Frieden, Fauci Speak at Maloy Distinguished Lecture in Global Health

Dr. Frieden and Dr. Fauci respond to student questions at the Maloy Distinguished Lecture in Global Health (Ye Domesday Booke/Josie Balistreri).

The Science, Technology, and International Affairs (STIA) program at Georgetown’s Walsh School of Foreign Service hosted the annual Maloy Distinguished Lecture in Global Health on October 16.  This year’s featured speaker was Dr. Tom Frieden, a former director of the Centers for Disease Control and Prevention, who was joined by Dr. Anthony Fauci, former director of the National Institute of Allergy and Infectious Disease and current Distinguished University Professor at Georgetown.  The focus of the lecture was Dr. Frieden’s recently released book The Formula for Better Health: How to Save Millions of Lives—Including Your Own, which considers past crisis responses and today’s public health challenges to help create a healthier and more resilient future.

In his lecture, and his conversation with Dr. Fauci, Dr. Frieden emphasized the importance of public health work.  From recounting his work on tuberculosis as the head of the New York City Department of Health and Mental Hygiene, to illustrating the challenges of emerging infections like ebola, Dr. Frieden highlighted both the everyday and the extraordinary impacts of public health interventions.

A major focus of the event was the importance of effective public health communication.  Dr. Frieden described the “Cassandra’s Curse,” faced by public health professionals, who often know what’s going to happen before it happens, but struggle to make this clear to everyone else.  As seen in current public health challenges, including vaccine hesitancy and the end of American foreign aid, communication of the risks of disease and the benefits of interventions are needed.

One challenge emphasized by Dr. Frieden was that major successes in public health are necessarily invisible.  These “silent victories” of public health include epidemics that never happened, not due to chance, but thanks to the tireless efforts of public health professionals.

“One life saved by heroic and well-publicized medical care is a recognized miracle while millions saved by public health are invisible,” writes Dr. Frieden in his book.

Another concern is that vaccines have become “a victim of their own success.”  With effective vaccination programs, diseases become less visible and their consequences are less paramount.  Public health professionals thus face the difficult task of warning people about the effects of a disease for which they have no firsthand experience.  “People need to see the product of disease to know why vaccines are so necessary,” said Dr. Frieden.

Risk communication is key in other parts of Dr. Frieden’s work, including addressing soda consumption and smoking in New York City, as well as increasing awareness about hypertension.  Here, Dr. Frieden suggests that saving lives can be simple—all that’s needed is to start seeing the things that are invisible; not just the risks, but the paths to solutions.  Using evidence-backed strategies can have a demonstrable effect not just on public health, but also on individual risks for hypertension and diabetes.

Dr. Frieden’s formula for better health is straightforward: “see, believe, create.”  First, see the invisible—the structural and personal factors that are affecting health.  Next, believe that it is possible to make a difference.  Finally, create a healthier future, with an emphasis on clear and systematic action.

Dr. Frieden also emphasized the importance of cultivating optimism—keeping people believing in the ability of public health to save lives.  “Only if we think we can make a difference can we make a difference.”

Turning to the current challenges facing public health professionals in the United States, Dr. Frieden and Dr. Fauci decried the current Administration’s attacks on public health, particularly cuts to the vaccine advisory committee, with Dr. Frieden calling them “horrific.”  He stressed the consequences of the Administration's decisions, emphasising that they were undermining the foundations of the public health systems that keep Americans safe and healthy.

Dr. Fauci also expressed concern about the removal of vaccine mandates for school children.  For Dr. Fauci, it is essential to understand what is driving misinformation campaigns.  When considering people who adhere to anti-vaccination ideologies, Dr. Fauci emphasized that it is essential to not “put them all into one bucket.”  Dr. Frieden agreed, adding that they often have “totally legitimate questions” that should be addressed.  These concerns, according to both doctors, can be remedied through clear-cut, well-articulated communication that understands why people feel a certain way and effectively engages with their concerns.

In addition, Dr. Fauci stated that it’s important to see public health emergency responses as dealing with “a moving target.”  In this, it is important to let people know that information is evolving, and that even medical professionals may not have all the answers at once.  Dr. Fauci also emphasized the importance of the “self-correcting nature of science” that allows disease responses to change and get better, noting that professionals need to be “humble” during this process and admit what they do not know.

Yet, with all these threats to public health, and acknowledging the personal threats that they have both faced in promoting better health for all Americans, Dr. Frieden and Dr. Fauci remained hopeful.

In the audience Q&A, Dr. Fauci and Dr. Frieden answered questions about restoring trust in public health, while also providing advice to students who are looking to take part in public health work.

“You will find something that you can be passionate about,” said Dr. Fauci.  “Embrace it.”

Dr. Frieden emphasized “building forward,” in public health, highlighting the role of structural causes and advising that practitioners of public health work towards making it easier for others to do the right thing.

Finally, Dr. Frieden gave three pieces of advice to students when picking their careers.  First, students should find work where they believe what they’re doing is meaningful.  Next, their work must allow them to continue to learn.  Last, students must find work with people they enjoy.

Dr. Fauci’s advice to students questioning public health careers in the face of deep uncertainty was simple: “Please don’t get discouraged.”  He emphasized that the current state of public health “cannot last.” 

For those working in public health, and those students considering a career dedicated to it, Dr. Fauci’s message was clear: “We need you.”