Ending HIV Epidemic in a Decade: CDC Director Robert Redfield on Treatments, Prevention and Hope For Vaccine

CDC Director Dr. Robert Redfield

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Margaret Flinter: Welcome to Conversations on Health Care with Mark Masselli and
Margaret Flinter , a show where we speak to the top thought leaders
in health innovation , health policy , care delivery and the great minds
who are shaping the health ca re of the future.

This week , we acknowledge December 1st World AIDS Day. We're
revisiting a conversation earlier this year with Dr. Robert Redfield.
He's a Director of the CDC and a renowned AIDS researcher. He
discusses the CDC’s commitment to bringing an end to the HIV AIDS
epidemic within a decade and he also talks about research
breakthroughs and advancement in treatment and preventing further
infection through PrEP .

Lori Robertson also checks in, Managing Editor of FactCheck.org looks
at misstatements spoken about health policy in the public domain,
separating the fake from the facts, and we end with a bright idea
that’s improving health and well - being in everyday lives.

If you have comments please e - mail us at c [email protected] or find
us on Facebook , Twitter, or wherever you listen to Podcast . You can
also hear us by asking Alexa to play the program Conversations on Health Care.

Now stay tuned for our interview with CDC Director Dr. Robert
Redfield on Conversat ions on Health Care.

Mark Masselli : We’re speaking today with Dr. Robert Redfield, Director of CDC, the
Centers for Disease Control and Prevention . Dr. Redfield was
Founding Director of the Department of Retroviral Research in the
U.S. Army Medical Corps a nd co - founded the University of Maryland's
Institute for Human Virology serving as chief of infectious diseases. He's also Vice Chair of Medicine at the University of Maryland School of Medicine. Dr. Redfield has advised the National Institute of Health on HIV. Dr. Redfield earned his bachelor's of science and his medical
degree from Georgetown .

Dr. Redfield , welcome to Conversations on Health Care.

Dr. Redfield: Thank you very much, Mark.

Mark Masselli : You know, you're known as one of the world's leading experts and
researchers working on the HIV AIDS epidemic and you carry that expertise to your current role as Director of the CDC and your agency
is recently part of President Trump's really bold initiatives. We just got
to get a shout out, ending the HIV epidemic plan for America. It seeks
to reduce the number of new HIV infections by 90% within a decade.

I wonder if you could just tell our listeners about who's involved in the

CDC Director Dr. Robert Redfield

effort and how you're planning to tackle this complicated challenge?

Dr. Redfie ld: Well, this really is a once in a generation opportunity. As you know,
President Trump and the State of the Union highlighted this initiative
to be able to bring an end to the HIV epidemic over the next decade,
with the goal of reducing new infections b y 90%, over the next 10
years .

Under the leadership of Secretary Azar, really all of the agencies
within HHS, the CDC , HRSA , The Indian Health Service and NIH have
really come together to put together this plan . When we looked at the
new infections that we re occurring in the United States between 2016
and ’ 17, we were all surprised to find out that more than 50% of the
new infections, there's about 40,000 new infections a year , 50% of
them were in only 48 jurisdictions, the District of Columbia and San
Juan , out of the more than 3 , 000 jurisdictions in the country , so it was
a very geographically focused outbreak.

When we looked even closer at the demographics of it, most of the
new infections that are occurring in the United States are actually in
African - Am erican men who have sex with men or Latino men who
have sex with men of those that are between the age of 25 and 34 , so
it's very demographically focused , so we have a very focused strategy
initially to target these geographic areas and these demographic
g roups to have four key strategies diagnosed , you know about 15% of
the people in our country with HIV infection still haven't been
diagnosed.

Prior to this initiative, it turns out that almost 50% of them one in
every two has been infected for at least thr ee years , probably 70% of
people that were infected diagnosed last year , actually have seen a
healthcare facility the year before, but not been diagnosed. One of
the areas is to really enhance diagnosis and try to re - instill in the
health system a fervor f or diagnosis.

To treat people that have HIV infection, we now know that it's pretty
straightforward now how to treat with the new antiretrovirals that we
have. They’re highly successful , unlike the earlier drugs where we
struggled with resistance. If we ca n get people to viral loads that are
undetectable , not only does that mean that the disease won't
progress in them, it also means that they're not capable of
transmitting the infection to somebody else. Th e phrase it's been
used as you equals you , undetect able means that you're uninfect ious
to somebody else.

The ability to protect , that is prevent , new infection acquisition.
Today, now we also have what we call pre - exposure prophylaxis using
medication itself and individuals at risk for HIV that will preven t them
even if they're exposed by method known to transmit HIV, they will

CDC Director Dr. Robert Redfield

not become someone with HIV. Combine that with other
comprehensive prevention strategies, particularly, say syringe
programs.

Then finally, we have a fourth pillar, which is to respo nd when we do
see hotspots that we can rapidly identify them and help the local
public health community be able to respond in a way to prevent
expanded transmission.

We're seeing that in a number of counties because of the comorbidity
with the drug use epi demic that we have. That's really, really the plan
that we fully intend to succeed , so that by the year 2030, the
epidemic is , we know it will no longer be here.

The purest definition of that is to bring the new infections down to
less than one in 100,000 Americans. Obviously , the goal is to go as
few new infections as possible, but the epidemic would then be over.

Margaret Flinter: Well, Dr. Redfield, I think it's always worth saying this epidemic has
taken 700,000 American lives since the early ’ 80s and 1 .1 million
Americans living with the disease.

I'm not sure that everyone understands this idea of how effective the
drug regimens have become and getting people's viral loads down to
undetectable levels. This advent of the PrEP drug protocol to protect
non - infected people from being infected , so maybe just a little more
about that for our listeners .

Dr. Redfield: It's really been exciting, you know, having been in this field really
since the early ’ 80s to see the progress that science has provided and
to se e that go from no really therapeutic options to see then different
early options , where we could prolong survival, but many people still
develop drug resistance and treatment failed.

I can remember back in the ’ 90s, some of my patients were taking,
you kno w, 30 , 40 pills a day. Today, there's multiple regimens where
you can take one pill or two pills a day.

The current regimens really are as close to , and I like to use the term
bulletproof. These are very, very highly effective drugs now that are
available to treat HIV infection and most individuals can really take
them and most individuals with HIV infection today can anticipate to
live a near normal lives.

If you're 20 years old today and you get HIV infection, today it would
project you to live somewhere between 74 and 75 years of age. The
therapy really is highly effective and the ability to get viral load s to the
undetectable level is now the rule.

Not only does that change the disease progression in the individual,

CDC Director Dr. Robert Redfield

but some of the real exciting data, is it really now definitively shows
that if your viruses are un detectable by the current laboratory
techniques, you really are not able to transmit this virus to somebody
else, that means the treatments not only good for the individual ’ s
long - term health , tr eatment of people living with HIV is a major
prevention strategy.

We could actually diagnose everybody, get everybody on treatment,
get everybody's viral load undetectable that and of itself w ould end
the HIV epidemic in America.

Mark Masselli : You know, D r. Redfield , I was thinking about the strategy that you're
going to have to employ. You were saying, you know, we've got to get
people to enhance their diagnosis, but also have to have this fervor
for people who want to treat this population and of course, you know,
community health centers play a vital role in treating HIV and AIDS .
Here in our own organization, we've had a lot of success and tell us
how you will scale this program up nationally ? How do you see the
CDC and its partner agencies working at t his local level?

Dr. Redfield: You know, and I've been very involved in the PEPFAR program from
the beginning where we had really to go into sub - Saharan Africa and
the Caribbean. Actually , we had to figure out not just how to provide
treatment; we really d idn't have a health infrastructure.

The beauty of this initiative is we're looking at multiple different
health capacities in this nation and much of which made this so
doable was the fact that there's 12,000 community health centers
throughout the United States and many of them in these jurisdictions
that we're discussing right now , so that the potential to expand the
capacity by bringing in HRSA’ s programs for those individual at risk for
HIV infection, that is the community health centers and get them
en gaged to help diagnosis and then those individuals that have
diagnosed HIV infection that is the Ryan White Program , it really, you
know, was sitting there that it's there .

The execution plans for this initiative are going to be developed by
each jurisdict ion , be cause what we're trying to do here is to figure out
how does the health system now engage a component of individuals
that are either at risk or living with HIV? How do we engage them
effectively into the health system and we would argue that
communi ty health centers as well as community groups themselves
are going to be the key stewards of understanding how we do this, as
I said, by the community, for the community and the community. The
community health centers are going to play a very, very, very
i mportant role.

Margaret Flinter: Dr. Redfield that prompts me to say we've had , I think , a little over 20
years Mark of stumbles and falls, evolving a model of highly effective

CDC Director Dr. Robert Redfield

care and treatment for our patients with HIV and along the way, other
challenge s emerged hepatitis C, arrived on the horizon. Ultimately , we
now have medication that actually cures hepatitis C, you've dedicated
some of your formidable decades of research to the quest for a
vaccine for HIV to o and this has proved daunting for everyone in the
field. Is the quest for a vaccine for HIV still on that list or are we really
looking at preventing new cases and effective treatment of the ones
that develop?

Dr. Redfield: Well, Margaret for the United States to be able to actually end the
HIV ep idemic, we have the tools, diagnose and treatment, developing
viral loads that are un detectable and comprehensive evidence based
prevention strategies, including perhaps unsafe syringe programs,
those tools can bring an end to the HIV epidemic in the Unite d States.

I can say for the world to bring an end to the HIV epidemic, we're
going to need to have an HIV preventive vaccine. I've always said that
when you look at trying to end -- eradicate an infectious disease,
whether it's smallpox or polio, the key t o that is having a vaccine.
We've eradicated smallpox, we're on the verge of eradicating polio ,
last year we only had 33 cases in the whole world. To bring in a true
global end to this epidemic, it is going to require an HIV vaccine and
I'm confident that science will continue and eventually succeed in
developing the scientific understanding that's required to develop an
efficacious prevented HIV vaccine ; but I can tell you as a young doctor
who was at the bedside of a 27 year old individual that was dying of
HIV infection and say in 1984 no one predicted that would become a
lifelong treatable disease.

Yet , I would say one thing I always h ave h ad strong confidence in , is
the power of science. I always had confidence that science would find
solutions.

I start ed my , some of my early work in ’99 B hepatitis , who would
have ever believe d that we'd actually be able to cure that. We need to
continue to invest significantly in the development of an HIV vaccine,
but we should not wait for the HIV vaccine to bring an end to the AIDS
epidemic in America.

Mark Masselli : We're speaking today with Dr. Robert Redfield, Director of the Center
for Disease Control and Prevention. I want to pull together two things,
one, the power of science and then vaccines . We're in this inc redible
throes of something that none of us would have imagined just a
couple of years ago, this dramatic resurgence of preventable diseases
like mumps, measles and chickenpox.

There's an anti - vaccination movement that just simply doesn't accept
the scienc e. Many families across the country are intentionally
choosing not to vaccinate their children and that's obviously causing a

CDC Director Dr. Robert Redfield

public health crisis in many communities.

I wonder if you could talk about this "anti - vax" movement . I was
thinking, as you were t alking earlier about, hey, we've mapped out
where the bolus of this population is. What do we have on the data
about the anti - vax population, if you're going to try to target them ,
this is a group of people that can be identified , what's the CDC doing
to t ry to find common ground with people who simply can be bright
and talented and educated and for some reason, they're off the track
on , on this particular issue. How are you handling it ?

Dr. Redfield: Well, this is really a very, very important question Mar k and
particularly very timely now. You know, the WHO this year actually
listed for the first time vaccine hesitancy as one of the 10 greatest
global health threats for the world.

Nothing saddens me more than to see the power of science left on
the shelf. When you think some of us , I remember , polio . I remember
measles. I remember a number of these diseases, pertussis and
dip h theria. The challenge that many of the younger parents have
today is they don't remember polio. They don't remember measles.
This is one of the reasons I've asked the grandparents to get involved
and maybe help in understand, you know, they may see certain issues
with vaccines, and they don't understand the true horror, that these
diseases , that these vaccines now prevent.

When I look a t the reasons for people not taking advantage of
vaccines, you know, I think it's important to stress that 94 , 95% of
parents vaccinate their children ; but unfortunately, there are a
number of people that have chosen to not accept vaccination. Some
obvious ly for medical reasons, but others, less so , either religious or in
some states now just philosophically, they don't agree with having a
vaccine.

We have great data on what the state vaccination rates are, but
within that state , there may be schools or com munities or pockets
where the vaccination rates are very, very poor, and that's what
you're seeing , for example, in the state of Washington with the recent
measles outbreak, although the State of Washington is very good
overall childhood vaccination rates and I've actually seen some data
from some schools where the vaccination rates are under 30% and
some different jurisdictions along the United States. I do think there's
an advantage to get a better handle on exactly what the regional
vaccination rates are so that there can be more targeted intervention.

The ultimate goal is to get individuals to embrace vaccination as a
critical tool to protect themselves, to protect their families, to protect
the communities. I think there are really four groups that need to be
reached.

CDC Director Dr. Robert Redfield

The first is the anti - vax group, which is I think a very small group and I
do think will be very difficult to reach. It's important that we can
negate their message and this is why I've said very clearly in the
recent New York Times, I bet that I did, vaccination does not cause
autism period. Vaccines are safe period. The diseases that they
prevent are not safe. They're complicated, and they can cause
significant morbidity and mortality.

Now, when you look at the people that don't get vaccin ated, it turns
out some of them are misinformed , because the anti - vaxers do have
significant information that's available o n social media. People have
different editorial systems now in how they get the information and
so there's significant disinformation and we need to try to counter
that and CDC has a site that I encourage people to go to
cdc.gov/vaccines. We have a parent portal they can get in and get a
lot of questions answered.

Secondly, I think they need to sit down with their healthcare
professiona ls and have a dialogue and healthcare professionals have
to take the time to listen to them, and listen to their misinformation
and not ridicule it, but take them through and try to let them
understand how they're misinformed.

Now, many more people that ar en't vaccinated, they don't want to do
something that might harm their child. They hear all this stuff, you
know, that maybe the vaccine can do this and they're just -- that
paralyzes them from making the proactive decision.

Again, healthcare professionals have got to step up and not just say,
do you want to get the vaccine and the parent says no, and then they
say, okay, why don't we have your next appointment in six weeks?
No, they’re going to say, wait a minute, why don't you want the
vaccine?

Margaret F linter: Dr. Redfield, thank you so much for that. We'd been speaking today
with Dr. Robert Redfield, Director of the Centers for Disease Control
and Prevention. Learn more about his work by going to cdc.gov or this
particular effort by going to HIV.gov.

Dr . Redfield, we thank you for your very important scientific work,
your commitment, and your quest to support the health of the public.
Thank you for joining us on Conversations on Health Care today.

Dr. Redfield: Thank you, Mark and Margaret.

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Mark Masselli: At Conversations on Health Care, we want our audience to be truly in
the know when it comes to the facts about healthcare reform and
policy. Lori Robertson is an award winning journalist and Managing

CDC Director Dr. Robert Redfield

Editor of FactCheck.org, a nonpartisan, nonpro fit consumer advocate
for voters that aim to reduce the level of deception in U.S. politics.

Lori, what have you got for us this week?

Lori Robertson: The measles outbreak in the United States and around the world has
sparked misinformation on social media . One false Facebook meme
blamed illegal immigration from South America, but the virus was
eliminated across both North and South America in 2016. The recent
outbreak is due largely to inadequate vaccination rates in some
communities.

Measles was eliminat ed in the United States in 2000 and as
mentioned from the entire North America and South America
continents six years later. Elimination means cases can still occur , but
that the disease hasn't been continuously spread for a year or more.

Recently , the vir us has been brought into the U.S. by people who have
traveled to places where there is an outbreak or where the disease is
still common, such as parts of Europe, Africa, Asia and the Pacific
according to the Centers for Disease Control and Prevention.

Fro m those travelers, the disease can then spread in U.S. communities
that have unvaccinated people. The pan - American Health
Organization said the measles outbreak in New York City, which
started in 2018 and spread in the Orthodox Jewish community was
brought on by travelers who had been in Israel , where a large
outbreak is occurring.

The CDC has said , this year marks the largest number of measles cases
since the disease was eliminated in the U.S. and it said misinformation
about vaccine was “a significant fac tor contributing to the outbreak. ”

Similarly, the Executive Director of UNICEF and the Director General
of the World Health Organization issued a joint statement that cited
online misinformation about vaccine safety as a contributing factor in
the rising number of measles cases in high and middle income
countries.

Some major social platforms have recently taken steps to curb this
spread of misinformation. Facebook announced in March that it
would reduce the visibility of vaccine misinformation. YouTube sai d in
February that it would prevent users who promote vaccine
misinformation from running ads.

That's my fact check for this week. I'm Lori Robertson, Managing
Editor of FactCheck.org.

Margaret Flinter: FactCheck.org is committed to factual accuracy from the country's
major political players and as a project of the Annenberg Public Policy

CDC Director Dr. Robert Redfield

Center at the University of Pennsylvania.

If you have a fact that you'd like checked, e - mail us at
www.chcradio.com . We'll have F actCheck.org’s Lori Robertson check
it out for you here on Conversations on Health Care.

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Mark Masselli: Each week , Conversation s highlights a bright idea about how to make
wellness a part of our communities and everyday lives. One in five
Americans will suffer a diagnosable mental health condition in a given
year, and most often don't seek treatment.

For those with serious mental health conditions the consequences can
be devastating, loss of job or home or even early death. Seeing a rise
in mobile a pps aimed at behavioral health entering the marketplace,
the University of Washington researcher Dror Ben - Zeev thought a
comparative effective analysis study would be a good idea.

Dror Ben - Zeev : Having a head - to head - comparison between a mobile health
inte rvention for People with Serious Mental Illness called FOCUS a nd
more traditional clinic based group intervention called WRAP or
Wellness Recovery Action Planning .

The study really gets at some of the core differences between mobile
health and clinic based care. The second thing we wanted to see is
after people complete care, what are their subjective ratings of their
experience and treatment? Are they satisfied with both
interventions? Are there differences? 90% of the individuals who
were randomized into the mobile health arm actually went on to
meet a mobile health specialist to describe the app to them and train
them how to use it and use the intervention app that's assigned to
them at least once. Whereas in the clinic based arm, we saw that only
58% of the participants assigned to that clinic based intervention ever
made it in for a single session.

Mark Masselli: Both groups of patients saw roughly equal results from their
completed treatment, but the mobile group was more likely to
engage in therapy.

Be n - Zeev says this suggests that mobile therapies may provide a
useful tool for clinicians having trouble getting those with serious
mental health issues to engage with the clinical interventions.

Dror Ben - Zeev : We know that the very existence of a group can be quite helpful ; but
for others , the interaction is anxiety provoking.

Mark Masselli: A targeted mobile app aimed at facilitating access to clinical care for
those experiencing serious mental illness symptoms, improving access
to intervention for behavio ral health needs. Now that's a bright idea.

CDC Director Dr. Robert Redfield
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Mark Masselli: You've been listening to Conversations on Health Care. I'm Mark
Masselli.
Margaret Flinter: I'm Margaret Flinter.
Mark Masselli: Peace in Health.
Margaret Flinter: Conversations on Health C are is recorded at WESU at Wesleyan
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If you have comments, please e - mail us at chcradio @chc1.com or find
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