1. Frieden TR, Lee CT, Bochner AF, Buissonnière M, McClelland A. Lancet. 2021[online] S0140-6736(21)01250-2

2. Frieden TR., Buissonniere M. BMJ Global Health. 2021;6;e006297:1-3

3. Morgan OW., Aguilera X., Ammon A., Amuasi J., Soce Fal I., Frieden T. . 2021. S0140-6736(21)01096-5

Book

211. Frieden T, Editor. Geneva: World Health Organization, 2004.

Selected Letters, Reports, Chapters, etc.

212. Moran AE, Whelton PK, Frieden TR. . JAMA Internal Medicine 2020; 1739 [letter].

213. Frieden TR. . Science 360 2018 (6393):1049.

214. Kishore SP, Salam A, Rodgers A, Jaffe MG, Frieden TR. . Lancet. 2018;392(10150):819-820.

215. . Geneva: World Health Organization; 2018. License: CC BY-NCSA 3.0 IGO.

216. Frieden TR. .* 2016;316(23):2550-2551.

217. Frieden TR. Thomas Frieden. In: The service minded physician. CreateSpace Independent Publishing Platform: 2014.

218. Frieden TR. Information is power. America’s Health Rankings: . United Health Foundation; 2011: 7-10 [commentary].

219. Frieden TR. . Am J Public Health. 2008;98:1543-1544.

220. Perl SB, Ellis JA, Vichinsky LE, Larson K, Levy J, Silver L, Bassett MT, Frieden TR. Smoking cessation strategies in New York City: 2002-2006. In: Progress in smoking and health research. New York: Nova Publishers; 2007: 89-115.

221. Myers JE, Henning KJ, Frieden TR, et al. . Public Health Rep 2007; 122:433-434 [letter].

222. Frieden TR, Munsiff SS, Desai Ahuja S. Outcomes of multidrug-resistant tuberculosis treatment in HIV-positive patients in New York City, 1990–1997.* Int J Tuberc Lung Dis 2007; 11:116–118 [letter].

223. Frieden TR, Sbarbaro JA. . Lancet 2006; Jun 24; 367:2055 [letter].

224. Frieden TR, Kellerman SE, Das-Douglas M. Public health principles for the HIV epidemic. N Engl J Med 2006; 354:877-8 [author reply to letter].*

225. Frieden TR. .* Am J Respir Crit Care Med 2006;173:359 [letter].

226. Bassett MT, Frieden TR, Deitcher DR, Matte TD. .* In: Galeo S, Vlahov D, editors. Handbook of urban health: Populations, methods, and practice. New York: Springer; 2005.

227. Frieden TR. .* Ann Intern Med 2005;143:760.

228. Frieden TR, Perl SB. Controlling the state of tobacco in the City of New York: a model for cancer and disease prevention. Cancer Prevention 2005;6:1,6 [newsletter].

229. Frieden TR. Fighting the costs of smoking. In: The business case for reducing workforce tobacco dependence. American Cancer Society, 2005.

230. Frieden TR. . Am J Public Health 2005;95:931-2* [letter].

231. Frieden, TR. In: Toman’s tuberculosis: case detection, treatment and monitoring – questions and answers. 2nd ed. Frieden T, editor. Geneva: World Health Organization, 2004.

232. Frieden, TR. In: Toman’s tuberculosis: case detection, treatment and monitoring – questions and answers. 2nd ed. Frieden T, editor. Geneva: World Health Organization, 2004.

233. Toman K, Frieden TR. In: Toman’s tuberculosis: case detection, treatment and monitoring – questions and answers. 2nd ed. Frieden T, editor. Geneva: World Health Organization, 2004.

234. Toman K, Espinal M, Frieden TR. In: Toman’s tuberculosis: case detection, treatment and monitoring – questions and answers. 2nd ed. Frieden T, editor. Geneva: World Health Organization, 2004.

235. Frieden, TR. In: Toman’s tuberculosis: case detection, treatment and monitoring – questions and answers. 2nd ed. Frieden T, editor. Geneva: World Health Organization, 2004.

236. Toman K, Espinal M, Frieden TR. In: Toman’s tuberculosis: case detection, treatment and monitoring – Questions and answers. 2nd ed. Frieden T, editor. Geneva: World Health Organization, 2004.

237. Espinal M, Frieden T. In: Toman’s tuberculosis: case detection, treatment and monitoring – questions and answers. 2nd ed. Frieden T, editor. Geneva: World Health Organization, 2004.

238. Frieden TR. In: Toman’s tuberculosis: case detection, treatment and monitoring – questions and answers. 2nd ed. Frieden T, editor. Geneva: World Health Organization, 2004.

239. Luelmo F, Frieden TR. In: Toman’s tuberculosis: case detection, treatment and monitoring – questions and answers. 2nd ed. Frieden T, editor. Geneva: World Health Organization, 2004.

240. Raviglione M, Frieden TR. In: Toman’s tuberculosis: case detection, treatment and monitoring – questions and answers. 2nd ed. Frieden T, editor. Geneva: World Health Organization, 2004.

241. Luelmo F, Frieden TR. In: Toman’s tuberculosis: case detection, treatment and monitoring – questions and answers. 2nd ed. Frieden T, editor. Geneva: World Health Organization, 2004.

242. Frieden TR. In: Toman’s tuberculosis: case detection, treatment and monitoring – questions and answers. 2nd ed. Frieden T, editor. Geneva: World Health Organization, 2004.

243. Galvez MP, Frieden TR, Landrigan PJ. . Environ Health Perspect 2003;111:A684-5 [editorial].

244. Feldman GE, McCord CW, Bassett MT, Frieden TR. Screening for colorectal cancer.* JAMA 2003;290:191 [letter].

245. Sterling T, Munsiff SS, Frieden TR. .* New Engl J. Med 2003;348:1289-1292 [letter].

246. Udwadia ZF, Schaller JG, Starke J, Khatri GR, Frieden TR. . New Engl J Med 2003;348:758-759 [letter].

247. Sterling TR, Lehmann HP, Frieden TR. . BMJ 2003;327:164 [letter].

248. Thorpe LE, Mostashari F, Berger DK, Cobb LK, Helgerson SD, Frieden TR. Diabetes is epidemic.* NYC Vital Signs 2003:2(1);1-4.

249. Thorpe LE, Mostashari F, Berger DK, Feldman G, Karpati AM, Cobb LK, Helgerson SD, Frieden TR. Cancer screening in New York City: we can do much better.* NYC Vital Signs 2003:2(2);1-4.

250. Karpati AM, Matte T, Kass D, Garg R, Mostashari F, Thopre LE, Frieden TR. . NYC Vital Signs 2003:2(4);1-4.

251. Feldman GE, McCord CW, Frieden TR. . City Health Information 2003:22(2);1-4.

252. Berger DK, McCord CW, Frieden TR. Diabetes prevention and management.* City Health Information 2003:22(3);1-8.

253. Frieden TR, Narain JP. Tuberculosis control – progress, prospects, and perspectives.* Chest [Indian Edition] 2002;3:63-64 [editorial].

254. Cegielski JP, Chin DP, Espinal MA, Frieden TR, Raviglione MC, Cruz RR, Talbot EA, Weil DEC, Zaleskis R. .* Infectious Disease Clinics of North America 2002;16:1-58.

255. Frieden TR, Khatri GR. Multidrug-resistant tuberculosis.* In: JP Narain, ed., Tuberculosis epidemiology and control. 1st ed. World Health Organization: Regional Office for South-East Asia, New Delhi, 2002.

256. McCord CW, Repetto P, Frieden TR. Treating nicotine addiction.* City Health Information 2002:21(6);1-8.

257. Khatri GR, Frieden TR, Rai SN. Prevention and control of multidrug-resistant tuberculosis.* South-East Asia Regional Office of WHO, 2002.

258. Frieden TR. . World Health Organization: Regional Office for South-East Asia, New Delhi, 2001, SEA/TB/233.

259. Frieden TR, Mullins J. Research for action: understanding and controlling tuberculosis in India.* World Health Organization: Regional Office for South-East Asia, New Delhi, 2000, ISBN 97 9022 223 9.

260. Fujiwara PI, Frieden TR. TB control in New York City: a recent history.* TB Notes 2000, US Public Health Service, 9-12.

261. Joint review of tuberculosis in India.* World Health Organization: Regional Office for South-East Asia, New Delhi, 2000 (WHO/SEA/TB/224).

262. Frieden TR. Tuberculosis control in India.* Centers for Disease Control and Prevention. TB Notes 1999;2:20-24.

263. Frieden TR. . World Health Organization: Regional Office for South-East Asia, New Delhi, 1999.

264. Weyer K, de Kantor IN, Kim SJ, Frieden TR, et al. Laboratory services in tuberculosis control (Parts , , and ). World Health Organization, Geneva, 1999.

265. Frieden TR. . Am J Pub Health 1999;89:604-605 [letter].

266. Frieden TR. . Lancet 1999;353:146 [letter].

267. Frieden TR. Directly observed treatment, short-course: the strategy that ensures cure of tuberculosis patients.* In: Sharma, SK, ed., Textbook of tuberculosis (Jaypee Brothers, New Delhi, 2001).

268. Frieden TR, Kumaresan J. Directly observed treatment, short-course: annotated bibliography.* World Health Organization, Geneva, 1997.

269. Frieden TR. . Am J Pub Health 1996;86:267-268 [letter].

270. Frieden TR. The phylogeny of Mycobacterium tuberculosis.* Tuberc Lung Dis 1996;77:291 [letter].

271. Frieden TR. Investigation of contacts to tuberculosis cases.* Introduction and conclusion (New York City Department of Health, 1996)

272. Frieden TR. New York City TB drug costs and regimens.* TB Notes 1996;2:5-6.

273. Fujiwara PI, Frieden TR. Tuberculosis epidemiology and control in the inner city.* In: Rom WN, Garay, SM, eds. Tuberculosis. Boston: Little, Brown and Company; 1996:99111.

274. Frieden TR. . Am J Public Health 1995;85:1723.

275. Frieden TR, Sterling TR, Simone PM. .* N Engl J Med 1996;334 [letter].

276. Frieden TR, Larkin C, Dorsinville M. Realities of directly observed therapy, New York City.* TB Notes. November, 1995.

277. Frieden TR, Dorsinville M, DeLott F, et al. Update on the DOT experience in New York City.* TB Notes, Spring/Summer 1995.

278. Frieden TR, Simone PM, Castro KG. .* N Engl J Med 1995;332:610 [letter].

279. Frieden TR, Hamburg MA. Transmission of tuberculosis.* N Engl J Med 1994;331:1095-6 [letter].

280. Frieden TR, Dooley SW. Drug resistant tuberculosis in New York City.* N Engl J Med 1993;329:135 [letter].

281. Frieden TR, Munsiff SS, Low DE, Kreiswirth B. Vancomycin-resistant enterococci.* Lancet 1993;342:616 [letter].

282. Frieden TR, Fujiwara PI. Tuberculosis treatment.* City Health Information 1992;11(5):1-4.

283. Frieden TR, Pearson ML, Jereb JA. Drug-resistant and nosocomial tuberculosis, New York City, 1991.* Centers for Disease Control EPI-AID 91-42-2. December 31, 1991.

284. Frieden TR. Typhoid fever in New York City, 1990.* Field Epidemiology Report, CDC, 1991.

285. Frieden TR. .* The New York Times. 1984 Apr 23; Sect. A:14 (col.4) [letter].

286. Frieden TR. “Nicaragua rural y las jornadas populares de salud (Rural Nicaragua and the Popular Health Campaigns).” Report to the Nicaraguan Ministry of Health. August, 1983.

287. Frieden TR. Marketing survey and market analysis: Douglas [Tennessee] Community Health Clinic. Report to the Board of Directors. July 31, 1982, 51 pp.

* Denotes articles that are behind a paywall or unavailable on the internet. For reprints of these, email contact@tomfriedenpublichealth.net and paste the details of the article.

Protecting Hearts and Brains

March 2021

Sometimes errors are instructive.

We made an ambitious goal of protecting 1 million heart attacks and strokes over a 5-year period through the Million Hearts program. We failed.

What's the diagnosis of our failure? Politics. It's not just in the Covid pandemic that political interference with public health science costs lives. It happens every day, and sometimes causes even more deaths than caused by the toxic combination of Covid+politics.

This month we published this – and s for how to make progress.

Let's start with the basics: The US has a shorter life expectancy, with more disability, and higher health care spending, than any other country in our income bracket. Have a good look at the figure below to see how the US has become a negative outlier.

(And don't think shorter life means less time lived with disability. The opposite is true. On average, the shorter the life, the more of it is lived with disability.)

It's not a small problem. Average life expectancy in the US is 6 years shorter than the places like Hong Kong and Japan and Italy, Spain and Australia.

There are a lot of reasons for the shorter life expectancy, in particular health disparities by race, sex, and location.

Two actions would make big improvements in life expectancy (as would improving economic opportunity, education, and other fundamental changes that are needed but likely to take longer).

1. Comprehensive tobacco control, including regulation of the amount of nicotine in all forms of tobacco, including cigarettes and e-cigarettes. (Basically, make smoked tobacco non-addictive and limit the addictive potential of all forms of nicotine sold legally. The latter is already done in some countries, the former would be a world first – and long overdue.)

2. Reduce sodium consumption through mandatory limits on the amount of sodium in food, as well as other comprehensive interventions.

In addition, improvement in hypertension treatment – t – could greatly reduce health disparities and improve life expectancy.

Here's the full article. Now, how can we have the societal will to get this implemented?

Article:

And, unusually, the (linked )is even more important and interesting than the article.

Hope you enjoy it!

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Effective Implementation

February 2021

Public health is, to a great degree, a management problem. What needs to get done is often clear, but the gap between what we as a society know we should do, and what we actually do, is great. Why?

A few years ago, I outlined the.

1. Innovation. Innovation is essential, ranging from new vaccines and medicines, to information systems, communication techniques, and more. Smallpox was eradicated through continuous introduction and implementation of innovations, including new organizational methods, new ways to find smallpox cases, new approaches to targeting which groups to vaccinate, new types of needles, and new ways to vaccinate different groups of people.

2. Technical package. The most effective public health programs are based on an evidence-based technical package: a selected group of related interventions that, together, will achieve and sustain substantial and sometimes synergistic improvements. A technical package of proven interventions sharpens and focuses what otherwise might be vague commitments to “action” by committing to implementation of specific interventions known to be effective. It avoids a scattershot approach of using a large number of interventions, many of which have only a small impact. Simplicity is key to success.

To implement public health programs effectively, it's essential to get the science right – this leads to having an appropriate technical package and innovating to improve that package continuously. And it's also essential to manage well, including communicating effectively and creating coalitions. But unless the politics is aligned, even the best designed and best managed public health programs will fail. At Resolve, our team recently of the Covid response around the world. Strong public health programs can be undermined by bad governance. This doesn't make effective management of public health programs any less important, but does emphasize the importance of promoting governance based on science and facts, openly and objectively derived.

###

Is Public Health "Nanny State"?

January 2021

Never in our lifetimes has there been as much controversy about public health action as there is now, during the Covid pandemic. Irresponsible leadership accounts for much but not all of the failure of the response in the United States and elsewhere.

It's timely to review basic principles. I outlined these in an article for the New England Journal of Medicine a few years ago. .* NEJM 2013;368(20):1857-9.

There are, fundamentally, three areas where public heath action reflects a responsible, responsive government. For each, there are long-standing, well-accepted examples as well as newer applications which are controversial now but which will likely be well accepted in future years.

First, promoting free and open information. We expect nutrition-facts panels on our food and inserts in our medications, but these are hard-won gains. Graphic pack warnings on cigarettes and public reporting of health care provider performance will likely become available in the future, but are being blocked now. In Covid, basic information about how each community is doing or even how much Covid is in each area, hasn't been available until now, but will be soon.

A second core role of government is protecting people from harms caused by other people. It's astounding to realize now, but drunk driving was once not taken seriously as a public health problem. There's a saying: “your right to swing your fist ends at my nose”.

Government has a responsibility to protect individuals from unhealthy environments, whether the sources of health risks are natural (e.g., mosquito infestation) or created by people or organizations. Few Americans now question government's role in preventing sale of contaminated food, water, and medications; reducing alcohol-impaired driving; or protecting workers and communities from industrial toxins.

Smokefree laws illustrate the growing acceptance of actions that protect people from others' behavior. Such laws are often controversial when introduced, with opponents predicting reduced hospitality-industry profits and decrying infringement of personal freedoms, but they gain acceptance as people see the health benefits — and no harm to businesses.

In Covid, mandates to wear masks protect us from other people and actions such as business limitations and closures can reduce spread, saving lives.

A third key role of government is to protect and promote health through population-wide action. Governmental action is often a more effective and efficient means of protecting health than the actions of individuals. Immunization mandates, fluoridation of water, iodization of salt, and micronutrient fortification of flour are classic examples of this type of action; many were controversial initially but are widely accepted today because they save money and reduce illness, disability, and death.

In Covid, examples of this type of action include government involvement to improve production and distribution of diagnostics, protective equipment, and vaccines. And, most importantly, vaccination. The more and sooner people get vaccinated, the safer and better protected we will all be.

When government fails to protect and improve people's health, society suffers. Opponents of public health action often fail to acknowledge the degree to which individual actions are influenced by marketing, promotion, and other external factors.

Government has a responsibility to implement effective public health measures that increase information available to the public and decision makers, protect people from harm, promote health, and create environments that support healthy behaviors. The health, financial, and productivity gains from public health actions benefit individuals and society.

Saving Lives Through Health Care

December 2020

This article by Tom Farley, Mehul Dalal, Farzad Mostashari and me answered a question is easy to ask but that for some odd reason had not been answered in the scientific literature previously: How can you save the most lives through health care?

Farley TA, Dalal MA, Mostashari F, Frieden TR. . Am J Prev Med 2010;38:600-9.

Treatment of hypertension is, far and away, the most effective single intervention. When this article was written a decade ago, there was more belief in the value of aspirin for the primary prevention of heart disease. It is now clear that the benefit of aspirin for primary prevention is modest at best, although it is still very important for people who have had a heart attack or other vascular problem. My father, a cardiologist, used to say wryly that the best time to give a patient an aspirin is 30 minutes before they have their heart attack. But for blood pressure, control thoughout life is very important. Not for nothing is hypertension called the silent killer.

This article formed the basis of the Million Hearts program in the United States and of the effort of Resolve to Save Lives to save 100 million lives around the world.

Forgetting is the key challenge in tuberculosis control. Political leaders forget the poor and disenfranchised, who are most likely to contract and die of tuberculosis. Health leaders forget simple, low-technology interventions and therefore neglect the core work of treatment observation, field supervision, and cohort monitoring and evaluation. Patients forget how sick they were and may stop medications when symptoms subside.

Dr. Frieden sounded the alarm on the emergence of drug resistant tuberculosis. For more than a decade following this, Dr. Frieden led investigation and control of tuberculosis, first in New York City, then, in support of national and state governments, in India.

Dr. Tom Frieden's scientific publications cover infectious and non-infectious diseases, health and public health policy, and broad concepts of effective action to save lives.

About

Dr. Tom Frieden has written more than 250 influential scientific articles to sound the alarm about emerging health threats, investigate health risks, document control of disease, and provide conceptual leadership on a broad range of health, health care, and public health topics.

Dr. Frieden’s early work included a focus on antibiotic resistance, including from of antibiotics, including a on the emergence of drug-resistant tuberculosis. This study led directly to a massive increase in city, state, and federal resources for and commitment to the control of tuberculosis. Dr. Frieden also conducted one of the first of tuberculosis, documenting the importance of spread in hospitals and of laboratory contamination.

coined the term, “Interventional Epidemiology,” and emphasizes the importance of using data to drive progress. In New York City, he led efforts that rapidly stopped the largest outbreak of multidrug-resistant tuberculosis ever to occur in the United States, and with a program that became a national and international model. Dr. Frieden emphasizes the importance of public health , of , and of recognizing and addressing the .

In addition to documenting the spread of multidrug-resistant tuberculosis, Dr. Frieden led an .* Learning from , Dr. Frieden also emphasized the importance of of every patient.

then moved to India, where he supported national and state programs to detection, treatment, and monitoring of tuberculosis. One important component of this progress was * to support progress. Working with the Tuberculosis Research Center - now the National Institute for Research on Tuberculosis of the Indian Council of Medical Research, the team in India implemented a Model DOTS Programme and documented . The team also showed that it was possible to increase case detection through a system of active monitoring of private laboratories, in a .

Health Disparities — Addressing Racism, Inequality, and Health Injustice

One of Dr. Frieden’s mentors, Dr. Colin McCord, that a Black man in Harlem was less likely to survive to age 65 than a man in Bangladesh. Dr. McCord suggested that Dr. Frieden investigate one of the leading causes of excess mortality in Central Harlem: liver disease. Dr. Frieden undertook a that identified the cause: synergistic liver damage from the combination of alcohol use and viral hepatitis (hepatitis B and C).

As CDC Director, Dr. Frieden and established a system to track and advocate for the reversal of health disparities. For the first time, the CDC published regular, on the state of health disparities, with a focus on areas where progress could be made through advocacy, program implementation, and empowering communities.

Broad Perspective on Public Health

Dr. Frieden’s concept of a has been influential for health departments, community organizations, and others around the country and world. Following the footsteps of two of his mentors, Dr. George Comstock and Sir John Crofton, he not only infectious diseases such as tuberculosis, but also the leading causes of ill health such as tobacco use, cardiovascular disease and . He outlined a way forward to improve the .

Dr. Frieden’s work includes analysis of the . Dr. Frieden outlined , , and of public health action. He established the initiative and the “” initiative at CDC, and and challenges of two terms as NYC Health Commissioner under Mayor Bloomberg and in the administration of President Barack Obama. With longtime colleague Dr. Kelly Henning, he outlined the . He also outlined how the world could .

Tobacco

Tobacco use will kill one billion people in this century unless urgent action is taken. Tuberculosis was once described as, “Captain of all these men of death”. Tobacco — and the tobacco companies that market it — now has that dubious distinction. As New York City Health Commissioner, he implemented a comprehensive program that . He outlined the . Along with Mayor Bloomberg, how to prevent 100 million deaths from tobacco.

Mayor Bloomberg funded a program along the lines Dr. Frieden outlined, which had by 2021 prevented approximately 40 million deaths. He in tobacco control, including implementing proven strategies and innovating to “reduce exposure of children to smoking imagery in movies, television, and social media; reduce youth access to tobacco (e.g., through changes in minimum age of purchase); decrease the addictiveness of cigarettes; and address the production, distribution, and marketing of tobacco.”

Heart and Brain Health

Joining in an important analysis led by Dr. Tom Farley, the authors showed that than any other clinical intervention among adults. Frieden conceptualized the — ultimately unsuccessful - “” initiative to prevent heart attacks and strokes, including through use of . Along with Mayor Bloomberg, he outlined how to globally through , .

Food Policy

Unhealthy food is another leading cause of preventable death. In 2009, Dr. Frieden and colleagues, as part of a comprehensive approach to reducing obesity, , the single leading driver of increased calorie consumption in the United States, of at least 1 cent per ounce. Excess sodium consumption is a leading health risk, contributing to an estimated 3 million deaths per year, and Dr. Frieden has advocated for public health action to reduce intake.

His initiative, Resolve to Save Lives, summarized and Dr. Frieden has about sodium reduction, and shown that reducing sodium consumption can by . In New York City, he led the successful that required chain restaurants to post calorie counts, thereby , and . Learning from Denmark, the trans fat ban became a global priority, and he and Dr. Tedros, the Director General of WHO, published an article on the REPLACE strategy, .

Health Emergencies

Dr. Frieden has been fully engaged in advancing an effective global response to the COVID-19 pandemic, including reviewing how to . This work builds on work from New York City advocating to , of the World Trade Center attacks, and work at CDC helping to stop . A core function of Dr. Frieden’s group, Resolve to Save Lives, is helping countries and the world become .

Selected Honors and Awards

• Ron Haddock International Impact Award from the American Stroke Association, 2018

• MedShare Humanitarian Award, 2017

• Campaign for Tobacco Free-Kids Champion Award, 2016

• Courageous Leadership Award, National Rx Drug Abuse and Heroin Summit, 2016

Honorary Doctorates

• Science. New York University, 2017

• Science. Albert Einstein College of Medicine, 2017

• Science, Oglethorpe University, 2015

• Science, Oberlin College, 2012

Photograph of Dr. Tom Frieden for Media

Covid is the most recent health emergency, but one of only a many in recent years. On average, one new pathogen with substantial potential for human harm is discovered every year.

The Global Health Security Agenda is an important initiative to reduce global risk. But outbreaks and epidemics of HIV, Zika, Ebola, drug-resistant bacteria, cholera, and more demonstrate our ongoing vulnerability to microbial onslaught and sneak attack. The articles in this section outline some of those risks - and some succesful responses that are important to learn from.

Featured Article

Frieden TR, Tappero JW, Dowell SF, Hien NT, Guillaume FD, Aceng JR. . Lancet 2014;383(9919):764-6.

Selected articles with summary and commentary

Global Health Security

Shahpar C, Lee CT, Wilkason C, Buissonnière M, McClelland A, Frieden TR. . BMJ Glob Health. 2019;4(4):e001885.

Health cannot be protected by Ministries of Health alone. Many sectors need to be involved in order to increase and sustain investment, build long-term capacity and implement policies affecting health in the food, security and animal sectors. In many countries, the JEE was the first opportunity for these sectors to work together. This group should continue to collaborate in order to prioritise which gaps to fill first, begin implementation, increase domestic financing and monitor progress. High-level support (eg, from presidential or prime minister offices) is essential for countries to take action. Engagement by journalists and civil society can convey that increased health security is essential. This support can help counter the pattern of a temporary surge of activity followed by waning interest, as typically seen after a major outbreak.

For the first time in history, the world has an in-depth understanding of how prepared most countries are to deal with epidemic diseases and of what must be done to improve preparedness. To save lives, funded, prioritised, well-planned actions must be implemented at scale as soon as possible, supported by a network of partners working together to support countries to step up their capacities to prevent, detect and respond to public health threats and make the world safer.

Redd SC, Frieden TR. * Health Security. 2017;1:1-12.

We reviewed experience from 2009 through 20017, drawing lessons from the H1N1 influenza pandemic, Ebola, Zika, and many tother emergencies. Our fundamental conclusion: the best emergency preparation is getting everyday systems to work well to find, stop, and prevent health threats, with the ability to scale these systems up quickly and robustly.

Frieden TR, Schuchat A, Petersen LR. . JAMA 2016;316:1443-1444.

The Zika epidemic was the most complex emergency CDC had faced. It required involvement of a broad range of expertise: virology, entomology, vector control, reproductive health, birth defects, laboratory development, pathology, and more. We're still learning about how to control it, and why the impact was so different in different places.

Tappero JW, Thomas MJ, Kenyon TA, Frieden TR. . Lancet 2015;385:1889-91.

This collection of artilces outlines the rationale and needs for the Global Health Security Agenda. The world now has a good sense of what is needed, where, how to address these needs, and how much it will cost to do so. What's lacking is action to meet these needs - with money, technical support, and strengthening operational capacities.

HIV/AIDS

Frieden TR, Das-Douglas M, Kellerman SE, Henning KJ. . N Engl J Med 2005;353:2397-2402. and Frieden TR, Foti KE, Mermin J. NEJM 2015;373(23):2281-7.

In 2005, I called for the application of public health principles to the HIV epidemic (table below). This was highly controversial at the time. Since then, the view has been widely accepted and applied, and we review the substantial, although far from complete progress, since, and concluded that, "The combination of patient empowerment, community engagement, clinical excellence, and public health focus on outcomes and impact could make management of HIV infection a model for combating other chronic diseases."

Torian LV, Wiewel EW, Liu K, Sackoff JE, Frieden TR. . Arch Intern Med 2008;168:1181-1187.

Delay in diagnosis of HIV results in both avoidable illness in the person diagnosed, and increased risk of spread to others. Addressing the root causes of delayed diagnosis and treatment is essential to controlling the HIV epidemic.

Ebola

Frieden TR, Damon IK. . EID 2015;21(11):1897-1905. and Frieden TR, Damon I, Bell BP, Kenyon T, Nichol S. . NEJM 2014;371(13):1177-80.

The Ebola epidemic was the most challenging emergency of my 15 years leading public health programs. Thousands of CDC staff worked for years in West Africa to help end the epidemic. Although as I said publicly early on, it was never "in the cards" for Ebola to spread widely in the United States, the epidemic caused a degree of fear and politicization in the public and by politicians that foreshadowed the deadly errors made in the US response to Covid in 2020.

Martin Meltzer's model of Ebola is one of the greatest modeling stories in public health history - and not widely enough known. Samantha Power's book outlines the impact his worst-case scenario had within the United States government and global community. But less well appreciated is the fact that his projection of what would happen with fast, effective action matched what did happen stunningly well, as shown in this figure below.

I outlined this in a brief (2 minute) that I wish more people would watch - because models have been so poorly understood and used during the Covid pandemic.

About Ebola, we made one specific and one general conclusion.

"The Ebola virus is a formidable enemy. If a single case is missed, a single contact becomes ill and isn't isolated, or a single lapse in infection control or funeral-practice safety occurs, another chain of transmission can start."

"We believe that stopping outbreaks in a way that leaves behind stronger systems to identify, stop, and prevent future health threats is a moral imperative."

Haiti including cholera

Periago MR, Frieden TR, Tappero JW, De Cock KM, Aasen B, Andrus JK. . Lancet 2012;379:193-286.

It's possible to eliminate cholera from Haiti and the Dominican Republic - but requires persistence and political commitment.

Dowell SF, Tappero JW, Frieden TR. . NEJM 2011;364(4):300-301.

The earthquake and cholera epidemic were devastating, and even before these events, Haiti had, by far, the worst health status of any country in the hemisphere. But it would be a mistake to fail to recognize the many areas where dedicated health workers and community volunteers have made substantial progress. This progress demonstrates that more progress is definitely possible.

Note: The earthquake also resulted in the death of , a dedicated and inspiring CDC staffer who was in the country on a short-term assignment to help improve prevention and control of HIV. This was the one death in the line of duty which occurred in my time as CDC director from 2009-2017. I will never forget meeting with her family to inform them. We established an award to recognize staff early in their career.

Drug-resistant bacteria

Antibiotics have saved millions of lives, but drug-resistance threatens to usher in a post-antibiotic time. In April of 1991, acting on a tip from an alert clinician, I conducted a study of every patient in New York City with tuberculosis. The results were alarming, and resulted in a substantial increase in funding and attention. We were ultimately able to control the outbreak, which was largely driven by spread in hospitals, and was the largest outbreak of multi-drug resistant tuberculosis the United States has experienced. Another bacteria, vancomycin-resistant enterocci, didn't spread widely. In 1990, while an infectious disease fellow, I wrote of the widespread inappropriate use of antibiotics.

Frieden TR, Sterling T, Pablos-Mendez A, et al. . N Engl J Med 1993;328:521-526.

Frieden TR, Munsiff SS, Low DE, et al. Lancet 1993;342:76-79

Pearson ML, Jereb JA, Frieden TR, et al. .* Ann Intern Med 1992;117:191-196.

Nivin B, Nicholas P, Gayer M, Frieden TR, Fujiwara PI. . Clin Infect Dis 1998;26:303-307.

Frieden TR, Mangi R. .* JAMA 1990;264:1438-1440.

Malaria

Writing with Dr. Tedros, now WHO Director General, and others, we outlined a way forward to control of malaria, tuberculosis, and HIV.

Frieden TR, Teklehaimanot A, Chideya S, Farmer P, Kim JY, Raviglione MC. . * Arch Intern Med 2009;169:1650-2.

World Trade Center / Health Registries

I became health commissioner in January, 2002, when the World Trade Center remains were still burning. We established a registry to track health effects and facilitate benefits for survivors and those suffering from the health, including mental health, complications. Rapid creation of health registries to better understand and support those effected by health emergencies is an important public health function, and must be done quickly and sensitively.

Farfel M, Digrande L, Brackbill R, Prann A, Cone J, Friedman S, Walker DJ, Pezeshki G, Thomas P, Galea S, Williamson D, Frieden TR, Thorpe L. . J Urban Health 2008;85:880-909.

Vitamins and infections

There's a long and interesting history of the interaction of nutrition and infection. In the early 1900s, anti-tuberculosis activists helped to create milk stations so children could receive wholesome milk as a nutritional supplement. During my training as an Epidemic Intelligence Service Officer of the Centers for Disease Control, I documented that vitamin A levels were low among children in New York City with measles. This resulted in a new recommendation to provide vitamin A to young children with measles in the United States.

While working in India, we gradually realized that tuberculosis has substantial seasonality: there is a much higher rate in cold weather in the north of the country, but no seasonality in the south of the country which doesn't have a winter season. (I was memorably informed that Chennai has three seaons: hot, hotter, and hottest.) The figure below is striking in showing this. Very high seasonality in the cold winter months in the north, and none in the hot winter months in the south. The reasons for this seasonality are not yet definitively known, but vitamin D deficiency in the colder months, when people are inside more, is a leading and plausible hypothesis, for which there is increasing evidence.

Frieden TR, Sowell AL, Henning KJ, Huff DL, Gunn RA. .* Am J Dis Child 1992;146:182-186.

Thorpe LE, Frieden TR, Laserson KF, Wells G, Khatri GR. * Lancet 2004;364:1613-1614.