On a Quest to Save 100 Million Lives, Former CDC Director Dr. Tom Frieden on His New Global Venture

Tom Frieden

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Mark Masselli: This is C onversations on H ealthcare. I’m Mark Masselli .

Margaret Flinter: And I’m Margaret Flin t er0

Mark Masselli: Well , Margaret , it appears this year’s flu epidemic is still of major concern around the
countries. The number o f patients entering clinician s’ offices and emergency rooms with flu
complications have continued to rise.

Margaret Flinter: And this year’s flu season has actually been the deadliest since the swine flu
outbreak of 2009 with outbreaks leading to more ho spitalizations and deaths than we ’ve seen in a
decade . It has put a real strain on the nation’s health system and you know, Mark, it is not consistent
across the country, still a lot of problems in many states.

Mark Masselli: Certainly are, and a large s ector of the population was not immunized, and the CDC and
the US Surgeon General are urging folks who haven’t had the flu shot - there is still time.

Margaret Flinter: And this topic brings us to our guest today, Mark. Dr. Tom Frieden is really a
giant in the world of public health. He was director of the CDC for eight years under President Obama,
before that well known as the Health Commissioner for the City of New York. He is spearheading an
exciting new global initiative now.

Mark Masselli: Dr. Fr ieden is now President and CEO of Resolve to Save Lives, a 5 - year initiative to save
100 million lives globally. He has got some powerful partners in this quest, really looking forward to
having Dr. Frieden back on the show, and Lori Robertson will stop b y , the managing editor of
FactCheck.org, but no matter what the topic, you can hear all of our shows by going to c h cradio.com . A s
always, if you have comments, please email us to [email protected] or find us on Fac ebook or Twitter,
and we would love hearing from you.

Margaret Flinter: We will get you our interview with Dr. Tom Frieden of Resolve to Save Lives in just a
moment, but first, here is our producer, Marianne O'Hare with this week’s headline news.

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Marianne O'Hare : I’m Marianne O'Hare with these healthcare headlines . As we are gathering at the
National Governors Association, a lot of talk about healthcare , bipartisan group of five governors issued
a healthcare blueprint for rational approaches mo ving forward on healthcare policy . Governor
Hickenlooper of Col o rado and Governor Wolf of Pennsylvania, both democrats, Governors Sandoval of
Nevada and Kasich of Ohio, both Republicans and independent Bill Walker of Alaska, they are all asking
the Federa l Government to an Act Legislation that will bolster the insurance market, increase drug and
hospital care, price transparency , and support healthcare access for all Americans. Apple a day may
keep the doctor away, but Apple is bringing the doctor in hous e with little fanfare and a newly launched
website Apple has announced , it is launching a healthcare company that says it will deliver the world’s
best healthcare experience to its employees . The tech giant announcing the launch of AC Wellness
starting wi th two new health clinics that will serve Apple employee s and their families, they have
openings listed on the website for primary care clinicians, fitness, and wellness experts and other health
providers. The persons of healthcare clinics on the Apple ca mpus serve as yet another hiring perk for

Tom Frieden

employees, but there are also plans to use the clinics as incubator for testing out their sweet of health -
related products being developed. Apple recently announced a partnership with Stanford Medicine and
the Tel ehealth Company, American Well to launch the first of its kind , large scale Apple Heart Study
using tens of thousands of Apple watch users to gather data on the prevalence of atrial fibrillation .
S peaking of AFib, it can lead to stroke and cardiac arrest and a new study suggests heart attack victims
fare much better if a bystander is able to deploy a defibrillator on the spot before emergency help
arrives. The new study looked at 2500 cardiac arrests that happened in public places that were
equipped with an automated external defibrillator or AED. Cardiac patients who were treated onsite
with the AED immediately were more likely to survive the heart attack and also suffer fewer long - term
impairments. Verily, the healthcare unit of Alphabet, formerly part of Google Life Sciences is reportedly
getting into the insurance business. The tech giant in talks with insurers to take on the risk of managing
large patient populations using data to ultimately bring cost down. The population and health
management sec tor is poised to grow in coming years, especially among payers and players who can
demonstrate real cost reduction in managing those populations.

I am Marianne O'Hare with these healthcare headlines.

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Mark Masselli: We are speaking today with Dr. Tom Frieden, President and Chief Executive Officer of
Resolve to Save Lives at the nonprofit organization, Vital Strategies, dedicated to saving 100 million lives
by building a stronger global public health system. Dr. Frieden served as the Director of U S Centers for
disease control and prevention for eight years. Before that, he was the commissioner for the city of
New York where he advanced sweeping initiatives to improve public health including launching the
Bloomberg Philanthropies initiative to redu ce tobacco use. Dr. Frieden earned his medical and public
health degrees from Columbia University.

Dr. Frieden, welcome back to Conversations in Healthcare.

Tom Frieden: Thank you very much for having me.

Mark Masselli: You presided over eight years ov er the CDC and before that health commissioner for the
City of New York where you launched initiatives that have limited smoking in public places, tackle d
transfats in foods, and confronted infectious disease like HIV . Now you are at the helm of this nonp rofit
global initiative, Resolve to Save Lives, which seeks to address big health challenges, that you’ve built
your career around . I am wondering if you could tell our listeners what you hope to bring from your
previous experience to this new global vent ure.

Tom Frieden: I feel I had an extraordinary privilege of being Health Commissioner in New York City
and Director of the CDC to learn from terrific public health doctors, nurses in the US and around the
world . It gave me a particular advantage point t o see globally where are the key areas that were poised
to make progress and we identified really two areas where I feel we can save the most of lives with a
combination of philanthropic supported effort and government action. The first of those is in
pre venting heart attacks and strokes and in that part of the Resolve to Save Lives initiative, we think we
can help countries implement programs that will save 100 million lives over the next 30 years . In the
second area, we think it is possible to greatly c atalyze more rapid progress preventing epidemics and if
we’re successful, we look back and we ’ll see this as an inflection point of big decrease in heart attacks

Tom Frieden

and strokes and a big decrease in the risk of epidemics and our approach at Resolve is to have simple,
scalable, fast interventions that will be able to make a difference.

Margaret Flinter: So Dr. Frieden, you are being supported by some very high - profile players in the
global health arena, certainly the Bill and Melinda Gates Foundation, the Chan Zuckerberg Initiative,
Bloomberg Philanthropies and of course the World Health Organization, World Bank and the CDC. Tell
us a little bit about how these partner organizations are working together with Vital Strategies to help
you meet the goals that you ’ve laid out in Resolve to Save Lives.

Tom Frieden: We’re so fortunate to have very generous donations of 225 million dollars worth five
years from Bloomberg Philanthropies, the Chan Zuckerberg Initiative and Bill and Melinda Gates
Foundation. Resolve to Save Lives is an initiative of an organization called Vital Strategy. It has offices in
more than 60 countries including more than 100 staff who are working side by side in countries around
the world including World Health Organization, World Bank, The J ohns Hopkins Bloomberg School of
Public Health where there is an urgent need and no available resources to provide the support that ’s
needed.

Mark Masselli: You know, your Resolve to Save Lives is focusing on two key areas of public health, and
you’ve tac kled these public health issues quite successfully with programs such as your smoking ban and
transfat ban in New York City and confronted epidemics such as HIV and more recently Ebola . I am
wondering if you could talk about some of the important public h ealth campaigns you’ve undertaken,
what you’ve learnt from them, and the challenges of scaling up some of those early successes.

Tom Frieden: What makes for success in global health is having three fundamental basi n s covered of
technical rigor , operationa l excellence , and political will. It ’s so important that there is what I refer to as
a technical package of high - impact interventions that when implemented will make a real ly big
difference. On the operational side, if we could manage them with [ Inaudibl e 00:08:52] tuberculosis
control where policies from the World Health Organization helped countries establish its accountability
for every single patient diagnosed, what is their outcome, and also political will , making the policy
initiative to tax tobacco and soda . These are decisions that have life and death consequences, whether
it has been making New York City more clean or working with communities throughout West Africa , to
stop the Ebola epidemic, they have to have those three components.

Margaret F linter : Certainly, one of the greatest public health interventions of the past century has
been the development of our vaccines, their li f e saving and disease preventing evidence is irrefutable,
but we’ve in the frontlines in community health seen a resur gence of preventable diseases like measles
and pertussis or whooping cough . This year, the flu epidemic has been so harsh , we’re seeing pediatric
deaths that we haven’t seen in years, but the vaccine was only administered to about half of the
country’s po pulation . It’s still an incredibly important h edge against contracting the flu, maybe you
could talk with us a little bit about the challenge of getting people to comply with vaccines.

Tom Frieden: Vaccines are truly a public health miracle. They have saved literally hundreds of millions
of lives, eradicated smallpox, brought polio to the brink of eradication, saved many millions of lives from
measle. What happens as those diseases get less common is that people become less interested in
getting vaccin ated. In Africa, there has been a wonderful program, which the Gates Foundation, they
call, PATH and others have been central to creating a vaccine for meningitis. That vaccine is available for
less than a dollar a dose, it is very effective and it is gi ven to people up to age 29, that is usually a

Tom Frieden

population that is quite harder to reach, much easier to vaccinate kids and yet the vaccine rate in that
campaign were more than 90%, and the reason for that was, people see meningitis.

In some ways, vaccines have been a victim of their own success.

Margaret Flinter : Alright.

Tom Frieden: Because people don’t see those diseases everywhere, they may be less interested in
getting a vaccine. The flu vaccine even in a good year isn’t nearly as effective as we’ve liked, it is about
60% effective. This year, it looks like it is going to be somewhere in the 15 to 25% effective range, which
is nowhere near what we would like, but it is the best option, 20%, after all, it is a lot better than 0%.

And I know there is a lot of interest in the universal flu vaccine, it is probably a decade or decades away.
This year, we could increase investment in understanding which vaccines work better and any one of
those three vaccines is going to be better, but only actual data w ill show and the Centers for Disease
Control is the best organization to study which of those vaccines works best, but doesn’t have the
relatively modest resources that would allow it to figure that out, it is sometimes frustrating and
sometimes ironic tha t we may be willing to invest in a very important effort. It is great the time we can
put in billions of dollars into that, but for 10 or 20 million dollars, they may be able to get the current
vaccine very effective for people within a couple of years.

Mark Masselli: We are speaking today with Dr. Tom Frieden, President and Chief Executive Officer of
Resolve to Save Lives, a 5 - year initiative at the nonprofit organization, Vital Strategies. Dr. Frieden, you
say that we are at a tipping point globally an d you expect a tsunami of non - communicable diseases, it
would be wonderful if you could tell our listeners what had you most concerned about those looming
health threats.

Tom Frieden: Two areas that I am most concerned about are the two areas we are focus ing on at
resolve, cardiovascular disease and epidemic. In terms of cardiovascular disease, the leading cause of
death in the world, it causes 1 out of 3 deaths and most of them are preventable. 10 million people a
year are killed by high blood pressure, that’s as many as are killed by all infectious diseases combined.
Globally, about 1.4 billion people have high blood pressure, but only 10 or 15% of them have it under
control and treatment can be scaled up, but what is happening now is that blood pressu re goes
untreated and all over Africa and other parts of low and middle - income countries, we are having an
epidemic of strokes, heart attack that are causing personal tragedies . W e think there are clear wins to
be had in cardiovascular preventions as ther e are in epidemic prevention and if we failed to do that, the
cost will be in millions of lives and billions or even trillions of dollars in avoidable health and societal
cost.

Margaret Flinter: You spent 8 years at the helm of the Centers for Disease Co ntrol and Prevention
under President Obama. The current administration has been taking a different approach. There have
been funding cuts to many key health programs and a significant cut to the CDC’s budget. Share your
thoughts on the progress that you were able to make during your tenure and in this very difficult couple
of weeks that we’ve experienced with another mass shooting, your thoughts about the restriction on
funding to study gun violence specifically.

Tom Frieden: Let me start, with the 8 ye ars that I had the privilege to lead CDC. We left America
stronger and healthier and we did that through strengthening systems to find and stop health threats in

Tom Frieden

this country and to improve ability to protect this country from threats that might arise fro m other
countries. The proposal of the current administration or the CDC's budget for the next budget year
would bring the CDC budget down to its lowest level in 15 years that would be more than a 20% cut. It
would also really harm CDC’s ability to preve nt heart attacks, strokes, and cancer by doing something
called block granting and cutting those programs. That’s just a very bad government. It does not allow
the CDC to support state in running effective programs and it makes it easier for those progra ms to be
cut in the future as in fact the administration is proposing in this year to cut the block grant. It also
would cut a very important program that helps state and municipal health departments find and stop
threats in schools, in hospitals. It is a very successful program that has stopped outbreaks of drug -
resistant bacteria and it would be ended under the administration's proposal and the proposal would
cut by two - thirds CDC's full deployed doctors and epidemiologists who are working around the wo rld to
help other countries stop diseases there so that we don't have to fight them here and that would make
Americans less safe . I hear from both houses of congress a strong support for CDC.

So, I am hopeful that when the ‘18 budget and the ‘19 budget a re finalized, administration's proposals
will not come to task. The second question is about coverage under the Affordable Care Act. It is
absolutely the case that the Affordable Care Act resulted in more than 20 million people having access
to health in surance and health coverage who didn’t have it before and that saves lives. We are spending
more than any other rich country on healthcare who are getting worst health outcomes. I hope there
can be a bipartisan approach to saying, what are some things th at we can do in healthcare that will
actually help us get more value to the dollars we put in and improve the health status of this country so
we stop being a laggard in health status? In terms of gun violence, I’ve been deeply moved by what
some of the s tudents of the most recent shooting have spoken out about and the CDC doesn’t advocate
the policy, CDC provides data on what the science shows. Every year, we ask Congress for 10 million
dollars to do research on gun violence and every year congress decli nes to provide those resources , but
we were able to support state governments in more than 40 states to study what is happening really far
too often. We have rates that are many, many, many times higher than any other operating gun
country.

Mark Massel li: You know, Dr. Frieden, I was thinking earlier as you were saying that you were inspired
by physicians and scientists in the work that you were doing and now you are taking on a challenge
about global health of course inspiring you and whose inspiring t hat next generation of young people to
get engaged in these public health initiatives.

Tom Frieden: For me personally, my father was the biggest influence on my life and he said very
simply, you got to help the people and I tried to structure my career t o save as many lives as possible. I
have been deeply inspired by leaders in public health like Bill Foege who led the efforts to eradicate
small pox and rigorous science, excellent management, eloquence , and listening to what is really
happening on the fr ontlines. Many of us in public health get most inspired when we see what is
happening on the frontlines, whether it is the public health nurse who was the person who sounded the
alarm for this terrific outbreak of HIV related to opiate use in Indiana.

Th at individual saved hundreds of lives by being alert or the patients who come to us and tell us what
either the disease means, or the traged y means . I became quite close to Terry [PH] who was one of our
spokespeople for tips from former smokers at CDC and I was just speaking about her. She is a wonderful
woman who wants to share her history. She had started smoking as a teenager in North Carolina,
picking tobacco and she developed cancer in her 40s, died in her 50s, and by sharing her story, she
probably saved more lives than most doctors will, in their entire career.

Tom Frieden

Margaret Flinter: We ’ve been speaking today with Dr. Tom Frieden, President and Chief
Executive Officer of Resolve to Save Lives, a 5 - year initiative at the nonprofit organization, Vital
S trategies, dedicated to saving 100 million lives by building a stronger global public health system. You
can know more about their work by going to resolvetosavelives.org or follow them on Twitter at
ResolveTSL and also at Dr. Frieden.

Dr. Frieden, we th ank you so much for your contribution to public health and for joining us once again
on Conversations on Healthcare .

Tom Frieden: Thank you so much for having me on .

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Mark Masselli: At Conversations on Health c are , 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 editor of FactCheck.org , a nonpartisan and nonprofit consumer advocate for voters that
aim to reduce the level of decept ion in US politic s. Lori , what have you got for us this week ?

Lori Robertson: The February 14th, deadly mass shooting at a high school in Parkland, Florida has
brought the public health issue of guns to the floor. One topic of discussion is background checks.
Results of a national survey published in 2017 show that 13% of US gun owners who purchased a
firearm in the past 2 years did so without a background check. Senator, Bernie Sanders was wrong
when he recently said that the figure was 3 times as hi gh. Sanders was referring to a statistic based on a
nearly 24 - year - old survey when he told NBC News' Chuck Todd on February 18th, "40% of the guns in
this country are sold without any background checks.” In January 2017, the Annals of Internal Medicine
p ublished the results of a study on firearm acquisitions offered by researchers at Northeastern
University in Harvard. It concluded that "22% of current US gun owners who acquired a firearm within
the past 2 years did so without a background check.” Just 13% of those who were sold a gun, as Sanders
said, in the previous 2 years, did not have a background check according to the data. The findings were
based on an online survey of 1613 adult gun owners in 2015. The older 40% figure had been
questionable be fore. That 1994 survey asked whether participants "acquired this gun from a licensed
firearm dealer," and 64.3% answered “yes” or "probably was/think so” leaving about 40% who said they
didn’t acquire the gun from a licensed dealer, but the question wasn’ t specifically about background
checks and that is my FactCheck for this week. I am Lori Robertson, Managing Editor of F act C heck.org.

Fact C heck.org is committed to factual accuracy from the country's major political players and is a project
of the Annen berg Public Policy Center at the University of Pennsylvania. If you have a fact that you'd
liked checked , e - mail us at chcradio.com, we’ll have FactCheck.org’s Lori Robertson check it out for you
here on Conversations on Healthcare.

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Each week, C onversations Highlights are bright idea about how to make wellness a part of our
communities and everyday lives.

When Wichita, Kansas’ nurse practitioner, Michael Wawrzewski learned of the harsh and often fatal
conditions that expectant mothers endure in Sub - Saharan Africa, all because they live too far from a

Tom Frieden

medical clinic, he thought there had to be a way to fill that need. He came up with the solution, Clinic In
A Can, transforming shipping containers into fully equipped mobile clinics and operating r ooms that can
be shipped anywhere in the world where there is a need.

Michael Wawrzewski : When you walk in the inside, you will believe or think that you are inside your
doctor's office or inside of the clinical environment, they look exactly the same.

M argaret Flinter: Wawrzewski learned from his early iterations that gas power generators could
be problematic in low resource areas and switch all of these portable clinics to solar power which he
says was a game changer.

Michael Wawrzewski : Solar power has become the cornerstone of how we re - engineered how we
power clinic fitted now. Every piece of equipment, we can run it off for 500 watts of electricity, which
means 6 solar panels and 8 batteries are enough to run a clinic for 18 hours.

Margaret Flin ter: Since its founding a decade ago, Clinics In A Can have been delivered to War
Torn Sudan, to earthquake ravaged Haiti and more recently to Santa Rosa , California , an area decimated
by the wildfires that also destroyed the main community health center there.

Naomi Fuchs: These are converted shipping containers that arrives fully equipped as a medical
examiner.

Margaret Flinter: Santa Rosa Community Health Center CEO, Naomi Fuchs, says that the portable
clinic was a God send for her providers. There are roughly 120 square feet shipping container clinics,
designed to support workflow and to become a permanent fixture in low resource areas.

Michael Wawrzewski : A containerized clinic is something that is a turnkey. It's all built in the United
States . We equip it with the best equipment and we ship it as a completed project that once on the
ground within 20 to 30 minutes is ready to be used.

Margaret Flinter: Clinic In A Can, a professionally outfitted shipping container fully equipped with
medica l and surgical equipment providing quality, state of the art medical facilities and a low resource
area, now that's a bright idea.

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This is C onversations on H ealthcare . I’m Marg a ret Flinter.

Mark Masselli: And I’m Mark Masselli , peace and health .

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Recording: Conversations on Healthcare broadcast from W E S U at Wesleyan University streaming
live at wesufm. org and brought to you by the community health center.
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