Understanding Vaccine Resistance Among Conservative Voters: Dr. Tom Freiden

Dr. Tom Frieden

[Music]
Female : 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 hea lth care
of the future.

This week, Mark and Margaret speak with former CDC Director
Dr. Tom Frieden, CEO of R esolve to Save Lives an initiative of
vital strategies, a global entity seeking to save 100 million lives
worldwide. He talks about their new report , Epidemics Th at
Didn't Happen , which claims millions of lives could have been
saved in this pandemic if countries were better prepared with
public health infrastructure. He also addresses vaccine
hesitancy, and the proposed FDA ban on menthol cigarettes.

Lori Robertson also checks in Managing Editor of
F act C heck.org looks at misstatement spoken about health
policy in the public domain separating the fake from the facts.
W e end with a bright idea that improving health and well
being in everyday life. If you have comments , please email us
at [email protected] or find us on Facebook, Twitter, or
wherever you listen to podcasts. And you can also hear us by
asking Alexa to play the program. Now stay tuned for our
interview with Dr. Tom Frieden h ere on C onversations on
H ealth C are.

Mark Masselli: We're speaking today with Dr. Tom Frieden, President and CEO of R esolve to S ave L ives, an initiative of vital strategies,
which is seeking to save 100 million lives globally by
addressing cardio vascular disease and preventing pandemics.

Margaret Flinter: Dr. Frieden served as the D irector of the US Center for Disease
Control and Prevention, and he was the Health Commissioner
for the C ity of New York. Dr. Frieden, we welcome you back to
C onversati ons on H ealth C are today.

Dr. Tom Frieden: Great to speak with you , looking forward to the talk.

Mark Masselli: Yeah, and we really appreciated reading your report E pidemics
T hat D idn't H appen, really which I think makes a bold
declaration that the COVID - 1 9 pandemic could have been, say,
prevented or contained, I should say. T he report highlighted
countries that responded well to the pandemic, as well as the
deadly outbreaks. What if you could share with our listeners
some of the success stories and where t hings went off the
track for others?

Dr. Tom Frieden: Well, the bottom line is that epidemics don't have to happen.

Dr. Tom Frieden

E very day there are epidemics that are being prevented
around the world, and we wanted to shine a spotlight on some
of them. For example, M o nkeypox in Nigeria where a single
case led to a rapid alert, there were good guidelines in place,
an intensive response followed, and here were no further
cases, or in Brazil where the threat of a massive yellow fever
outbreak led to very aggressive, effec tive action to vaccinate
or in Kenya where a community volunteer recognized the risk
of A nthrax and stopped an outbreak there. These are success
stories, and they tell us that epidemics don't have to happen,
but only if we invest in it. We're going to need sustained
financial resources, but also stronger technical skills around
the world, as well as better institutions , a stronger WHO,
regional centers for disease control and stronger health
departments in countries , states, provinces, cities, and
localitie s all around the world.

Margaret Flinter: Well, and Dr. Frieden, here we are today just watching in
horror at what's going on i n India, the news reports on a daily
basis just as raging surge of COVID - 19. T he idea of hospitals
collapsing, being unable to ac cept patients , it's really
overwhelming. We're seeing some of this in Brazil and Latin
America, worry about variants, not enough vaccines . W e
would really welcome you laying out what should the global
community be doing right now to address these hotspots
around the world. We certainly want to prevent these in the
future. But right now today, with what we're seeing in front of
us around the world, what should the global community be
doing i n your opinion ?

Dr. Tom Frieden: T here's something that every countr y can do . First off, we
have to recognize that although in the US we're turning a
corner, we're going to see , as I've been predicting since
January, many fewer cases by June , we’ll be toward a new
normal over the summer and at the new normal by the fall, a s
long as we keep it up and don't get thrown any worse
curveballs with the varian ts . But globally, there isn't nearly
enough vaccine , and even if there were , it wouldn't drive
down cases fast enough. That's why we need to first and
foremost, protect health care and health care workers. M ask
up , distance and avoid super spreading , continue essential
services, including schooling, vaccinate especially health care
workers, and the elderly.

We have to learn and adapt. The virus is learning about
people. It's ad apting. It's evolving. We have to learn and adapt
also , and part of that means making sure that we avoid those
super s preading events that we mask up, and that we

Dr. Tom Frieden

vaccinate as quickly and strategically as possible. But you
know, what has been most concerne d is that we don't have
enough vaccine. Although there are rosy projections for 2021,
the plain truth is that the manufacturers missed their target
for 20 20 by 96%. C urrent manufacturing is running at about a
quarter what it needs to be.

W hat we think need s to happen is that all proven vaccines
need to be scaled up as quickly and safely as possible in terms
of production. But we especially need to look at th e mRNA
vaccines, particularly Mode r na which was paid for by US
taxpayers . T hat vaccine , mRNA vaccines are kind of like an
insurance policy against variants , against production failures,
because mRNA production is more a chemical process as
opposed to a biological process with AstraZeneca, or J & J
vaccines, which is much less certain.

They also -- mRNA vacc ines can be scaled up more quickly,
maybe six months or nine months after starting , a nd they can
be made in large numbers a nd they're easier and easier to
handle in terms of the temperature requirements. W e think
there needs to be manufacturing hubs in var ious countries
around the world for global supply. That's our insurance
policy, because the pandemic won't be over in the US until it's
over globally.

Mark Masselli: I think that's such a important point that it's Planet Earth, and
we all need to work toge ther. But you say the United States
was woefully unprepared for the global pandemic and that we
lacked the supply chain for PP E a nd hospital equipment,
medication , vaccine productions, as you just talked about
w ere off a n d certainly the distribution of tho se , s o many of
these limitations and shortcomings were revealed. I guess
what's next as we prepare for the next pandemic, which you
say is absolutely a certainty and could be far worse. I was just
thinking you were talking about the mRNA vaccine , nine
mont hs also seems like a long time . I s it that we can prepare
for production on those because it didn't take long to develop ,
i t took a while to produce it. Is that right , i n large enough
volumes?

Dr. Tom Frieden: Well, for the mRNA e ven with a variant, we thi nk it's just a
matter of months before we could have a new vaccine already.
There are clinical trials of vaccines against variants. But the
broader issue is preparedness , and that goes beyond
vaccination. It's true that if we had global mRNA vaccination
hu bs, they could be a very important platform for future
vaccine preventable diseases. But we don't know what the

Dr. Tom Frieden

next threat will be. We know there will be another threat,
maybe we don't get so lucky , n ot that this is lucky , b ut maybe
there won't be a vacci ne against it a nd we'll need to use
treatment or other modes of prevention. The key is that we
have a system that can find outbreaks rapidly when they first
emerge, respond effectively and prevent them wherever
possible. W e've proposed a global target for that, that we call
717 t hat every outbreak of a new health threat anywhere
should be able to be identified within seven days. Within one
day it gets reported , investigation begun and response begun,
and w ithin seven days effective response in place. If we do
that we'll be much safer and much more secure.

Margaret Flinter: Well, Dr. Frieden, one of the biggest COVID - 19 challenges we
faced here in the United States, no surprise to you, was just
how deeply politicized this became . I honestly can't remember
ano ther situation quite like it o ver the course of my career. We
were so fascinated by the work that you did recently in the
focus group led by GOP Pollster Frank Luntz in the De
Beaumont F oundation, I think described a group of self -
described Trump voters, m any of whom were very skeptical
about the pandemic , skeptical about the vaccine, probably
safe to say, resistant to getting the vaccine. Tell us what you
learned from that experience. Did it surprise you? Was there a
new information that really changed the way you thought
about this and would approach this going forward again?

Dr. Tom Frieden: First, I think we have to put things into perspective. We think
masks and vaccines are controversial, but actually 80% of
Americans have been wearing masks, and about 80% of
Americans plan to get vaccinated. W e're not talking about a
large number in terms of vaccines . T he problem of vaccine
access remains quite a bit larger than the problem of vaccine
hesitancy. You wouldn't get that from reading most of the
news media because frankly, hesitancy makes a better story
than access. But access is a real issue and access means hours,
languages , distance , cultural sensitivity, getting vaccine into
doctor's offices , s o it can be done as a routine, making it easy
for people so that -- in public health we always like the healthy
choice to be the default choice, it should be very easy to get a
vaccine.

But with the group of Trump voters that F rank L untz and the
De Beaumont F oundation put together, it was really
interesting to hear the extent to which they feel so alienated
from the health, the political system . T hey didn't want to hear
about vaccines from any politician, not even from President
Trump, of whom they think very highly. They want to hear

Dr. Tom Frieden

about it from doctors . T here we re certain messages that really
resonated with them.

There's a lot of concern about vaccines, people think I'm
putting this foreign substance into my body, an d why was it
develop so quickly. T here were some messages that really did
make a difference. One o f them was that if you get the virus
it's going to spread all over your body in billions of copies for a
week or 10 days. If you get the vaccine, it'll be in your body for
a day or so a nd then it'll be gone. It will save your body to
trouble of getting inf ected to learn how to fight the virus.

We also had to clarify that the mRNA vaccines were not
rushed to the market, they moved quickly but not rushed.
T hey're not in a year. This is 20 years of research , a nd there
weren't corners cut on safety, they were r ed tape cut, and
that's why it was able to be brought to the market so quickly.
It's also really important to make the point that nearly every
doctor who gets offered the vaccine takes it. T his made a big
impact on them because they trust their doctors, do ctors can
be crucially important messengers, plus, the quicker we get
vaccinated, the quicker we'll get our jobs back our economy
back. V accinating can save at least 100,000 lives of Americans
who would otherwise be killed by COVID.

Mark Masselli: We're sp eaking today with former CDC Director Dr. Tom
Frieden, President and CEO of R esolve to S ave L ives. I saw the
recent R epublican ad made by physicians, Republican
congressional leaders, I believe, who certainly got that
message out . I think this work is so i mportant that you're
doing even if it's 20%, it's an important group of people that
we reach out to because it seems to be growing over time , t he
folks who are having these feelings in it . S ounded like some of
it was also around their sense of maybe not li bertarianism, but
the sense of independence, concern for their body and purity
and other things.

Th ere's, there's such good work that's happening here a nd I
think it's so important to try to figure out how to translate that
out into the field . O ur own orga nization has given out about
400,000 vaccines. We know the importance of being
everywhere. I love your new initiative that you have diners,
dentist a n d dollar store i s very important. We have our own at
the ABC, amusement parks, beaches and Chambers of
Com merce . W e're all headed in the same direction of trying to
pull everyone together.

W alk us through some of your strategy to reach the hardest
one translating in this particular group so that people who

Dr. Tom Frieden

aren't R epublican congressmen a nd aren’t physicians ca n also
use this in the field , b ecause we now have this difficult task of
really reaching -- considering here -- w e're here in Connecticut
and done a reasonably good job. But there's a big number still
the reach , and I think the public would appreciate to h ear from
you about a roadmap to get to that final hurdle , get over that
final hurdle.

Dr. Tom Frieden: What we're seeing is the movable middle is moving. T he
proportion of people who were not sure about vaccination,
th ey’re getting vaccinated . I think they ’ll increasingly get
vaccinated. In fact, the number of people who are somewhat
reluctant has steadily decreased. What we're left with are
people who have a lot of concerns , and some of them are
going to be very difficult to reach. Some of them won't be
re ached at all. Many of them will be reached by their doctors
and that's why getting vaccination into doctor ’ s office i s really
important.

Also overcoming reluctance with convenience really works. It’s
great idea amusement parks, beaches, chambers of
commerc e, shopping centers, there are lots of ways that make
vaccine more routine so that somebody says, oh I'll do this. In
terms of how to convince someone , I think that has to start
with listening. What are their concerns? One thing we've
heard on these focus groups is people really feel not respected
and not listened to , and every group deserves to be listened
to , respected . T he fact that they have c oncerns validated even
if those concerns aren't accurate or aren't fact based.

For an issue like , I'm worried ab out putting an impurity into
my body and I want freedom . I think what we have to think
about is what about the virus? That's a big impurity. I f you're
on a ventilator that's about as far away from yet being free as
you can be, and still be alive.

Margaret Flinter: Re ally, really great points. Dr. Frieden, I think we first came to
know of your incredible work when you were the
Commissioner of Health for the city of New York a nd the work
that you did around smoking cessation which was just so life
changing re ally in the United States. W e were very happy to
see the FDA just issued a ban on the sale of menthol cigarettes
which has certainly been also contribut or to some of the racial
ethnic disparities that we've seen in smoking.

T hen a little bit more good news , t he Biden administration's
just made it a little bit easier maybe for frontline providers to
participate in treating opioid use disorder with B uprenorphine .
T ell me or tell our listeners, why are these moves so

Dr. Tom Frieden

important, addressing nicotine on one hand, opioid addiction
on the other, which remains such persistent and deadly
threats to the health of the public?

Dr. Tom Frieden: W ell, I'm really encouraged by these two moves, which both
came in the past week. I've been advocating for 15 years to do
away wi th the irrational policy on B uprenorphine.
B uprenorphine is an opiate , i t's the only opiate that is less
likely to kill you or get you addicted than heroin a nd yet it's
the only opiate for which there were these extensive
cumbersome requirements to prescri be. It was completely
irrational, I think well meaning but irrational, and so that has
been largely done away with , not completely but largely, and
now many more doctors should be able to prescribe it. There's
a misunderstanding here that B uprenorphine jus t replaces one
addiction with another. B uprenorphine addresses a chemical
craving in the brain for opiates, and people who are on
opiates. I t's really important to get much more widely used , s o
that's a really big move.

The second is even bigger , menthol c igarettes are the major
way that kids and especially black African - American people get
started on cigarettes, and banning menthol, which has just
been announced , it hasn't been done . I t's got to get through
the courts, it's got to get through regulation , b ut a big step
forward, really a big step forward is a huge move to continue
action that can make tobacco history . W e can have a
generation grow up not addicted to tobacco, we can reduce
health disparities because of the huge amount of ment hol
because of th e vigorous marketing by the menthol cigarette
makers in black communities. T hese are big public health
moves.

I think, with progress on COVID in the US and on tobacco, and
we hope on opiates and other public health issues, we could
begin to reverse what's a really bad reality in the US, which is
that we pay a lot more than other countries for our health
care , and we live shorter lives with more disability, we can
reverse that . W e can have longer healthier lives and get much
more for our health care dollars.

Mark Masselli: I n reversing that save tens if not hundreds of thousands of
lives. I want to get back to your thought about how we might
proceed with the next pandemic, which you say is probably
somewhere around the corner . W e had a 50 state strategy ,
a nd I'm wondering if that makes sense to you. O ne sort of
element of that , I'm wondering if you support giving vaccines
to people even if they don't live in the state that they're

Dr. Tom Frieden

receiving it . I t seems to now what we have is the borders are
drawn around the s tate and one state may be effic ient, the
other less efficient, and we seem to be narrow minded in this.
What's your thought about how we might proceed in that
area?

Dr. Tom Frieden: Well, as we look back at COVID w e’ ll identify many problems.
In 2020 w e sa w the lack of organization, the lack of a plan, the
lack of reliance on science, and really poor communication.
But even if all of those political issues had been addressed,
the re were preexisting weaknesses , preexisting conditions in
the public health sys tem . O ne of them was the lack of good
coordination among federal to state and state to many city
and local health departments. We have to have a more joined
up response , a more coordinated response.

In terms of vaccines, we are increasingly having plenty o f
vaccines and it should just be much easier for people to get
vaccinated . W e should do away with photo ID requirements
for vaccination . W e should do away with appointments and
have walk up increasingly . W e should do away with residency
requirements. Howev er, we really need to double down on
reaching the unreached. There are many communities around
us urban and rural, Democratic and Republican, white, black,
Latino, Asian, that don't have adequate access. W e need to do
more to get ready access because the p andemic isn't over.

If we keep at it, we should be in a much better condition by
the summer and at the new normal by fall in the US. But
globally, we're looking at another year or two of a severe
pandemic unless we do much better with control and with
vacc ine production and distribution.

Mark Masselli: Let me just ask about vaccine cards or for travel restrictions ,
a re you supportive of having some identity card, or vaccine
identification for people in terms of people who are coming
into the country and als o for us traveling outside of it?

Dr. Tom Frieden: I first wrote on this a year ago , a nd what I said is they're
inevitable , they're going to happen , s o let's make sure they
happen in a good way. First off, it has to be voluntary , opt in
only . Second, you h ave to control privacy, so that your data
isn't used for anything other than what you want it to be used
for. Third, yo u have to have a paper analog. I f someone
doesn't have a smartphone, they should be able to have the
same privileges as someone who does . B ut done right , I do
think that vaccine verification or vaccine certificates can
facilitate reopening. They can't change the unfortunate and
tragic reality that we don't have adequate vaccine access

Dr. Tom Frieden

globally.

Margaret Flinter: Yeah. W e've been speaking to day with former CDC Director
Dr. Tom Frieden. He's the P resident and CEO of R esolve to
S ave L ives an initiative of vital strategies. Y ou can learn more
about his very important work by going to R esolve to S ave
L ives.org and please follow him on twitter @ Dr . Tom Frieden.
Dr. Frieden, we thank you so much for your decades long
commitment to improving global health and well being for
leveraging the tools of public health to improve outcomes and
for taking the time to come and join us today on C onversations
on H ealth C are.

Dr. Tom Frieden: Thank you. It's been a pleasure speaking with you and thank
you for what you do great.

Mark Masselli: Great.

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Mark Masselli: At C onversations on H ealth C are we want our audience to be
truly in the know when it comes to the facts about health care
reform and policy. Lori R obertson is an award winning
journalist and Managing Editor of F act C heck .org a
nonpartisan, nonprofit consumer advocate for voters that aim
to reduce the level of deception in US politics. L ori , what hav e
you got for us this week?
rd
Lori Robertson: On April 23 , the Centers for Disease Control and Prevention's
Advisory Committee on immunization practices voted to
resume the use of the Johnson & Johnson COVID - 19 vaccine
was a warning that there may be an in creased risk of a very
rare but dangerous blood clotting condition. The vote came 10
days after the CDC and Food and Drug Administration on April
13 th recommended “ a pause in the use ” of the Johnson &
Johnson vaccine out of an abundance of caution due to s ix
reports of a rare blood clot combined with low levels of blood
platelets among more than 7 million J & J vaccines
administered .

A t the April 23 meeting a CDC scientist presented nine
additional reported cases bringing the total confirmed cases to
st
15 o ut o f nearly 8 million vaccine doses as of April 21 . T hree
of the 15 have died and four were in intensive care. 13 of the
cases occurred in women between the ages of 18 and 49 , a nd
two involved women between the ages of 50 and 64. These
reported cases after vaccination with the J &J vaccine appear
to be similar to heparin - induced thrombocytopenia, a
condition in which the body has an immune response after a

Dr. Tom Frieden

patient receives the anticoagulant drug heparin, causing both
low levels of blood platelets and blood cl ots. One hematology
expert told us there appears to be overlap between the two
disorders.

The 15 cases after vaccination in the US represent nearly two
in one million of the nearly eight million J&J vaccines
administered since 13 of those cases were among women
under 50 , t he incidence would be seven in one million for
women ages 18 to 49. The FDA has added warnings to its
emergency use authorization of the vaccine and its fact sheets
for healthcare providers and vaccine recipients, saying the
reports of the se conditions suggest an increased risk of the
rare blood clot combined with low levels of blood platelets,
one to two weeks after vaccination.

The FDA fact sheet f or vaccine recipients says, “T he chance of
having this occur is remote. ” The CDC Meanwhile, says .
“W omen younger than 50 years old especially should be aware
of the rare risk of blood clots with low platelets after
vaccination, and that other COVID - 19 vaccines are available
where this risk has not been seen. ” T hat's my fa c t check for
this week. I 'm L ori Robertson, Managing Editor of
F act C heck.org .

Margaret Flinter: FactCheck .org is committed to factual accuracy from the
country’s major political players and is a project of the
Annenberg Public Policy Center at the University of
Pennsylvania. If yo u have a fact that you’ d like check, email us
at www.chcradio.com . We’ll have FactCheck .org’s Lori
Robertson check it out for you here on Conversations on
Health Care.

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Margaret Flinter: Each week C onversatio ns highlights a bright idea about how to
make wellness a part of our communities and everyday lives. While the world grapples with a global pandemic , public
health experts have been simultaneously battling another ongoing health threat. Mosquitoes are cons idered one of the
deadliest animals on earth, leading to hundreds of millions of illnesses and some 2.7 million deaths per year globally. D iseases such as malaria, dengue fever, and Zika are on the
rise.

Dr. Scott O’Neill: There is this one mosquito called Aedes Aegypti that transmits
a range of different viruses to people. They include viruses like yellow fever, dengue fever, Chikungunya, Zika, and the consequences can be very dire from a loss of life through to

Dr. Tom Frieden

crippling social and economic cost.

Margaret Flinter: Dr. Scott O'Neill is the director of the World Mosquito
Program , which has developed an innovative appr oach to
eradicating the threat.

Dr. Scott O’Neill: I was particularly interested in this bacterium called
Wolbachia. This bacteri um is present in up to 50% of insects
naturally, but not this one mosquito t hat transmits all these
viruses. When we put the bacterium into the mosquito the
viruses couldn't grow any longer in the mosquito. W e're
seeding populations of mosquitoes with our own , mosquitoe s
that contain Wolbachia . We’re able to spread the mosquitoes
across very large areas very quickly. Once the mosquitoes have
it they're protected from being able to transmit viruses. When
they're protected, th e humans are protected as well.

Margaret Flinte r: Dr. O'Neill's team released the genetically modified
mosquitoes into a targeted area and the results showed a
dramati c reduction in human infections.

Dr. Scott O’Neill: In Northern Australia we deployed the Wolbachia over quite
large areas, entire citie s, and we've seen ess entially a
complete elimination, 96% reduction in dengue in those cities.
We believe if we can scale this intervention across entire
cities, we can completely prevent the transmission of diseases
like dengue, C hikungunya, and Zika.

Mar garet Flinter: The World Mosquito Program is one of the six finalists in the
MacArthur Foundation's 100&Change competition which
awards a $100 million grant to innovative public health
intervention s.

Dr. Scott O’Neill: We're hoping that over the next five years, we could bring this
technology to protect 75 to even 100 million people. We
would hope within 10 years we could bring this intervention to
500 million people .

Margaret Flinter: The Wo rld Mosquito Program, an effective targeted genetic
engineering ap proach to eradicating the threat of deadly
mosquito borne pathogens, leading to a dramatic reduction in
harm to public health , now that's a bright idea.

[ Music ]

Mark Masselli: You've been listening to Conversations on Health Care. I'm
Mark Masselli.

Marga ret Flinter: And I'm Margaret Flinter.

Mark Masselli: Peace and Health .

Dr. Tom Frieden

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Female : Conversations on Health Care is recorded at WESU at
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