, and programmatic performance of all U.S.

taxpayer dollars.

Funding provided under this NOFO is subject to the availability of funds. The total number of years for which federal support has been programmatically approved (project period) will be shown in the “Notice of Award.” This information does not constitute a commitment by the federal government to fund the entire period. All future year funding will be based on satisfactory programmatic progress and the availability of funds.

b. Evaluation and Performance Measurement

i. CDC Evaluation and Performance Measurement Strategy

The applicant should select indicators from the menu that best measure the strategies, activities, and bolded outcomes identified in the logic model. There is no minimum or maximum number of indicators that should be selected. The purpose of collecting and reporting on indicators is to measure progress toward achieving the NOFO activities and outcomes. Results will also be used for program planning, improvement, accountability, and reporting. Results will be shared with recipients and other key parties. CDC will work with the recipient throughout the life of this award to ensure that all activities and expected outcomes are in alignment with current USG and the recipient’s strategies and goals. The recipient should dedicate funds made available under this NOFO for evaluation and performance monitoring within each project. The final funding amount will be agreed upon by both CDC and the recipient; however, it should be expected that approximately 3% (of a given project’s funding) will be dedicated to monitoring, reporting, and evaluation activities. CDC and the recipient will agree upon the specific funding amounts within review of each project’s work plan and budget.

Monitoring CDC expects that the work conducted under this NOFO will be structured as a series of discrete projects oriented at achieving elements of the NOFO’s strategic objectives. CDC and the recipient will jointly select performance measures (indicators) from the menu shortly after award based on activities within each project. For each project, these performance measures must include CDC’s Division of Global Health Protection’s program implementation indicators (included in the Notice of Award), as well as other CDC or recipient’s standard indicators relevant to the intended outcomes of the project. Recipients will identify which indicators they will report on in their Evaluation and Performance Measurement Plan (EPMP). Recipients will be required to report on program implementation indicators selected from the below list through reporting mechanisms that will be specified by CDC after award (e.g. APR).

While recipients will be responsible for reporting on program implementation indicators relevant to proposed strategies and activities, they are not limited to only program implementation indicators. Applicants can, and are encouraged to, propose additional relevant indicators that, combined with program implementation indicators, will be monitored over the life of the NOFO.

Recipients will also be encouraged to consider additional measures from relevant USG GHSA Interagency Metrics, WHO Joint External Evaluation (JEE), and/or Healthy People 2030 standardized metrics and WHO benchmarks.

Additionally, recipients are only required to report on indicators relevant to their funded scope of work. Recipients should denote identified indicators relevant to their funded activities in their EPMP and should report annually against selected indicators in their APR.

Below is a menu of DGHP M&E Program Implementation Indicators that span eight technical areas: (1) Infection Prevention and Control, (2) Border Health, (3) Community Mitigation, (4)

Emergency Operations and Response, (5) Laboratory Diagnostics, (6) Surveillance and Epidemiology, (7) Vaccines, and (8) Field Epidemiology…