Tom Frieden started his career as a public-health detective, fighting outbreaks of tuberculosis in New York and India while wearing the worn-shoe logo of the Centers for Disease Control and Prevention's Epidemic Intelligence Service.
Those foot-soldier days are long gone. But his gumshoe sensibility remains, and has come in handy as he leads America's response to an Ebola crisis in West Africa.
Frieden, now the CDC's director, is the face of the American public health system. He is everywhere lately, trying to calm nerves over two infected Americans receiving treatment in Atlanta while mustering his agency's troops to the heart of the scourge.
He’s doing it with the cold, procedural focus of a scientific investigator, repeating the same key points of one of the deadliest diseases in the world to politicians, reporters and Twitter followers. Ebola can be stopped at its source through “tried and true” public health measures, he says, but America must also be prepared for the possibility that a traveler will bring the disease here.
"It's helping people understand that the only way we can really keep America safe is by engaging with the world," Frieden said in an interview Friday. "We're going to protect Americans best by stopping it at the source in Africa. It's going to be a long, hard fight. It's not going to be easy. But we have the tools, and we have to use them."
A day earlier, emphatic but calm, Frieden told members of a Congressional panel that beating Ebola "requires meticulous attention to detail. Because if you leave behind even a single burning ember, it's like a forest fire — it flares back up."
In these public pronouncements, Frieden projects thoughtful confidence, as if he believes he is exactly where he is supposed to be. That seems to be true.
As a young EIS officer in the early 1990s, he worked the streets of his native New York to stop the spread of a drug-resistant strain of tuberculosis. His multi-year plan contained the outbreak.
The CDC then loaned him to the World Health Organization, which sent him to India to deal with a tuberculosis epidemic. He spent five years building a public health system that saved thousands of lives. People back home took notice, including Michael Bloomberg, who'd just been elected New York mayor. Bloomberg hired him to head the city's health department.
From 2002 to 2009, Frieden led Bloomberg's aggressive crackdown on smoking, trans-fats and sugary sodas. Critics called them nannies, or totalitarians. But New York got measurably healthier. And when President Obama took office, he tapped Frieden to return to the CDC as its director — the guy America turns to for help battling a myriad of maladies, from obesity to AIDS to swine flu.
And now, Ebola.
“He’s almost ideally situated by temperament and experience to be in a leadership role in this particular outbreak,” said Alfred Sommer, dean emeritus at the Bloomberg School of Public Health at Johns Hopkins University, who recruited Frieden to run New York’s health department. “He’s a person who understands it.”
"It's helping people understand that the only way we can really keep America safe is by engaging with the world,"
The son of a cardiologist, Frieden double-majored at Oberlin College in philosophy and pre-med. He wrote his honors thesis on Wittgenstein. He studied medicine at Columbia University, where he was reportedly influenced by Berton Roueché's book "The Medical Detectives," a series of true-life medical mysteries solved by health-care sleuths.
Colleagues have described Frieden as a quick but rational thinker who applies a physician’s evidence-based methodology to problems. The married father of two children is 53, but looks much younger, presumably because he lives the way he advises others to. Aides have trouble keeping up with his furious walking pace.
When he took the helm of the Atlanta-based CDC in June 2009, Frieden's challenges were as much political as medical. He inherited the agency from Julie Gerberding, who served under President George W. Bush and was criticized for putting non-scientists in key managerial positions. Frieden dismantled much of that bureaucratic layer.
Later that year, facing a rise in cases of H1N1 influenza, Frieden made the controversial call to roll out small batches of vaccine as they were produced, which led to heightened demand and widespread shortages. He argued that it was better than hoarding the vaccines until large amounts became available.
Since then, he’s focused the agency on the types of diseases he tackled in New York, non-infectious, chronic, lifestyle-related ailments such as obesity, heart disease and diabetes. The dean of Harvard School of Public Health earlier this year praised his “uncompromising pragmatism.”
"My approach is to figure out what works, get it done and base it all on data," Frieden said.
Just before the Ebola outbreak engrossed his agency, Frieden came under sharp criticism after revelations that lapses in laboratory protocols led dozens of CDC scientists to be exposed to anthrax and smallpox. A CDC lab also accidentally contaminated low-risk samples of bird flu with samples of a highly dangerous strain, then sent it to another government lab.
Frieden temporarily closed the labs, issued a 25-page report and held an hour-long press conference in which he said he was disappointed and angry. But he didn’t appear to lose his cool.
On Ebola, Frieden has been seemingly unflappable as he tries to get out ahead of public fear.
“His job is to tell the American people what he knows and what we don’t know and what the risk is, and try to put that risk in contest with other things we do every day," said Georges Benjamin, executive director of the American Public Health Association.
Benjamin added: “So far, he’s gone a good job communicating that.”
Frieden says that his approach to epidemiology was influenced by a former mentor, Sir John Crofton, the pioneering doctor who proved that a strict regimen of antibiotics could cure tuberculosis, and that the biggest risk was for doctors to waver from that regimen before the medicine had a chance to work. The same holds for Ebola: patients and everyone they've come into contact with must be treated and tracked for weeks.
Frieden says that there's a very real possibility that someone infected with Ebola will enter the United States. But the chances of a U.S. outbreak are highly unlikely; it’s a matter of isolating patients, careful cleaning and using protective clothing, which American hospitals are very good at. He has pressed Congress for more money to help other countries prevent, detect and stop Ebola and other infectious diseases.
"Ebola so scary and so unfamiliar, it's really important to outline what the facts are, and that we know how to control it. We control it by traditional public health measures. We do that, and Ebola goes away."
First published August 10 2014, 12:05 PM