Tom Frieden, director of the Centers for Disease Control and Prevention, has taken on an even higher profile as the public face of the American response to the world’s most deadly health crises, spearheading the campaign to eliminate the Ebola threat that has traveled from West Africa to the United States.
For Frieden, this is arguably the most daunting challenge in a career that has included crusades to combat tuberculosis in India, limit smoking in New York City, and halt the 2009 flu.
Frieden was among the earliest proponents of an aggressive U.S. plan to handle a virus that by January could afflict 1.4 million people in West Africa. He has pledged that a similar outbreak won’t happen here.
Critics wonder why the United States didn’t act sooner. Many African leaders say a swifter American response to the epidemic could have saved thousands of lives.
The handling of the Ebola outbreak will largely define President Obama’s legacy in greater Africa, and it’s Frieden in whom the president has placed his trust.
Though Ebola is dominating much of his time, the CDC director says a variety of health threats pose a greater danger to Americans.
In an interview with the Washington Examiner, Frieden talked about the public health outlook, his expectations about Ebola and whether he has managed to get some sleep during this tumultuous week. The interview was edited for length and clarity.
Examiner: Where does the Ebola threat rank in terms of challenges since you started at CDC?
Frieden: Ebola is the most urgent challenge CDC has faced since I became director in 2009, because the exponential growth of the epidemic requires extremely rapid scale-up of response. But CDC continues to face other critical challenges at the same time. Ebola is just the most dramatic example of why we’re working hard to implement the president’s global health agenda, because a health threat anywhere is a health threat everywhere.
Here at home, nearly one in five Americans still smoke cigarettes — shortening their lives and putting others at risk from secondhand smoke. Millions die each year of preventable illnesses and injuries. Prescription drug abuse is ravaging communities across the nation. We’re stepping up to all of these challenges by creating, implementing, and evaluating effective programs — all of which are every bit as important, if not so immediately urgent, as our fight to end the Ebola epidemic in West Africa.
Examiner: How does the Ebola scare compare to the other outbreaks you have encountered, such at the 2009 flu pandemic?
Frieden: Ebola poses no significant threat to our domestic health system. U.S. hospitals are exceptionally well equipped to quickly identify and isolate people potentially infected with Ebola, limiting the opportunity for that person to infect others. The 2009 H1N1 pandemic strain of influenza, once inaccurately referred to as swine flu, now circulates as a seasonal flu bug, and, like seasonal flu, causes tens of millions of illnesses, hundreds of thousands of hospitalizations, and many thousands of deaths each year. The current flu vaccine is the best way to protect against this and other circulating flu viruses.
Examiner: How would you respond to the “too-little-too-late” criticisms on Ebola?
Frieden: For the past three years our top global priority has been to strengthen global health security along with our partner nations. In Uganda, where a pilot program helped create such an infrastructure, recent Ebola outbreaks have quickly been controlled. Guinea had no such system, and when Ebola emerged there this past December, it went unrecognized for months. Unfortunately, conditions in West Africa — lack of health care infrastructure and isolation facilities, little personal protective equipment, crowded living conditions, and longstanding burial traditions that expose mourners to the body fluids of the deceased — facilitated Ebola’s spread. As West African nations became aware of the extent of the problem, they asked for assistance, and the United States has been foremost among nations responding to that call.
Examiner: Could Ebola become airborne?
Frieden: Like all viruses, Ebola constantly undergoes genetic changes. The vast majority of these changes have no effect on how the virus acts. Sometimes these changes can increase the ease with which a virus spreads, other changes may have the opposite effect. It is rare for any virus to change the way it enters a human body. Ebola spreads through direct contact with body fluids. It does not linger in the air, and airborne spread is not currently a significant form of transmission. We cannot say that Ebola will never do this — the odds are non-zero, though [that] increases with every passing day of the outbreak — but our gut feeling is that it is unlikely.
Examiner: How long could it take to corral this virus?
Frieden: CDC’s models show that once 70 percent of people with Ebola are effectively isolated in treatment centers, medical facilities, or Ebola care centers, case counts will drop almost as rapidly as they increased. Even before that tipping point is reached, the Ebola epidemic will slow. It is too early to predict exactly when this will happen, but we are greatly encouraged by the magnitude and speed of the response we are seeing.
Examiner: You’re still getting sleep, right?
Frieden: I do sleep most nights, but I work most days. This is the first time since the height of the H1N1 pandemic that I work through many nights. It reminds me of the years I spent in India working on tuberculosis control, when I was faced with the reality that more than 1,000 people per day were dying from a completely curable condition. The two key differences are that with Ebola, the disease is moving at a pace that is almost inconceivable, but we have wonderful capacities throughout CDC, the U.S. government, and the world to confront it — truly, the battle has been joined.
Examiner: Did you see this coming?
Frieden: Disease outbreaks are not predictable. We know that they will come, but we don’t know when, or where, or how bad they will be. That’s why CDC experts prepare for and stand ready to respond to health emergencies at any time, anywhere in the world.
