as they provide their insight about the court and the building. the supreme court, home to america's highest court. the first sunday in october on c-span. >> you are watching news makers and our guest is dr. thomas [unintelligible] dr. friedman, thank you for your time today. >> good to be here. >> joining us is lauren with the associated press and maggie fox of reuters. thanks for coming in. maggie fox, you get the first question. >> dr. friedman, i will start off here. this week, the president's council of science advisers issued a report on swine flu, h1n1 flu. it gave a clue as to what the impact of the united states would be. can you tell us how the cdc to

seize the various aspects of that report and whether you think some of the numbers might have been overblown or exaggerated? i think one of the numbers was that 90,000 people could be expected to die this flu season. . .

>> how can we plan to surge up when those plans are underway? what can we do to vaccinate people as quickly as possible when vaccine becomes available? how could we make sure people have underlying health conditions like asthma, diabetes, and you might get very sick from the flu get rapidly treated if they did sick and fluid circulating, at the same time making sure that when the flu comes this year, we do not overwhelmed emergency departments with people who are not very sick and should not be in an emergency department? unfortunately, the media coverage of the report was not nearly as balanced as the report itself. the report was very helpful as a review of the needs and what has gotten all the play is one particular scenario that they outlined. there are various scenarios you can come up with. our approach is to say that yes,

the flu is a very serious problem, we are taking intensive steps to respond to it, and we will work to ensure that as few people get sick and die as possible. what that number will be, only time will tell. we know that if we work well now and prepared to treat people promptly when they become ill if they have underlying conditions, to vaccinate people properly when it becomes available, will be much more likely to have a low -- as low an address possible. >> when the vaccine becomes available is one of the key questions. it does not like -- does not look like we will have significance supplies until october. the report urged you to get some of the door by september, partly because of school being started. is there any effort to do that and start the priority groups getting vaccinated in september? >> we wish we had new vaccine technologies that will allow us

to turn on a dime and making new vaccine in a question of weeks or months. despite over zero billion dollars of research, we don't have that yet. it's not responsible for today's technology to do that. what has happened is that immediately, when the new virus began circulating, the cdc developed a strain to develop a new strain. health and human services has been working and a number of different manufacturers and companies have been working together to make as much vaccine as can be done. lee to make sure it pays attention to the safety guidelines. one of the decision that had to be made was to go ahead with producing the vaccine and prepare it. we anticipated being available in october, which were sooner, realistically it does not look like that be possible in large

numbers. at the same time, we are talking about is potentially tens of millions of doses in october and then the next challenge is getting people vaccinated. that will be have -- that have to be done on a state-by-state basis, then through schools, workplaces, use -- using all the different ways to get people vaccinated a proper -- appropriately. >> who should be first in line? howdy make sure the people in the priority lines are not -- are there and the ones not are not getting ahead of them? >> highest priority are those who would become very sick or risk dying if they develop the flu. that means people of asthma, diabetes, heart disease, lung disease, and in the suppression, thing -- people with neuromuscular or neurological problems.

children with severe morale -- severe developmental delays, this is have trouble breathing on the rhone, and pregnant women. these groups were -- reading on their own. and pregnant women. >> how you make sure their first in line? -- how will you make sure they are first in line? >> we will work with the number of societies and other groups and we will work with each state to identify within their state how they will reach the group's, whether the endocrinology clinics for people with diabetes, party -- primary-care practitioners, one of the biggest challenges will be school clinics. kids don't get vaccinated in large numbers in a routine season. large numbers of kids will not be easy. to do that, it will be important to get consent forms back from

parents and work with schools, nursing staff in the schools, administrators, and we have had wonderful collaboration with the department of education here in washington as well as at the state level between the state education departments and the state health departments. one of the key roles the ctc can play tell it -- is to the states and localities -- one of the key roles the cdc can play is to help states and localities repair for vaccine programs and prepare emergency departments to deal with large numbers of ill people and prepare specialist societies. one thing we will do to get vaccines out is use the infrastructure of the vaccines for children program. this is a very effective program responsible for many childhood vaccines. we have a way for doctors to

sign up easily online and by signing up with their state or locations, the vaccine for children program provider and system, they can call down the vaccine and it becomes available if it is approved by their state. we need to use all resources of the health-care system and all the resources of the society. addressing this is a shared responsibility. >> i want to ask you of what kind of indication you have of the acceptance of the vaccine? there seems to be indications -- we hear that health care professionals say they are very unlikely to get the vaccine and we have a problem with health care professionals. what kind of indications the have that the u.s. public will be accepting and line up to get it? >> in every vexing campaign in the world, there are people who are suspicious, people who are hesitant, i can tell you that

when it comes time for my kids to get vaccinated, they will be vaccinated. if i am in a group that needs to be vaccinated, i will be vaccinated. this is a vaccine, like every year's vaccine, it protected against the flu. there are lots of people who believed it causes the flu. it is important to understand the flu shot is a killed vaccine. it cannot result in you getting the flu. it can give you a sore arm, but you cannot get the flu from the flu shot. each year, you need this year's flu shot to protect you from this year's flu. there will be nasal spray for some groups of people who prefer not to get a shot if you are eligible. >> do you have an indication people are signing on to this and making the leap from understanding the vaccine and

going to get it. >> it is our strongest weapon against the flu. people want to know that the flu vaccine is available and we're working hard to have it available. we're not talking about mandating that are making it required, it's an option. we encourage people to take it and we hope they will take it. realistically, what you will see in different parts of the country is that as more people become sick or seriously ill or die from the flu, they will get an increased demand for the vaccine. that's one of the challenges. it is likely this that theme will require 2 different doses, separated by three weeks. if you wait until people are getting sick, that's not quick enough to get vaccinated. when it becomes available, we hope people, particularly people at high risk, will be vaccinated. we know some of the most effective ways to do that are to work with professionals. it is very unfortunate that health care professionals don't

get vaccinated at as high rate as we would like. we do know 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 is what we expect that all health-care facilities. >> can you talk about what will make this a different lease season? you said the 90,000 death figure is overblown, but this will be different flu season because of who this flu seems to target. >> i was the health commissioner in new york city before taking this job. we have lot the outbreak in schools. that unusual for the flip. we at schools with hundreds or even 1000 kids sick with flu. the overwhelming majority had at moderate or mild illness. some people had it without knowing they had the flu even. we did not see large outbreaks in most classes in and we saw

them this past spring. we expect it is not unlikely we will see outbreaks' based in schools in the coming year. exactly when, how large, when, only time will tell. one of the defining characteristics of influence it is it is hard to predict. we have to be ready and one of the ways we can be ready is to understand 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 will get better quicker and you will make other people sick. cover your costs and knees and washer and often. -- cover costs and sneeze and wash your hands off and. this season is likely to be different because of outbreaks in places like schools, child care settings, and elsewhere. that is why we worked very closely with the education

department to give guidance out for schools, what to tell kids, parents, teachers and administrators so kids can keep learning and people can keep going to work. people can continue to go about their lives even if we have many people ill with flu and health care system can be ready to deal with it. >> what about the mortality? to actually dies from this flu? is it the people in their 20s, 30s, and 40's -- completely different from a flea season typically? >> typically we have dozens or hundreds of deaths in children. this year, we don't expect to see fewer and tragically we may see more. we will do everything we can to reduce the number of people who die. that means taking simple measures but staying how much you are set as well as making sure people get prompt treatment if they are very sick and getting the vaccine as quickly

as possible when it becomes available. >> can i ask about surveillance? one of the problem with seasonal flu isn't actually knowing who is sick. -- is actually knowing his sick. there was a president -- presidential report issued this week urging the centers for disease control to get better surveillance. what can you do to get better grip on it? can we have a better number than the general more than 1 million people have been infected so far that -- that has been out there? that is unsettling leave vague for many people i think. >> in an average floozies and, between five and 20% of the population is infected by the flu. that's all lot of people. -- in an average of lucy's and, between 5% and 20 top -- 5% 20%

of the population is infected by the flu. that's a lot of people. the vast majority did not get severely ill and don't need to be hospitalized. those who get severely ill need to be hospitalized and tend to die tended to be those with underlying health conditions. what we have to do is prepare for it, understanding it will be very different in different places. this past spring, the level of flu infection varied at least twentyfold between different parts of the country. no one knows exactly why that is, but we expect some places will have more and some places will have less. every place needs to be repaired and a lot of the data will come from the local area. it is one of the things we're working on, to help laboratories be ready to diagnose when needed. not every case needs to be diagnosed, but everyone hospitalized should have a test

for flu. doctors need to understand the test is falsely negative. just because it's-doesn't mean some should not be treated. we will track closely to see if the virus is becoming resistant to the drugs we're using to treat it. we will track to see if the virus is changing to be less affected or protected by the vaccine. up to now, it looks to be a very good match with the strains of the virus circulating. but that's -- we will look closely at emergency departments. how heavily are being utilized? are there because they're sick or concerned about their health? what is going on with the intensive care unit? are they being overwhelmed or is there ample capacity?

the cdc is hard at work enhancing and improving the systems to track. >> you are watching "newsmakers" with dr. thomas frieden. >> would be a fair assumption to say that over 2 million americans are 5 million americans have already been infected with h1n1? >> one of the things we will do in the fall is to track more closely than we have the number of people have the infection based on telephone service. that will help to get a national number. right now, we're confident that it is more than 1 million. the fact is what the member is not essential. what is is that we prepare well for having potentially quite a few cases in the fall and winter. >> this will be hard to track. can we talk about the challenges you face in tracking it?

i enter stan that some of the reports indicate the people -- i understand that the people who have it don't always have a fever. is the input important in judging how to react besides just being prepared with lots of hospital beds? >> because lots of people have a list they think might be the flu but don't necessarily have the flu are -- our general recommendation is that everyone should get a flu shot, for seasonal flu, and for h1n1, we're prioritizing groups that would benefit the most. it has tended to spare the elderly, so few people over the age of 65 -- seasonal flu vaccine will become available in september and a concern taking that. one thing that will be important is that as of this breadth, attracted by community by community to know when it is

present -- when it is present. in some communities, when you have a fever, is likely will have h1n1. fever is quite predictive of having flu and infecting others. that is the key symptom people should watch for. there are always people who are infected and get a very mild case and may not have a fever. they're much less likely to get severely ill and much less likely to infect others. >> there was a lot of confusion in the spring about people moaning a test to know whether or not it is one flew or something else. given that the majority of food now circulating in the world is now h1n1, is it worth it to have a test unless you're actually hospitalized this fall? it will be important to find out what is happening initially. find out if live has arrived in

the community, which flew it is, whether it is resistant to antibiotics and whether it's protected by the vaccine have. so far, it looks promising. doctors need to understand that sometimes there can be false negatives and anyone who is very ill, certainly anyone in an intensive care unit, we would like to know if people are in an intensive care unit with the flu. by and large, testing is not necessary. one flew is an it community, most people don't need be treated. you certainly don't need to know whether you have that particular strain of flu. if you have an underlying condition, you don't need a flu diagnosis. many of those tests have a lot of false negatives. on the one hand, if you test

path of, you're not going to do any thing different than you would otherwise. if you test negative, you are possibly not going to do anything different. in most cases, it will be necessary to test and in many cases it will be very important to act without having a test. if you want to treat properly and make sure you are treated for someone to make a false negative test. >> this is not the only thing on your plate. what are your other parties besides dealing with h1n1. i know you have tackled smoking and trends that restaurants in new york. what's on your plate now? >> h1n1 is the top priority right now. the potential for flew to cause widespread unless, of death, and economic and social disruption to people's jobs, children learning, is huge and we're doing everything we can. we have mobilized more than a

thousand staff at the cdc to work on h1n1 and we will continue to do that as long as necessary. there are other things we're doing to try to make sure the cdc does the best job it can to protect the american people and support states and localities as well. the cdc is a wonderful institution. the world's experts in many or most public health problems are here and it has been a delight to get to the people here and learn what people are doing. some of the directions we're going are to strengthen science, to make sure we have the best possible information to address whatever the problem as, whether new manufacturing technology and making sure workers are safe or h1n1 or smoking or obesity, to make sure whatever we are proposing and studying is based on what is actually happening and what is likely to help people most. a second key priority is

strengthening state and local health departments. state and local departments are were the action is that and that's where prevention and response happens. cdc exists to help state and local health departments to do a better job of protecting people and their areas. i want to make sure everything we do as an agency is practical, helpful and focused. as a city health commissioner for seven and a half years in new york city, i saw many ways in which cdc was terrific in helping local areas respond and other areas that can be improved. the third area is global. globally, cdc does a lot run the world to help other countries track health problems. that is in our own interest as well. with h1n1, are on the world, lab experts and epidemiologist to were able to tell us what is going on and track the virus to a large extent in some lower

income company -- lower income countries. >> those are the sexy areas. fighting h1n1 and fighting scary viruses. but there are all lot of other things on your plate and a lot of improvements to be made. can you talk about some of those areas? we have understood for years there are people at cdc the feel neglected, and happy and unmotivated. what will you do to reenergize the people working in some of the of our areas? >> cdc handles a very broad range of health problems. we have to continue to address the communicable diseases, infectious diseases like h1n1, hiv, sexually transmitted diseases and so on. at the same time, we need to strengthen our work in non communicable diseases. i have said before that public health as a great job monitoring and controlling diseases and conditions that kill people 100

years ago, but not a great job on a train and controlling the leading causes of death today. that include smoking, obesity, high blood pressure, heart disease, stroke, all qualities, problems that are the leading causes of illness and death today. there are things that can be done to understand them better and control them better. >> are you going to try to carry the same kind of big stick you did in new york city? you have talked about taxing junk food. is that something be cdc can get into? >> we have to look at what are the leading causes of illness and death and what can be done about them. all lot of those things will be done at the state and local level. if you look at what happened with tobacco control, we have much farther to go. there are still 45 million smokers in the united states today. 1000 people will be killed by cigarette in the united states. we have had some real success -- the number of male smokers has

been cut by two-thirds over the past few decades. our recent progress in tobacco control the stalled and we need to do more. but you have 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 we can make a difference with. no one could have predicted a couple of decades ago the obesity epidemic would have gotten as bad as it has as quickly as a pass. the number, the proportion of americans who are obese has doubled in just a couple of decades. that's not because our genes have changed, they have not. that's because our tastes that change -- is not because our chape -- our tastes have changed. we are hard wired to like sweet and salty foods. our environment has changed. there's more unhealthy food, it's accessible and cheaper.

there is less healthy food. it's harder to get to and more expensive. until we change that environment, we're not going to tip the scales on the obesity epidemic we're living through. not only does of the city caused lots of health problems, but it is driving the increase in health-care costs to a large extent in this country. >> dr. frieden, we are time. thank you for being on "newsmakers." >> thank you very much. >> let's start with the swine flu. what did you learn from him compared to what the president's team said about it? >> it's interesting. the cdc in the last couple of days have distanced themselves from some of the press coverage of what came out of the report. the report itself was a fairly balanced report written by scientists who are not normally a ball in medical issues with the exception of one doctor who used to head the nih and was on

the panel who wrote the report. people tend to jump on the scary numbers. that 90,000 number became a huge issue in the media. some of us who had been writing about the flu for a long time were surprised at the play that got. dr. frieden reflected that. it's a bit exaggerated. we have known that fluke and cause a huge number of deaths very quickly if it takes off badly. this blue does not look like it's going to do that. the preparation is based on a worst-case scenario. -- this fluke does not look like it's going to do that. -- this flu does not look like it's going to do that. you want people to pay attention and be concerned that if their child sews symptoms that they don't just send them to school and go off to work. they also don't want people to panic, so that will be a fine line. >> what about vaccine

availability? >> he was not optimistic was going to be much earlier than mid october. that is what a lot of the concern is. kids are back in school and there are already schools experiencing clusters of illness. the question is how rapidly bullets start? it doesn't usually start until october or rubber, but this looks different. >> he had mentioned that a billion dollars had been invested so far but there was still questions about availability. >> making vaccines is a slow process. we rely on 40-year-old technology to make vaccines. some companies are trying to come up with quick ways to do it, but the process is very slow. there was an incident with swine flu in 1976 when a lot of people were vaccinated and surveillance showed a lot of side effects. it was never clear this side effects caused by the vaccine, but caused doubt about the safety of vaccines. people don't like getting shots and will look for an excuse not to.