Science Friday - As The CDC Falters, How Do We Fill Public Health Gaps?

Episode Date: October 6, 2025

Our country’s public health system is ailing. With layoffs and leadership changes at the CDC, changing vaccine guidelines, a government shutdown, and declining public trust—where do we go from here? Can state and local public health agencies pick up the slack? Are there other solutions?Host Flora Lichtman talks with former CDC director Tom Frieden to put these questions into perspective.Guest: Dr. Tom Frieden is a former CDC director, president and CEO of Resolve to Save Lives, and author of The Formula for Better Health: How to Save Millions of Lives—Including Your Own.Transcripts for each episode are available within 1-3 days at sciencefriday.com. Subscribe to this podcast. Plus, to stay updated on all things science, sign up for Science Friday's newsletters.

Hey, this is Flor Lixman, and you're listening to Science Friday. Between layoffs at the CDC and a shakeup of its leadership, changing vaccine guidelines, a government shutdown, declining public trust, where do we go from here? Can state and local public health agencies pick up the slack? Are there other solutions? Joining me now to talk about it is Dr. Tom Frieden, former CDC director under President Obama, and president and CEO of the global public health organization resolved to save lives. He's also the author of the new book, The Formula for Better Health, How to Save Millions of Lives, Including Your Own. Tom, welcome back to Science Friday. Great to speak with you.

Okay. So, you know, we've talked a lot on this show about what's happening right now with the cuts to public health and cuts to science, vaccine skepticism. So I really want to look ahead. You know, we've heard from former CDC scientists that now is the time for state and city public health agencies to step up. Do you agree? It's absolutely the time for lots of organizations, especially state and local governments and also philanthropy and non-governmental organizations to fill the gap as one thing that needs to be done, even though there is no replacement for

a competent national public health system or public health approach. And second, to begin not building back, but building forward, figuring out. out and trying new things so that public health can be faster with more impact, better at communicating, including listening, with stronger alliances so that we can make more progress. And really, that's what the formula for better health is about. It's an approach, an approach that has been proven to save millions of lives. It's see, believe, create. Three steps.

To see things that are not apparent and make them apparent. to build confidence, belief that we can make more progress, and the hardest part to create a healthier future by organizing, prioritizing, simplifying, communicating, and overcoming barriers, because there are always barriers to public health progress. I want to get into the details a little bit. I mean, before leading the CDC, you were the NYC Health Commissioner.

What do state or city public health departments have control? troll over. It varies. So New York City is a special case because the city is part city and part state. It has its own health code, its own regulatory authority. So there are lots of things that states and cities can do to try things out. Sometimes the state and the local health departments are the same organization. Sometimes they're different. Sometimes they get along. Sometimes they don't. But everywhere, you have the possibility to say, what matters to people? What can we make a difference with? And And what I do in the book is I outline what does technical rigor really mean? And it starts with finding the right problem to address, a problem that has a large burden and that is amenable to intervention.

We don't want to just try things that are impossible. We don't want to have big programs for small problems. We want to identify those big problems that we can do a lot about. Give me an example of a problem that the NYC Health Department took on. We took on smoking in restaurants and bars. Nobody thought that could be changed. That was the way bars and restaurants were. And what we did was we first made visible the problems. We showed that a smoky bar was way more polluted than places like the traffic tunnels that New Yorkers think.

of us the most disgusting polluted places in the city. We also made visible the personal impacts, a pregnant waitress who testified in front of the city council saying, why does my baby have to be harmed so people can smoke at my restaurant? We made those things visible, and then we made clear that the restaurant industry was going to fight back, but we pre-bunked. Because we regulated restaurants, we knew how many closed every day. And I had a press conference. the day before the law went into effect. And I said, starting tomorrow, the restaurant association is going to claim that every single restaurant that went out of business went out of business because of this law. But I can tell you, this is the number that go out of business

on an average day. And we'll tell you each month, whether it's increased or decreased. And actually, it decreased because it turns out that people like to eat in places that don't smell like an ashtray. I remember I lived this in New York. And I remember how, what a reprieve it was. Even smokers liked it. You know, even smokers didn't like eating in places that smelled terrible. Yeah. Okay, so you said New York is a special case.

I mean, do you think that generally speaking, state and local health departments are equipped? You know, have the resources, have the purview to actually step up in places where the CDC fall short. I don't think the gap can be fully closed, but there are fantastic health departments out there. Creative, innovative, great folks take the issue of unsafe water. Traditionally in public health, we got the bacteria out of water. We got the parasites out of water. Now we've got to get the PFS, the forever chemicals and the microplastics out of water. And that's an area for innovation, for action at the household level.

but more importantly, at the community level. Yeah, because we know, actually, at the federal level, those regulations are being rolled back around PFS. I think it's so important to look at what this administration is saying versus what they're doing. Yes. They're saying they want to address chronic disease. They've eliminated the tobacco, cancer, and heart disease programs at CDC.

They've rolled back regulation of tobacco or leading cause of chronic disease. They say they want to address environmental issues, but they've rolled back, as you say, the PFS requirements, and even more impactfully, the PM2.5 requirements, SUD or PM2.5, is estimated to kill 100,000 Americans a year already. And if it gets worse, it'll mean more deaths. That's one of the things the formula can make clear.

See the real harms that are happening and then build confidence that we can change it. But do you feel like states can really do all of this by themselves without the resources of CDC? There are some things that are going to be impossible to do, both because of the deep technical resources of CDC and because of the money. A great quotation by a public health leader of more than 100 years ago named Herman Biggs, he said,

public health is purchasable. Within natural limitations, a community can determine its own death rate. And with the formula, communities and individuals can make a lot more. more progress to see what are the threats that we can control, what's the way to control them, to build confidence that we can do it, and then to overcome the barriers, whether it's inertia or misinformation or companies that sell deadly products so that we can live a longer,

healthier life. Well, as we talk about building trust, I mean, do you feel like we can trust the guidance coming from CDC right now? I never, ever thought I would see the day when and I couldn't trust things coming off the CDC website. But we've got more than a dozen political operatives running the agency. And we have an ideologue who ignores the facts running HHS. So no, I don't think we can trust it. And that's a big problem. I want to talk about trust in science.

You know, people, I think a lot of people think about the loss of public trust, especially in public health, starting around COVID. Do you agree with that? Was that the inflection point? I think that certainly accelerated the lack of trust enormously. And it does break down somewhat among partisan lines. So it's a much bigger breach of that trust among Republicans than among Democrats. And that's unfortunate because this shouldn't be about Democratic versus Republican.

This is about fact versus fictions. Simple truths versus simplistic misinformation. health versus disease. I think public health needs to listen well. One of the most striking conversations I had during the height of COVID was coordinated by Frank Luntz, a messaging guru, and he put together about 15 or 20 vaccine skeptics, and we spent almost three hours talking. And I really learned a lot. These were folks who had totally legitimate questions, very, very reasonable questions. And they felt not only had their questions not been answered, their questions hadn't even been addressed and they felt they had been vilified for even asking them. So you have to,

I think, distinguish between the people who are profiteering on valid concerns and the valid concerns that need to be addressed. Well, right. And parsing the difference between things we're certain about and things that were not certain about. Oh, that's so important. I review this the book. First is almost certain. We're almost, you know, we're basically never going to learn that smoking a cigarette is good for you. Second, things that are really quite likely, but we have to be humble because good science doesn't lead to certainty. It leads to humility. So I think that measuring your blood pressure and keeping it under 120 over 80, which is lower than most people aim for, is the right thing to do. But there's some nuances there. How do you measure it right? We're going to learn more.

But you always have to make a recommendation based on imperfect data. If we waited for perfect data, we would never make any recommendation. And that would be making a recommendation to do nothing. There are other things that we have some evidence for, one well-conducted study. And there's still others that are theories that may sound convincing, but we have no valid evidence for them or actually evidence that they're not correct. What do you think individuals or communities should be doing? Should we be creating GoFundMeets for epidemiologists or like just going straight to the UK's National Health Service website for info?

What's your directive to us? As individuals, support your local health department. It is your health protection, just as your fire department and your police department is. We can also advocate for a better health care system. It is scandalous that we spend $4.5 trillion on health care and a third of America, Americans don't have a primary care provider, don't have a doctor or nurse who they can call up when they have questions. So advocate for better health care, advocate for primary care, advocate for your local health department. There are lots of things that we can do at every level.

Dr. Tom Frieden, former CDC director, president and CEO of the global public health organization resolved to save lives, an author of the new book, The Formula for Better Health, How to Save Millions of lives, including your own. Tom, thanks for joining us today. Thanks so much. It's been fun discussing this, and yes, we can make progress, but it's not going to be easy. Today's episode was produced by Shoshana Bucksbaum. I'm Flora Lichtman. Thanks for listening.