CDC Director on Antibiotics, Influenza, and E-Cigarettes

Editor's Note:
Centers for Disease Control and Prevention (CDC) Director Thomas R. Frieden, MD, MPH, sat down with Medscape during the recent National Health Research Forum in Washington, DC, to discuss the agency's role in fighting global health threats and antibiotic resistance. He also discussed how the government is looking for ways to create a better influenza vaccine, and he shared his concerns on the growing popularity of electronic cigarettes.

Medscape: You have been very vocal about the severity of the global health threats we are facing. How are we using research to combat these threats?

Dr. Frieden: One of the things that we need to do better is unlock the microbial genome so that we can understand which infections are spreading where, whether outbreaks are occurring, and whether organisms are resistant. We can do that in closer to real time using next-generation molecular sequencing, and that is a great potential for further progress with research. Globally we have made progress with applying new vaccines, new treatment, and figuring out how to be most effective in our programs so that we can get the most health out of each of our health dollars.

Medscape: You've described the problem of antibiotic resistance as catastrophic. How is research being used to address this problem? Are we looking for ways to create new antibiotics, or are we looking for new ways to fight antibiotic-resistant diseases?

Dr. Frieden: We need a balanced portfolio. We need to track where antibiotic resistance is happening. We need to stop it where it is happening. We need to improve antimicrobial stewardship and we need new antibiotics. Antimicrobial stewardship is very important. We estimate that about half of all the antibiotics used in this country are either unnecessary or inappropriate. Those are antibiotics used in people in this country. And so there is a lot more that we can do to make sure that people get the right antibiotics at the right time. That will protect patients and that will preserve the antibiotics for the future, but we need that balanced portfolio of tracking, prevention, stewardship, and research on new drugs.

Medscape: There is a growing health concern about the electronic cigarette and how it is being marketed to consumers. We have made so much progress in recent years fighting the tobacco problem in this country, and now we are faced with a new product that may be just as concerning. What is the CDC doing to address this concern?

Dr. Frieden: What we are doing first is tracking, and we are seeing some very concerning trends. Use of e-cigarettes in youth doubled just in the past year, and many kids are starting out with e-cigarettes and then going on to smoke conventional cigarettes. Nicotine can be a very addictive drug, so we want to make sure that e-cigarettes don't lead to another generation of kids becoming addicted. In addition, if smokers want to quit, we know that there are FDA-approved medications that can double or triple their likelihood of succeeding. Every adult nonpregnant smoker who tries to quit should be offered medication. Also, we need to make sure that people who have quit smoking don't get hooked back on nicotine by starting up with e-cigarettes and then go on to smoking conventional cigarettes. Finally, to the extent that e-cigarettes reglamorize the act of smoking, they could be very dangerous, but we don't know what that will bring in the long term. It may be that if they are carefully regulated, for some people they may do good. But right now we have got those 4 areas I have mentioned that we are very concerned about.

Medscape: We are approaching flu season and there is a concern that our way of making the influenza vaccine is antiquated, that it takes too long and doesn't always match the strains that emerge during flu season. Is the CDC looking for ways to make the vaccine better and quicker to produce?

Dr. Frieden: There is a government-wide effort to improve our ability to make flu vaccines and to make them work even better than they do now, because they don't work as well as we would like. This year's flu vaccine is what you need to protect yourself against this year's flu, and the flu vaccine is the single best way to protect yourself against the flu, but there is a lot that we need to do to make better vaccines. One thing that CDC scientists came up with is a faster way of documenting the potency of the vaccine, so that once it has been made we can quickly see whether we can get it to market and whether it has got the quantities we want. Little by little we are cutting time off what it takes to make a flu vaccine in case a new strain does emerge and is causing a pandemic, but much more needs to be done.

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