“Putting Americans at Risk:” Fmr. CDC Dir. on RFK Jr.’s Public Health Cuts

HARI SREENIVASAN: Bianna, thanks. Dr. Tom Frieden, thanks so much for joining us. Last week, the HHS announced that it is beginning a significant round of layoffs and force reductions. 10,000 to 20,000 people are going to be downsized. What was your reaction when you heard the news?

 

TOM FRIEDEN: Unfortunately, this is targeting the wrong number. It’s an arbitrary reduction in jobs. The goal should be a reduction in preventable suffering, illness, injury, and death. That’s what we should be focused on when we’re trying to improve health and make America healthier.

 

SREENIVASAN: So you wrote a column recently, and the title was, “Cuts to the Agency will Cost American Lives and Dollars.” Explain that. Why is this life or death?

 

FRIEDEN: Traditionally, for decades, the CDC has protected Americans from threats, whether those are infectious or otherwise manmade or natural from the US or anywhere in the world. If you look at those three areas that threats come from, two of them are being undermined by recent actions. One of them is non-infectious threats, which are very real. The chronic disease crisis is indeed a crisis, and there are things we can do about it. And if you look at the cuts to the global health programs, they’re devastating. They, and if not reversed, they will cause millions of deaths around the world and make Americans less safe.

 

SREENIVASAN: You know, people might recognize your face. You used to run the Center for Disease Control and Prevention. Kind of put this in perspective for us. I mean, where the CDC sits, what it’s responsible for, where the HHS sits, what it’s responsible for?

 

FRIEDEN: This is unprecedented, Hari. Nothing like this has ever happened before. What we’re looking at is reversing decades of progress in public health. Let me give you three examples. First, smoking. The CDC Office on Smoking and Health has made tremendous progress. We’ve reduced adult smoking to the lowest level ever. Smoking in kids is less than 4% now, it used to be 28%. These are programs that were working and overnight they have been ended. And that means the laboratory work, the disease tracking, the support for state programs. There are many state programs that rely for most of their money for tobacco control on the CDC. This includes Kansas, West Virginia, Michigan, and others. So tobacco is one big area.

A second is environmental health risks. The whole unit that tracks environmental health risks, whether that’s asthma or soot called PM 2.5 or harmful algal blooms, a big issue in Florida. That whole unit was ended from one day to the next. The third area is communication. Americans rely on the CDC for fact-based information. Doctors rely on the CDC for medical guidance. All of the CDC communications programs were ended. I have no idea how they’re going to update their website or live stream programs or run what’s called CDC info where they answer questions from the public. This really does undermine health and safety of the US.

 

SREENIVASAN: You know, there’s a story in the Washington Post, which said that “Employees who were laid off worked on measures to,” quote, “prevent drowning, gun violence and smoking. Scientists researched asthma, climate change, and worker safety.” Now these programs, should they be under the Centers for Disease Control?

 

FRIEDEN: Well, first off, it’s really important to understand that when funds go to CDC, about two thirds of all of those funds go out to state and local health departments and some to community organizations to confront those problems in communities. So when you cut the budget for CDC, you’re actually cutting state and local programs. And when you cut the number of staff working at CDC, you’re undermining the ability of CDC to both increase the effectiveness of those programs and to support state and local governments. 

 

SREENIVASAN: Robert F. Kennedy has said that – Junior, that has said that this overhaul is necessary, he put it out on social media recently, quote, “The reality is clear. What we’ve been doing isn’t working. Despite spending $1.9 trillion in annual costs, Americans are getting sicker every year. In the past four years alone, the agency’s budget has grown by 38%, yet outcomes continue to decline.” What’s wrong with his line of thinking?

 

FRIEDEN: There are elements of what Secretary Kennedy says that I completely agree with. We do have a chronic disease crisis. We must address it. What we’ve learned in public health is when we focus on things, we can see big progress. Look at HIV. With HIV, we have a 90% reduction in deaths and a 75% reduction in infections because of public health programs. When you eliminate those programs, you get rid of labs that track things like hepatitis and STDs. You eliminate tracking systems for behavioral risks, you’re really putting Americans at risk.

 

SREENIVASAN: There seems to be a focus on chronic disease from the part of the Cabinet Secretary. Where are we in terms of the work that HHS and CDC do in preventing those?

 

FRIEDEN: The big picture about chronic disease is there is no mystery about it. There are five things that are driving most chronic disease in America. Tobacco, salt, sugar, soot called PM 2.5 and alcohol. The difference between addressing infectious diseases and addressing chronic diseases is that infectious diseases don’t hire lobbyists. The tobacco industry has been trying to get rid of the CDC program for decades. The current administration accomplished that in weeks. second area that’s really challenging is improving nutrition. This means improving the choices that Americans have in the supermarket, in restaurants so that the healthier foods are less expensive, more accessible. Right now, the agriculture department spends billions of dollars to subsidize unhealthy food that’s sold cheaply to Americans.

 

SREENIVASAN: When you think about chronic diseases, I mean, the data doesn’t seem to back up our current way of doing things, right? I mean early onset cancer increased by 79% between 1990 and 2019 around the world. If medical problems like this seem to be persisting, why should we not shift course as cabinet Secretary Kennedy says?

 

FRIEDEN: We know what to do about chronic disease. Tax tobacco, tax alcohol, tax soda, tax junk food. This makes a really big difference. If you can’t do that, at least don’t subsidize junk food and unhealthy food; make healthy food cheaper, more available. It’s also critically important that we improve our primary healthcare system.
Here’s a shocking fact. Less than 5% of all of the funds that Medicare provides goes to primary care. Primary care is your local doctor, your family clinician. That is very, very cost effective care. In fact, the best evidence is that if we do it right, we could triple spending on primary care and reduce overall Medicare spending. And in fact, primary care is not available for about a hundred million Americans, don’t have a local doctor.
So, yes, we do need improvements. We need better primary healthcare, and frankly, we need more investment in some of the leading causes of illness, injury, disability, and death. 20 years ago, I wrote an article called “Asleep at the Switch,” that we are asleep at the switch from infectious to non-infectious causes of death. But when we invest, we see big improvements.

 

SREENIVASAN: You know, I wonder, when you talk about infectious diseases, I mean, I was reading a paper last week by McClure Gandhi at UCSF, and it said that we are likely to see more drug resistant cases of tuberculosis and HIV spread in the world. This is kind of what happens after periods of war or economic collapse. And that’s what these two researchers were kind of making this parallel to our withdrawal from USAID or in some of the preventative issues with, under both these departments.

 

FRIEDEN: The chaotic US withdrawal from global health is going to have terrible consequences, not only on the health of children, mothers, and adults around the world, but also on American health. Drug resistant tuberculosis is an important example. When you stop a TB treatment program, when you disrupt it with messing up supply chains, with stopping funding of organizations providing care. To give you one example, an excellent organization in Bangladesh had thousands of workers helping tuberculosis patients get through treatment. They were laid off. Hundreds of thousands of health workers in LA, in Africa have been laid off because of these very drastic chaotic and unplanned cuts. This is really bad for the world and it’s bad for the US. Also, a single case of drug resistant tuberculosis can cost hundreds of thousands of dollars or even a million dollars to care for in the US. And yet preventing that overseas could cost less than a hundred dollars.

 

SREENIVASAN: How do we get over what has become a structural mistrust in the institutions within our government regarding health? Right. There was an economist, an Ipsos Axios poll March of 2020, before the pandemic, or at the beginning, 85% of Americans, regardless of party identification, trusted the CDC. By August of 2024, only 49% of Republicans and 59% of independents did compared with 88% of Democrats. It becomes an incredibly partisan split. What do you think accounts for this kind of lack of trust and what do we do to try to rebuild it?

 

FRIEDEN: This isn’t easy to rebuild, and I think both administrations bear some of the blame for this frankly. In the Biden administration, the CDC was required to speak as part of the White House. And that’s a problem because if they’re connected with politicians, then people who don’t like those politicians aren’t gonna like the advice that CDC gives. Unfortunately, trust is only built very gradually and can be destroyed in a moment. What CDC and public health need to do is listen, address what people are concerned about, have small wins, and stay away from mandates. Not popular, not effective. And for most things not necessary. The few things that are necessary, shutting a local restaurant that’s spreading typhoid or salmonella, that’s something that people can understand.

 

SREENIVASAN: You know, speaking of things that are, infectious diseases that are affecting populations today, just over the weekend, a second child in Texas died from a measles outbreak there. In an op-ed, Secretary Kennedy has promoted vaccines, but he’s also pursued remedies like vitamin A and cod liver oil. And I wonder, given what you’ve said about sort of communications and messaging, do you see something wrong, do you see something wrong with that approach?

 

FRIEDEN: There are really big problems with the US response to measles. Just to be clear, this is the second largest outbreak we’ve had in the last 25 years, and as many deaths as we’ve had in the last 25 years combined in the US. The measles vaccine is safe and effective. Measles virus is dangerous. And as we’ve seen, it can be deadly even for healthy children.
Vitamin A, actually by chance – I did the studies on vitamin A when there was a big outbreak in New York City in the early 1990s – Vitamin A may have a role not to prevent measles or before you have measles, but for young children who have measles, a very controlled dose of vitamin A might be able to slightly reduce the severity of illness. That’s it for vitamin A. And if you take too much, it can be quite toxic. So these are not just toxic potential medicines, but toxic advice. The way you stop a measles outbreak is by vaccinating, providing it to people, answering their questions, being clear the measles vaccine is safe and effective.

 

SREENIVASAN: Is Robert Kennedy Jr., the Cabinet Secretary, misinterpreting your data about the vitamin A studies?

 

FRIEDEN: Anyone who says that giving vitamin A prevents measles or should be given before a measles infection is saying something that’s not supported by any scientific facts.

 

SREENIVASAN: Recently we had Dr. Peter Marks, the top vaccine chief. He left the position at the FDA because of disagreements with the cabinet secretary. He said, told the Wall Street Journal that Kennedy sought non-existent data to justify anti-vax narratives. So what do you see here, if the person who’s running the agency in charge of health and human services is promoting mis or disinformation?

 

FRIEDEN: I’m worried, and I’m worried about things like the advisory committee on immunization practices where Mr. Kennedy has spread inaccurate statements. He said 97% of them have severe conflicts of interest. That is simply not true. And in fact, what CDC has done is put on the website every potential conflict of interest in every member of the advisory committee. These are parents, pediatricians, public health specialists who volunteer their time. And this group, what’s called the ACIP, is what gives doctors the recommendations for which vaccines to give and what requires insurers to pay for these vaccines, whether they’re for covid or meningitis. So messing up our infrastructure to use facts to protect people from microbes is a very dangerous road to go down.

 

SREENIVASAN: What’s the problem with saying that perhaps these functions can be done by other departments, other agencies, and this is a way that we could cut costs.

 

FRIEDEN: There’s a move to create a centralized unit in the federal government. And actually Congress has outlined some interest in looking at that. Until you see what actually would be done and how it’s hard to say whether it’s a good or bad idea.
Certainly doing things in an unplanned way, getting rid of thousands of people who spent decades of their lives learning how to protect Americans, that’s a bad idea. And it’s not a recipe for success. And communication is so very important. Who’s going to trust a political appointee to give information when the taxpayers are paying the world’s top experts in microbes, in environmental toxins, in prevention of stroke and heart attack and treatment of diabetes? That’s who we need to be hearing from, and that’s what we need to be strengthening. We can reverse the chronic disease epidemic in this country, but that means better primary healthcare with a focus on controlling high blood pressure and implementing the programs that work while we figure out what’s causing some of the increases, for example, of cancer in young people, which is most likely a result of some environmental contaminations, whether it’s microplastics or nanoparticles or endocrine disruptors. All of those things were studied by the CDC unit that got axed last week.

 

SREENIVASAN: So tell me, I mean, one of the sections that we see here that’s being significantly impacted is the NIH and the grants that usually go through NIH for researchers around the country and really sometimes around the world. Put this in perspective for us, right? If somebody understands that, okay, the government is interested in trying to prevent chronic disease, is trying to get me healthier from the get go, if that’s what the cabinet secretary says, should we be investing in research that might not bear fruit for years or possibly even decades?

 

FRIEDEN: In my view, what we need to do is implement what’s proven and for the things that aren’t proven, study them to figure out what works. There’s a lot that’s proven to reduce chronic disease. Tobacco, alcohol, junk food. We have proven mechanisms of reducing the consumption of those harmful substances. Soot PM 2.5. There are proven ways of reducing exposure. We don’t need studies on whether that’s a problem. We may need research to figure out how to best implement programs like that. There are other things like cancer in young people, which are increasing and we need to understand why that’s happening so we can confront it.

 

SREENIVASAN: Make the case for how interconnected global health is to American health. Because some of the pushback that people have been seeing recently is, okay, you know what? I don’t necessarily know if I should be spending taxpayer money on preventing tuberculosis in a different country or HIV in a different country. What does that have to do with American health here?

 

FRIEDEN: Viruses don’t need passports. Viruses don’t obey borders. And when a disease emerges anywhere in the world, it may be a threat, not just there, but to the US as well. It’s faster, it’s more efficient, and it’s more effective to stop health threats when and where they emerge than to wait till they’ve spread and gained momentum and are now spreading within the United States.

 

SREENIVASAN: Former director of the CDC Tom Frieden, thanks so much for joining us.

 

FRIEDEN: Thank you, Hari.