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Antibiotics, lab safety and disease outbreaks top CDC Director Tom Frieden's to-do list

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I caught up with Dr. Tom Frieden, director of the U.S. Centers for Disease Control and Prevention, last week, prior to his address at the National Press Club in downtown Washington, DC. Other media outlets joined in later. Here are some takeaways from his speech on antibiotic resistance, as well as our conversation.

But first, as background information, you should know that Frieden was grilled by Congress July 16 about the exposure of CDC scientists to anthrax and the accidental release of bird flu into a U.S. Department of Agriculture lab. Based on subsequent media coverage, Congress wasn't impressed by the director's performance.

-- The incentives to create antibiotics are still lacking.

CDC Director Tom Frieden--Photo by James Levin

"From a strictly business standpoint, a terrible thing about antibiotics is that they cure people and then you can stop taking them. That's not a model for a highly lucrative pharmaceutical product. … So we have to figure out a way for government and industry to work together so that the incentives for antibiotic production and antibiotic development match the need," he said during the speech. He also suggested that "the low-hanging fruit" have been plucked, meaning future antibiotics will take more time and money to develop.

-- Hospitals can do better. They must stop the spread of hospital-acquired infections and the overprescription of antibiotics. It's an animal health issue too.

During the speech, Frieden emphasized the commonality that MERS, Ebola, measles, multidrug-resistant tuberculosis, Clostridium difficile and carbapenem-resistant Enterobacteriaceae all share: They can all spread in hospitals. He also said that one-third of all antibiotic prescriptions are unnecessary or inappropriate. (But he also gave a shoutout to statins, saying they are one of the medications that are underutilized.)

"We want to see rational prescribing everywhere antibiotics are prescribed," he said. And that includes the farm, where 80% of all U.S. antibiotics are used. "Using antibiotics that are of importance to humans for growth promotion (of animals) is clearly something that we, the FDA, the USDA [U.S. Department of Agriculture] and the food industry is concerned about."

-- One consequence of the recent lab safety scares could be a reduction in the number of CDC labs.

"We need to make sure [the number of labs] is kept to the minimum necessary. What is the minimum necessary is something we are looking at carefully through our internal review," he said during the media session.

-- Frieden is concerned about the cost of Gilead Sciences' $1,000-per-pill Sovaldi for treating hepatitis C.

"It's a great thing that appears to cure an infection that has killed a lot of people in the past, but we have to somehow address some of the drug cost issues," he told FierceMedicalDevices during the interview, adding, "I think we need a societal discussion about drug costs." Reflecting on the sensitivity of the issue, he prefaced his comments on the cost with "I may be saying something inappropriate." The CDC is adding to demand for the medicine by recommending that everyone born between 1945 and 1965 be tested for the disease.

-- On the emerging infectious diseases front, Ebola, MERS and chikungunya are on his mind.

"We are very actively scaling up Ebola response. We're sending four teams in for strengthening the three countries that are affected. Particularly we're establishing a program in Liberia to establish a program there to address it comprehensively there," he said during the media session. "It's going to take many months and it's going to be challenging." He said that a vaccine "would be great, but it's not easy to do and it's not clear who to give to." Instead, old-fashioned public health measures, like community education and quarantine of the sick, are needed, he said.

MERS appears to be under control in the Middle East thanks to better infection control in Saudi Arabian hospitals, he said during the speech. Finally, he predicted that some cases of chikungunya will appear in other parts of the U.S. besides Florida, where it has already arrived via the Caribbean countries.

- here's more coverage of his speech at the National Press Club from Varun Saxena
- read the transcript of his speech
- and watch the video of it

-- Varun Saxena (email | Twitter)

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