respiratory infections such as pneumonia and influenza are the leading infectious cause of death in the United States and globally, responsible for an estimated 3.5 million deaths worldwide each year. As experience with the 2003 global outbreak of severe acute respiratory syndrome (SARS) and the 2009 H1N1 influenza pandemic demonstrated, these infections can spread rapidly. Tuberculosis also remains a significant global health threat, with unrecognized infections and drug-resistant strains complicating control efforts. The emergence of highly transmissible novel influenza viruses also remains a global concern and a primary focus of prevention efforts for CDC and public health partners throughout the world. Safe water An estimated 2.5 billion people (half of the developing world and more than one-third of the world’s population) lack access to safe water and adequate sanitation. Diarrheal diseases are the second leading infectious cause of morbidity and mortality worldwide, with particular impact on growth, development, and survival among children. Lack of these basic needs also impedes socio-economic progress for many developing countries, perpetuating a cycle of poverty and disease. CDC’s global water, sanitation, and hygiene (WASH) program provides expertise and interventions aimed at saving lives and reducing illness by improving global access to healthy and safe water, adequate sanitation, and improved hygiene, with particular efforts targeted toward reducing diarrheal disease in children. These efforts also include outbreak response, such as those undertaken in response to the large outbreaks of cholera in Haiti following the country’s 2010 earthquake. Domestically, CDC works with state and local health departments to conduct infectious disease surveillance and other prevention activities associated with drinking water and recreational water. Vaccine-preventable diseases Vaccines are our most effective and cost-saving tools for disease prevention, preventing untold suffering and saving tens of thousands of lives and billions of dollars in healthcare costs each year. CDC works to reduce vaccinepreventable diseases, helping to ensure broad immunization coverage and the availability of recommended vaccines for children affected by inability to pay; identifying and responding to outbreaks of vaccine-preventable diseases; and monitoring the impact and safety of vaccines and communicating their efficacy and public health significance. These efforts help advance the 2010 National Vaccine Plan, the nation’s roadmap for vaccine research and immunization coverage. On the international level, CDC works with public and private partners to reduce vaccine-preventable diseases worldwide, including intensive efforts to complete the eradication of polio; introduce new, life-saving vaccines; and identify strategies to help strengthen immunization systems in developing countries. Zoonotic and vectorborne diseases An estimated 75% of emerging infections are zoonotic, i.e., they emerged from animal populations to infect and then spread among humans. Examples include HIV, Ebola virus, H5N1 and H1N1 influenza viruses, and the SARS coronavirus. Diseases transmitted by vectors such as mosquitoes also remain major concerns, posing challenges not only in tropical areas but throughout the world, with diseases such as Japanese encephalitis, West Nile virus infection, and dengue fever resurging or appearing in new areas. Lyme disease, spread by infected ticks, is among the top 10 notifiable diseases reported to CDC. CDC works with domestic and global partners in developing and advancing new approaches to improving zoonotic and vector-borne disease prevention and control and helping to advance a “One-Health” approach that links human, animal, and environmental health experts in these efforts. ELEMENTS AND PRIORITIES Strengthen public health fundamentals, including infectious disease surveillance, laboratory detection, and epidemiologic investigation ELEMENT 1 Strong public health fundamentals at the local, state, and national levels—including disease surveillance, laboratory detection, and epidemiologic investigation—are the bedrock of U.S. capacity to protect the public from infectious diseases and to save lives during outbreaks and other unusual health events. These three core activities create and sustain a flexible, multi‐purpose U.S. public health system that reduces endemic diseases and is ready and able to respond to new threats. Because of the unpredictability of infectious diseases, any weaknesses in these public health fundamentals can have far‐reaching consequences. For example, the dramatic declines in the incidence of tuberculosis (TB) that began in the mid‐20th century led to a dismantling of most state and local TB control programs, leaving many communities unprepared for the rise in TB cases that began in the mid‐1980s. Largely associated with the emerging epidemic of HIV/AIDS and the increase in drug‐resistant strains, the TB resurgence continued for nearly a decade and only began to decline in the early 1990s after aggressive action was taken to rebuild local disease control programs (3). Broad efforts to rebuild the nation’s infectious disease infrastructure were undertaken in the 1990s, and further enhancements were made in the 2000s through