As the 16th director of the U.S. Centers for Disease Control and Prevention (CDC), Thomas R. Frieden has had to tackle some of the biggest disease challenges the U.S. agency has faced in decades.
At seven and a half years in office, he is the longest-serving CDC director since the 1970s. His tenure has encompassed the surprise emergence of Zika and Middle East Respiratory Syndrome, the international epidemic of Ebola, the opiate addiction crisis, and the 2009-10 pandemic of H1N1, popularly known as the swine flu.
As is customary for political appointees, Frieden submitted his resignation after the election, and unless the Trump presidential transition asks him to stay on, he will leave his job at noon ET on Friday, January 20.
Last week, Frieden sat for an interview with Maryn McKenna at CDC headquarters in Atlanta, Georgia, to discuss his experiences in office, his hopes for the agency's future, and his worries about the world's ongoing health crises.
You worked in the U.S. government before you came to the CDC in June 2009; in fact, you started your career at the CDC as an Epidemic Intelligence Service officer in 1990. Were there things that surprised you about returning?
Frankly, it's frustrating how slow things move in the federal government. The seven-month delay getting Zika funds approved is just the latest example of that. Even with Ebola, our ability to move quickly, to contract quickly, to hire quickly was impaired by administrative procedures that are not appropriate for an emergency. That's why we have really pushed for a rapid-response fund that would have not just dollars but authorities.
With Zika, for example, the White House was able to get what's called direct hiring authority. We've hired 200 people that have been working on Zika, doing mosquito control and birth defect surveillance. We didn't have to pull people from all over CDC and have them stop doing their jobs, which we had to do with Ebola. (Also see "It’s Official: Zika Is a Sexually Transmitted Infection.")
You’ve been outspoken about the impact of politics on public health funding. When the federal government shut down over budget negotiations in 2013, the CDC was in the midst of investigating a nationwide salmonella outbreak, and you told me, “We are juggling chainsaws.”
Do you remember my tweet from then? We were told not to do social media because it was seen as frivolous. But the first night of the shutdown … I was at my desk working at ten o'clock at night and I took out Twitter and I said, "Today CDC had to furlough 8,754 staff. Yesterday they protected you. Tomorrow they can't."
During the shutdown, I was walking around to talk to the few people left, and I went up to our central lab facility. It was empty! There was no one there, and there was an alarm going off. It turned out a machine had run out of oxygen for running some routine procedure; there was no danger. But the image of this lab that is an entire floor of a building that usually is bustling with people doing things, empty: That was really bad.
Given there is a new Congress arriving, do you feel confident that people understand why the CDC shouldn't be shut down like that again?
I think the CDC has good support: Republicans and Democrats, House and Senate. People understand that our job is to work 24/7 to protect Americans from threats, and that we do that. There is hardly an elected official who hasn't come here and left saying, What a great institution. But we are the largest federal agency headquartered outside D.C. On a positive note, that means we're not swayed by things. On a negative, when it comes to getting resources, we're not usually first in line.
What would you claim as accomplishments during your tenure?
CDC staff really were essential to stopping the Ebola outbreak in West Africa: 1,400 people spent 75,000 workdays going to every community where Ebola was spreading, tracing contacts, improving infection control, staffing incident management systems, improving clinical care, and stopping the outbreak.
We [also] sounded the alarm and began a strong response on things like opioid overdoses and antibiotic resistance. We have reduced the number of smokers in the U.S. by 10 million since 2009.
In addition to better capacity to find and stop threats in the United States, we have strengthened the ability to stop diseases there so we don't have to fight them here. We proposed the Global Health Security Agenda in 2012. The U.S. launched it in 2014. There are now more than 70 countries involved.
You’re describing responses to infectious disease threats, which the CDC was founded on and is best known for. But here in Atlanta, we’re in the heart of some of the worst chronic disease problems in America: obesity, diabetes, stroke. Can you say anything about those?
We started a program we called Winnable Battles and set really ambitious goals that we could measure. We met tobacco and teen pregnancy fully. We made really significant progress on teen pregnancy, HIV, and healthcare-associated infections. Breastfeeding increased, walking increased. Obesity among young children decreased in about 19 states, so it was not no progress there, but we had hoped to at least level off the increase.
We launched the Million Hearts campaign five years ago to try to prevent a million heart attacks and strokes over a five-year period. We won't know with certainty for a few years because it's a five-year program, and it takes a few years to get the data in. But it looks like we'll reach a little over half of the million. Not bad, to prevent half a million heart attacks and strokes.
Do you have any regrets—things you wanted to accomplish and did not?
I had hoped we'd be over the finish line with polio. I think but for security problems we would be. In India, we surged and got over the finish line. Nigeria, we thought we were over the finish line. Turns out that Boko Haram [a militant group that has been hampering vaccine distribution] was in control of a much larger population that anyone realised. (See "Polio Returns to Nigeria for the First Time in Years.")
I wish some policy decisions had happened faster, so that they would not be at risk now. Things like trans fat and sodium, because there are a lot of lives associated with those. The sodium guidance from the FDA has not been finalised.
As you leave, what is on your “worry list”?
I have worries for the country and worries for the CDC. Continued support for the Global Health Security Agenda is really important; it's running on one-time dollars. So keeping Americans safe is at risk. And the lack of a rapid-response fund with authorities; I hoped that Congress would do that.
The country needs to do better at managing both pain and addiction; opiates remain a big problem. Antibiotic resistance: We've gotten some additional dollars from Congress, but this needs to be continued year after year, or modern medicine is at risk.
I don't think we should lose sight of the leading killer, heart attacks and strokes. They're largely preventable, and for not much money, but we're failing to prevent them reliably, so we need to make even more progress there.
And a lot of our budget is tied up in the Prevention and Public Health Fund, which puts money into programs that everyone likes—block grants for states, immunisation, cancer control—but it's part of the Affordable Care Act. So it's at great risk.
I came in saying we wanted to make America stronger and healthier and the CDC more effective, and it is. That doesn't mean it's finished business. There's a lot that still needs to be done.
This interview has been edited for clarity and length.
Header image: CDC director Thomas Frieden briefs the press on the Ebola epidemic in October 2014. PHOTOGRAPH BY ERIK S. LESSER, EPA