NEW YORK – After 8 years of leading the CDC, Tom Frieden wanted another challenge. He picked a good one: Save 100 million lives in 30 years.
That’s the goal of Resolve to Save Lives. He launched the initiative (as part of Vital Strategies) in September 2017 with $225 million in funding from Bloomberg Philanthropies, the Chan Zuckerberg Initiative and the Gates Foundation. Resolve zeroed in on cardiovascular disease and epidemics as its twin priorities. To reduce preventable deaths, Frieden has built a lean team that emphasizes speed and working with health systems rather than creating parallel efforts.
Having also led the New York City health department and helped establish the world’s largest TB control program in India, Frieden is a fast-talking, engaging storyteller who’s apt to pepper his talk with quotes from public health legends like Hermann Biggs.
3 of the most interesting things Frieden shared with GHN before he had to take a Lyft to his next meeting: The best blood pressure medications could be made available for just $2 per patient per year. China’s stroke rate is 5 times that of the US. And, his Resolve team has deadlines of just days——not weeks or months—to turn around contract proposals from potential partners.
You have 225 million over 5 years for the Resolve initiative, how are you prioritizing your spending?
We looked at … what could we do to make the biggest difference in a few years. And, we identified 2 core areas that are poised for progress but are currently either making very slow progress or stalled. One is the prevention of heart attacks and strokes, and the second is the prevention of epidemics. In both areas, a lot of terrific work has been done. There are many very dedicated people working in public health and on the front lines and scientists who have created really good systems, and yet, we don’t see the kind of rapid progress that’s possible.
We have the ability within Resolve, if we’re successful, to work with speed to get to scale, and we’ll do that by having simple protocols and procedures that would support the public sector, support the private sector, support nongovernmental organizations, and catalyze progress in these 2 areas.
Why is Resolve needed? Can’t national governments, WHO, take care of this?
Well, there are currently about 10.5 million deaths a year from hypertension. Most of those deaths could be prevented with inexpensive interventions. As Ebola showed us, we’re still not ready for many of the severe emergencies that we may face. So, we want WHO to be more effective. We especially want national governments to have more effective programs that they either operate or regulate or oversee in both of these areas. Our role isn’t to create some other entity to do it. Our entity is to help them get stronger in doing it.
Where do you see Resolve headed in the future?
We want to save 100 million lives over the next 30 years. Our kind of Zen koan of this is when does 50 plus 30 plus zero equal 100? It’s if we can get the global control of high blood pressure up to 50%. It’s currently at 10 to 15%. It’s really shockingly low, appallingly low. Because of that, all over Asia, Africa, and Latin America, people are having heart attacks and strokes and kidney failure that could have been prevented for very little money. In fact, the preliminary data we’re seeing suggests that it’s about $2 per patient per year with the best blood pressure medications available. Not with second class mediations but with the absolute best medications. They’re all generic. They’re all off patent. They’re all inexpensive, but they’re not available to many patients.
That 30 is a 30% reduction in sodium consumption, and that third one is zero grams of trans fats. Trans fat is a toxic product. There’s no reason for it to be in the food supply. The US is removing it. Canada is removing it. Denmark removed it many years ago. The EU is removing it. We need to get a global momentum to get rid of it… . We do know that elevated trans fats increases your risk of a heart attack and you can remove it without altering the taste, increasing the price, and reducing availability.
So, in the next 5 years, what we hope is progress in each of these 3 areas.
Tell us more about your sodium reduction program.
In China, we’re really looking carefully at the issue of sodium because sodium intake is so high there and the government is committed to reducing it, but it’s not easy. It’s a combination of getting food producers to reduce it in packaged foods and [persuading] people to use different spices at home. Turns out the spicer the food, the less the salt [is needed]. You can have perfectly good food that doesn’t make you sick. But, the stroke rate in China is 5 times the stroke rate in the US.
No one’s certain what that’s about, but it’s certainly not unrelated to the fact that their sodium consumption is sky high. There is no one in China who doesn’t know someone at a young age who had a stroke. So, this is a major problem and we hope to see progress.
I’m sure sustainability is a big priority for you. How do you ensure that, that when you support a project, that the national government or other organizations will continue it?
In the areas we’re identifying, I think that’s less of a challenge. If you get trans fat eliminated, it’s done. If you get sodium reduced, it’s not done but it’s hard to reverse that. If you get systems in place to treat high blood pressure, it’s the government that’s buying the drugs. It’s the government that’s spending the money on the staffing. It’s just a question of the technical partnership to identify a way of making sure that patients get the right drug at the right time.
One of Resolve’s main priorities is speed. Tell us why and how it’s received by government agencies.
Every day that goes by and we’re not making progress, people are dying unnecessarily. If we don’t have that in our mind vividly, we don’t work with the urgency that people deserve to be protected from health threats that are preventable.
I tell the story of when I was in India, I would work from early in the morning until late at night. I would leave the Ministry of Health usually around 9, 9:30 p.m. with a counterpart who also worked very, very hard. At that point, there weren’t very good TB treatment services in India, and more than 1,000 people are dying every day. Every day, I would leave the Ministry of Health and I would say 1,000 people died today of conditions nearly 100% curable, what can I do about it?
That sense of urgency is important to infuse in to our work, particularly in places like Geneva and Atlanta and Washington where they don’t see it, or even state, city, or even country capitals where you don’t see it. We have to have in our minds, what does this really mean for people on front lines … what does it mean to the person who gets typhoid that we could have avoided, or plague, or Ebola or Lassa, or measles. So, I think it’s ethically required of us to work with a sense of speed. It doesn’t mean you’re being careless, but it means being responsible.
So, for example, on a mundane or seemingly mundane issue, we’ve established contract turnaround times at Resolve. We expect that if one of our partners gets a contract proposal, we’ll give you the turnaround times. It’s 2 days in this situation, 4 days in this situation, because I don’t want things sitting. If we’re not gonna do it, we’re gonna tell you we’re not gonna do it. If we’re gonna do it, yes, let’s do it. If we’re gonna say we’d like to do it a different way, let’s have that discussion and get it done.
My father use to say when he was driving, if he got lost, “I’m gonna speed up, that way I’ll know if I’m lost and I can turn around and get back to the right place faster.”
Speed runs in the family. Well, I would like to shift now to—
Could we just stick on Resolve for just 1 minute ...
I think we [can] just discuss a little bit what’s happened because, in fact, we’re going faster than I had hoped. I had very ambitious plans and we’re exceeding them. Part of the reason for that is that countries want to do this. This is pushing through an open door. We got to India in July of last year before the formal launch and the Health Secretary basically said “We’ve been screening people, but we recognize that we’re not treating effectively. Please work in these 105 districts where we’ve been working … the sooner the better.” And so, we got 6 states to sign on. The government of India approved the project in mid-November. I’ve been working in India for more than 20 years. I’ve never seen a project approved that quickly.
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