In his third annual “state of public health” address for Public Health Newswire, CDC Director Tom Frieden discusses topics from the past and current year, including Ebola, funding, antibiotic resistance and teen pregnancy. Photo by CDC

Centers for Disease Control and Prevention Director Tom Frieden has been busy since he last checked in with Public Health Newswire, from leading the agency’s global response to the Ebola epidemic in West Africa— the largest and most intensive response in CDC’s history — to promoting the power of vaccinations during the U.S. measles outbreak.

Last week, Frieden came to APHA to share that there were “more things to like than not to like” in U.S. President Barack Obama’s proposed fiscal year 2016 budget for CDC. This week, in his third annual “state of public health” address for Public Health Newswire, he tackles a smorgasbord of pressing health issues and shares how, despite notable successes, “we can’t carry out our primary task of protecting the health of all Americans without our state, tribal and local partners and our APHA colleagues.”

Q: This was an “unprecedented” year for public health, and certainly at CDC, headlined by the ongoing Ebola epidemic. You’ve said that “Americans will be 100 percent safe only when we succeed in stopping Ebola at its source in West Africa.” How close are we to that point and what more needs to be done?

There have been promising developments over the past weeks and months, but we still have a long way to go and have many more months of hard, meticulous work ahead of us. The Ebola epidemic is different in each of the three affected countries. Liberia is seeing a marked decrease in cases; the problem there will be to fight complacency, trace every case and contact, and continue to test intensively to identify new cases, if they arise. Cases in Guinea have gone up and down since the first days of the outbreak there; efforts to counter resistance in rural areas are making progress. Sierra Leone recently mounted effective programs, leading to recent declines in case counts.

The good news is that the epidemic model CDC published in September showed that once the Ebola response reached a tipping point through safe care and safe burial, cases would decline just as exponentially as they increased. This is exactly what we have seen in Liberia and now are seeing in Sierra Leone. We’re finished with the first phase of our response: breaking the back of the epidemic. Now we’re in the equally important second phase: getting to zero cases in West Africa. Until we do, the risks remain everywhere, including here at home.

Q: Your 2014 year in review included new and familiar infectious disease threats, laboratory safety and addressing several of the leading causes of death. Public health was successful in many of these areas but barriers remain. What will be your top opportunities, and challenges, for 2015?

CDC is continuing to intensify our efforts to get to zero Ebola cases in West Africa. It’s been the largest and most intensive response in the history of the CDC, but that won’t be the end of the job. Our goal isn’t just to get to zero, but to stay at zero. We will continue our work to protect Americans by helping more countries strengthen their ability to prevent, detect and respond to infectious diseases.

In 2015 we stand at the threshold of eliminating polio from the face of the earth — we’re closer than ever before with no new cases in Africa in more than six months. And we will extend the remarkable achievement of the President’s Emergency Plan for AIDS Relief, or PEPFAR, in getting life-saving HIV/AIDS treatment to 7.7 million people. With more people needing treatment, but without more funding available, we are working to increase PEPFAR efficiency and to invest in the right interventions in the right locations at the right time.

Here in the United States, we will expand our efforts to combat antibiotic resistance. Drug resistant pathogens threaten to return us to the pre-antibiotic era when simple infections were killers. As part of this effort we will accelerate programs to control hospital-associated infections. We’ll also continue our efforts to fight the nation’s leading cause of death heart disease by helping more Americans quit smoking and get their blood pressure under control. CDC is on the front lines in the battle to curb prescription drug overdose. And we’ll be facing new challenges from emerging diseases such as chikungunya and from potential hazards such as e-cigarettes.

Q: Congress passed a fiscal year 2015 spending bill that provides critical funding for key public health programs and agencies, including Ebola relief, disease prevention and health promotion, workforce and notably, full allocation of the Prevention and Public Health Fund. How does this funding enable CDC to fight disease and support communities and citizens to do the same?

All public health is local. CDC has tremendous expertise gained though decades of experience, and, thanks to our advanced molecular detection program and other scientific and technological advances, state-of-the-art equipment. But we can’t carry out our primary task of protecting the health of all Americans without our state, tribal and local partners and our APHA colleagues. We at CDC stand ready to fully support our partners as they respond to their unique local public health situations.

Q: You’re familiar with APHA’s goal of becoming the “Healthiest Nation in One Generation,” and you gave us several essential components that must be in place for it happen. Since you last spoke with us, which of these components have seen progress — and where must APHA and other public health organizations push harder?

There have been some real successes:

  • Teen pregnancy is down by half, and at the lowest levels ever recorded.
  • CDC’s “Tips From Former Smokers” advertising campaign introduced a series of new hard-hitting ads on smoking’s impact on pregnancy and babies, gum disease and tooth loss, and stroke caused by smoking in people who have HIV. We also analyzed the cost effectiveness of our first Tips campaign, which ran for 12 weeks and was responsible for 100,000 smokers quitting permanently and helping to prevent 17,000 premature deaths. With a campaign cost of roughly $48 million, the Tips campaign cost $393 per year of life gained, and less than $3,000 per life saved — far less than standard benchmarks of $50,000 per year of life gained and $10 million per life saved.
  • Progress has been made in the effort to eliminate infections that commonly threaten hospital patients, including a 46 percent decrease in central line-associated bloodstream infections, or CLABSI, between 2008 and 2013.

Last year I laid out the components essential for success. What it boils down to is this: find out what works, scale it up, and continue to evaluate and improve. It’s just as essential to find out what isn’t working. For example, CDC and our partners have been successful in getting people at risk for HIV to get tested. Because of this, we find that most Americans with HIV who are not in treatment actually do know their HIV status, but have not been successfully linked to and maintained in care. Our efforts now are directed toward moving patients along the care continuum from testing to treatment — and ensuring that they stay in treatment. Even when evaluation shows that a program is working, we should always look at ways to make it work better so that we can expand its impact even further.