Podcast: How we overcome infectious disease with a public health renaissance

TRANSCRIPT: How we overcome infectious disease with a public health renaissance

Dr Tom Frieden:

We can't predict what will happen next with COVID, but we can predict with absolute certainty that either a new variant of COVID or another virus is going to create another massive threat to world health in the future that we can be much better prepared for.

Ian Bremmer:

Hello, and welcome to the GZERO World Podcast. This is where you'll find extended versions of my interviews on public television. I'm Ian Bremmer, and today between cratering global markets, record-breaking inflation, a war in Ukraine and midterm elections in the United States, there's a lot dominating the headlines these days. But hey, the fact that there is even other news in the papers today is a sign of just how far the world has come since 2020 when a new virus entered our lives. The World Health Organization estimates that more than 15 million people likely died as a result of COVID-19 in the first two years of the pandemic. And while the coronavirus is no longer the only story in town, the global fight against the disease is far from over. This week I speak with Dr. Tom Frieden. He's former director of the Centers for Disease Control for a look at where we are today in our fight against the coronavirus. Let's do this.

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Ian Bremmer:

Dr. Tom Frieden, thanks for joining us on GZERO World.

Dr Tom Frieden:

It's great to be here with you.

Ian Bremmer:

So let me start of course with how you are thinking about the pandemic today because of course you and I were talking about nothing but for just about two years and now we're feeling more comfortable walking around without masks. We're mostly vaccinated, at least those of us that think that's important and we really desperately want this to be in the rearview mirror. Tell us how much that reflects accurately on the state of the pandemic as you see it, at least in the United States, in Europe and the advanced industrial democracies.

Dr Tom Frieden:

In countries where there has been access to vaccination and there's been a lot of exposure already. We're in a different world right now. With the Omicron variants, the COVID virus is not deadlier on a person by person basis than influenza. And although we underreact to influenza every year, the fact is that if you're vaccinated and if you're vulnerable and get sick, you get Paxlovid, you're probably going to do pretty well with two big unknowns. The first is long COVID. Lots of people suffering with long COVID. We don't understand it well. We don't know how to treat it. We don't know what the future will hold for it. So something can be taken seriously. And second, we don't know what the future will hold for COVID. Bottom line, Ian, we can't predict what will happen next with COVID, but we can predict with absolute certainty that either a new variant of COVID or another virus is going to create another massive threat to world health in the future, that we can be much better prepared for.

Ian Bremmer:

We know that the variants continue to change and that as a consequence vaccines that we get today really aren't very great at stopping people from contracting COVID. What does it look like for you going forward? What kind of recommendations do you think are likely about the future of how frequently and what kind of vaccines people will be taking?

Dr Tom Frieden:

The bottom line is that people should get the vaccines that are available now. Now, when they're eligible and recommended to have them. We don't know what the future will hold. It may be that there's an annual vaccination. It may be that the combination of vaccination and prior infection protects you for a few years. It may be that we have what's called a multivalent vaccine against several different strains or even a combination of COVID and influenza vaccines, but that's all speculative about the future. What we know now is that staying up to date with your vaccination is the single most effective thing that you can do to keep yourself out of the hospital, and quite frankly, out of the morgue.

Ian Bremmer:

Now we know that we're seeing continually millions upon millions upon millions of cases all the time. We know how transmissible this disease is. In your view, does that make it much more likely that we are going to see even more transmissible variants? Does it also make it more plausible that we could see variants that could be much more deadly than Omicron?

Dr Tom Frieden:

I have to say, Ian, I've been stunned by how infectious this virus was and has become. It started out really infectious compared to other viruses, and then it became even more infectious and then it became even more infectious still. It's impressive. If we look at the single most infectious virus known, it's probably measles and measles is pretty stunning. Measles will infect essentially everyone in a immune naive population. And yet measles has a doubling time in the population of about 8 to 10 days, Omicron 2 days. So you're seeing just stunningly infectious virus. If you look at December and January, more than a million Americans were getting infected every single day. Now, there's nothing to say that a future highly infectious variant won't be deadlier than Delta, which was quite deadly. That's why we have to be prepared. Anyone who predicts with certainty and confidence, what's going to happen more than about three or four weeks out with COVID, frankly Ian, they don't know what they're talking about.

Ian Bremmer:

So it's completely plausible that we could, in your mind, that in the next six, 12 months really at any time going forward, that we could have a new variant that spreads like wildfire, but is actually much, much more lethal.

Dr Tom Frieden:

Not only is that possible, but it's also possible that that variant would be what's called immune escape. That means that it really doesn't respond very well to our vaccines. Currently our vaccines, although they don't protect against infection beyond a few months, very well, do a great job protecting against severe disease, hospitalization, and death. But it's possible that won't always be the case. Whether or not that happens with a future variant of COVID, we are definitely at risk of that happening with an influenza variant or some other viral disease.

Ian Bremmer:

Now, Tom, you said that you were really surprised by how infectious this disease has become. I'll tell you who else was really surprised, the Chinese government, and I'm wondering what you would advise them to do given what is clearly a failed zero-COVID policy in the face of their existing vaccines and the transmissibility of omicron, but also recognizing how it appears impossible for them to get away from it.

Dr Tom Frieden:

So I think you have to step back and look at how China has done with the virus. Initially, there was a clear failure in recognition and rapid response. Their response after that was stunning, right? And if they had a death rate like most other countries in the world, there would be a million people dead now in China, who are alive today. They have two problems, at least. One of them is that they don't yet have highly effective vaccines available. And second, they, like many countries in the world, including in the US, have a fair amount of vaccine hesitancy or people who are not very willing or not very interested in taking vaccines, particularly among the elderly. And if you look at what happened in Hong Kong, it's just stunning. Many of us thought, oh, Omicron must be a pretty wimpy virus, doesn't cause a lot of illness and death. Well, that was if it affects people who have either been infected before or had vaccination.

Omicron in Hong Kong represented what happens in an immune naive population and it was devastating. And if it's that devastating in all of China, that would be millions of deaths. So they're in a bind, they don't have the most effective vaccines and they don't have the most vulnerable people vaccinated. Those I think, are the two things to focus on. Get effective vaccines to the most vulnerable. And then you'll be able to have a policy that is not zero COVID infections, but aim for zero or close to zero COVID deaths, which is, for example, what Singapore has done.

Ian Bremmer:

So they are, I mean, realistically speaking, even if we don't have any of the downside scenarios for future COVID variants, they are months and months and months away from being able to effectively respond here.

Dr Tom Frieden:

I wouldn't underestimate the capacities of the Chinese government. They test entire cities of 10 million people in a few days. So the ability to get very effective vaccines to those who need it most in a short period of time is certainly within their grasp.

Ian Bremmer:

Do you have any idea why it is that they've refused to, it's the one major country in the world, if they wanted to have vaccine mandates, they could certainly impose them? Is it because they don't have vaccines that are effective yet themselves? Do you have any view on that?

Dr Tom Frieden:

I don't know what their thinking is. Obviously vaccination in China has a long history, and as CDC director, we had a very close partnership with the Chinese government to look at all of their vaccination policies to improve their vaccination standards. Vaccines do require a higher threshold, unlike a medication which you give to someone who's sick, you're giving a vaccination to someone who's not sick. And so you really need to make sure that it's safe and that it's effective.

Ian Bremmer:

So tell me, I mean, now that we've been through a couple years and now that you're saying we can, at least for now in the US start to look at this with some caveats, as a flu. What are the lessons that you think we've learned and that we haven't learned, but we need to learn for this horrible pandemic?

Dr Tom Frieden:

Ian, people always talk about lessons learned. I think we should be talking about lessons that we'd better learn. And I think there are three of them for COVID, I'll call them the three Rs, that we need a renaissance in our public health system. We need a robust primary healthcare system, and we need resilient populations in terms of health resilience and in terms of societal resilience.

And just briefly taking those one by one, our renaissance in public health. We need to invest in public health. We need to make sure state, local, city, county levels are aligned along with global levels. We need to make sure that public health has good engagement with communities, all communities in our society in terms of primary healthcare, unless we have good primary healthcare, and we do not in this country, unless we do, we're not going to be able to detect things promptly. We can't diagnose and treat, use Paxlovid, for example. We can't get people vaccinated effectively. We still have tens of millions of vulnerable people who are not up-to-date with their vaccination. Primary healthcare is so important, but so underfunded in our system.

And third is resilient populations. That means healthier. So chronic diseases in good care, tobacco use decreasing hypertension control, control diabetes in control. That means that if there is an infectious disease shock, we're more likely to be able to withstand it. And resilient in terms of trust. Trust is the one thing that you cannot surge during an emergency. We need to rebuild that. We need to rebuild some of our common platform of understanding. Moynihan used to say you're entitled to your own opinions, but not to your own facts. Now it seems like people feel entitled to their own facts. We need to get back to a world where we can agree on the facts and disagree on things that are not factual.

Ian Bremmer:

Now look, I mean, I saw the movie Contagion and I saw it again right at the beginning of the Pandemic and the CDC, they were heroes in that film. And at the beginning of the pandemic, it certainly looked like people like Dr. Fauci and the CDC were very widely respected in the United States. I don't think you can say that today. And you, you've just kind of in intimated that. Where do you think they've gone wrong and what concretely needs to happen? What could happen that could help to rebuild that trust for the American public?

Dr Tom Frieden:

Well, first, Ian, just about Contagion. It was filmed at CDC. I got to meet Matt Damon, Laurence Fishburne and others, which was pretty exciting. And the movie is pretty accurate. Interestingly, the one thing that many people criticized it for at the time was, "Oh, they'll never produce a vaccine so quickly during a pandemic." And here we are with mRNA Technologies and a stunningly effective vaccine.

In terms of rebuilding trust in the CDC and in government work more widely. It's very important that CDC reestablish its identity in separation from the White House, whoever's in the White House, because if all or most of the CDC press conferences are done as part of the White House, then a big part of the country, whichever side is in charge in the White House, is not going to believe what they say. CDC is in Atlanta, it has advantages and disadvantages, but that separation can be very powerful. Second, CDC needs to follow its own playbook as I think it's been increasingly doing. Be first, be right, be credible, be empathetic, and give people proven, practical things to do, to protect themselves and their family. And third, have some successes. Nothing succeeds like success. And as CDC, which is doing great work, which still has thousands and thousands of people who dedicate their lives to protecting Americans 24/7, as those successes become apparent, I think trust can be rebuilt.

Ian Bremmer:

Now, Tom, you've devoted your career post CDC to trying to advance public policy, understanding and action on the ground in the United States and around the world. I'm wondering, given the target rich environment that you now see what's top of resolves agenda in terms of where you think you can make a difference post-pandemic?

Dr Tom Frieden:

In terms of preventing the next pandemic? I have a concern. There's a lot of global discussion. What's the structure? What are some funding streams? What should WHO do? What should other organizations do? But I'm concerned that we may be losing the focus on countries, making sure that every country in the world is able to find, stop and prevent health threats promptly and having steady progress doing that. And that's where I think we really need to accelerate because we are in a real risk of going headlong into the neglect part of the panic/neglect cycle that we see with infectious disease outbreak, epidemic and pandemic after pandemic.

Ian Bremmer:

So Tom, how can countries know if they're improving along those lines?

Dr Tom Frieden:

What we find is that the key indicator is how quickly you found something and how quickly you stopped it. There's a 7-1-7 target that every outbreak would be found within seven days, reported within one, and all essential control measures in place within seven days. We've been working with half a dozen countries in Africa as well as countries elsewhere in the world. And this kind of an approach for every single outbreak quickly identifies the things that need to be fixed and quickly enables countries to improve their quality. The challenge is getting the resources quickly so that countries can make a difference with faster detection and fast response. And that might be a better lab system, that might be better reporting, that might be better connection between their public health program and their frontline clinicians. And progress is really possible.

We're seeing countries around the world drop the time from recognition from months to week, or weeks to days, or days to hours if they focus on it and continuously improve. And that metric of 7-1-7, which needs to be supported with resources for countries to accelerate progress once they identify the problems, that can be as transformational for global health as another metric, what's called 90-90-90 was for HIV. That HIV metric resulted in millions of additional people, effectively treated, millions of lives saved and reduced spread of HIV. 7-1-7 can do the same thing for deadly pandemics.

Ian Bremmer:

What's the spend priority here? I mean, how much of this is it new data systems? Is it new surveillance capabilities? Is it human capital? I mean, give me the priorities in terms of what you need to allow a sub-Saharan African country that potentially is going to be incubating an awful lot of these new diseases and among the poorest and weakest infrastructure in the world that gets them there.

Dr Tom Frieden:

Fundamentally, we need staff more than we need stuff. We need systems more than we need meetings. And we need to use real life as our drill more than we need tabletop exercises. And that means supporting staff in countries around the world to focus on preparedness day in and day out, and systematically look at each of their outbreaks, routine foodborne outbreaks, measles, yellow fever, there's no shortage unfortunately of outbreaks going on every day that can be used to identify the weak spots in a country's detection response system and then rapidly address those weak spots and improve preparedness. But it does require focus. What we've done at my group Resolve to Save Lives with half a dozen countries around the world is to put in acceleration teams or A teams embedded with the Ministry of Health, that focus just on helping that country become better prepared. And that needs to be the kind of intervention in countries all around the world. And what we find is there are terrific people in these countries. They know what needs to be done, they just don't have the resources and the focused time to enable the rapid progress that will benefit not only their country, but their neighbors and the world.

Ian Bremmer:

From what I remember, the A team that's pretty much the opposite of a tabletop exercise. So I'm I'm very glad to hear that. Tom, I want to ask you, how much unnecessary damage was done on the basis of lockdowns both more broadly, as well as say, for kids, for schools? Looking back on this over the last couple years, where do you think that there was really too much error on the other side?

Dr Tom Frieden:

Well, I was on record throughout of saying I didn't think schools should be closed. We knew from influenza that if you close schools, you're going to close them for a long time. And we knew that that would be devastating for educational outcomes and devastating for the economy. We also knew from the outset that outdoors was not a risk. And so stay at home was a wrong concept. The concept of not having close indoor spaces, I think those were the two biggest challenges in terms of going too far. But Ian, if you step back, fundamentally in the US, at least half of all of the deaths in 2020 could have been prevented by better lockdowns, smarter lockdowns, smarter closures that looked at what was happening. It's kind of like you see a hurricane coming, you need to know what to batten down and what not to, and then when it's gone, you can let up. So in 2020, more than half of all the deaths were from failure to implement public health measures. In 2021 and throughout 2022, more than half of old deaths have been from failure to reach everyone with vaccination.

Ian Bremmer:

Two and a half years of focusing on COVID, on the one hand, lot more money available for pandemic research and a lot going on in terms of mRNA and all of the infrastructure around that. I'm wondering though, when you have this much focus on one disease, are there areas that we've lost focus that we better not?

Dr Tom Frieden:

Absolutely. If you look at Africa, we have a big gap in, for example, tuberculosis diagnosis. And what that means is there are a lot of people out there who had tuberculosis, have tuberculosis, spread it to others, and we may be unfortunately dealing with the ramifications of that for years to come. So it's a big setback in some programs like the tuberculosis control program globally. It's also a setback for a lot of chronic care. One of the things that I think about a lot is high blood pressure. People take for granted that there's a lot of high blood pressure, but actually hypertension is a pandemic and it's deadlier than COVID, and it kills people at a younger age and it's more preventable and more treatable. And yet we're not doing that effectively. In the US We treat people with hypertension effectively only 44% of the time, despite trillions of dollars in healthcare. Globally, it's only 14% of the time, and yet the best healthcare systems are at 90% and the best countries are at 70%. So there are really important health programs that could save lots of lives that have absolutely been set back by the pandemic.

Ian Bremmer:

I really didn't want to hear about another disease that I hadn't heard of before, but monkeypox, there's way too many headlines, it bothers me. Should I care? Does it matter? Or can you at least tell us that this one doesn't matter?

Dr Tom Frieden:

Well, it certainly matters to people who have monkeypox and it matters to the communities in which it's spreading, including in up in many countries, men who have sex with men. It also matters that we don't know what's really happening in Africa with monkeypox because there hasn't been the kind of investment needed. There hasn't been the kind of support for people who've been doing research on monkeypox for 20 years. I traveled more than a decade ago to look at a monkeypox outbreak in DRC. The CDC had developed a new primer that could be used with the gen expert machine that was very effective at identifying monkeypox. But there are a lot of unknowns in how it spreads, where it's spreading, can it be controlled? Should we be using ring vaccination? And because there's a lot we don't know globally, there's a lot we don't know in places that it's spreading newly. We really are connected by the air we breathe, the water we drink, the food we eat, the planes we travel on. Anywhere in the world can connect with anywhere in the world within just a day or two. And unless we invest in better understanding and better control of infectious diseases, they will continue to too great a degree, to control us.

Ian Bremmer:

Okay, darn it, tom. You've convinced me that we need to pay attention to monkeypox. So tell me one big health scare out there that people worry about that we don't need to worry about, that's actually really overstated?

Dr Tom Frieden:

Well, there's a lot of them, right? So let's take coffee. Coffee is not bad for you. So people they go, public health you, you're going to take away all my fun. So there's a lot of things you can do that aren't bad for you. Drink coffee or tea. And by the way, getting physical activity is probably the single best thing you can do for yourself. Regular physical activity, a brisk walk, 30 minutes a day makes a huge difference to your health, mental health, physical health. There are health scares all the time. One of our challenges is that we've kind of lost the trust in the institution to say, this is big, this isn't big. And obviously if there's a problem that affects a few people severely, that is a severe problem for those people. So we never want to minimize something that has devastating personal consequences for some people. But you can still have a great fun life, lot of fun things to do, lot of enjoyable things to do that are healthy and will help you not just live longer, but live healthier, happier, and more fully.

Ian Bremmer:

You heard it from Tom Friedan, scalding hot coffee as much as you want. No problem. Right to it. Tom, thank you so much, man. Enjoyed seeing you and well, I'm sure we'll have you back soon.

Dr Tom Frieden:

Great to see you again, Ian. It's always a pleasure speaking with you.

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The GZERO World Podcast is brought to you by our founding sponsor, First Republic. First Republic, a private bank and wealth management company, places clients needs first by providing responsive, relevant, and customized solutions. Visit firstrepublic.com to learn more.

The GZERO World Podcast is also brought to you by Foreign Policy. The next time you order some calamari, stop for a minute and think, where does this actually come from? In The Catch, a new podcast from our friends at Foreign Policy, get a behind the scenes look at the state of global fishing by tracking squid from the waters off the coast of Peru, to the processing plants, all the way to restaurants and finally, your plate. Follow and listen to The Catch wherever you get your podcasts.

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