Dr Tom Frieden interview and PDF transcript

[00:00:00] Biographical details, physician; training in internal medicine, infectious diseases, public health, epidemiology. Epidemic Intelligence Service at CDC. Ran tuberculosis control New York City 4.5 years. Worked in India 5 years on tuberculosis control. Health Commissioner New York City 8 years. CDC Director 6.5 years. Global Health Security Agenda and Ebola risk mentions launch February 2014; Ebola listed as major health risk. Notes Ebola high fatality, deaths, previously no urban epidemic. Initial outbreak response and WHO frictions, learns about first Ebola case while travelling; ensures staff deployment. Reports frictions with WHO regional offices March and July 2014; direct intervention with WHO Geneva to allow CDC staff entry. WHO Geneva supportive; regional offices resistant. Calls Keiji Fukuda to resolve. Nature of outbreak and infrastructure challenges; describes outbreak; spread across countries, urban transmission, multiple chains, funeral exposures, poor infrastructure; no mail, internet, cell service, electricity, roads. CDC had prior lab in Sierra Leone destroyed, minimal presence in region. July 9, 2014, activates CDC Emergency Operations Centre; sends mobile lab to West Africa; sets goal 50 staff by end of July, achieves 100. Visits West Africa late August–September; observes Liberia health system collapse, corpses unburied, deaths from malaria, childbirth, vaccination halted. Visits MSF treatment unit Monrovia; overcrowded, insufficient staff, bodies unremoved. [00:11:30] Meetings with leaders and incident management systems, meets President Ellen Sirleaf Johnson; stresses worsening situation; advises against cordon of West Point; establishes incident management systems in all three countries; appoints Talbot as Liberia incident manager. Advocates community isolation, safe burials, micro-planning September–October. Reflects Island Clinic opening correlates with decline in Monrovia cases. [00:16:00] Community behaviour and Sierra Leone policy, Highlights Sierra Leone outbreak lag; criticises mandatory quarantine policy prolonging transmission. Notes community behaviour change essential. [00:18:00] U.S. domestic response and Lagos incident, discusses missionaries evacuated to Atlanta August 2014; media frenzy; public fear; death threats. Emphasises stopping outbreak at source; cites Lagos incident as pivotal; redeploys polio infrastructure in Nigeria; 894 contacts traced, 19,000 home visits, ETU built in 14 days. [00:25:30] Reflects on Dallas case October 2014 and infection control lessons; two nurses infected; revises infection control guidance; categorises lessons: foresight, hindsight, preventable errors. Notes diarrhoea volume, hands-on care as factors. [00:30:40] Challenges reaching zero Ebola cases, sexual transmission, miscarriage; distrust major barrier; Guinea adopts micro-encirclement strategy. Advocates for survivor engagement, community trust. [00:34:30] Vaccine trials and therapeutics; Mentions CDC vaccine trial STRIVE Sierra Leone; WHO ring vaccination Guinea; debates on RCTs for therapeutics. [00:39:00] Key lessons and future preparedness; concludes with three lessons: country preparedness, international surge capacity, hospital infection control. Notes largest CDC response in history; 1300 staff deployed; plans permanent offices, lab networks, rapid tests. End of interview.

26/10/2015

525 MB 1 WAV file, 1 transcript

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