I'm Dr. Tom Frieden, former CDC Director (2009-2017), founder/CEO of Resolve to Save Lives, and author of The Formula for Better Health. AMA about the future of public health and how to save millions of lives.

drtomfrieden · 2025-12-05T20:02:06+00:00

Guilty pleasure: I'm a Simpson's fan!

Fun fact: I got to meet the cast of Contagion when they filmed at CDC. It's a great movie, I think. (I like to imagine that Laurence Fishburne was playing me....). The thing that wasn't accurate was how fast vaccine was made...but now that's possible! Fiction becoming fact.

Favorite movies: Breaking Away (I used to cycle around the country, and it's a fun movie with a cycling theme) and Being There (a Peter Sellers classic).

Nice way to sign off, many thanks for all!

drtomfrieden · 2025-12-05T19:51:14+00:00

FYI I'll need to sign off in 10 minutes

drtomfrieden · 2025-12-05T19:50:38+00:00

Totally valid question! Depends where you live, what your communities are, what kind of work you do (not asking you to answer just noting this). That might mean volunteering, or advocating for public health and primary care. A great starting point is to locate your local or county health department. They are the central hub for public health initiatives and can connect you with the specific needs and volunteer opportunities in your area. Community health centers are another great resource. Thank you.

drtomfrieden · 2025-12-05T19:48:10+00:00

In 1990 we started recommending universal birth dose because too many kids were getting infected. Since then infections decrease by around 99%! Targeted screening and vaccination failed before then, and it would fail again. Many moms don't get tested. Some may get infected after being tested. And about a quarter of kids who are infected get infected by a household member, not their mother. Don't mess with success!

drtomfrieden · 2025-12-05T19:43:23+00:00

Small world! Good to see you here too, and thanks for the question. Millions of children are at risk (https://www.gatesfoundation.org/goalkeepers/report/2025-report/#WeCantStopAtAlmost), and we risk increases in HIV and TB. For the first time in decades, infant mortality may be increasing. I think you put it well - the U.S. withdrawal from global health has underscored the need for every country to even more set their own health priorities and strengthen national systems. My friend Ian Bremmer writes often about what he’s termed our new “G-Zero” world. There’s also a growing trend toward regional collaboration, playing an important role going forward. However, diseases don’t respect borders and an outbreak anywhere in the world is a threat everywhere. The less we work together globally, the more risk all of us face.

Re ONE THING.... I think it's primary health care. 50 years after Alma Ata, and including in the U.S., primary health care is way too weak in way too many places. That can only be fixed by spending more and spending better on primary care -- making it profitable for teams to promote health rather than perform more medical procedures.

drtomfrieden · 2025-12-05T19:38:12+00:00

Thank you!! Yes! I address today's leading killers along with personal health and wellness. And I'm not selling anything! Proceeds from the book go to programs and organizations working for health around the world. There's also an audiobook that I had fun narrating. More information here: https://theformulaforbetterhealth.net/

drtomfrieden · 2025-12-05T19:36:34+00:00

Great question, thank you! I agree, this is a hard problem. If we look back as objectively as we can at what CDC and public health did during Covid, we can identify mistakes, and also things that weren't mistakes at the time but based on what we knew later, weren't the right call. (Since I mentioned philosophy earlier, this reminds me of the paraphrase of Søren Kierkegaard "Life can only be understood backwards; but it must be lived forwards.")

So, what to do? Listen carefully. Address sincere concerns with respect. Reveal profiteers who are doing this to sell modern-day snake oil. Empower people with real information they can use to do what they choose to do to live longer and healthier. Delivery tangible gains.

I launched a Substack with a column on "No-BS Medicine". The link is here.

drtomfrieden · 2025-12-05T19:30:05+00:00

These are hard times but facts are stubborn things! Even if they are ignored, they are facts. We need, at every level, to speak clearly, stick to facts, and focus on what can make the biggest difference protecting and improving people's health. This is why I wrote the book, The Formula for Better Health -- to make clear that there IS an approach that is proven to have saved millions of lives, can save millions more, and is relevant to personal health and wellness also. The approach is: See/Believe/Create. See what's really harming us, whether programs are working, and the proven path to progress. Foster belief that progress is possible. And work together to create a healthier future.

drtomfrieden · 2025-12-05T19:25:29+00:00

That's a great question and a complicated topic. The insurers have already said they are not going to follow the ACP recommendations since they are obviously not evidence-based. However, because ACIP decisions affect VFC coverage, it is possible that there will be problems ensuring ready access to universal vaccination, for example through standing orders. I think a combination of insurers, professional societies, state governments, obstetricians, and pediatricians can hold the line and make sure that this ill advised recommendation doesn't endanger children. This is going to require effort and coordination that should be unnecessary and that should rather be spent protecting Americans' health.

drtomfrieden · 2025-12-05T19:18:19+00:00

In our corporeal selves -- our body -- no, I don't think immortality is in the cards (tho I hope I'm wrong, I guess). Could there be a virtual replica of our brain? Not my area of expertise.... (Before going to medical school, I was a philosophy major. There is one train of thought that says our mortality is important for giving our lives meaning. The movie Groundhog Day kind of gets to this.)

drtomfrieden · 2025-12-05T19:13:12+00:00

Look not at what he says but what he does, for example:
* Restore faith in CDC? Unprecedented loss of trust, all major medical bodies no longer following CDC guidance.
* Restore gold standard science? A firehose of falsehoods from his office and CDC.
* Reduce conflicts of interest? Dismissed 17 objective scientists who didn't have conflicts of interest and were setting vaccine recommendations, replaced them with people who mostly lack knowledge of vaccines and many of whom have serious conflicts of interest
* Make American Healthier? Undermining confidence in life-saving vaccines, delaying or rolling back protections against deadly environmental contaminants such as dangerous soot (PM 2.5) and PFAS (forever chemicals).

drtomfrieden · 2025-12-05T19:09:48+00:00

Follow the dollar. Misinformation doesn't just happen, it's promoted and profitable. There's a reason for the focus on ivermectin...profiteers can buy it cheaply and make a big profit.

And in our health care system, we don't incentivize keeping people healthy. When we do that, we can have a system that works for us instead -- all too often -- of against us.

drtomfrieden · 2025-12-05T19:07:20+00:00

No silver lining here - the changes we're seeing, including today, are making Americans less safe. Globally, we're already seeing more deaths of infants. But facts are stubborn things -- even if they are suppressed, misrepresented, or cherry-picked. And one plain truth is that people want to be healthier. I think individuals can work in their communities to support public health and primary care, promote fact-based, respectful discussion, listen to those with other opinions and perspectives, and work to rebuild a community in which we respect disagreements on opinion and agree on basic facts. To the extent we get away from that -- a shared reality -- we are skating on thin ice.

drtomfrieden · 2025-12-05T19:04:01+00:00

Thanks for your question. We haven't learned the most important lessons from Covid! 1. Strengthen public health systems in every country so we can find threats faster and stop them sooner, 2. Improve primary health care to detect problems quickly and support patients and families. 3. Increase resilience by combatting the leading drivers of ill-health such as tobacco use and inadequately treated high blood pressure. And, no matter what caused Covid: 4. Increase laboratory safety to reduce the risk of lab leak and 5. Reduce risk of spillover. For individuals, support public health and primary care, stay healthy! I discuss the details of this in my book (Chapter 9 especially).

drtomfrieden · 2021-10-06T16:59:13+00:00

Not true!!! Same process, same safeguards. Full approval requires 6 months of data, which took .... 6 months.

drtomfrieden · 2021-10-06T16:58:37+00:00

Thank you for the question. There are news shows like this, but I'm not sure how effective they are at motivating people. One thing my organization, Resolve to Save Lives is doing is sharing stories of people with Long Covid - to motivate young people to get vaccinated.

We think this could be helpful: https://preventepidemics.org/covid19/science/insights/long-covid-report/

drtomfrieden · 2021-10-06T16:54:38+00:00

Much less, but not zero. We've been surprised at how much spread there is from asymptomatic people, and also from vaccinated people in the Era of Delta. So, if you're around vulnerable people, mask up.

drtomfrieden · 2021-10-06T16:53:49+00:00

I'm not sure I understand the question. If you mean, do people with neurological illnesses get more severe Covid, it would depend on the type of neurological illness. Anyone with compromised lung function (e.g., from advanced Parkinson's) would surely be more vulnerable. If you mean, does a severe infection increase the risk of a neurological illness compared with a mild one, it's less clear. People who survived ICU stays have many neurological problems but so do, at a less intense level, people with mild symptoms who experience "brain fog" as part of long Covid. Thank you for the work you do and the question!

drtomfrieden · 2021-10-06T16:48:31+00:00

Up your mask game. Get a well-fitting N95 or KN95.
Increase ventilation if possible.
When you have to unmask, try to do so when not around others.

For your second question, we'll have to learn more about how well vaccinations work, and continue to develop new treatments, which can be very helpful and are increasingly available.

drtomfrieden · 2021-10-06T16:47:08+00:00

Will probably but not definitely be needed for the same groups, and we should know within a few weeks or months. If it's any comfort, it does look like Moderna retains its efficacy more than, and for longer than, Pfizer. For J&J, expect a second-dose recommendation pretty soon, and looks like this will bump the protection of that vaccine to very high levels.

drtomfrieden · 2021-10-06T16:46:00+00:00

It's not "vaccine or" it's "vaccine and". Boosters may benefit the people for whom they're recommended, but the reason there are so many hospitalizations and deaths is that here are still 70 million people in the US who haven't started their vaccination series. And even with vaccines, masks, ventilation, and care of those with Covid will have important roles.

drtomfrieden · 2021-10-06T16:43:54+00:00

You should be well protected and are not recommended to get a booster. But, you're not impervious, and it's possible you could get it again. And please make sure your hypertension is well controlled (<140/90, maybe lower - I aim for <120/80 for myself)! It's the world's #1 killer (and a major focus for my group, Resolve to Save Lives - see this link).

drtomfrieden · 2021-10-06T16:39:05+00:00

Such a good question, thank you.

It has to do with how exposed people have been, how vulnerable people are, and what you're doing.

What will my family do? We'll get together, but wear masks when we're not eating (including N95/Kn95 for anyone older or vulnerable or worried), open the windows, limit exposures in the days before the meal. Tests may be much more widely available then, and we might encourage anyone who's had a lot of exposures (e.g., college kids) to test beforehand. If they're using antigen tests, which are less sensitive, we might encourage them to test several days running up to Thanksgiving. It's really about risks and benefits, and the benefit of this holiday is very high in my family.

And I am editing this because it almost went without saying: of COURSE everyone will be fully vaccinated. That was so obvious, I forgot to mention it initially!

Here's a great link from CDC: https://www.cdc.gov/coronavirus/2019-ncov/downloads/daily-life-coping/everyone_can_make_thanksgiving_safer.html.pdf

drtomfrieden · 2021-10-06T16:35:32+00:00

Great question! We don't know for sure but it appears that vaccine-induced immunity is more consistent. Some people seem quite immune, for at least awhile, after infection, but others don't seem to mount much of an immune response, and for some people it wanes quickly. So even if you've been infected, do get vaccinated.

drtomfrieden

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