As he prepares to leave office, Centers for Disease Control and Prevention Director Tom Frieden shared with us his hopes for the future of public health and the challenges that still lie ahead. Throughout his seven-and-a-half year tenure, Frieden has led CDC’s efforts to address a wide array of public health issues – from fighting infectious disease outbreaks, to tackling the opioid crisis, to protecting public health funding. In his fifth annual “State of Public Health” for Public Health Newswire, Frieden discusses CDC’s successes and what’s next for the agency.
Q: What were some of CDC’s greatest accomplishments this past year, and what do you anticipate being the biggest public health challenges for 2017?
A: CDC works 24/7 to protect the health, safety and security of Americans. Given space limitations, it’s not possible to provide a comprehensive list of everything we did to protect the nation’s health this year, but a few highlights include:
- Led responses to some of the most serious health threats facing the United States and the world. We stopped the Ebola outbreak in West Africa, dedicated tremendous resources to lead the fight against Zika in the U.S. and its territories, and released guidelines to curb the ongoing epidemic of opiate overdoses. With our partners in clinical medicine, agriculture and public health, we continue to address the serious threat posed by antimicrobial resistance.
- Restoring America’s public health infrastructure. CDC’s Advanced Molecular Detection initiative is rapidly improving our national and state labs’ ability to identify infectious disease threats through cutting-edge gene sequencing and bioinformatics technology. Our Public Health Associate Program fills gaps in public health agencies in the U.S. and provides on-the-job training to the next generation of public health experts. And CDC’s laboratory safety initiative – including the Laboratory Leadership Service training program – ensures the safety of our work with the world’s deadliest pathogens.
- Protected America’s health security by improving health security abroad. CDC’s leadership role implementing the Global Health Security Agenda began with strengthening outbreak detection and response and laboratory capacity in 17 nations. In many parts of the world, CDC’s Field Epidemiology Training Program continues to establish a global workforce of disease detectives. And CDC continues to be a significant driver of the U.S. government’s fight against HIV/AIDS. Of the 17 million people worldwide now receiving life-saving antiretroviral treatment, 5.8 million are in programs supported by CDC.
In 2017, CDC’s Emergency Operations Center will continue its focus on protecting pregnant women against Zika virus. Staff from across the agency are involved in our response to this unprecedented and complex epidemic, including experts in pregnancy outcomes and birth defects, mosquito control, travel guidance, laboratory science, epidemiology, sexually transmitted infections, blood safety, communication and more. We will also continue our efforts to ensure that no child on earth will ever again be paralyzed by polio.
Q: Over the past year we saw the spread of Zika virus and the link between Zika and microcephaly and other health conditions grow stronger. What was CDC’s strategy in responding to the outbreak, and what needs to happen to ensure a strong public health response in the year ahead? Did you learn any lessons for combatting future disease outbreaks?
A: CDC’s strategy against Zika is straightforward: Protect pregnant women from Zika virus infection. Zika is the first mosquito-borne virus ever known to cause severe birth defects, and it’s also the first one ever known to be passed from person to person through sex. Very little was known about Zika when it began to spread in the Americas last year. We’ve learned an enormous amount in a very short time, but we still have much to learn. What we do know is that this virus can have devastating effects on the developing fetus. We advise pregnant women not to travel to areas where Zika is spreading. People who live in or must travel to these areas should take extreme care to prevent mosquito bites. Men whose partners are pregnant and who may have been exposed to the Zika virus should use condoms consistently and correctly for the duration of pregnancy. We are helping mosquito control districts prepare for and implement effective mosquito control, and we’re helping labs better diagnose Zika infections by developing newer, faster diagnostics.
Now that the U.S. mosquito season is largely over for 2016, our strategy is twofold. First, we are alerting health systems to the likely increase in numbers of babies born with microcephaly or other Zika-associated birth defects and providing guidance on the support these babies and their families will need in the coming months and years. Second, we are planning ahead to protect women during the 2017 mosquito season. We are looking into new mosquito control strategies and working to improve the technology to diagnose Zika.
The lessons of the Zika and Ebola outbreaks reinforce CDC’s strategy of rapid response. We can’t wait until all the unknowns become known – it is imperative to move forward, acting on what we do know and adapting our response as we learn more. Zika and Ebola show that we can’t sit back until disease threats cross our borders. Stopping outbreaks wherever they occur is America’s best defense. Zika is the newest, but it won’t be the last health threat or even the last mosquito-borne viral threat.
Q: What’s the outlook for public health funding given a new administration and Congress? In particular, pledges to repeal the Affordable Care Act and eliminate the Public Health and Prevention Fund would deal a blow to CDC’s budget. How do you foresee the agency’s strategy changing while continuing the progress that’s been made thus far?
A: Protecting American’s health, safety and security will continue to be CDC’s mission, as it has been throughout the agency’s 70 years and a dozen presidential administrations.
Whatever Congress does regarding the Affordable Care Act, public health will be as relevant – or more relevant – today than ever before. The ACA established the Prevention and Public Health Fund to provide expanded and sustained national investments in prevention and public health, to improve health outcomes and to enhance health care quality. The fund supports more than 10 percent of CDC’s total program budget, with most of these funds supporting widely supported programs at the state and local level such as the public health and social services block grant, protecting children and adults through immunization, strengthening capacity to respond to domestic infectious disease threats and preventing childhood lead poisoning.
The threats to our nation’s health are real and come in different forms and in different ways. Public health is a quintessential government function; it is part of our infrastructure and needed to keep Americans safe. And public health is a best buy: investments in public health are repaid many times over. The work CDC and our partners do saves lives and money, protects the American people’s health and is good for the country.