health care centers which will obviously fund [unintelligible] by a couple of people who were avid followers of adolf hitler. host: we will stop there. we'll ask you what role the senator will play as the health- care battle resumes next week? guest: you will see him continuing to be on the senate floor early and often opposing the current version of reform. he is out there proposing a more incremental type of reform that would address access and cost. . . i believe he will be extremely adamant going against that kind of reform. host: things for joining us. guest: it is a pleasure.

host: tomorrow morning we will look at three days, looking through the eyes of one hospital in virginia. we will also talk the politics of the town hall meetings and what the house will face when they return. we will have the perspective of congressman from fairfax county, virginia. then, the next two guests concern healthcare and are pressures at that hospital. finally, on this anniversary of hurricane katrina, the next guest is the executive director of the louisiana recovery authority. that is all tomorrow morning. "washington journal" occurs every day in the morning. enjoy the rest of your weekend. [captioning performed by national captioning institute] [captions copyright national cable satellite corp. 2009] . .

>> you're watching "newsmakers." and our guest this week is dr. thomas frieden, the director of the centers for disease control. thank you for your time today. >> thank you. it's good to be here. >> joining us in the studio is lauren nearguard of the associated press and maggie fox of thompson's roiter, serves as

their hentsdz and science editor. maggy, you get the first question. >> doctor, i'm going to start off hard here. this week, the presidential council of science advisers issued a report on swine flu. it gave a pretty surprising estimate of what the impact on the united states would be. can you tell us a little bit about how the cdc sees the very facets of that report and whether you think some of the numbers might have been overblown or exaggerated? i think one of the numbers given, as many as 90,000 people could be expected to die from h1n1 through this flu season. >> certainly. everything we've seen suggests that we won't see that kind of number if the virus doesn't change. but the presidential commission did a terrific job of giving an overview of what are the

challenges in addressing h1n1 and what are some of the things that we need to do. many of those things are under way now. many of them are difficult. addressing influenza is hard. influenza is one of the least predictable of all infectious diseases. and that means that, among other things, we need to do lots to get ready 689 what with would we do if we needed more people on ventilators in intensive care unit sns how can we plan to surge up? and those plans are under way. what can we do to vaccinate people as quickly as possible? how can we make sure that people who have underlying health conditions like asthma, diabetes, and who might get very sick from flu get rapidly treated if they get sick and flu is circulating? at the same time, making sure that when flu comes this year, we don't overwhelm emergency departments with people who aren't very sick and shouldn't

be in an energy department. the report i think unfortunately the media coverage was not nearly as balanced as the report itself. the report was very helpful, thorough and overview of the needs. and what's gotten all the play is one particular scenario that they outlined. and there are various scenarios you can come up with. our approach is to say, yes, flu is a very serious problem we're taking very intensive steps to respond to it and we will work to ensure that as few people get very sick and die as possible. what that number will be only time will tell. we know that if we work well now, if we prepare to treat people promptly when they become ill if they have underlying conditions, to vaccinate people promptly when vaccine becomes available will be much more likely to have as low a number as possible. >> when vaccine becomes available actually is one of

the key questions. it doesn't look like we'll have significant supplies until the middle of october. that report urged you to get some out the door in september partly because of all the concern about transmibblet with schools getting started. is there any effort to do that and start some of the priority groups getting vaccinated in september 1234 >> we >> we wish we had new vaccine technologies that would make a new vaccine in a question of weeks or months. despite over $1 billion of research we don't have that yet. it's not possible with today's technologies to do that. what has happened is immediately when the new virus begins circulating, the c.d.c. developed a seed strain to help develop a new vaccine. hfs has been working a number of different eebtties have been working with companies to make as much vaccine as can be made.

we need to ensure that it's made with full attention with all of the safety guidelines and that's being done. one of the decisions that had to be made was to go ahead with producing the vaccine, go ahead with preparing it to be used. we anticipate that vaccine will be available in mid-october. it would be great if some were available sooner but realisticically it doesn't look possible in large numbers. at the same time, what we're talking about is potentially tens of millions of doses available in mid-october. then the next challenge is getting people vaccinated and that will be something that will have to be done on a state by stace basis working with doctors, other health care providers, pharmacies, schools, work places, using all of the resources of different communities to get people vaccinated promptly. >> can you talk a little bit about who really ought to be first in line and what steps you're taking to make sure that the people who are in those

priority groups are first in line and the people who aren't aren't getting ahead of them? >> the highest priority for flu vaccination are people who would get very sick or risk dying if they develop the flu. that means people with asthma, diabetes, heart disease, lung disease, immuneo suppression, people with neuro muscular or other neurological problems. children, for example, with severe developmental delays who have difficulty coughing or breathing on their own. and pregnant women. these are all groups which were disproportionately affected by flu in this past year. >> but how are you going to make sure that they're first in line? >> we're working with a number of the professional societies, the obsteck ricks and gineology. specialty societies and other groups. and we've worked with each state to identify within their state how are they going to

reach these groups, whether it's the endo chronology clinics, primary care practitioners, one of the biggest challenges will be school vaccine clinics. kids don't get vaccinated in large numbers in a routine flu season. to do that, it will be important to get consent forms back from parents, to work with schools, nursing staff in schools, administrators in schools. and we've had really wonderful collaboration with the department of education here in washington as well as at the state level between state education departments and state health departments. one of the key roles that c.d.c. can pray is to help states and localities become better prepared, plan better. we've been providing funds, more than half a billion dollars worth of funds to the states and localities to prepare for vaccine programs to

prepare emergency departments to deal with large numbers of ill people, to prepare specialties at societies. one of the thing that is we'll be doing to get vaccine out is using the infrastructure of the vaccines for children's program. this is a very effective program that is responsible for many of our childhood vaccines, and we have the way for doctors to sign up easily on line, and they can by signing up with their state or locations vaccine for children's program provider and system, they can then call down vaccine when it becomes available if they're approved by their state to receive it. so we need to use all resources of our health care system, all resources of our society. addressing h1n1 is a shared responsibility. no one part of the -- yes. >> sorry. but i want to ask you, what kind of indication you have of acceptance of the vaccine? as you know, there's controversy over vaccines and there seems to be indications,

in britain we hear that even health care professionals say they're unlikely to get the vaccine. and we have a problem here with health care professionals. what kind of indication that you have that the u.s. public is going to be accepting of this vaccine and line up to get it? >> in every vaccine campaign anywhere in the world there are people who are suspicious of it, people who are hesitent to get vaccine. i can tell you when it comes time to get my kids vaccinated, they will get vaccinated. i will get vack nated if i'm in the group. this is the flu vaccine protects against the flu. there are lots of people who believe that it causes the flu. i think first it's important to understand that the flu shot is a killed vaccine. it can't possibly result in you getting the flu. it can give you a sore arm. that's common. but you can't get the flu from the flu shot. and each year you need this

year's flu shot to protect you against this year's flu. there will also be nasal spray for some groups of people who prefer not to get a shot if you're eligible for that you can get that as well. >> do you have an indication that people are actually signing on to this and making the leap from understanding that they should get the vaccine to actually going and getting it? >> vaccine is our strongest weapon against the flu. people want to know that flu vaccine is available and we're working hard to have the flu vaccine available. we're not talking about mandating it for anyone, making it required that people take it. it's an option for people to take it. we encourage people to take it. we hope they'll take it. and i think what you'll see in different parts of the country is that as more people become sick or seriously ill or die from flu, you'll get an increased demand. and that's one of the challenges that we have. it's likely that this flu

vaccine will require two different doses separated by about three weeks. so if you wait until people are already getting very sick from the flu, that's not quick enough to get vaccinated. when flu becomes available, we hope that people particularly people at high risk will get vaccinated. we know that some of the most effective ways to do that are to work with health care professionals. and you're absolutely right, it's very unfortunate that health care professionals don't get vaccinated in as high rate as we would like. but we do know that in the best performing health care systems, in the u.s., you get 60, 70, 80, even 90% of health care workers vaccinated and that's what we expect of all health care facilities. >> can you talk a little bit about what is going to make this a very different flu season? you did say that that 90,000 death figure is way overblown. but this is going to be a very different flu season because of who this particular strain seems to target. >> in the spring, i was health

commissioner for new york city before taking this job and we had lots of outbreaks in schools. that's unusual for flu. we had schools with hundreds or even a thousand kids sick with the flu. the overwhelming majority of them had moderate or mild illness. some people had it without knowing they had the flu. but we didn't see large outbreaks like that in most flu seasons and we saw them this past spring. we expect that it is not unlikely that we will see outbreaks beased in schools in the coming school year, in the fall or as the flu season progresses in the wincht. exactly when, how large, where, only time will tell. one of the defining characteristics of influenza is that it's very hard to preticket what will happen. we have to be ready. and one of the ways that we can be ready is understanding how to respond in schools. in most cases, we need to ensure that kids who are sick stay home. if you have a fever, stay home.

you'll get better quicker and you won't make other people sick. cover your cough and sneeze and wash your hands often. those three key measures can make a big difference in how fast and how widely flu spreads. this season is likely to be different because of outbreaks in places like schools, child care settings and elsewhere. and that's why we worked very closely with the education department to get guidance out for schools. what to tell kids, what to tell parents, what to tell teachers and mrs. so that kids can keep -- administrators, so that kids can keep going, people can continue going about their lives even if we have a lot of people ill with the flu and the health care system can be ready to deal with it. >> what about the mortality? who actually dies from this flu? are you still seeing it's people in their 20's, 30's, and 40's, which is completely different from a regular flu season? >> each year tragically we have

dozens or even a hundred deaths from flu in children. and this year we don't expect to see fewer and tragically we may see more deaths. we will do everything in our power to reduce the number of people who die. that means taking those simple measures like staying home if you're sick, covering your cough, washing your hands, as well as making sure that people get prompt treatment if they're very sick and getting the vaccine out as quickly as possible when it becomes ablinge. available. >> can i ask you about surveillance. it's actually knowing who is sick, the so-called denominator is in the figure of deaths to people who are only mildly ill. and the pcas report urged c.d.c. to do a little more about getting better surveillance. what can you do to get a better grip on who has flu? and can we have a little bit better number than the kind of general more than a million

people have been infected so far that's been out there? because it really is a bit unsettlingly vague for a lot of us. >> in an average flu season, between 5 and 20% of the mop lation are infected by flu. that's a lot of people. in new york city where we had a lot of h1n1 this past spring, the estimate is that about 800,000 people, about 10% of new york city residents got infected with the flu. that's a lot of people. but vast majority don't get severly ill, don't have to be hospitalized. and those who get severly ill tend to be those with underlying health conditions. what we have to do is prepare for it, understanding that it will be very different in different places. this past spring, the level of flu infection varied at least 20 fold between different parts of the country. no one knowst capactsly why

that is but we expect some places will have more flu, some will have less. every place needs to be prepared. and a lot of the data will come from the local area. it's one of the things that we're working on is helping laboratories be ready to diagnose when needed, not everycase needs to be diagnosed but certainly anyone who is hospitalized should have a test for flu. doctors also need to understand that that test sometimes is falsely negative. so just because it's negative doesn't mean someone shouldn't be treated. we'll track closely to see if the virus is becoming resistant to the drugs that we use to treat it. we'll track closely to see if the virus is changing to be less affected or protected by the vaccine. up until now the vaccine looks to be a very good match with the strains of the virus that are circulating. but that needs to be checked week to week, month to month, to see if that changes.

we'll look closely at emergency departments. are the people in emergency departments there because they're very sick or because they're very concerned about their health? do they have fever? are they being admitted? what's going on with the intensive care units? are they being overwhelmed or is there ample capacity, enough beds? those are some of the thing that the report quite appropriately high lights and which c.d.c. is hard at work on enhancing and improving our systems to track. >> you're watching "newsmakers" with dr. thomas frieden. he serves as their director. joining also is maggie and lauren. >> just to follow up on that. would it be a fair assumption to say that over 2 million, 5 million americans already have been infected? >> one of the things that we will do in the fall is to track more closely than we have till date the number of people who have the infection based on telephone surveys.

that will help us get a national number. right now we're confident it's more than a million. the fact is that what the number is isn't so essential. what is essential is that we prepare we will prel for having potentially quite a few cases in the winter. >> this is going to be hard to track. can we talk about some of the challenges in tracking it. i understand some of the reports that people who are infected don't have a fever sometimes, that their symptoms are a little bit different. people are asking questions like well, if i think i was infectd this spring, does it mean i don't need the vaccine in the fall? isn't this input a little bit important in judging how to react besides just being prepared with lots of hospital beds? >> because lots of people have illness that they think might be the flu but don't necessarily have the flu our general recommendation is that everyone should get a flu shot, particularly each year for

season al flu and for h1n1 we're prioritizing groups that would benefit the most. h1n1 has tended to spare the elderly, so relatively few people over the age of 65. season al through vaccine will become ablee in september. one of the things that will be very important. as flu spreads. is to track it community by community to know when it's present. in some communities when you have a fever it's likely that you'll have h1n1. in other communities with a fever it's less likely. fever is quite predictive of having flu and it's quite predictive of potentially infecting others. so that's the key symptom that people should watch for. there are always some people in each flu season who are infectd with flu who get very mild illness and may not have feefer. that's much fever. that's much less of a concern. they're much less likely to get siverlly ill or infect others. >> there was a lot of confusion

in the spring about people saying i want a test, if it's swine flu or other kind of flu. don't just tell me it's flu. given that the majority of the flu now circulating in the world is h1n1, is it going to be even worth it to have a test unless you are actually hospitalized this fall? >> in the fall, it will be important to find out what's happening initially. so find out if flu has arrived in a community, which flu it is, whether it's resistant to antibiotics, whether it's still protected by the vaccine that we have. and so far that looks very promising. everyone who is hospitalized and may have flu should be tested. doctors need to understand, of course, that sometimes that can be falsely negative. and anyone who is very ill and you're concerned it is flu, you might get a test. anyone in intensive care urent, we'd like to know if people are in intense combrive care with the flu. by and large testing is not

necessary. most times it's in a community. if you don't need to treat, you don't need to know if you've got that strain of flu. and if it's in a community and people have an underlying health condition and need to be treated, you also don't necessarily need a flu diagnosis. we also know that many of those tests have a lot of false negatives. so on the one hand if you test positive, you're not going to do anything different than you would otherwise. and, on the other hand if you test negative, you're also possibly not going to do anything different. in most cases then it won't be necessary to test. and in most cases it will be necessary to act without having a test. if you are treating for someone who might have a falsely negative test. >> this is not the only thing on your plate. you're brand new at cdc. what are your other priorities other than dealing with h1n1 flu? i know in new york city you tackled smoking, transfat in

restaurants. what is up first on your plate now? >> well, really h1n1 is the top priority for the agency right now. the potential for flu to cause widespread illness, deaths, and economic and social disruption to people's jobs, to kids learning, is huge. and we're doing everything we can. we've mobilized literally more than a thousand staff at c.d.c. to work on h1n1. and we'll continue to do that for as long as is necessary. that's our top priority. there are other things that we're doing to try to make sure that c.d.c. does the best job it can to protect the american people and to support states and localities to do that as well. c.d.c. is a wonderful institution. the world's experts in many or most public health problems here at c.d.c. and it's been a delight to get to know people here and learn what people are doing. some of the directions are going are first to strengthen

the science. to make sure that we've got the pest possible information to address whatever the problem is, whether it's new manufacturing technologies and making sure that workers are safe, or h1n1 or smoking or obesity, to make sure that whatever we're proposing, whatever we're studying is based on what is actually happening and likely to help people the most. a second key priority is strengthening state and local health departments. they are where the action is at. that's where prevention happens. that's where response happens. c.d.c. exists to help state and local health departments do a better job of protecting the people in their areas. and tonight make sure that everything we do as an agency is practical, helpful, and focused. as a city health commissioner for seven and a half years, i saw many years in which c.d.c. was terrific in helping local areas respond. other areas where there could be some improvement. and we're working on that.

the third big area is global. globally, c.d.c. does a lot around the world to help other countries track health problems. and that's in our own interest as well. in fact, in h1n1, it's the c.d.c. staff around the world and labs, experts and epidemiologists who have been able to tell us what's going on and track it in some of the lower income countries. those are key priorities for us. >> those are the sexy areas, fighting h1n1, sending the teams abroad to fight scary viruses like ebowli. but there are other things on your plate and a lot of improvements to be made. can you talk about some of those years? because we've understood for years there are people who feel neglected, who feel unhappy, who feel unmotivated. what are you going to do to reenergize the people working in some of the other areas? >> c.d.c. handles a very broad

range of health problems. we have to continue to address the commune cable diseases, the infectious diseases, like h1n1, hiv, sexually transmitted diseases and many more. at the same time, we have to strengthen our work in the noncommune cable diseases. i've said before that public health does a great job monitoring and controlling diseases and conditions that killed people a hundred years ago but not such a great job monitoring and controlling the leading causes of death today. that includes smoking, obesity, high blood pressure, heart disease, stroke, alcohol abuse. these are problems that are the leading causes of illness and death today, and there are things that we can do to understand them better and to help control them better. >> are you going to try to carry some of the kind of big stick that you did in new york city where you've talked about maybe taxing junction food. is that -- junk food. is that something c.d.c. can

get into? >> we have to look at what are the leading causes of illness and death. a lot of things are going to be done at the state and local level. with tobacco control, we have much farther to go. there are still about 45 million smokers in the u.s. today a thousand people will be killed by cigarettes in the u.s. but we've had some real success. the number of male smokers, the number has been cut by two thirds over the past few decades. our recent progress in tobacco control has stalled and we need to do more. but you've seen lots of local creativity, local innovation in tobacco control. we need to see that same type of local leadership and creativity on issues like obesity, physical activity, things that we really can make a difference with. no one could have predicted a couple of decades ago that the obesity epidemic would have gotten as bs