00:00Joining us now is Dr. Tom Frieden. He's the former director of the Centers for Disease Control and Prevention and
00:04now the president and CEO of the organization Resolve to Save Lives.
00:08Dr. Frieden, great to have you with us. I confess the reason that I wanted to have you on is
00:11we were speaking with Jeremy Konendyke last week about this outbreak as it unfolded.
00:16And he said back when he was running point for USAID in 2014, 2015, this was your full-time job,
00:23that you as the head of the CDC had a complete focus on the Ebola outbreak.
00:28I'm curious, as you look at the response thus far, if you have confidence that somebody within this administration is
00:33doing just that, paying as much attention to this outbreak and focusing on containing it.
00:39Well, I'm not directly involved, so I can only comment as an outsider.
00:43I do see the U.S. providing some financial assistance, and I do see the many, many scientists, doctors, nurses,
00:54lab experts at CDC very dedicated to trying to stop things.
00:58But it is a world of difference, and I think first we have to start with what the context is.
01:04This is going to be really hard to control.
01:07Just to give you a flavor of that, by the time we started responding in 2014, there were between 40
01:13and 50 cases.
01:15By the time the world started responding this year, there were between 400 and 500 cases.
01:21And why is that? Is that partially because the reporting structure was reliant on things like USAID that are just
01:27no longer there?
01:29You know, to be blunt, I think that's what some people are saying.
01:32I think that's a knee-jerk response.
01:33It may or may not be correct.
01:35I don't know that.
01:37There are plenty of reasons to explain a delayed detection without that.
01:41And there will be plenty of time to assess whether or not that contributed.
01:46The point right now is we need an emergent, immediate, meticulous response just so quickly.
01:55I can't express just how important it is to work with urgency.
01:59And the reason for that is with Ebola, what we figured out in West Africa, and I went there multiple
02:05times and worked with the teams.
02:07We had fantastic staff.
02:08You know, when I ran CDC, all 158 disease detectives went to Ebola.
02:14We had went to respond to the Ebola outbreak at some point.
02:17We had close to 4,000 people working.
02:20Within days, we had put 50 people in the field in the three countries.
02:25We had, on average, 200 people a day in the field, 400 working at CDC for years of this outbreak.
02:33But what we found early on was that if you get there in days, you can stop it in weeks.
02:39If it takes weeks to get there, it's going to go on for months.
02:43And if it takes months, it may go on for years.
02:46So we really need to surge in support, understanding that 90% of the response will be local doctors, nurses,
02:53community leaders.
02:54But still, they need funds, they need logistics, and they need some partnership on some of the more specialized elements
03:02of care and disease detection and control.
03:06Walk us through what you make of the plan that was floated, I guess.
03:09It's been struck down by a Kenyan court here to have a quarantine facility in Kenya for those from the
03:16U.S. who have been exposed to Ebola.
03:18What do you make of that?
03:19I know that some pushback against this that I've seen is that if you have been exposed, there's no way
03:23for you to get back to the U.S. to get treatment here.
03:26What do you make of the plan that has been floated there by the U.S. government?
03:30Yeah, I don't know the details of it.
03:32But fundamentally, if we're talking about people who are going over to fight the epidemic, that's kind of equivalent to
03:41our warfighters who we send into danger areas.
03:44And if they get hurt, we expect to bring them back to this country and treat them as the returning
03:49heroes they are, not to put them in some slapped-together facility somewhere.
03:55The other thing to say is it really is important that people get good quality care as quickly as possible
04:02if they become ill.
04:03Even though there's no proven treatment for this particular strain of Ebola, supportive care makes a really big difference.
04:11It can make the difference between life and death.
04:14We stopped the 2014-2016 epidemic without significant contribution from vaccination or treatment.
04:23So it's possible to do with the core public health activities of isolating patients, providing safe and dignified burial, contact
04:33tracing, and then quarantine and care for contacts who become ill.
04:38Given where this outbreak is right now, Secretary of State Marco Rubio has said, quote,
04:43we cannot and will not allow any cases of Ebola to enter the United States.
04:48Do you think that's a reasonable goal?
04:51And was that the goal in the past for these kinds of epidemics?
04:55Well, it's certainly a goal.
04:57How realistic it is if this spreads widely in Africa is very questionable.
05:02People travel for business, for tourism, for family reunification.
05:08People have contacts.
05:12People go from one country to another and then come here.
05:15So, really, there's no way to build a moat around the United States and keep everybody out.
05:21It is reasonable to reduce the risk that there will be any spread in the U.S., and there are
05:26really good ways to do that.
05:28But what we did during my time leading the CDC was when a couple of Americans got sick overseas,
05:34we have a special biocontainment airplane that went, picked them up, and brought them to a biocontainment facility at Emory
05:43University in Atlanta.
05:44And both of them survived, and nobody else got infected.
05:48And that didn't serve as a deterrent for people to go stop the outbreak there,
05:53understanding that they would be well cared for if they became ill.
05:57I remember that.
05:58I remember that flight coming back and us live on the air, where I was working at the time,
06:03tracking that movement of that patient all the way to that hospital.
06:06Let me ask you, Dr. Frieden, about the loneliness of the WHO director making the trip to the Democratic Republic
06:12of the Congo to see this firsthand.
06:14In the past, somebody in your previous position might have gone.
06:17We don't currently have a permanent head of the CDC right now.
06:20Now, use that as a jumping-off point, if you would, just to talk about the way that the WHO,
06:25the global health apparatus, is operating here without the cooperation of the kind of hand-in-glove relationship
06:31that we would have seen in the past between the U.S. public health infrastructure and global public health infrastructure.
06:37There's a bottom line here.
06:40For all of its problems and challenges and weaknesses, the WHO is absolutely essential.
06:47There is no replacement for it.
06:49There's no way for bilateral engagements to make the kind of interaction and intervention that the WHO can.
06:56And the stronger WHO is, the safer we are as a country.
07:01During my time at WHO, Margaret Chan was the director.
07:04She and I were in almost daily telephone communication.
07:07We were very closely coordinated.
07:09We provided dozens or even hundreds of staff to support and strengthen WHO.
07:15In the past decade, WHO has gotten stronger.
07:18They created a new emergencies unit that's more capable of responding to things like this.
07:24But the U.S. was always in the lead along with WHO.
07:28And now we're really kind of on the sidelines.
07:30And that also means that we have less intelligence, less information about what's really happening.
07:36We haven't paid our dues to WHO.
07:38We walked away from WHO.
07:39We pulled out overnight several dozen CDC experts who were embedded with WHO, helping them to do a better job.
07:47And fundamentally, when we turn our back on an organization like WHO, we can't improve it and we are less
07:55safe.
07:55Talk to us a little bit about what this virus is like and what this strain of this virus is
08:01like.
08:01It's not as contagious as something like COVID, right?
08:04You have to become into direct contact with it.
08:06But I think the reason it is so scary is because the outcomes can be very bad.
08:11If you are in a facility that is not what you've got in Atlanta, it's not all this supportive care,
08:16how do you treat it?
08:18And what is the best way to prevent the spread, given the resources a lot of people have at their
08:22disposal?
08:23Ebola is a scary disease.
08:25It kills a significant proportion of the people who are infected.
08:30It kills in some horrible ways, including bleeding and loss of body fluids.
08:36And it spreads through close contact, especially with people who have died from Ebola, who have a huge number of
08:43organisms.
08:43And that's one of the reasons it's just not in the cards for Ebola to spread widely in this country.
08:50We don't have the kind of burial practices or health care that would lead to widespread transmission.
08:58On the other hand, it is certainly possible that a traveler will come into this country, as one did in
09:032014, 2015, with Ebola or without Ebola and develop symptoms of Ebola,
09:10go to an emergency department or a doctor's office.
09:13And that's why for the general public, there's really no cause for concern.
09:18For doctors and nurses working on the front lines, keep an eye out for people who have traveled.
09:24But there's one issue beyond this that I think is really important to emphasize.
09:29Even though this strain of Ebola and this Ebola outbreak is not going to cause a pandemic,
09:35it's not going to cause a significant risk to large numbers of Americans, it's a stress test.
09:41And it's a stress test the world is not doing well at.
09:45I would say so far we're failing.
09:47And that bodes ill for the future.
09:50That means that the next time there's a pandemic, and there will be a next pandemic, we are not well
09:56prepared.
09:56Our defenses are down.
09:58The WHO needs to be stronger.
10:01The CDC needs to be robust.
10:03And what we saw in recent weeks is another deadly blow to the U.S. CDC.
10:08In the past, we've seen 3,000 staff pushed out, virtually all leaders of the CDC gone, acting part-time.
10:17And now what we've seen is the State Department halt more than 100 different contracts CDC has with organizations around
10:26the world
10:27that provide care for 8 million people living with HIV and that can support binding problems quickly and stopping them
10:35soon.
10:36That plan is to roll out in the coming weeks.
10:40And it would result basically in the CDC having to call back hundreds of disease detectives,
10:47shut offices, outposts in countries where we can support countries to find and stop outbreaks faster.
10:54This is something that would not only devastate CDC's global health footprint, but make Americans much less safe.
11:01So if this plan of the State Department isn't paused and done in a careful, thoughtful way,
11:06we will be even less prepared for the next pandemic.
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