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As head of the Centers for Disease Control and Prevention, Thomas Frieden oversees an agency with the sprawling mission of reining in diseases in the United States and across the globe. From fighting food-borne illness outbreaks and influenza epidemics to educating people about the risks of obesity and smoking, the CDC’s work touches every corner of public health.
Given that broad range of responsibilities, we asked Frieden about what he considers the top public health priorities for 2014. Below are five areas he said deserve special attention, and why each is important. His comments have been edited for length:
1. Increasing human papilloma virus (HPV) vaccinations.
The bottom line here — this is an anti-cancer vaccine. Usually, when we introduce a new vaccine, we expect the uptake will be gradual and will increase by about 10 percent per year. HPV has stalled. We’re at 30 percent, and it didn’t increase at all last year. The country of Rwanda is at 85 percent. If we were at 85 percent, then 4,400 girls alive today would not get cervical cancer in their lifetimes. But because we’re not, they will.
2. Fighting the growing problem of antibiotic resistance, which kills an estimated 23,000 Americans each year.
We talk about the antibiotic era and the pre-antibiotic era. But if we’re not careful, we’re soon going to be in a post-antibiotic era. There are now organisms out there that are resistant, potentially, to all the drugs that we have. And they’re spreading. We need to scale up the work that we’re doing at CDC to support doctors and hospitals to have more rational and more effective strategies for treating patients, so that we can treat infections that could be fatal but don’t waste the antibiotics that we need to preserve for ourselves, our kids and grandkids.
There’s a series of things we have to do. One is, we have to track things better so we know what’s happening when, where and why. The second is to do a better job of responding when there are outbreaks. So, if we have a cluster of cases, we swoop in with the state, with the hospital, with the local in coordination and stop it. The third is to prevent it better, so we figure out how it’s spreading and prevent that in the future.
3. Reducing deaths attributable to prescription painkiller abuse and overdose.
This has been one of the very few things in health that has gotten substantially worse over the past decade. There’s no reason it has to. This is a problem that is, to a very great extent, caused by the health-care system. I believe we can do a great deal to reverse this problem through public health action and coordination with law enforcement. There’s really good, bipartisan agreement on what needs to happen. But we need to make it happen. We need to support states, support localities and reduce the risks to people by improving the management of people with chronic pain.
We want to make sure people with pain get effective treatment, but we know that all too often, the path of least resistance for a physician may be to prescribe long-acting opiates. But the risk-
benefit ratio of those opiates isn’t adequately recognized. There are a lot of risks and pretty uncertain benefits. Someone who’s got cancer and is likely not to survive the cancer — we want to absolutely make sure they get every bit of palliation they need. But that’s very different from someone who’s got back pain and comes in and asks for a prescription and may end up addicted for life.
benefit ratio of those opiates isn’t adequately recognized. There are a lot of risks and pretty uncertain benefits. Someone who’s got cancer and is likely not to survive the cancer — we want to absolutely make sure they get every bit of palliation they need. But that’s very different from someone who’s got back pain and comes in and asks for a prescription and may end up addicted for life.
4. Ending polio once and for all.
Polio eradication is something that CDC has been working on since 1988. We’re closer than we’ve ever been, but that last mile is always the hardest.
Fundamentally, it’s about Nigeria and Pakistan. In both countries, you have insecurity and violence. In Pakistan, you have assassination of health workers who are protecting children from paralysis. It’s almost inconceivable. In Nigeria, you have some violence in some areas; that was the big setback last year. But you also have a health system that doesn’t always reach where it’s most needed.
When we began this [effort] in 1988, there were about 1,000 kids per day who were paralyzed by polio. Last year, there were just a couple hundred. So we’ve made a lot of progress. But until we get over the finish line, every kid everywhere in the world is at risk, because polio anywhere is a risk everywhere.
5. Defending against health threats that originate elsewhere in the world.
We are all connected by the air we breathe, by the water we drink, by the food we eat. What we’re seeing is that it’s part of our self-interest to ensure that countries all over the world are better able to find, stop and prevent health risks. It will help them be safer, more productive, more stable. And it will help us protect Americans from threats that could end up making us sick or killing us.
Ten years ago, after the SARS epidemic, the Chinese government began working with the CDC and said, “We want to create something like a CDC for China.” And they did. When it came to the flu, we helped them learn how to grow the flu virus in the lab, how to do tracking to see where flu is spreading. We helped them to become a World Health Organization collaborating center for influenza. We helped them learn how to sequence the entire genome of the flu virus.
Because of that, when the H7N9 [virus] hit, they found out about it promptly, they rapidly responded and they informed the world openly about it. In fact, they posted on the Internet the genome of the H7N9 within hours of identifying it. That allowed us to make a diagnostic test so we could find out if people have flu, and to begin making a vaccine.
This is a long-winded way of saying that it was a harvest of 10 years of collaboration with the Chinese, that they were able to find this faster, stop it faster and share information faster. We need to do that with many countries and many diseases, all over the world, or we won’t be safe.
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