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Expert Q&A

VitalTalks Q&A With Dr. Tom Frieden

Vital Strategies
Moderator Dr. Sandeep (Sunny) Kishore, Director of the Chronic Disease Action Center at the Arnhold Institute for Global Health, Icahn School of Medicine at Mount Sinai and speaker Dr. Tom Frieden, President and CEO of Resolve to Save Lives at the first VitalTalks event at Vital Strategies’ new headquarters in New York City.

VitalTalks, our new series of thought leadership events bringing together leaders in global health, kicked off at Vital Strategies’ headquarters in New York City last month. Dr. Tom Frieden, President and CEO of Resolve to Save Lives, presented the inaugural talk, which focused on government and society’s responsibility for the control of epidemics, cardiovascular disease and cancer. We sat down with Dr. Frieden to get his top takeaways on what’s being done to prevent these illnesses, and what steps can be taken to reduce their prevalence and impact.

Dr. Frieden speaks about “Government and Societal Responsibility for Control of Epidemics, Cardiovascular Disease and Cancer” at VitalTalks.

You spoke about how countries can prepare for epidemics by developing tracking systems and training disease experts, supporting labs that do research on infectious diseases and creating rapid response teams. What are the main barriers to achieving this readiness, and what do you think are the most effective ways to overcome them?

There really are three barriers: technical, financial, and operational. To facilitate the technical work, the World Health Organization (WHO) published the WHO Benchmarks for International Health Regulations (IHR) Capacities, an invaluable tool giving specific and actionable next steps for countries. Financial resources need to come primarily from each country itself, although increasingly additional resources are available from the World Bank and others. Operationally, focusing on strategically stepping up key actions and rigorously tracking and accelerating progress is essential.

It’s understandable that strategies for epidemic preparedness must take time to carry out at the national level. What role can cities play in preparing for epidemics?

More than half of the world’s people now live in urban areas, and that proportion continues to grow. It’s important for city leaders to be included in preparedness planning and capacity-building initiatives, coordinating across private and public sectors. They’ll need expertise and resources for robust monitoring and surveillance, a plan to utilize both traditional and emerging media for risk communication, and a community engagement strategy.

How is, the new website by Resolve to Save Lives, helping?

Our Prevent Epidemics site is the world’s first website to provide clear and concise country-level data on epidemic preparedness and individual countries’ ability to find, stop and prevent epidemics. Within three months of launch, activists in one country utilized site resources to advocate for greater domestic funding for preparedness; people on social media initiated discussions on their country’s preparedness status and submitted success stories for publication; two countries committed to the Joint External Evaluation (JEE), which evaluates countries’ epidemic preparedness, and one country published its JEE results in part because of seeing its score on the site. The site demonstrates that it is possible for a user-friendly and easily understandable website to generate demand for improved epidemic preparedness.

Why is the elimination of trans fat from the world’s food supplies critical to the control of cardiovascular diseases?

No person anywhere in the world should consume an artificial product that increases their risk of a heart attack—especially additives like trans fat, which people aren’t aware is in their food, and won’t notice when it’s gone. Going trans fat–free by 2023 would be a win for global health, a win for public health, and a win for the 17 million people who then won’t die from heart attacks in the 25 years after trans fat is eliminated. Most of the countries that have implemented trans fat bans so far are rich countries, but this is changing. As more low- and middle-income countries implement bans, we’ll be able to reduce global inequalities in cardiovascular health and also strengthen countries’ regulatory capacity, which can be also be used to advance other public health programs.

When it comes to cancer and cardiovascular disease—including high blood pressure, heart attacks and strokes—why do you think there’s a lack of progress and sense of urgency in prevention efforts worldwide?

It’s difficult to feel a sense of urgency when you’re dealing with a silent killer. The absence of symptoms in the case of hypertension makes it harder for people—and governments—to prioritize prevention efforts. With noncommunicable diseases (NCDs) we’re also dealing with a misunderstanding of agency. We like to think that we are in complete control of the choices we make, but often we can’t choose the food that is available to us, the opportunities we have for exercise, and our access to high-quality medical treatment and medications.

How does tobacco use affect the control and prevention of cardiovascular disease and cancer?

Smoking causes one out of every four deaths from cardiovascular disease. The number of cigarettes smoked per day is directly related to a person’s risk for heart attack and stroke. Efforts to curb tobacco use have taught us lessons we can use to reduce deaths from other causes of cardiovascular disease. For example, taxing cigarettes has been proven to reduce smoking. We’re looking at taxes for salt to see if it will lead to lower-sodium foods.

What are some immediate steps and long-term solutions governments and countries can take to reduce the burden of cardiovascular disease and cancer?

It’s important to prioritize the interventions that have been proven to work, such as taxes, regulation and warning labels, and to develop focused strategies. If your efforts are too diffuse it will be easy to get off track. Be transparent in your efforts, control costs, try new approaches and share your results openly.

With high blood pressure (hypertension) killing more people than any other medical condition, how is Resolve to Save Lives working to tackle this problem, particularly in low- and middle-income countries?

We believe in speed, simplicity, and scale, and we’ve identified five interventions that are proven to improve control of high blood pressure. First, it’s important to use a practical, drug- and dose-specific treatment protocol—this can streamline care and improve adherence to treatment. We work with partners on implementing community-based care and task-sharing, which expands the number of health workers who can provide hypertension care and helps health systems treat more people. It’s also critical to ensure the supply of medications—to get the right medications to the right place, at the right time, so that they reach the patients who need them. This all needs to be done in a context of patient-centered care, so we use strategies to reduce barriers to controlling blood pressure from the patient side, like offering medications that are free and easy to take and making blood pressure monitoring readily accessible. Finally, we’re leveraging technology to develop information systems, so that health systems can determine how patients and providers are doing and make rapid improvements.

What is the biggest challenge you face in cardiovascular health?

The lack of a focused sense of urgency. We need to treat epidemic preparedness and NCDs like the everyday emergencies they are. Thousands of people will die from hypertension today. The Ebola outbreak in the Democratic Republic of the Congo just topped one thousand deaths. Many of the interventions for preparedness and NCDs are cheap; the cost is political capital.

What projects currently underway at Resolve to Save Lives are you most excited about?

I’m excited about all the work that we’re doing! The world is at a tipping point. We can either become better prepared for epidemics or see another Ebola outbreak of the magnitude we experienced in 2014. We can either better address cardiovascular disease as the leading cause of death worldwide or see millions of people continue to die from preventable causes. Resolve to Save Lives and our partners are leading the effort to tip the scales in favor of health, and it’s wonderful to be a part of the effort.

Resolve to Save Lives is a five-year, $225 million program funded by Bloomberg Philanthropies, the Bill & Melinda Gates Foundation, and Gates Philanthropy Partners, which isfunded with support from the Chan Zuckerberg Foundation. It is led by Dr. Tom Frieden, former director of the U.S. Centers for Disease Control and Prevention, and housed at Vital Strategies. To find out more, visit or Twitter @ResolveTSL