Robert Redfield on the state of public health

Public Health Newswire interviewed Centers for Disease Control and Prevention Director Robert Redfield, MD, on the state of public health and the agency’s plans for 2019.

Q: As public health moves in to 2019, what priority issues do you hope to tackle?

A: I have laid out three key priority areas for the CDC:

Ending epidemics. When I took the job of CDC director, I had the opportunity to discuss with HHS Secretary Alex Azar and key leaders within the department, how we could end the HIV epidemic in America. This is no longer just an aspirational goal – we now have the tools to achieve this once-distant dream. Thankfully, the president and Secretary Azar are taking leadership on this historic initiative.

HIV is further complicated by another threat to Americans’ health today. The public health crisis of our time is the epidemic of overdoses and spread of disease from opioids and other drugs of abuse. On average, 115 Americans die every day from prescription opioids and illegal opioids like heroin and illicitly manufactured fentanyl; and as well as the ongoing epidemic of stimulant abuse. Thanks to enhanced surveillance, CDC is now able to track overdoses more quickly, allowing public health communities to respond rapidly to developing trends.

Eliminating disease. One of CDC’s key functions is disease control and elimination. We must see the possible and act. Years ago, a group of Rotarians saw that it would be possible to eliminate polio – and now, because of their leadership, we are on the verge of seeing the last-ever case of this once-common disease. By putting science into action, there is much more we can do to stop hepatitis C, HPV, and chronic noninfectious diseases like diabetes and tobacco-related diseases. We also need to ensure our food and water won’t make us sick. Thanks to advanced molecular detection, we’re now able to more quickly detect and track multistate diseases from contaminated foods, speeding outbreak responses.

Securing global health and domestic preparedness is CDC’s center of gravity. Pandemic flu remains our number one threat even now, more than a century after the devastating 1918 flu pandemic. Ensuring our response to seasonal flu is our best course of action to be prepared. Worldwide we are seeing a continued increase in antimicrobial resistance. The problem is more than a few bacteria with extreme antibiotic resistance – we are seeing resistance in viral, fungal, and parasitic diseases as well. This also includes responding to health threats outside of the U.S., such as malaria, Lassa fever, Ebola, monkey pox and cholera. It is important to stop infectious diseases at their source, before they cannot be controlled and pose a threat to us here at home.

“The recent spate of measles cases is a wake-up call for Americans.”

Q: We’ve seen a flood of headlines lately on falling vaccination rates and new cases of previously eliminated infectious diseases, such as measles. What’s the CDC’s approach to turning the tide on vaccination?

A: Immunizations are our strongest and most powerful public health tool. Vaccines have been so successful, many people have forgotten how serious vaccine-preventable diseases can be. The recent spate of measles cases is a wake-up call for Americans. CDC is redoubling efforts to reach out to vaccine-hesitant parents and public health leaders to remind them of the solid science behind recommended immunizations. The key is for individuals to embrace vaccination for themselves, their families, their communities, their schools, and their churches. Science that sits on the shelf has no value.

Q: The administration recently announced an exciting new initiative to eliminate HIV transmissions in 10 years. Tell us more about CDC’s role in the initiative and what the public health community can do to help meet this goal.

A: This is a once-in-a-generation opportunity; we have the right data, the right tools, and the right leadership to end this terrible epidemic. The Administration’s plan aims to reduce new HIV infections by 75 percent over the next 5 years, with the hope of a 90 percent reduction within 10 years. We know that over 50 percent of new HIV diagnoses occur in 48 counties, Washington, D.C., and San Juan, Puerto Rico. By first focusing our resources on these areas – as well as seven states with a high rural HIV burden – we can achieve this goal. Efforts will focus on four key strategies: diagnosing new HIV infections as early as possible; treating those with HIV rapidly and effectively to achieve sustained viral suppression; protecting people at risk using proven, comprehensive prevention approaches and treatments; and responding rapidly to growing HIV clusters to stop new infections.

To accomplish this, CDC will accelerate our work with state and local health departments and more importantly with the communities they serve. We will establish a specialized team, putting “boots-on-the-ground” to support expansion of local HIV prevention and treatment efforts and community outreach and engagement. We will listen to people living with HIV, and to public health partners in the most affected communities, so we learn from their experiences and help ensure local progress. We must work together to empower them to lead the initiative’s efforts in their communities and to combat the stigma that is associated with HIV. We must see stigma for what it is – stigma is the enemy of public health.

The time to end the HIV epidemic is now. I have always believed in seeing the possible. Embracing the possible, we will do it together.

Q: You recently traveled to the Democratic Republic of Congo, which is facing an Ebola outbreak. What was your experience like there, and what did you take away from the trip?

A: This is a complicated and serious outbreak – it is now the largest outbreak in DRC’s history. I recently returned to DRC to reassess and recalibrate aspects of the current Ebola outbreak and response. I saw once again firsthand the complexity of this urban Ebola outbreak. The men and women of the Ministry of Health in the DRC – which CDC has helped train and equip for many years – is doing an outstanding job under extremely difficult circumstances. Armed conflict and civil unrest continue to hinder efforts to control the outbreak. Response teams are also facing pockets of community mistrust and resistance in the impacted areas. While there, I met with members of the DRC government, frontline response partners such as WHO, and I reinforced CDC’s commitment to end this outbreak, as soon as possible.

“We can achieve so much when we dare to see the possible and act to make it our reality.”

Q: National Public Health Week is this week, April 1-7. What public health accomplishments would you like to see celebrated?

A: Public health can look back proudly at many accomplishments. That said, I prefer to celebrate the many things we can do together in the near future: the elimination of polio, stopping HIV transmission in the U.S., bringing curative treatment to every American with hepatitis C, increasing HPV vaccination to protect women and men from cancer, and see all people in our great nation benefit from immunization for all current vaccine-preventable disease. There are so many possibilities with new tools science has given us to achieve. We can achieve so much when we dare to see the possible and act to make it our reality.

Q: What do you anticipate being the biggest public health challenges for our country in 2019?

A: The biggest public health challenge we face is being prepared for the next major health threat. We don’t know for sure what that will be – or when it will happen – but we do know that health threats will arise again. When they do, we won’t have time to build public health preparedness from scratch. With your support, CDC stands ready 24 hours a day, seven days a week to help protect the health, safety and security of this Nation.