A new initiative to save 100 million lives globally through simple interventions such as cutting down on salt and banning trans fats, as well as getting countries prepared for epidemics like Ebola, is being launched with $225m of philanthropic funding.
At the helm is Dr Tom Frieden, former director of the Centers for Disease Control (CDC) in the United States and in charge of health in New York City before that. Frieden, with then-mayor Mike Bloomberg, pushed through a public smoking banand other tobacco control measures which slashed smoking rates in the city and increased life spans. At CDC, he tackled tuberculosis, swine flu and Ebola.
The latest initiative has two distinct aims. One is to cut deaths from heart disease and stroke through three simple measures: reducing sodium intake worldwide, banning trans fats from foods in all countries and getting people with high blood pressure on treatment. The other is to help low and middle income countries prepare to deal better with the inevitable epidemics he says will come along, from flu to Sars.
He left CDC asking himself what he could do that would save most lives. “With a kind of unique privileged perspective of having been CDC director for eight years and working in global health for more than 20 years, I was able to identify a couple of areas which I believe are really at a tipping point, where there’s been a lot of good groundwork, there’s a very strong set of policies and tools available but they are somewhere between stalled and moving very slowly right now,” he told the Guardian.
Frieden is not aiming to bypass the World Health Organisation (WHO), which was heavily criticised over its handling of Ebola. He says he is a supporter of the WHO, which he worked for in India on secondment for some years. The work will support what the WHO – and the World Bank and the CDC and national governments – are doing, he says.
There were calls for the WHO to be scrapped, and although Frieden does not agree, he believes it does need help. “I think it is crucially important that we support the WHO, but I also think if the WHO is not able to deliver we can’t fail the people who need the service,” he said.
“We do see the WHO as a crucial part of the solution here, and we’d like to see them become more effective than they are now, but by doing this from a non-governmental sector, we’re able to move very quickly and very flexibly. For example, we don’t need 200 countries to agree,” he said.
“We’re not going to be reinventing the wheel. We’re going to be getting the car moving.”
Frieden will run the initiative with staff from Vital Strategies, a New York-based non-profit global health organisation, funded by Bloomberg and others, that works in 60 countries. “After more than 25 years in government it’s great to be in an organisation that can work at that pace,” he says.
Cardiovascular disease causes 18 million deaths a year from heart attacks and stroke – a third of all deaths worldwide. But Frieden believes there are basic things governments can do to protect their people, such as helping to lower high blood pressure.
“Here we are really in a shameful situation,” said Frieden. “There are 1.4 billion people around the world with high blood pressure of whom 1.1 billion don’t have it under control. That’s despite the fact that the medicines are cheap, effective, safe and have been used in the west for more than 50 years. So it’s kind of ironic that we have scaled up treatment for HIV and TB and other things but not for high blood pressure, which kills more people than all infectious diseases combined and is much simpler to treat and much simpler to monitor the treatment of.”
Another easy win, he believes, is a ban on trans fats. “Why should we have a toxin in our food that isn’t necessary?” Resolve will support governments to monitor trans fats in food and get rid of them. Sodium is more tricky. “We are talking about steady gradual reduction,” he says. Some societies add a lot of salt to their food during cooking and others at the table; people like the taste. But he points out that the UK has shown that they don’t notice if salt content comes down slowly.
WHO has done some great work on epidemic preparedness, he says, but countries need help to put in place the four core elements: surveillance systems, laboratory networks, trained public health staff and rapid response.
Frieden certainly has experience of getting systems working. Nigeria stamped out the Ebola outbreak that flared dangerously in Lagos and spread to Port Harcourt. Frieden, then director of the CDC in the USA, had a hand in that.
“The first person put in charge of the outbreak was incompetent and spent more than four hours debating what to do with a corpse that had been embalmed and passed through Liberia,” said Frieden. “While he was having that four-hour debate with the entire team, a doctor and a nurse were dying in the back of an ambulance, no contacts were being traced, no facility was being found for treating Ebola patients and nothing was being done about screening at entry or exit.”
Frieden picked up the phone to the governor of Lagos state, Babatunde Fashola, for whom he has high praise. I said, “Governor – if you don’t control Ebola the only thing you will ever be remembered for is not controlling Ebola.” Fashola put the polio team in charge, who had been trained by the CDC and knew all about contact tracing and controlling outbreaks.
“They were able to build an Ebola treatment unit in 14 days, identify 893 contacts, do 17,000 home visits to measure temperatures, identify 43 people with suspected Ebola, diagnose 19 patients and stop the outbreak in two generations,” he said, reeling off the numbers from memory. “And replicate that in Port Harcourt when people went there from Lagos. If that hadn’t happened, Ebola could have swept all over Nigeria and Africa for months or years.”
The WHO and the World Bank and others are helping countries fight cardiovascular disease and prepare for the inevitable next epidemic. “We’re here to basically catalyse progress by being strategic about where rapid progress can be made. I’m just delighted at what we’re able to do,” he says.
Read more at theguardian.com