Opioid epidemic the ‘public health issue of our time,’ CDC’s Redfield says
BALTIMORE — CDC Director Robert R. Redfield, MD, recounted an incident he witnessed riding the train to work one day.
Commotion erupted as a woman, dressed nicely, approximately 38 to 40 years old, underwent a medical emergency 10 seats in front of him. Twenty minutes of CPR compressions followed, to no avail. The train stopped for a medical team, which was unable to revive the woman. A second team boarded the train and moments later:
“Lo and behold, she sat up after receiving Narcan. Here she was, this white-collar woman, who had apparently overdosed on her way to work on the train,” Redfield recalled.
“The opioid epidemic is the public health issue of our time,” he said.
In a keynote address at the National Foundation for Infectious Diseases’ Annual Conference on Vaccinology Research, Redfield discussed some CDC priorities, including the opioid crisis, ending the HIV epidemic in the United States and preparing for pandemic influenza.
“One of the areas we want to recognize is seeing the possible in public health,” he said. “There are really three major areas we try to focus on — ending outbreaks and epidemics, eliminating diseases and securing global health and ensuring domestic preparedness.”
Ending outbreaks and epidemics
According to CDC data, more than 70,000 people died from a drug overdose in 2017. The opioid crisis has exposed millions of people to other health risks, too, including a range of infectious diseases.
Overdose deaths, Redfield explained, could result from the American public’s lack of understanding of the “true risks” of prescription opioids. For example, many are unaware that the average person leaving a simple dental procedure such as a wisdom tooth extraction with a prescription for pain killers has a 2.6% chance of becoming addicted, Redfield said.
He said that a small town in West Virginia with less than 3,000 residents had 20.8 million pain killers shipped to the pharmacy in 1 year.
“Why?” Redfield asked.
He said the CDC has taken several steps to combat the issue, including conducting timely syndromic surveillance, developing prescription drug monitoring programs, drafting clinical guidelines for chronic and acute pain, educating the American public about the risks associated with opioids and creating rapid response teams.
‘Historic opportunity’ to end HIV
In speaking about the CDC’s efforts to eliminate diseases, Redfield noted that the HIV/AIDS epidemic has killed 700,000 people in the U.S. since 1981, and that without immediate action, the CDC estimates that 400,000 people will be diagnosed with HIV within the next 10 years. Progress has been made, but Redfield said prevention efforts have stagnated, with around 40,000 people being newly diagnosed each year. Of new infections, 52% occur in the South and 44% in African Americans.
Redfield and other public health officials helped draft a plan to end the HIV epidemic in the U.S. by 2030, as announced by President Donald J. Trump during his second State of the Union address in February.
"It's a historic opportunity," Redfield said, explaining the specific goal of reducing new diagnoses by 75% within 5 years and 90% within 10. “It’s based on putting science into action — increasing diagnoses, protecting those at risk, responding quickly and developing an HIV health force to bring the epidemic to an end once and for all.”
Another example of putting science into action to eliminate diseases, Redfield said, is vaccination. He turned his attention toward seasonal influenza, which killed 80,000 people during the 2017-2018 season.
According to CDC data, there have been between 28,000 and 47,000 deaths due to influenza in the U.S. this season. Redfield said one reason is low vaccination rates, which is partly caused by public skepticism of whether or not the vaccine “really works.”
Experts continuously stress that the best way to protect against influenza is to get vaccinated. Yet last season, influenza vaccination coverage decreased more than 6 percentage points in adults, with only around 37% getting vaccinated, according to CDC estimates.
“No vaccine works if individuals don’t take advantage of it,” Redfield said.
“Talking to cab drivers, as I do often, I ask if they’ve been vaccinated and most say ‘no,’” he said. “I explain who I am ... and explain that [the vaccine] may not always protect against infection but it does protect against death.”
Global health and domestic preparedness
Redfield spoke about the ongoing Ebola virus outbreak in the Democratic Republic of the Congo — “the largest and longest Ebola outbreak in a single country,” he said.
“There are about 10 cases a day in 21 health zones, including war zones with 100-plus rebel groups,” he explained.
Marred by violence and distrust, the outbreak has resulted in more than 1,000 cases and almost 700 deaths. Redfield noted some of the breakthroughs that have occurred, including the most widespread use of an Ebola vaccine. Merck’s investigational V920 vaccine has been given to around 94,000 people during the outbreak, and Redfield said he expects that a second vaccine developed by Janssen “will be aggressively deployed in the days ahead because this outbreak is not under control.”
As for what keeps him and other public health officials up at night, Redfield said pandemic influenza.
“That’s the real threat right now,” he said. “I’m encouraged by the work to create universal flu vaccines for H1N1, for H3N2, but in the meanwhile, we need to look at how to make the current flu vaccine and the current technology work better.”
According to Redfield, the best way to prepare for pandemic influenza “is to be better at seasonal flu.”
“I don’t think it’s a question of if, it’s a question of when,” he said. “This is a big push right now to try and increase the U.S. capacity to be better at flu, and like I’ve said, there’s a lot of opportunity.
“Our flu vaccine is [not] like our measles vaccine, which is 97% efficacious. Our flu vaccine in our best year is 60% efficacious. And there’s science there that can bring that to an end. We can do things like increase the rate of vaccination, and we’re going to work hard this year to try and do that. We’ve got to change the hearts and minds of the American population. But there are scientific things we can do.”
These include examining the role of production technology, the role of post-translation modification, the role of immunological imprinting and the roles of adjuvants and antigen presentation, Redfield said.
“It’s hard to believe that we’re this far into it and this is the most important single, global public health pandemic threat that we face and we still don’t have the level of investment from science, I think, that we need to have to allow science to bring the flu what I showed you science brought to HIV,” he said.
Redfield concluded his speech by reminding attendees to never underestimate what is possible.
“We need leadership and initiative to act,” he said. “Apply science, don’t leave it on the shelf.” – by Caitlyn Stulpin
Reference: Redfield R. Opening keynote. Presented at: NFID Annual Conference on Vaccinology Research; April. 3-5, 2019; Baltimore.
Disclosures: Redfield reports no relevant financial disclosures.