Javier Guzman, Center for Global Development debriefs on the High Level Meeting on Anti-Microbial Resistance held in New York City on September 26. Successes took several forms: significant new data, analyses, and projections; a political declaration committed to the creation of a scientific panel; elevation of equity of access and accountability; a target to reduce deaths by 10% by 2030; and agreement to convene again in 5 years. The panel has to be seen as a joint enterprise between the north and south. Emerging economies are getting more engaged. There are serious reservations among many countries that are heavily dependent on animal production. We do not have much visibility into what is happening in China. Data remains elusive. The $100m target of national governments commitment is “a drop in the ocean.” There is an urgent need for creative, large-scale financing and plans to bring to scale access to AMR technology. Countries themselves have to take control and commit. 

Dr. Michael Osterholm unpacks the history of H5N1, as we struggle with the question of whether the current H5N1 outbreak may pose a grave threat of a human-to-human pandemic. "It’s possible that H5N1 may never get over the bar for human disease and we don’t know why.” He also speaks to what we are likely to face in the months ahead from the mpox clade 1b outbreak, centered in Africa. 

Nidhi Bouri, DAA at USAID Bureau for Global Health, joined us to speak to the U.S. response to the dangerous mpox outbreak (clade 1b) centered in the Democratic Republic of Congo, boosted by President Biden’s commitment at UNGA to $500m in support, including 1 million vaccine doses. Much better data is urgently needed on the needs for diagnostics and vaccines. Tensions remain high among Africa CDC, WHO, and other key institutions with proven response capability, most notably Gavi, UNICEF and the Global Fund. Much is not known about modes of transmission, and the durability and efficacy of the Jynneos vaccine for clade 1b. As the virus inevitably lands in the United States, communications will be critical. Some important progress was seen in the High Level Meeting on anti-microbial resistance. The Marburg outbreak in Rwanda is of acute concern for multiple reasons: no vaccine, little testing, little knowledge of the pattern of spread. It is crunch time, as multiple replenishments converge. “Let’s be clear, there is not enough money.”

Dr. Jerome Adams authored his 2023 memoire, Crisis and Chaos: Lessons from the Front Lines of the War Against COVID-19. In it, he reflects on his upbringing in southern Maryland and the acute “hurting” among many citizens, rural and poor, dissatisfied with the status quo. Profoundly impactful to his tenure as Indiana State Health Commissioner was managing the opioid, Hepatitis C, and HIV outbreaks in Scott County, IN. As U.S. Surgeon General, he carried forward his enduring commitment to the overdose reversal drug, naloxone. During Covid, politics and toxic partisanship severely hampered the US response. “We keep playing whack-a-mole.” Upgraded communications were urgently needed. The attacks from within the Trump White House upon Dr. Fauci were paralleled by attacks on public health officials at state and local levels. Give a listen to learn more. 

Dr. Anthony Fauci sat down with J. Stephen Morrison, CSIS, on August 13, for a conversation on his remarkable 54 year career of service as a doctor and scientist. Listen to hear about his early upbringing in Bensonhurst, Brooklyn; his Jesuit training; his expansive leadership at NIH on HIV/AIDS in the darkest days; the creation of a position of influence in science and public health unprecedented in American history, tied to the trust and confidence of six presidents; and, of course, his confrontation with President Trump during Covid and Trump’s campaign to discredit and damage him.

Dr. Megan Ranney, the dynamic, charismatic Dean of the Yale School of Public Health, joined us to illuminate the strategy she has pioneered to curb firearm injuries and deaths in America. It is a true epidemic that begs a serious public health approach. It requires coming to terms with suicide and homicide in America—both sensitive, disturbing phenomena. It requires a concentrated focus on data gaps, research investments, effective interventions, and scaling the response. Together these actions hold the promise of reducing deaths and injuries by 50 percent. Many commonsense actions are steadily achieving major gains, including safe storage of weapons, better engineering of weapons, fostering a community of dedicated researchers, and introducing economic incentives that favor safety. In combination, these are demonstrably raising hope, even in the face of enduring stigma and skepticism, political divisions, gaps in knowledge, and misinformation and disinformation. Come listen for the full story.    Please note this episode contains subject matter relating to gun violence and the topic of suicide. Listener discretion is advised.

With the International AIDS Society’s 25th global conference taking place next week in Munich, Mark Lagon, Chief Policy Officer at Friends of the Global Fight Against AIDS, Tuberculosis, and Malaria and Bennett Freeman, Associate Fellow with Chatham House, joined Katherine to discuss a new Friends report regarding the role of the private sector and civil society organizations in advocating for global health programs, including HIV services. Lagon and Freeman argue that in a period during which restrictions on civic space seem to be increasing in many countries around the world, there is a business case to be made for the private sector in defending civil society organizations’ efforts to promote respect for human rights, monitor for equitable access to services, and encourage transparency and accountability within global health programs and beyond.

Leonard Rubenstein is Professor at Johns Hopkins Bloomberg School of Public Health, non-resident Fellow at CSIS, and Chair of the Safeguarding Health in Conflict Coalition. He joins us to unpack the Coalition’s 11th annual report on 2023. Four big wars—Ukraine, Myanmar, Gaza, Sudan—are driving up attacks upon civilians, and deaths, to exceptionally high levels. At the same time, attacks on the health sector reached over 2,500 recorded incidents in 2023, a 20% increase over 2022. Attacks on hospitals are often part of a deliberate, targeted military strategy. In other instances, they are a result merely of “contempt and indifference” as combatants wage war indiscriminately. What can be done, if policy is typically “hand-wringing” and “total impunity”? There could be breakthroughs through investigations and prosecutions in Ukraine and the International Criminal Court’s actions in the Israeli-Gaza war. Over time, we do see progress at the UN High Commissioner on Human Rights and the World Health Organization.

Dr. Raj Panjabi, former NSC Senior Director for Global Health Security and Biodefense, shares his personal story, his deep ties to Liberia, the genesis of Last Mile Health, the profound lessons that emerged from Ebola in Liberia. In his time (2021-2023) heading the President’s Malaria Initiative and serving at the NSC, what accomplishments is he most proud of? Alternatively, what were the toughest revelations? As the ground shifts politically in America, what strategy might sustain and renew global health as a priority? Give a listen.

This episode is the lively conversation J. Stephen Morrison had the pleasure to hold with Dr. Angela Apeagyei and Dr. Chris Murray, IHME at CSIS on May 14. It begins with the compelling findings of the 15th IHME annual report Financing Global Health 2023. Global health is beset by high interest rates, the rising claim on resources for climate, costly geopolitical ‘forever’ wars, and an era of populism and multiple elections. What are the elements of a proactive, updated strategy to sustain support for global health? Give a listen!

France’s dynamic Ambassador for Global Health, Anne-Claire Amprou, visited CSIS for an extended conversation on the topline historical challenges that her office addresses: elevating climate’s health impacts, the pandemic treaty negotiations and reform of the IHR, anti-microbial resistance (AMR) in the year of the UN General Assembly High Level Meeting in September, navigating multiple ambitious global health replenishments amid scarcity, investing in workforce training, the WHO academy in Lyons, strengthening the French-US relationship, and France’s special engagement on the humanitarian crisis in Gaza. Give a listen! 

The inimitable Jennifer Kates, KFF, joins us to make sense of the multiple, convergent, competitive replenishments of the most significant instruments in global health – the Global Fund, Gavi, the Pandemic Fund, WHO at historic moment of intense geopolitical tensions and big, costly wars, the ascent of climate, fiscal scarcity, many elections in the populist era, and post-pandemic fatigue. The US elections are stirring high anxiety across the globe. Attention is focused on the Project 2025 blueprint for a Trump victory. Where is the hope and optimism? Give a listen.

In the fifth episode of the CommonHealth Live! series, J. Stephen Morrison speaks with Dr. Sandro Galea, Dean and Robert A. Knox Professor, Boston University School of Public Health on the public health workforce pipeline. How to position public health schools and departments within universities to be more powerful, better funded, with better access to senior leadership? What are the concrete changes in the curricula of public health programs and the recruitment of faculty and students that are going to be most essential to meet the demands of the post-Covid era and correct the drift into illiberalism? How to make the case more effectively that public health is a national security measure? 

In our ongoing series on climate and health, we had the great fortune to enlist a friend and colleague, Noam Unger, Director of the CSIS Sustainable Development and Resilience Initiative, to discuss PREPARE, the President’s Emergency Plan for Adaptation and Resilience. Why did it take so long for adaptation to rise in significance?  PREPARE is “a presidential initiative that is not coming with a big bag of money along with it,” which means its principal focus is coordination around food, water, health, infrastructure, data forecasting, and financing and insurance. What might that achieve? Is it meaningful to compare its prospects with those of PEPFAR? How to build a geostrategic rationale, a program framework, and a mixed constituency for PREPARE incrementally over time? Give a listen to the answers to these questions and more.

Since the start of 2024, several countries in South America have experienced a rapid increase in cases of dengue, a viral disease transmitted by the aedes aegypti mosquito. According to the Pan American Health Organization (PAHO), this year alone at least 18 countries in the Americas have reported cases, with more than 400 deaths. In Peru, at the end of February, the government declared an emergency in 20 districts, setting up makeshift clinics and sending additional financial and human resources to affected areas. Dr. Andrés (Willy) Lescano, who leads the Emerging Infections and Climate Change Research Unit at Cayetano Heredia University in Lima, Peru and was one of the co-authors of the Lancet Countdown on Health and Climate Change 2022 report on South America, explains why it has been so challenging to control aedes aegypti mosquitoes in the region, the extent to which urbanization, global warming, and the el Niño phenomenon are driving the current outbreaks, and steps that can be taken to better prepare the health sector for future crises associated with a changing climate.

In the fourth episode of the CommonHealth Live! series, Vanessa Kerry, World Health Organization (WHO) Director General Special Envoy for Climate Change and Health and Austin Demby, Minister of Health and Sanitation for Sierra Leone join Julie Gerberding, CSIS Bipartisan Alliance for Global Health Security Co-chair and CEO of the Foundation for the National Institutes of Health for a discussion about the intersection of climate change and global health. How do you make new partnerships around climate and health work? What are the expectations for wealthy countries and the United States in particular to find solutions to these challenges? How do you make the case for climate and health in a divisive environment, with scarce financial and political resources? 

Donald G. McNeil, the prize-winning science and health reporter—45 years with the New York Times—unpacks his newly published memoir, The Wisdom of Plagues. It covers his remarkable personal and professional story, his reflections on the travails facing PEPFAR, the stark lessons of Covid, his "radical" prescriptions for the future, and his reflections three years after abruptly departing the NYT. 

In the third episode of the CommonHealth Live! series, World Health Organization (WHO) Senior Advisor Dr. Scott Dowell joins J. Stephen Morrison for a discussion about the Global Health Emergency Corps (GHEC) concept, development thus far, and plans for 2024. What will it take to bring GHEC to life? What might the U.S. role be?

Dr. Sandro Galea, Dean of the BU School of Public Health, discusses his incisive, provocative new book, ‘Within Reason.’ Its central proposition: public health slipped into illiberalism during Covid-19, a “closing of the mind.” Over the course of the book, Dr. Galea unpacks that striking phenomenon: how and why it happened, what it means, and what needs now to happen to correct course? The loss of trust is the most poignant but not the only price. Give a listen!

Joseph Majkut, Director of the CSIS Energy Security and Climate Change Program, unpacks the big picture of COP28 (Dubai, Nov. 30-Dec 13, 2023), both the formal negotiations and the “trade show.” Is the commitment to “transition away” from fossil fuels a truly pivotal moment? What’s the significance of the launch of the "Loss and Damage Fund" especially with regard to tensions between the North and the South? What to make of the day dedicated to health and climate? How to assess UAE leadership? Ultimately, Dubai is not likely to stand shoulder-to-shoulder with Paris and Kyoto. It’s more of a “punctuation mark.” Give a listen!

In the second episode of the CommonHealth Live! series, J. Stephen Morrison speaks with International Rescue Committee (IRC) President and CEO David Miliband about the recently released IRC 2024 Emergency Watchlist. The onset of 2024 has brought with it record levels of humanitarian crises. How and why are global humanitarian crises evolving? How do we address these unprecedented global challenges? What can be done to reduce the impact on affected communities? This event is made possible by the generous support of the Bill & Melinda Gates Foundation. 

Dr. Yanzhong Huang, Council on Foreign Relations and Seton Hall University, argues in the CFR report Negotiating Global Health Security (co-authored with Georgetown Professor Rebecca Katz) that the US-China clash over Covid-19 origins in Wuhan has had a catastrophic impact on US-China relations. A "détente" is now needed. But how is that to be achieved, given the multiple ongoing geopolitical crises? Given what is happening in Congress vis-a-is China? And given that political will at the highest levels is the most significant missing element? “Avoidance” post-Covid has taken root there. Give a listen to hear the answers. 

On the occasion of National Influenza Vaccination Week, former Senate Majority Leader Thomas Daschle, chair of the Coalition to Stop Flu, joins us to discuss the Coalition’s mission and composition, its recent compelling report, ‘The 2022-2023 Influenza Season: Outcomes and Policy Recommendations,’ and the comprehensive legislation it has had a hand in crafting and advancing, The Influenza Act (S. 3219, H.R. 5846 – 118th Congress 2023-2024). Senator Daschle is alarmed by the decline in vaccination levels – a national security threat – combined with the spread of mis and disinformation and the urgent imperative to forge new communications capabilities to rebuild trust and confidence. Trusted messengers, new public-private partnerships, determined and collaborative leadership, additional resources, and hard work: these are essential elements for turning things around. Health equity must also be elevated as a top priority, with a special focus on the elderly, pregnant women, children, and racial and ethnic minorities. Much more work is needed to improve testing capacity and develop new antivirals for flu. 

In this episode recorded in advance of World AIDS Day 2023, Katherine speaks with Ambassador John Nkengasong, U.S. Global AIDS Coordinator and Senior Bureau Official with the Bureau of Global Health Security and Diplomacy at the U.S. Department of State. They discuss the current challenges around PEPFAR reauthorization; opportunities for enhanced U.S. diplomatic engagement to strengthen domestic and donor funding for global HIV programs; the critical role youth organizations can play in promoting equitable access to HIV prevention, diagnostics, and treatment; and why it is important to involve communities of people living with or at risk of HIV in policy development and program implementation. Check out the video here!

In this episode, Heidi Larson, Professor of Anthropology, Risk and Decision Science at the London School of Hygiene and Tropical Medicine, speaks with Katherine about the goals of the Global Listening Project, which is focused on “driving real understanding and positive action to better prepare society for times of crisis.” She shares information on the Project’s recent survey results regarding how people in more than 70 countries experienced the Covid-19 pandemic; how people perceive, trust, and adopt new technologies, such as digital apps or mRNA vaccines; and why people in some countries in sub-Saharan Africa seem to be more optimistic than people in other parts of the world about the potential of their health systems to respond to future outbreaks and health crises.

In this episode Merck’s Jenelle Krishnamoorthy, a member of the CSIS Bipartisan Alliance for Global Health Security, joins Katherine to discuss the growing challenge of antimicrobial resistance (AMR); the importance of incentivizing research and development of new amicrobials, even as there is pressure to use them in a limited way; plans for a United Nations High-Level Meeting on AMR in 2024; and opportunities to improve funding, governance, and international collaboration to meet the global threat of AMR in the years to come.

Dr. Dylan George, Director of the CDC Center for Forecasting and Outbreak Analytics (CFA), walks us through the CFA’s status, almost two years after its launch. Though still a startup, CFA has modeled multiple outbreaks, including Omicron, Mpox, and now the respiratory virus season (Covid, RSV, flu). Its clients? The White House and executive agencies, and increasingly, state, local and territorial officials. Its products? October 24, it issued its Respiratory Season Outlook. On November 8, CFA launches its $262 million/five year investment in a National Network for Outbreak Response and Disease Modelling, encompassing thirteen key university and private sector expert data partners across the country. Critical to CFA’s success will be building new communications capabilities to cut through noise and distrust and build trust and confidence.

Dr. Suerie Moon, Co-Director of the Global Health Center and Professor of Practice, International Relations and Political Science, walks us through the status of the pandemic accord negotiations (underway for two years), the recently released new draft, what lies ahead in the next round of deliberations, and how that diplomatic process relates to parallel negotiations underway over reform of the International Health Regulations (IHR). The draft treaty speaks to four core issue sets: One Health; access and benefits sharing (ABR); countermeasures (including intellectual property, R&D, technology transfer); and financing (including “common but differentiated responsibilities”). Today, there is “lots of space to bridge.” While the negotiations are not likely to cross the finish line in May 2024, that does not necessarily signal failure. “More time is needed.” A breakthrough in a few areas by May 2024 could sustain progress. The U.S. negotiating role remains “incredibly important.” Remarkably, in these polarized and difficult geopolitical times, these dual talks have not yet been torn apart. The focus remains on health, with a newfound belief in equity as a guiding norm.

Len Rubenstein shares his trenchant, mixed reflections from a September visit to Ukraine, specifically the multiple burdens that the war imposes on Ukrainian society. Ukrainian morale and resolve remain strong, though gaps persist in medical rehabilitation services, including prostheses for soldiers who have lost limbs. 500 Ukrainian military medics and reportedly 20,000 Ukrainian civilians are currently held in Russian prisons, in violation of international law. Almost everyone points to the high level of mental health disorders. The war itself has changed: Russia has created the world’s largest mine fields.

Dr. Eric Goosby walks us through the Lancet Commission report on tuberculosis—which he chaired—that was issued immediately prior to the September 22 UN High Level Meeting on TB. The environment for progress remains very tough—shortfalls in political will, prioritization, finances, and investment by industry. But there are recent, promising gains in diagnostics and therapies. And a promising vaccine, M72, is now in advanced trials. That could be a breakthrough in the future. GSK, in partnership with Gates Foundation and Wellcome Trust, are investing $550m in fields trials across Africa and Southeast Asia. What was the significance of the High-Level Meeting? It generated a detailed agenda to which national governments should be held to account. Eric closes with personal reflections on the passing of Senator Dianne Feinstein.

Kate Dodson, UN Foundation and Nellie Bristol, CSIS Senior Associate, survey the outcomes of the UN General Assembly during the third week of September, with a special focus on SDGs and the health High Level Meetings (HLMs on pandemic preparedness and response, TB, Universal Health Coverage). Big cross-cutting themes emerged–gaps in finance, equity, health workforce, access, R&D, and intellectual property. Results were decidedly mixed: “process got in the way of ambition.” Overload carries a price, as do acute geopolitical tensions. Senior U.S. officials “showed up” at every point. President Biden spoke early about the SDGs–before Ukraine. What happened in New York may help nudge the negotiators in Geneva working on the pandemic accord. The results in New York may argue for greater precision in the 2024 High Level Meeting on Anti-Microbial Resistance (AMR). One resounding signal–members of the African Union were exceptional in their engagement. 

In this episode of The CommonHealth, we share the audio of a September 11 conversation among several different CSIS scholars on the question of whether the climate shocks of this summer were simply a continuation of underlying trends – an exclamation point – or a thunderclap signaling the arrival of a new moment. Hear from economist Stephanie Segal, climate scientist Joseph Majkut, water and food security expert Caitlin Welsh, and CommonHealth’s co-host, J. Stephen Morrison. 

Dr. Scott Dowell, the Bill & Melinda Gates Foundation, unpacks the foundation’s $2 billion in investments during the three-year acute phase of the pandemic. Some of the most impactful were in surveillance and modeling. The Seattle Flu Study, which predated the pandemic, was fortuitous in what it taught us. Bill Gates’ 2022 book, How to Prevent a Pandemic, introduced the concept of ‘the GERM team’ which has now evolved into the Global Health Emergency Corps, led by the World Health Organization. What are the GHEC’s component elements, and how will it be launched? The foundation continues to engage intensely with the Chinese: what is to be gained? What lessons have emerged from China’s experience? Current foundation R&D priorities include scaled diagnostics, early start of broad spectrum anti-virals, and vaccines in 100 days. On surveillance, priorities are sequencing and wastewater testing. End of the day, “I am optimistic.”

Dr. Celine Gounder walks us through what to expect as the fall respiratory virus season unfolds—the ‘tripledemic’ of Covid, flu, and RSV (respiratory syncytial virus). Promising new vaccines are becoming available amid confusion, disinformation, and burnout of the health workforce. Competent communications remain essential, though “most people do not believe the lies or the truth.” The elderly and the immunocompromised stand to gain the most from these vaccine opportunities. In the post-Covid moment, ‘hyperlocal’ leaders and the business sector matter enormously in shaping the response. 

In this episode of The CommonHealth, Andrew Schwartz engages Michaela Simoneau and co-host J. Stephen Morrison on their newly published analysis of the post-Covid moment, “The Worst is Over—Now What?” How do we define this moment we have entered, and what are the factors that lead inexorably towards pessimism? Inversely, what is the argument for a positive, sober realism? Optimism rests on pursuing five pathways for progress: rebuild trust, sustain bipartisan legislative achievements, operationalize new security doctrines, accelerate new technologies, and elevate U.S. health diplomacy.  

According to the recent report from the WHO/UNICEF Joint Monitoring Program for Water Supply, Sanitation and Hygiene, coverage of safely managed water and sanitation supplies has improved globally since 2000, but the world is not on track to meet the Sustainable Development Goal targets related to universal coverage. Placing a special emphasis on gender, the JMP report notes that inadequate access to water and sanitation, as well as hygiene services, affects men and women in significant, but different, ways. In this episode, Sera Young, Associate Professor of Anthropology and Global Health at Northwestern University and senior associate with the CSIS Food and Water Security Program, discusses the relationship between gender and water, sanitation and hygiene (WASH) and explains why it’s important to gather data, not just about men’s and women’s access to water and sanitation infrastructure but also about how individuals’ experience of water insecurity affects their physical and mental health. Armed with data about access and impacts, communities can raise awareness, demand policy change, and oversee improvements in the WASH sector.

In this episode, Anuradha Gupta, President of Global Immunizations at the Sabin Vaccine Institute, discusses key findings from the new World Health Organization-UNICEF Estimates of National Immunization Coverage (WUENIC). The latest report shows that countries are beginning to recover from decreases in coverage observed during the pandemic, although there is considerable regional and sub-national variation, and some low-income countries continue to show stalled progress. Gupta emphasizes the importance of examining community experiences to understand where greater effort needs to be made and stresses the need to build coalitions of civil society, patient advocacy groups, the private sector and governments to promote equitable access to, and uptake of, vaccines.

Gary Edson, Covid Collaborative, reflects on the President’s Emergency Plan for AIDS Relief (PEPFAR), now at its 20th anniversary. It originated with a Republican president, George W. Bush, who transformed development assistance. Bipartisanship was vital, and PEPFAR fulfilled moral and geostrategic goals. Now, PEPFAR reauthorization is in peril in the post-Dobbs era. What needs to happen to rescue things? In the toxic, polarized post-Covid era, how do we step over that noise and bring about a new conversation about topline goals to protect Americans on a bipartisan basis? Give a listen!

Sheryl Gay Stolberg, NYT national correspondent on health and politics, unpacks the post-Dobbs era: does it imperil or boost the right to contraception? Or both? Does it put the President’s Emergency Plan for AIDS Relief (PEPFAR) under new scrutiny? Calls to “take a fresh look” at PEPFAR may signal trouble. “Abortion politics is laying over all of our conversations” in this “super-partisan era.” In the post-Covid era, the reporting environment has loosened. Why is it that filling the US leadership gap in science and health is moving along so slowly? What should we make of RFK Jr’s arrival on the scene, a figure in the larger campaign to vilify Dr. Anthony Fauci? What can we expect in the coming battles over Medicare drug pricing following the Inflation Reduction Act? 

Dr. Mitch Wolfe, former CDC Chief Medical Officer, explains the genesis of CDC’s vision for six regional offices as a “long-term permanent overseas presence” that would expand coverage, deploy senior staff to develop regional strategies, and provide specialized technical expertise. Geopolitical security calculations predominate as CDC gets more involved in politics and policies. Proximity builds networks and knowledge. To succeed, the CDC regional offices will need strong leadership, an aggressive mandate with backing from Washington and Atlanta, and serious sustained funding. Mitch also opines on Rochelle Walensky’s legacy leading CDC and living in London these past months amid the UK’s acute economic and political travails. 

Helen Branswell, STAT, unpacks for us important complicated topics that can, frankly, be confusing. She explains why this is a big moment for Respiratory Syncytial Virus (RSV). She illuminates why GAVI is moving ahead with a hexavalent (6-in-1) vaccine that incorporates polio vaccines, and what that signals for the future of global polio control. In her recent profile of Mandy Cohen, the incoming CDC Director, Helen reflects on the changed understanding of what is required to lead CDC effectively. In the post-Covid period, how has health reporting changed?

Dan Diamond, Washington Post, reflects on big emerging themes. The administration’s scientific, biomedical, and public health leadership has emptied. What should we make of Mandy Cohen’s appointment to be the next Director of CDC? With the turnover, who will be the “quarterback” of government during the next crisis? Congressional panels are raising “uncomfortable” questions about Covid's origins. It is an “open question” what happens with the reauthorization of PEPFAR and the Pandemic All-Hazards Preparedness Act (PAHPA). The shift of opinion against NIH and CDC will leave “the brands damaged.” Presidential campaigns—Governor DeSantis’ attacks against “Faucism” and RFK Jr’s anti-vaxxer efforts— offer “nothing good for public health.” Attacks upon science and public health have far more energy than the defenders. “Easier to play offense than defense.”

Twenty years after President George W. Bush signed the U.S. Leadership Against HIV/AIDS, Tuberculosis and Malaria Act of 2003, establishing PEPFAR, David Kramer, the Executive Director of the George W. Bush Institute in Dallas, Texas, discusses the process of establishing the multi-billion dollar program at the Department of State; how ensuring equitable access to health care services for vulnerable and marginalized populations is important for national security; how investing in HIV services and partnering with countries to strengthen health care improves the relationships of the United States with countries overseas; and why it’s important that Congress reauthorize PEPFAR later this year. 

Jeremy Konyndyk, President of Refugees International, is a humanitarian leader, emergency operator, and policy innovator. He joins us to share his thoughts on diverse crises. During the Turkey/Syria earthquake, donors failed to surge resources to Syrian civil groups, something that is indefensible a decade plus into Syria’s war. U.S. policy on the southern border is narrowly understood to be law enforcement versus protection of rights of individuals in flight, a disappointment not expected of the Biden administration. USAID has struggled to overcome its internal divisions to begin building an enduring emergency health security response capability. American opponents of public health and science are winning the battle for opinion and influence, with little political leadership pushing back from the opposing side. After the Russian invasion of Ukraine, many low- and middle-income countries rejected the West’s appeals for solidarity. The West had shown “zero solidarity” for their needs during the pandemic. With Ukraine, those countries are now responding “in kind.”

Matt Goodman, CSIS SVP and Simon Chair in Political Economy, unpacks the several striking developments at the recent G-7 Summit in Hiroshima. Russia’s invasion of Ukraine has unified and energized the G-7, with side benefits in economic security, nuclear disarmament, food security, health and climate. With the Ukrainian counteroffensive imminent, the G-7 made multiple specific commitments on Ukraine. On China, “economic coercion” and “de-risking” were the watchwords. Paragraph 51 of the communique laid out nine specific items on China, an unprecedented step. On health, President Biden committed an additional $250m to the Pandemic Fund, nudging his G-7 peers. The G-7 reaffirmed in detail its consensus on UHC, global health architecture, R&D of new technologies. Anti-microbial resistance (AMR) enjoyed higher salience, as did health reconstruction in Ukraine and violence in multiple wars targeting the health sector. The Covid origin stalemate was deliberately downplayed, while the Global Health Emergency Corps merited a mention.

Adam Havey, Executive VP, Emergent BioSolutions, speaks to the “great unwinding” with the end of the Public Health Emergency, including the outstanding work to bring about adequate sustained funding for preparedness capabilities. To keep long-term bipartisan investment front and center, “lead with the facts.” 8 in 10 voters favor government action. There were several hard lessons at the Bayview facility in Baltimore, where over 500 million Covid vaccine doses were contaminated. How do we rebalance the Strategic National Stockpile? Over-the counter sale of Narcan (naloxone spray, used to reverse opioid overdoses) will face several challenges but overall be a net positive. The Pandemic All-Hazards Preparedness Act (PAHPA) will be critical to predictable funding, strengthened ties with industry, and workforce development. 

Dr. Ashish Jha, the White House Covid Response Coordinator, speaks to the “great unwinding” of the $4.6 trillion pandemic wartime transformation of America into a temporary social democracy. As we rush to the exits, are we emerging stronger? We do see huge turnover of public health leadership across the country, a real loss. We also see that cities and states, the front lines, have “learned a ton” about Test to Treat, mass vaccination. Will we transition out of this “collective trauma” of anger and “amnesia?” How will this pandemic transform public health itself? The White House is to stand up a new office to lead pandemic preparedness, at a time when U.S. scientific and public health leadership is depleted. What can we realistically expect? As he prepares to exit, what has Dr. Jha learned in the past year?

Joe Grogan, former Assistant to the President and Director, White House Domestic Policy Council in the Trump Administration, shares his insights on several outstanding policy challenges. How has the Inflation Reduction Act (IRA) reshaped innovators’ investment patterns in new drugs, and what adjustments might improve outcomes? It will be difficult to keep the proposed Next Gen $5 billion for Covid vaccines and therapies at the top of the agenda on the Hill, in the absence of strong figures like Senators Burr and Kennedy. While the NIH budget needs to be re-prioritized, CDC needs “massive cultural change.” Progress on anti-microbial resistance and steering the Pandemic All-Hazards Preparedness Act to a successful re-authorization each rest ultimately on leadership.

“Not all U.S. states struggled equally.” Thomas Bollyky, CFR, led an ambitious, nuanced effort to break down Covid outcomes across 50 states and Washington DC, published in the Lancet in April. There is a striking four-fold difference between the best and worst performing U.S. states. Some of the best states, led by Republican and Democrat governors alike, rivalled the best performers in Europe. High-performing states provide a formula for success which may be helpful in the future. Pre-pandemic differences were decisive—poverty, education, and race. Partisanship and politics skewed results. “Trust plays an outsized role.” The current hardening of opinion today in America remains a cause for worry.

As World Immunization Week gets underway, Professor Heidi Larson, anthropologist, founder of the Vaccine Confidence Project, and co-founder of The Global Listening Project, discusses the importance of closing the gaps in routine immunization coverage that have widened during the Covid-19 pandemic; describes why trust in health care providers has declined as beliefs about health and scientific expertise have become more polarized; and explains that in order to reach people with information that can help them respond effectively to crises, whether pandemics, climate change, or other emergency situations, it's important to really listen to people's concerns and articulate practical solutions that directly respond to people's needs. 

Sachiko Imoto, SVP, Japan International Cooperation Agency (JICA), is the lead on JICA’s human development work. In our conversation, she illuminates several key dimensions of Japan’s policy. What health gains will the Japanese Presidency of the G7 in 2023 generate? Both the U.S. and Japanese governments are committed to supporting the Pandemic Fund, Universal Health Coverage/primary care, surveillance, and equity and access to new countermeasures. What are the areas where Japanese-U.S. cooperation in health security could most profitably deepen? What concrete benefits could result from this alignment? How does the U.S. decision to launch a regional CDC office in Tokyo fit within the evolving geopolitical environment in Asia? How to address the intersection of health and climate change, Misinformation, conspiracy, decline of trust, and, of course, China? Give it a listen!

Dan Jørgensen, Denmark’s Minister for International Development and Global Climate Change Policy, reflects on a busy week of spring meetings at the World Bank, the importance of considering gender equality in supporting climate adaptation programs, the growing challenge of antimicrobial resistance in the context of climate change, and the role the private sector can play in helping to advance climate mitigation and adaptation projects.

We sit down again with Victor Cha, Professor at Georgetown University and Senior Vice President at CSIS, for an update on what we know, suspect, and do not know about a North Korea still in extreme isolation from the rest of the world; the status of its Covid outbreak and response; the heightened risk of famine; and the burgeoning exchange of North Korean weapons and ammunition in return for Russian food and energy. A narrow reopening with China is underway, while the continued high pace of missile launches is unnerving much of the world and is crowding out humanitarian considerations. The international presence inside North Korea remains miniscule. How might this isolation be cracked? Give a listen. 

Professor Jennifer Nuzzo, Brown University SPH Pandemic Center, reflects on the recent March 28 hearing that the House Select Subcommittee on the Coronavirus Pandemic staged on school closures. The subject remains “a political football.”  But “we now better understand the potential harms. We have not all suffered the same harms.” Progress possible? Not clear, given how toxic the politics has become. Need to “take down the heat.” “We need a national plan for schools’ recovery.”

Dr. Raquel Bono, a recently retired, highly accomplished 3-star Admiral as 2020 opened, unexpectedly found herself advising Washington State Governor Inslee at the very advent of the pandemic. What did she experience and learn over the next six and a half months? Subsequently she became the chief medical officer for Viking Cruises, as it reopened its operations. What did that reveal, in particular about its interactions with CDC? Her views on Congress rescinding the mandate for Covid vaccines among US servicemen and women?

Sheryl Gay Stolberg, the iconic health policy/politics reporter at the New York Times, helps us inaugurate The CommonHealth podcast, companion to the newly launched CSIS Bipartisan Alliance for Global Health Security. Her recent prodigious output delves deeply into the evolving – and thoroughly confusing – story of the swirling debate over Covid origin in China. The Biden administration will soon declassify what intelligence it has on the Wuhan Institute of Virology: what might that mean? Will it cast light on the Institute’s cooperation with the Chinese military? Is a legitimate civil debate possible in America? Will we ever get the evidence to reach serious conclusions? Yikes! Give it a listen.

Welcome to The CommonHealth, the podcast of the CSIS Bipartisan Alliance for Global Health Security. The CommonHealth replaces the Coronavirus Crisis Update. In it, we delve deeply into the puzzle, at home and abroad, that connects pandemic preparedness and response, HIV/AIDS, routine immunization, primary care, and the geopolitical impacts these have on human and national security.

Sam Radwan, founder of Enhance International, has worked on health developments inside China for two decades. He shares his insights and raises some difficult questions. Over 80 year olds continue to be highly vulnerable; only 66% have been vaccinated. China’s 400 million rural poor live with starkly different medial support realities, and we have little visibility into what they are experiencing. An increasing number of Chinese will be traveling abroad to seek medical care, as medical literacy rises. Hong Kong is gearing up as a medical center. Can we imagine a radical decoupling in the health sector, between China and the United States? The deterioration of the US-China relationship is pushing in that direction and will have consequences for reform of the health care sector in China. We need to watch the Chinese government’s drive to restore economic growth. His hope: “cooler heads will prevail” as we realize we need one another in health.

In this newest episode in our series on China, Mike Osterholm reflects. There is no easy explanation for why the Chinese government did so little to prepare while knowing Zero-Covid was failing. Even as Omicron reached an R-naught of up to 16, and 8 million elderly above 80 had received no vaccine. We are now seeing progress by the Chinese in data sharing through George Gao’s recently published Lancet paper. Luckily, there Is no evidence of a dangerous new subvariant emerging, though we have to be cautious and humble. China has experienced a massive increase in deaths. After the Omicron surge that swept the United States in 2022, Omicron settled into a “high plains” continued outbreak of 380-550 deaths per day. That pattern may be seen in China. On the Covid origin controversy, we will likely never know the source. Prospects for an informed U.S.-Chinese dialogue on preparing for the next pandemic? “We are back in the 1970s.”

Dr. Scott Rivkees served under Governor DeSantis as Florida’s Surgeon General and Secretary of Health for 27 months during the pandemic, in what became a rocky political experience. Behind the scenes, what was he able to achieve, in serving Florida’s 67 counties, and in particular, in protecting seniors, managing schools, setting early vaccine priorities? What were the hard lessons for public health professionals, as vaccine hesitancy grew, and morphed into refusal? How well did CDC fare in this period? In his current position as a Professor of Practice at the Brown University School of Public Health, how has he used his columns to push against misinformation and conspiracy theories and urge medical professionals to be more vocal?

As part of our series on China post-COVID-19, Chris Murray reflects on where things stand, almost two months after President Xi threw off Zero-Covid controls.  A huge Covid-19 wave has likely led thus far to a million deaths. It is likely not over. Don’t expect greater Chinese government transparency on numbers. That remains a highly sensitive matter domestically and, no less important, an integral component of China’s foreign policy image and prestige. The Chinese government is driving to get through the outbreak as fast as possible, tough it out, and reopen the economy. China's elderly bear the biggest toll. 

In our continued series on China post-Zero Covid, Dr. Scott Kennedy recounts the revelations from his six weeks in Beijing and Shanghai in late 2022, and reflects on what has transpired – societally, politically, medically -- since President Xi suddenly threw off the Zero-Covid controls in early December.  What is the “toll” for not preparing for the colossal speak of Covid? What to make of a “crisis of confidence” that the government has to face, that is going to “hurt?” What can we expect in the spring in terms of “normalization?’

As 2023 opens, Yanzhong Huang, Council on Foreign Relations/Seton Hall University, kicks off our new podcast series focused on China. Over the past month, since Xi threw off Zero-Covid, China has experienced an extraordinary pace and scale of infection. “The worst is yet to come” as Lunar New Year migration rush – 200 million – spreads the virus into the countryside. Why should Americans care? Are travel restrictions counter-productive? How should we think about what lies on the other side of this extraordinary outbreak?

In this 153rd episode, Doctors Kristina Box and Judy Monroe walk us through the recently concluded Indiana Governor’s Commission on Public Health. Why Indiana? What are the Commission’s mandate, methods, findings and recommendations? How did Commissioners navigate the polarization and anger? Indiana’s $55 per capita investment in public health lags far behind the $91 national average: how is Indiana to catch up? What’s CDC’s special value to Indiana’s public health? How important is the Commission to the rest of the nation?   

In Episode 152, we share the audio of the one-hour conversation J. Stephen Morrison held at CSIS on October 19 with Dr. Raj Panjabi, Special Assistant to the President and Senior Director for Global Health Security and Biodefense at the National Security Council. The focus is the launch of the new U.S. National Biodefense Strategy and Implementation Plan and the issuance of the President’s National Security Memorandum-15. What do these steps promise, in strengthening the protection of Americans and advancing U.S. leadership globally? What is it going to take to ensure success, in terms of high-level sustained political will, sustained finances, and the partnership and mobilization of state and local authorities, industry, university researchers and others?

In this special CCU episode, #151, we bring you the audio of a conversation that J. Stephen Morrison held with Dr. Ashish Jha on September 27. How is the bivalent vaccine launch going? How does the White House navigate the wildly divergent realities of the pandemic? We are living a tale of two cities: the drive to normality, built on major achievements that have lowered the threat of severe illness and death, versus persistent danger and uncertainty, and the multiple accumulating barriers to action: the fiscal, political and technological impasses, and our frayed institutions. What are his reflections, six months into the job, on the role of the White House Coordinator? Will the White House exit an emergency context in early 2023? Give a listen!

In episode 150, Dr. Daskalakis, White House Deputy Coordinator of the monkey pox response, has been at his job for six weeks, attempting an urgent turnaround of a response that went very badly initially. He looks at “his medium term crystal ball” and sees several causes for cautious optimism: a deceleration of spread, changed behavior, greater vaccine availability, greater flexibility in use of HIV and STD resources, improved communications. But much progress still hangs on far more funding, better data flows, and bipartisan political support. Listen to hear more!

In this special episode, we bring you the audio of a broadcast interview that J. Stephen Morrison held on Monday, September 19 with Dr. Fauci, Chief Medical Advisor to President Biden and Director, the National Institute of Allergies and Infectious Diseases. Dr. Fauci addresses the multiple tough challenges that confront us, as we approach year 3 of the pandemic, as well as the historic achievements that give us hope. 

Dr. Krishna Udayakumar, founding director of the Duke Global Health Innovation Center, shares his trenchant insights into this confusing moment of transition in the global response to Covid-19. What should be the priorities and the principles to guide action? How to take account of the profound changes in the pandemic, while not losing focus on equity? Please give a listen!

On this 147th episode, we are offering the fireside chat, held on August 30 at CSIS, at which CDC Director Rochelle Walensky laid out her newly announced reform agenda, moderated by Julie Gerberding and Tom Inglesby. Julie is former director of the CDC and current director of the Foundation of the National Institutes of Health, and co-chair of the CSIS Commission on Strengthening America’s Health Security. Tom is Director of the Johns Hopkins University Center on Health Security and co-chair of the Commission Working Group on CDC.  

On this 146th episode, Dr. Chris Murray, IHME, delivers several sharp messages. Tracking Covid is increasingly difficult, a function of both underreporting of cases and overreporting of incidental hospital admissions. Studies are emerging which suggest that protection against severe ill and death may be waning after 20 weeks. Without far better data on hospital admissions, however, we are “flying blind.” Essential “big” investments in next-generation vaccines that block infections and address multiple variants are expensive. Without ample funding, we will “muddle through.” The case for Paxlovid as a lead global tool is strong, but production is expensive. Is Monkeypox “a really scary thing? No!” China clings to Zero-Covid for more than health reasons. That choice is “part of a broader geopolitical strategy.” Hope rests on strong and vibrant scientific cooperation, amid multiple crises.

Dan Diamond, Washington Post, joins J. Stephen Morrison, CSIS, for a tour d’horizon of rapidly unfolding Monkeypox developments: How to explain the early egregious USG stumbles? Are we correcting course in testing, vaccines, and therapies rapidly and effectively enough to head off the entrenchment of Monkeypox? Does the math surrounding vaccines and demand add up? Or are we sailing into a profound gap? How should we be thinking strategically about the global response?

Dr. Marci Nielsen, Vice President for Policy and Advocacy at Resolve to Save Lives, joins J. Stephen Morrison for episode 144. For an 18 month period beginning in the fall of 2020, Dr. Nielsen served as Chief Advisor for COVID-19 Coordination for Kansas Governor, Laura Kelly, where she led outreach efforts across the state to advance dialogue, access to data, and transparency. Regular public fora on schools – when to close or open, promotion of tests, vaccinations, masks – were a key tool to counter rising political tensions and disinformation. Over her career, the public health sector has “never been political” to this extent, fostering a significant “lack of understanding.” “Great hope” lies in strengthening communications, the determined commitment of public health and elected officials, and youth.

Dr. Celine Gounder, senior fellow & editor-at-large for public health at KFF's Kaiser Health News, joins J. Stephen Morrison and Andrew Schwartz for this 143rd episode. Monkeypox has spread beyond the endemic regions, and is rapidly becoming a pandemic. It has already become de facto politicized in the United States because of the community affected, but monkeypox per se is not a gay disease and I will soon reach beyond men-who-have-sex-with- men and endanger the immunocompromised, pregnant women and newborns. Covid-19 taught us that we need to invest in public health infrastructure and move rally fast in introducing tests, data collection, vaccines and therapies, but the U.S. government is not moving quickly enough and at the scale required to avoid monkeypox becoming a permanent fixture in the United States. BA.5, the latest Covid variant, is moving very quickly because its spike proteins are so different from other variants that people are losing residual immunity. New vaccines are in development, but BA.5 may no longer be the dominant variant by the time they become available. 

Dr. Margaret Bourdeaux, Research Director of the Global Public Policy and Social Change Program, Harvard School of Medicine, joins J. Stephen Morrison for Episode 142. Her mentor Dr. Paul Farmer, who recently passed, inspired her with his exhortation to “do hard things together” even when the odds are against you. Her project, the Covid Academy, is developing a locally-informed model for standardized health security outbreak investigation and response. Though the United States is deeply divided politically, Dr. Bourdeaux believes the situation is not as dire as it seems. Common sense can win. “I don’t believe that Americans can’t see reason on this”.

Apoorva Mandavilli, a science and global health reporter at The New York Times, joins J. Stephen Morrison and H. Andrew Schwartz for this 141st episode. Apoorva unpacks the sudden spread of Monkeypox into Europe and now the United States, outside African states where it is endemic, and the challenges this poses to Americans and Europeans weary of Covid-19, as well as to Africans who fear gross inequities in access to vaccines and therapies, which are presently quite limited in supply. Containment of rising numbers of cases will be through ring vaccination of close contacts, which is doable but requires effective communication which up to now has been wanting. Much transmission is through men having sex with men, which raises the complex specter of stigmatization and politicization. The virus, far less severe and transmissible than smallpox, is nonetheless dangerous for infants, pregnant women, persons living with HIV and others who are immunocompromised. Case counts in Europe top 1,000 (very low numbers thus far in the United States) and are often difficult to confirm because of the resemblance to chickenpox or other rashes. Cases in the United States are projected to rise steeply and be seen in every state over the coming weeks and months.

Dr. Jeffrey Gold, Chancellor of the University of Nebraska Medical Center (UNMC), joins J. Stephen Morrison for this 140th episode. How did UNMC evolve over the past decades to become such a lead national institution in advancing America’s health security, through its Global Center for Health Security? In 1997, UNMC created a public health lab with the state of Nebraska, followed by 2004-2005 with the establishment of one of the country’s first containment units, following the 9/11 anthrax attacks, capable of handling people exposed to high-risk pathogens. These life-saving capacities were put to dramatic use during Ebola 2014-2105, and during Covid-19 when UNMC repatriated patients from the Diamond Princess cruise ship and U.S. citizens evacuated from Wuhan. Proactive communications skills proved essential to winning public trust in Nebraska and beyond. Multiple partnerships with executive branch civilian and military institutions – and private sector health providers -- proved equally invaluable. What next? UNMC stands ready to improve the U.S. surge capacity for managing future pandemic shocks, but that will require expanded partnerships and long-term financing from the federal government, backed by bipartisan action in Congress.

In this 139th episode, Dr. Deborah Birx joins J. Stephen Morrison to discuss her new book, Silent Invasion. On that day, former President Trump responded to the book by, among other things, lamenting oddly that “Debbie Birx does not have a lot of dresses.” In her inside account, Deborah details the repeated failures both to acknowledge the power of silent transmission by fully vaccinated, asymptomatic infected individuals, and the need to keep a relentless focus on testing, masks and limiting the size of gatherings. The Trump administration’s catastrophic failures stemmed from the president himself and those around him, including their prevailing worries about the economy and the quest for reelection. Her journey to 44 states and 30 universities brought home the fragility of the rural health system in much of America and the need to engage far more closely with local communities. In the Biden administration, repeated stumbles in guidance and communications have weakened public trust and confidence.

In this episode, Andrew Schwartz and J. Stephen Morrison are joined by Victor Cha to discuss the Covid-19 outbreak in North Korea - which CSIS predicted back in March, the impact of the pandemic on the unvaccinated country, and the road ahead amidst ongoing health and food crises worsened by an extreme lockdown.

Yana Panfilova, a 24-year-old Ukrainian woman born with HIV, fled Kyiv shortly after Russia’s invasion and is currently based in Berlin with her mother, grandmother and cat. Eight years ago, she helped found Teenergizer, an organization supported by UNAIDS that seeks to end discrimination against youth in Ukraine living with HIV. Over time, its scope widened to include other youth groups and its services expanded into mental health counselling and sexual health training. Affiliates arose across Eastern Europe and Central Asia. In the face of Covid-19 and, most recently, the Russian invasion of Ukraine, Teenergizer greatly enlarged its network in Ukraine from 20 to over 120 counsellors. Using her experience living with HIV, Panfilova has reached more than 5 million teens living with HIV and those facing other forms of discrimination, providing them with the support she wished she had as an adolescent.

Yasmeen Abutaleb, health policy reporter at The Washington Post, joins Steve Morrison and Andrew Schwartz for this 136th episode. The Biden administration struggles on multiple fronts, from systemic dysfunction within agencies to increased polarization of virtually every measures to mitigate Covid-19. The administration wants to invest in a long-term vaccine strategy that protects against multiple variants in advance -- but lacks the resources. Omicron taught us:  "You can't start buying stuff when the wave has started.” "The disinformation problem is so widespread"  that "… everyone in the Biden administration is going to be distrusted by half of America." The US government has not staged a powerful Covid-19 messaging campaign on social media, and a national commission on the pandemic, with real bipartisan leadership, remains out of reach.  Courts are exercising considerable sway over health security policy which require a careful political calculations. Would appealing federal Judge Mizell’s April 18 injunction against the national mask mandate on transport ultimately leave the CDC in a weakened position? Americans continue to experience the pandemic in vastly different ways, depending on socio-economic profile. Many who have protections through vaccines and treatments may feel they will be exempt from infection, yet they make up a significant share of those experiencing severe illness. 

Dr. Dylan George is the Director of Operations for the Center for Forecasting and Outbreak Analytics (CFA), newly established at the Center for Disease Control and Prevention (CDC). Dr. George joins J. Stephen Morrison and Andrew Schwartz for this 135th episode following the April 19th White House CFA launch. Its mission: Predict, Inform, Innovate. Its data science team will strengthen advance warning of biological emergencies, with a heavy emphasis on improved communications. Building trust is a major challenge, including navigating privacy sensitivities. Sustained funding is essential, and an outstanding question. If successful, CFA will provide the tools people need to keep their families safe while improving decision-making at the local, state, and federal levels. Like extreme weather communications, CFA will make complex models accessible.

Dr. Larry Gostin is a professor of global health law and the faculty director of the O’Neill Institute for National and Global Health Law at Georgetown University. Dr. Gostin joins Steve Morrison and Andrew Schwartz for this 134th episode in the aftermath of the April 18 nationwide injunction to block government mask mandates on public transportation. In Judge Mizelle’s opinion, the C.D.C. has exceeded its legal authority. But if the C.D.C. doesn’t have the power to make someone do something as unintrusive as wearing a mask, what can it do? If this ruling stands, it changes the role of the government, and our regulatory institutions will lose the power to protect us. The C.D.C. has been in a weakened position since the Trump administration but is staffed by strong scientists who want to do their best for Americans. Dr. Gostin argues for a High-Level Commission to take a top-down and bottom-up review of the C.D.C. to determine what systems, data, scientists, funding CDC needs, and what powers are legitimate. He does have hope: the U.S. is approaching higher levels of immunity, and the darkest days of the pandemic may be behind us.

Dr. Yanzhong Huang is Professor at Seton Hall University's School of Diplomacy and International Relations, Senior Fellow for global health at the Council on Foreign Relations, and co-chair of the US-China Working Group of the CSIS Commission on Strengthening America’s Health Security.  He joined Steve Morrison in the our 133rd episode for a wide-ranging conversation: on China’s huge immunity gap; its “dynamic Zero-Covid approach;” the spread of BA-2 beyond Shanghai to 45 cities affecting 25% of China’s population and 40% of its GDP; the acute vulnerability of China’s elderly; and the supply chain disruptions and huge economic consequences experienced inside China and, increasingly, felt across the globe. Deaths are underreported, and popular discontent has risen, even while it remains doubtful that majority opinion has shifted against Zero-Covid. While the Chinese government has made some modest adjustments to its fierce reliance on mass lockdowns, testing and quarantining, it has not fundamentally changed course. “Zero-Covid will continue.” Opposition is at the highest level -- at the Presidency itself: “the barrier is political.” It remains unclear when if ever the government will move to a mass campaign using a Western mRNA vaccine, a key step to creating immune protection and easing reliance on lockdowns. Successful development of a Chinese mRNA vaccine has thus far been elusive. 

Dr. Beth Cameron, Special Assistant to the President and Senior Advisor for Global Health Security and Biodefense at the White House, joins Steve for Episode #132. The Biden administration is making progress on the Global Health Security and Pandemic Preparedness Fund, envisioned as a Financial Intermediary Fund at the World Bank. The fund will invest in a globally linked bio-surveillance and early warning system, aid to the most vulnerable countries to build their health security, and rapid research and development in regulatory systems to create, rapidly scale, and distribute medical countermeasures. We need to "finish the job" and get out of this phase of the pandemic and need truly global surveillance systems and stronger information sharing to prevent the next biological threat. The second Covid-19 Summit has been announced for May 12, with the dual goals of ending the acute phase of the Covid-19 pandemic and strengthening preparedness for variants and future pandemic threats.

The Washington Post's Dan Diamond returns for Episode #131. Public attitudes towards Covid-19 have changed, and the pandemic has become a lower political priority. "It's been a steady saga of lack of action compounded by different political priorities swamping Covid." Midterms are coming up, and candidates want to show that there are other issues they are attentive to: inflation and crime. Republicans argue that there are a lot of unused emergency funds, and there needs to be better rigor and transparency in their use. But money is urgently needed to go to reliable partners. Anecdotally, it feels like Washington, DC is experiencing a wave, but it isn't reflected in the data–people aren't reporting their results, so we've lost some awareness of our surroundings. There are disincentives for politicians to speak about the pandemic across partisan lines, and we've relaxed all of our mechanisms in place to help us stay vigilant. This has been a long pandemic, and Americans are exhausted. Dr. Ashish Jha inherits a new set of challenges, and a new set of opportunities to build on the achievements of his predecessors in his new role as the White House Covid-19 Response Coordinator. He is talented in messaging but has never held a full-time government role before. How will he adapt to these new challenges? Dan Diamond is a national health reporter for The Washington Post, focused on accountability, federal agencies, and the coronavirus pandemic.

Dr. Matt Hepburn of the White House Office of Science and Technology Policy joins Steve and CSIS Senior Associate Tom Cullison for this 130th episode. Beginning as an Army infectious disease researcher and DARPA project manager, Dr. Hepburn’s visionary leadership was instrumental in the rapid availability of Covid vaccines through Operation Warp Speed. The world continues to face catastrophic consequences with the highly contagious BA2 variant. Hong Kong, Singapore, South Africa, and others are in the midst of spikes, while China wrestles with the strong likelihood of widespread outbreaks. Africa is largely unvaccinated, adding Covid to the list of diseases that burden the continent. Although he suggests summer will not save the United States from another surge, Dr. Hepburn remains positive. He’s posed seemingly impossible challenges like “let’s create a vaccine against an unknown disease in 60 days”, then won over skeptics by creating a solution. “We have to change the culture of our government to escape the cycle of crisis and complacency”

In this 129th episode, Steve joined in frank conversation with University of Wisconsin-Madison Chancellor Rebecca Blank as she approaches the conclusion of a nine-year tenure that dramatically tested her leadership and the university itself. There is considerable progress -- an increased graduation rate, shorter time to graduation, student debt reduction, improved diversity. The financial foundation of the university’s $3.6 billion budget has been systematically strengthened, through innovative fundraising and new partnerships with the private sector. But those gains are fragile, the university faces fierce competition from its peer institutions, serious financial and governance challenges persist, and changes in culture are difficult and require time. Worsening political polarization in the state is quite problematic. The university finds itself a “pawn” in partisan battles, and Republican legislators lag far behind in supporting sustained investments in the university. Covid-19 remains a live matter – it is not over – but the university has built better systems – ventilation, testing, vaccination, safety protocols, hybrid instruction – and created trust and commitment within the university community. Even without a vaccine mandate, the university achieved 96% vaccination coverage. The university responded to the shock of rising racist incidents and the drive for racial justice, in the aftermath of George Floyd’s death. Most significant has been changes in the recruitment and retention of students, faculty, and staff. Much work still remains: UW remains predominantly White in a predominantly White state.

Two years later, Dr. Richard Hatchett, CEO of the Coalition for Epidemic Preparedness Innovations rejoins Steve for the second iteration of our Live From Munich mini-series. Dr. Hatchett reminds us that having just had a pandemic does not prevent outbreak from another, and that pandemic preparedness needs to be “viewed as a security challenge, not as a health challenge, not as a development challenge”. He points to lessons in vaccine manufacturing and financing arrangements that incentivize disease surveillance that can better prepare us for the next pandemic. “Many of the high-income countries see the value from a geopolitical and security perspective in making these investments. The challenge for the long term, obviously, will be whether these facilities can be successful, sustainable, and be sustained.” Richard J. Hatchett, MD, is Chief Executive Officer of the Coalition for Epidemic Preparedness Innovations (CEPI).

In this 127th episode, an edited version of a live event recorded on March 2, Scott Kirby, CEO of United Airlines, joins Steve for a fireside chat. Scott Kirby has been a health security leader in the private sector, achieving a 99.7% employee vaccination rate in eight weeks. The Covid-19 pandemic forced a major change in internal culture “about leading, about doing the right thing, about a customer service culture that didn’t really exist before”, including abandoning some policies like flight-change fees. After getting news of the second Covid-19 related employee death, he decided to implement the mandate “just because its the right thing to do”. Despite pushback, he does not regret it: “Saving lives? There’s never a decision I’ll make in my career that is as important as that one, or one I’ll ever feel as good about”. This change in company culture extends to climate change too. United is going green by 2050 with sustainable aviation fuels for long flights and investing in electric and hydrogen solutions for short flights. They have also partnered with Occidental Petroleum Corp to invest in carbon capture sequestration, which will offset United’s annual emissions without traditional carbon offsets.   Scott Kirby is the Chief Executive Officer of United Airlines Holdings, Inc.

In the fourth episode of our Live From Munich Mini-Series, Steve is joined by Tom Bollyky, the Senior Fellow for Global Health, Economics, and Development and Director of the Global Health Program at the Council on Foreign Relations. Mr. Bollyky attended the Munich Security Conference “to keep the conversation about the response to the COVID crisis still on the national security agenda”. National security and global health have been historically linked, as exemplified with the birth of PEPFAR. Could the war in Ukraine lead to a similar program for Covid-19? And what are the major obstacles in creating pandemic preparedness policy? Tom Bollyky is the Senior Fellow for Global Health, Economics, and Development and Director of the Global Health Program at the Council on Foreign Relations. 

Two years ago, Dr. Jeremy Farrar joined Steve for the first iteration of Live From Munich, when the Covid-19 Pandemic was just emerging. Today, for episode #125 and the third installment of this Live From Munich mini-series, he returns to discuss this murky transition into the next stage of the pandemic. Dr. Farrar predicts that “political interest will wane from the pandemic because other events take over.” Politics are turning towards an exhausted, frustrated, even sometimes violent public. “We all feel fed up with this pandemic. But our emotional state doesn't determine the outcome of the pandemic.” We must be prepared for all scenarios, not just the ones we prefer. Dr. Farrar takes a lesson from the Munich Security Conference: “The truth is that the security community does this all the time. They think of a central scenario that is the most likely and they put most of their planning around it, but they do not ignore the other scenarios.” Dr. Jeremy Farrar is the Director of Wellcome Trust. 

In episode #124, the second episode of our Live From Munich mini-series, Steve is joined by Seth Berkely, CEO of Gavi, The Vaccine Alliance, “the largest purchaser of vaccines in the world”. He speaks on strengthening health security: “Do we prepare for our hopeful future? Or do we prepare for reality?” “The right thing to do is to continue to prepare for worsening variants, worsening disease. And the best way to do that is to make sure high-risk people all over the world are as protected as they can be.” We are only as safe as our neighbors. Longterm, "it hurts the world if new variants appear, get the chance to circulate, and then jump out again, as we’ve seen.” Different vaccines have different advantages for various levels of infrastructure, and “we want to get countries to a place where they can say we have the right vaccine, in the right place, at the right time to meet the needs of our population.” “We’re fools if we don’t keep in mind that we have to protect everyone in the world.” Seth Berkely is the CEO of GAVI, The Vaccine Alliance.  

Dr. Nkengasong, Director of the Africa CDC and soon to be head of PEPFAR joined us for this 123rd episode, and the first episode of our Live From Munich mini-series, a collection of episodes recorded at the Munich Security Conference. He is a leader in the initiative to incorporate global health in security discussions like the Munich Security Conference. “We have seen how an outbreak of a disease can truly be a health security matter, and also human security, as well as even going as far as a national security threat.” The Covid-19 pandemic has shown us “the need for us to look at the security from a human perspective”, that “we are more connected as humanity”, and “the inequalities that we thought existed are more profound within countries between countries and between regions than we thought”. As North America and Europe begin this murky transition to the next stage of the pandemic, Dr. Nkengasong is concerned that we will “begin to refer to COVID as a disease that will soon be over in the US. And then of course, because of that, it becomes one of the neglected tropical diseases where we now have to rely on foundations or charity to take care of.” He recently called for a pause in vaccine donations: “we're saying that we have a lot of vaccines in the country. Now our problem is vaccination”. “I'm a big believer in that we should always pause to evaluate where we are in response, and then make corrective actions”. How will Africa overcome its major challenge of vaccine hesitancy? “I think every good public health practice as you and I know is local. The concepts are global, but in practice is local, which means Africa must take its own socio-cultural context and deal with it and then find the touchpoints” Dr. John Nkengasong is the Director of the Africa Centres for Disease Control and Prevention, and has been nominated by President Biden to be the next head of the Office of the Global AIDS Coordinator in charge of PEPFAR, the President’s Emergency Plan for AIDS Relief.  

John Barry, historian and author of the award-winning The Great Influenza; the Story of the Deadliest Pandemic in History, a study of the 1918 pandemic, joined us for this 122nd episode. He is currently working on a volume on Covid-19: “Writing books makes me happiest and craziest.” He has penned many editorials over the course of the pandemic, drawing lessons from 1918. What has he discovered? “What we learn from history is we learn nothing.” Where are we today? “Until vaccines are widely distributed and there is easy access to antivirals, the virus will rule. … I am optimistic the virus will continue trending to mildness” but there may be intermediate steps. “Mutations are random.” “We are at a potentially dangerous time” if we throw away our defenses and become indifferent or complacent. His high school football coach taught him a lesson for today: late in the game, you are tired and the other guy is tired. “The guy who focuses at the end will win.” That does not mean you “live in a box” and isolate yourself. Aaron Rodgers, while a great football player, “lied” about his vaccination status. He “is a total jackass.”   Before becoming a writer, John Barry coached football at the high-school, small college, and major college levels. He is a Distinguished Professor at Tulane University’s Bywater Institute and a professor at the Tulane School of Public Health and Tropical Medicine.  

In 2021, Indiana Governor Holcomb launched the Public Health Review Commission, charged with asking hard questions that cover the waterfront of public health challenges in Indiana and delivering actionable answers this coming summer. Its co-chair, Dr. Judy Monroe, and its director, Indiana State Health Commissioner Dr. Kristina Box, joined us to share what this unusual and promising, fast-moving enterprise is all about. The challenge before Hoosiers is formidable: the state ranks 48th in the country in public health financing. The Commission is off to a quick start staging monthly public meetings and conducting listening tours across the state. It has created a website for public comment and staged outreach to businesses, schools, and universities. Any big surprises? Public health capacities vary enormously across the state – it is “eye-opening.” Indiana’s 49 rural counties especially struggle. Data systems are woeful and antiquated. In the current acutely politicized environment, the Commission is “well-positioned to lift above the politics” and help the state’s citizens focus on the future, especially children’s health. The Commission can contribute to “lifting all the voices.” It can offer space for people who fear mandates are “stripping people of their rights” to vent their frustrations. At the same time, it can convince citizens that public health, when successful, lengthens life expectancy, especially in focusing on chronic diseases. Communications are in urgent need of an upgrade: countering disinformation requires listening carefully to people’s concerns and mobilizing trusted partners in communities, and enlisting and training the next generation of public health professionals. The private sector will be vital partners in any modernization of data systems and in building stockpiles that better meet future needs. Dr. Kristina Box is Indiana State Health Commissioner. Dr. Judy Monroe is the president and CEO of the CDC Foundation.

In Episode 120, the first episode of our Department of Defense mini-series, Joint Staff Surgeon Major General Paul Friedrichs, discusses how the Department of Defense has overcome challenges from the pandemic, incorporating lessons applicable to any large organization struggling to function in today’s environment. Early in the disease the aircraft carrier USS Theodore Roosevelt was sidelined, recruit training and military exercises were interrupted as they searched for answers on how to safely operate. Currently, vaccination rates among active-duty military members are among the highest in the nation and operations continue relatively unimpeded. Domestically, tens of thousands of National Guard and active-duty troops have responded wherever needed to support communities throughout the United States in roles from intensive care delivery to administrative support. Worldwide DoD biosurveillance and research programs designed to protect U.S. forces against disease while deployed overseas play a major role in virus identification and vaccine development - including the mRNA platform which is the basis for the Pfizer and Moderna vaccines. The establishment of the Defense Health Agency presents an opportunity for much-needed organizational streamlining of the extremely wide breadth of military health capabilities, however, it is important that less visible, yet vitally important, assets such as overseas infectious disease laboratories, are able to continue their vital work. Likewise, the impact of active duty medical personnel cuts must be carefully considered regarding the ability to detect, prevent and treat infectious disease threats. As Covid-19 evolves, U.S. military medical personnel will continue to work collaboratively with colleagues at home and throughout the world for answers.  Air Force Major General Paul Friedrichs is the Joint Staff Surgeon, the medical advisor to the Chairman of the Joint Chiefs of Staff and responsible for coordinating all issues related to health services including operational medicine, force health protection, and readiness among the combatant commands and the Office of the Secretary of Defense. Read the report here: https://www.csis.org/analysis/department-defense-contributions-us-covid-19-response-home-and-abroad

In episode #119, Dr. Peter Kilmarx, Fogarty International Center, discusses the struggle to advance contact tracing. Efforts early in 2020 to create a national Covid-19 Response Corps – at least 100,000 needed – were not successful. Instead a “hunger games scenario” ensued in which each jurisdiction scrambled to make its own solution. In our federalized system, each state, and in some instances county, has had to build its own public health workforce while balancing the budget. The lack of an integrated data system made it difficult to track progress. Contract tracing has made only marginal progress in curbing transmission. Experiments in the use of new technologies have not gotten off the ground in most places. New York City is one shining exception where 90% of cases are tracked, and 75% of their contacts. Success in places like New Zealand, Taiwan, and Viet Nam relies on robust, fast testing systems, consistent social support for those in quarantine, and a tradition of public health workers in the communities. Public health in America has entered a period of crisis, in the face of politicization, distrust, and abuse. In the Biden administration, executive orders and the American Rescue Plan have made major commitments towards contact tracing, testing, and strengthening the public health workforce. In the meantime, foundations, civil society alliances, and public health professional associations have played an expanded role. “Contact tracing does work” if the right pieces can be put in place. Dr. Peter Kilmarx is the Deputy Director of the Fogarty International Center, at the National Institutes of Health and is a Rear Admiral (retired) in the US Public Health Service.

Dr. Michael Osterholm, head of CIDRAP at the University of Minnesota, is among the most popular, respected, and trusted communicators on the pandemic. What is the recipe?  Simplicity rules. He learned from his rural Iowa background, “if something doesn’t play at the 10:00 o’clock coffee club at the S&T Café on the main street of my little town, then it’s not going to play.” Be frank and honest: “Always tell the truth.” If dark things such as variants lie in the future, do not shy away from spotlighting them. But be careful of forecasting too far into the future, which can at times be based on “pixie dust.” Appeal to both “hearts and minds.” “Kindness is one of the most important virtues.” In his lauded and highly successful podcast, ‘The Osterholm Report: Covid-19,’ he is able to “combine science, policy, and life all in one venue.” The anti-vaccine movement has gained substantial strength; witness the ‘Defeat the Mandates’ rally on January 23rd at the Lincoln Memorial, which featured Robert Malone, now a celebrity since embraced by Joe Rogan, who compares public health officials to Nazi Germany. “This is the biggest challenge to global health in my lifetime.” It threatens childhood immunizations, generates “death threats I have received.” Many colleagues are burning out and leaving. He and other colleagues from the Biden presidential transition Covid-19 Advisory Group recently laid out a road map for “the new normal” in three Viewpoints published in JAMA. “We can’t keep swinging from surge to surge.” We need a better plan for data, testing, ventilation, rebuilding our health workforce. But we still have to prepare for the unknown. Recall Lewis Carroll’s advice: “If you don’t know where you are going, any road will get you there.” And “Don’t be surprised when you are surprised.” China’s ‘Zero-Covid’ approach, based on draconian lockdowns and mass testing, has delivered far better outcomes than we have seen here in the United States. But it will not succeed in the face of Omicron. “It is like trying to control the wind.” Something beyond ‘Zero-Covid’ is needed. Dr. Michael Osterholm is Director of the Center for Infectious Disease Research and Policy (CIDRAP) at the University of Minnesota.

Dr. Chris Murray, head of IHME, joined us in episode 117 to discuss his recent provocative piece in The Lancet, ‘Covid-19 will continue but the end of the pandemic is near.’ “The Omicron wave is really different,” extraordinarily fast and much less severe. The current massive Omicron wave will infect 50%-60% of the world by March, creating dramatically enhanced population-level immunity. The unvaccinated and never-infected will become quite scarce, as transmission becomes very low. Aided by the advent of antivirals, “Omicron will become another recurrent infectious disease” that in magnitude is going to be like a bad flu season. Major emergency government interventions will become a thing of the past, even as future variants emerge. Americans will celebrate – almost like a post-war moment -- even as America passes the milestone of one million deaths. Complacency is a risk: some will see this shift as a license to do nothing. “We really have to stick to the truth,” strengthen data and surveillance, improve the health system, and better manage future outbreaks. Another risk: those opposed to vaccines, masks, mandates, social distancing may seize on this transition to advance their cause. “I have not yet received an invite from Tucker… or Joe Rogan.”  China, through its Zero-Covid approach, is hugely vulnerable to Omicron which will eventually break out and threaten to overwhelm China’s health system. In this new phase, attention will turn to other pressing global health concerns, including anti-microbial resistance, the subject of a newly released five-year study of its global burden, led by Dr. Murray. Dr. Chris Murray is Director of the Institute for Health Metrics and Evaluations, (IHME), at the University of Washington, where he is also the Chair of the Department of Health Metric Sciences.

Dr. Anthony Fauci joined J. Stephen Morrison for a CSIS live-streamed conversation on January 11. Today’s podcast is based on that conversation. Does Dr. Fauci believe the pandemic is in transition? Yes. “I have been talking about a transition since October 13.” What might that mean? “Ultimately we will need a new strategy. We cannot let this virus dominate our lives for much longer. We have to get to the point where all of us get our lives back.” The pandemic remains “a moving target.” Omicron is in effect the fifth wave, and we have to get the American people to pull together to end it. “We all really want the same goal.” It’s a mistake “if we landed on Normandy and begin to argue among ourselves over whether it was a mistake to land...  soon enough you get off the beach and win the war.” A reset on communications is needed but the “degree of divisiveness and polarization is profound, driven by disinformation and misinformation.” Internationally, it is in both the U.S. moral and national self-interest to assist low and middle-income countries to respond to the pandemic. The United States is doing “more than the rest of the world combined” and will do more. But other wealthy countries must also step up. Dr. Fauci remains worried that as the situation stabilizes the will to finance long-term capacities will fade. “We have been to that movie before.” The decision to restore US membership in WHO “was a big shot in the arm” for WHO, and WHO has done very well of late, particularly under the leadership of Dr. Tedros. It is “absolutely critical to develop a new détente with China” as well as with other countries in Asia where future viruses may also arise. The Department of Defense has a critically important role to play in our response, in logistics and science. Advancing the readiness of US forces overlaps with protection of the world. Dr. Anthony Fauci is the President’s Chief Medical Advisor and Director, the National Institute of Allergy and Infectious Diseases (NIAID).

Dr. Gigi Gronvall, a leading international expert on tests, kindly joined us for a spirited tour d’horizon. People need tests for multiple purposes on a continuous basis: You “can’t just get one test and forget it” since a test is just one moment in time. Sometimes however there are unrealistic, outsized expectations that tests will peer into the future. Why is the United States so prone to stumbling on tests? In 2020, responsibilities were thrown to the states, and antibody tests in the early days, approved by the FDA, were “the wild west” where often you could get a more accurate result “from flipping a coin.” In 2021, “a supply and demand market model” for antigen tests predominated, and when demand collapsed, Abbott destroyed millions of doses. More recently, since September of 2021, and accelerating under the pressure of Omicron, things are improving -- but “turning the ocean liner” is slow. The $3 billion investment in affordable antigen supply and accelerated development of new tests is showing results. The more recent commitment by President Biden to provide 500 million antigen tests through the mail to Americans has promise. “People want health information about their own bodies … people want access to tests. They know it is possible.” "Perhaps that progress can be extended in the future to home flu tests.” Dr. Gronvall also shared her thoughts on the Covid-19 controversy: put a focus on animal health and cleaning up live animal markets. And yes, we should cooperate with the Chinese: “You could get people together to exchange baseball cards and it would be productive.” So why not focus on vaccinating the world? On widespread, pernicious misinformation: “cut off the poison” immediately at its source and invest in long-term education. Dr. Gigi Gronvall is a Senior Scholar at the Johns Hopkins Center for Health Security and an Associate Professor in the Department of Environmental Health and Engineering at the Johns Hopkins Bloomberg School of Public Health.

Ashish Jha reflected as the year closes. Communications are now fundamental to public health. Most critical is to speak as though you are engaging friends or family who are outside medicine. Put the decisions in terms of your own family. Don’t tie masks and vaccines to political identity. The lessons of 2021? We were surprised by 20-30% of Americans unwilling to be vaccinated, by Delta’s power, and by limits to the federal government’s power. FDA and CDC remain weak and muddled. “Process and nonsense” delayed a booster decision for three months. What’s in store for 2022? Coping with omicron will be tumultuous. Americans are exhausted, frustrated, and angry, which will narrow the tools at our disposal. We may see 50-80 million infected with omicron. Over the long term, if we settle into 30,000-50,0000 Covid-19 deaths per year, on top of flu, that will overwhelm our health system. We need now to institute fundamental changes in ventilation, test and trace, and other capacities. The international environment? Friends in South Africa emphasize that “the problem in South Africa is what you export to us – Tucker Carlson.” Biden has not done a good job internationally, has lacked bold leadership or any strategy. US global engagement “feels like an afterthought.” A national commission on the pandemic “is undoubtedly urgently needed.” Simplistic narratives do not serve our nation. Build on the emerging consensus: this is not the last pandemic; our agencies are ill-prepared; states need stronger public health capacities. Republicans and Democrats are more united than divided over these issues. Public health education is in need of an overhaul to work effectively in both red and blue states, engage the public, and broaden to enlist social scientists and security experts. Dr. Ashish Jha is Dean of the Brown University School of Public Health.  

Philip Zelikow, former Executive Director of the 9/11 national commission, has for the past year directed the Covid-19 Commission Planning Group. He visited with us to explore where that effort stands, should a national commission move forward? How and why? It is “absolutely essential to take account of this sprawling crisis.” Our performance to date, despite our “magnificent edifice” of science and modern health tools, has been far worse than during the 1918 Spanish flu. A national commission can counter polarization, offer an alternative that unites citizens. It can avoid the “gotcha blame game” and construct choices made – the values, tools, and information that shaped critical decisions. Most of the story of what happened is in fact not yet well known or understood. A commission is “a bridge to rethink the American health system.” “Does anyone think the American health system is fine?” There is an urgency to act in 2022, while pain and memory are fresh before we turn our attention elsewhere. We cannot wait until a pause: “the disease is going to run for a while.” The political momentum behind a commission is rising: we see a bipartisan Senate effort behind new legislation, and a recent strong endorsement from Dr. Anthony Fauci. Philip Zelikow, White Burkett Professor of History at the University of Virginia, directs the Covid-19 Commission Planning Group. He previously was executive director of the 9/11 commission

Dr. Richard Lessells is among the exceptional South African experts on the front lines of discovering and investigating Omicron in South Africa. Alarm bells went off within the scientific community, as it became clear after just a few days that “an extraordinary number of mutations” are clustered in the key regions in the genome for immune protection and transmissibility. It was a “gut feeling. ” Omicron is highly transmissible, spreading very efficiently in a population with high levels of immunity gained from previous infection and in some cases from vaccination. How long to know just how dangerous Omicron is? It’s “too early to tell.” Lab work is underway to understand whether the virus affects T cells which are central to immune protection against severe disease. Why do we see such an unusual variant in South Africa? One theory, which Omicron may shed light on, is that the SARS-CoV-2 virus finds hosts who are very immune-compromised, persons living with HIV but not on anti-viral therapy. These individuals have difficulty clearing the virus, which permits it to replicate constantly over a very long period. Is this moment a pivot in the pandemic? That depends on whether Omicron significantly sets back vaccine protection, which would be a “step change.” Will this moment shock the world into more concerted global action, superseding the pattern of “vaccine apartheid”?  “I remain skeptical.” In the meantime, we have to fight against Omicron being fitted to a politicized narrative: by anti-vaccine groups, to tell the story that vaccines do not work. By others, to argue that there is nothing to worry about, that the virus is becoming less pathogenic, based on anecdotal evidence.  Dr. Richard Lessells is an infectious disease physician at the University of KwaZulu-Natal, in Durban, South Africa. He is a member of the Network for Genomic Surveillance in South Africa, and a researcher at CAPRISA, the Centre for the AIDS Programme of Research in South Africa.

Dr. Taison Bell, MD, an acclaimed African-American doctor, educator, and emergency medicine director in Charlottesville, Virginia, shares his personal story of how medicine – back home in Virginia – became the center of his life. “Success was not assumed in my neighborhood.” As a child with asthma, he connected with his physician, as he did also with his Black dentist and several teachers. Such “affirmative experiences” made the dream “seem like it was achievable.” In retrospect, “so many things had to align at the right place and right time.” The pandemic now puts a premium on doctors becoming communicators. “Things will not be the same from this moment forward.” “People arrive in my ICU because they are unvaccinated… People are generally willing to trust their local provider in their community regardless of what side of the aisle they are on.” But “everyone has an opinion, some spread by misinformation.”A recent conspiracy alleges doctors put patients on ventilators to intentionally make them sicker. “That has become one of the toughest parts of care.” You have to have a “therapeutic alliance” and trust with the patient and family. When those do not exist, it almost always does not end well. Boosters a good thing? Yes, though “everyone has good points.” Talking openly about how he makes decisions with his family during the pandemic makes him “relatable.” It opens a window into how he is processing things.  Dr. Taison Bell, MD, is an assistant professor of medicine in the divisions of Infectious Diseases and International Health and Pulmonary and Critical Care Medicine at the University of Virginia. He is also the Director of the medical intensive care unit (ICU) and director of the UVA Summer Medical Leadership Program.

We asked Cary Funk, Pew Research Center, to make sense of how the pandemic has impacted our society and American opinion as we approach the pandemic’s two years. “It can be confusing.” Polarization now increasingly aligns between the vaccinated versus the unvaccinated, versus simple partisan identity. At the fundamental level, Americans are split over whether Covid-19 is a common problem. Does the “Big Lie” bleed over into the field of public health? “It’s all complicated.” “The political lens” increasingly encompasses so much of public health, accelerating the erosion of public trust and confidence in science, a trend that had already been underway for years. False statements can travel the globe in 48 hours, but knowing the impact is much more difficult. Are we at a turning point, a softening of polarization? “We need to wait and see.” Heightened US international engagement enjoys majority support and has not become politicized. What is the impact of the loss of 757,000 lives on opinion? We have to continue looking at that.  Cary Funk is director of science and society research at the Pew Research Center.

From September 17-October 1, Suzanne Brennan Firstenberg created the largest participatory art installation on the Washington National Mall since the AIDS quilt of 1996, entitled ‘In America: Remember,’ composed of 700,000 white flags, in the shadow of the Washington Monument. A stunning achievement. Listen to her reflections on listening to those among the 16,000 who personalized a flag to memorialize their loss. “So many of these deaths happened in isolation.” The project unfolded amid our bitter divisions: “ We are tearing ourselves apart as a society.” 35,000 died unnecessarily over the two-week course of the installation. Remarkably, though, she succeeded in creating a solemn, quiet, respectful space where it was “safe to bring one’s grief” and escape our politics. Does this memorial create a lasting constituency that will press for a national commission? Any memorialization has to include an in-depth examination of what happened. Suzanne Brennan Firstenberg is an artist based in Bethesda Maryland.

Dr. Richard Brennan, WHO Emergency Operations, sat down this week with Steve and Professor Leonard Rubenstein, Johns Hopkins Bloomberg School of Public Health. Rick has been at the very center of urgent efforts, following the Taliban’s coming to power in mid-August, to avoid the collapse of Afghanistan’s health system, through fast-moving negotiations to bring emergency funding, opening air links, resuming Covid-19, polio, and measles immunization programs, and delivering emergency medical supplies. The political and security complexities to achieving these short-term, emergency stop-gap measures remain formidable, and the space for striking deals exceedingly narrow. How has the Taliban leadership seen things, and how did they agree to these initial measures which have to operate outside their control, a precondition of donors? What is the space in which he and others can find financing solutions that will sustain the health system long-term? Pressures upon WHO Emergency Operations in Afghanistan, combined with demands in Lebanon, Yemen, and Syria, have escalated to levels that greatly exceed capacities. What is to be done now?   Dr. Richard Brennan is Regional Emergency Director, Eastern Mediterranean Region, World Health Organization.

Dr. Jennifer Nuzzo has emerged as a forceful expert voice making sense of the complex and times confusing, shifting shoals of the pandemic. ”All of us have had to step into this sphere,” filling “a power vacuum.” It has however been chaotic. Public communication is essential “to move the needle” but the experience can be “tough.” Vocal experts are the subject of attacks, the worst during the Black Lives Matter protests. The field of public health needs to invest more in how to message on vaccines. People are "swimming in disinformation.” Though she is “cautiously optimistic” for the United States, “no one is going to run out the clock on this virus.” For poor countries, which increasingly are in desperation abandoning a response, the future is “bleak.” Are we numb to the more than 700,000 dead Americans? Perhaps. It’s impossible to wrap our minds around this scale of death in America. There is a need for a “national reckoning” through a commission, “a true opening of the books that goes deep.” Have we entered a new era of high-level diplomacy? “No.” “We don’t have a Covid control strategy” at home or abroad. The lack of strategy is causing people to disengage. Can we be optimistic? “It can feel like there’s an unraveling” but that in fact is not happening.  A “civic spirit” among citizens is buoying America. Dr. Jennifer Nuzzo is a Senior Scholar at the Johns Hopkins Center for Health Security and an Associate Professor in the Department of Environmental Health and Engineering at the Johns Hopkins Bloomberg School of Public Health. She is also a Senior Fellow for Global Health at the Council on Foreign Relations.

On October 7, Andrew and Steve sat down with a close friend, Georgetown’s Prof. Larry Gostin, for a lively live-cast conversation about his new book, ‘Global Health Security: A Blueprint for the Future.” The podcast captures that rich, vivid exchange. The big messages: We underestimate the power of the SAR-CoV-2 virus: it is wily and pernicious and will continue to surge. We cannot forget anti-microbial resistance. A fundamental shift is needed in the US international approach – away from charity and towards advancing technology transfer to manufacture vaccines in low and middle-income countries to create resilience. That requires far greater pressure upon Moderna and Pfizer to cooperate in meeting urgent global needs. The USG has the legal authorities to make that happen but has not yet followed through. USG health communications have been “pitiful” and left the public “utterly confused.” That too can be corrected.   Professor Lawrence O. Gostin is University Professor at Georgetown University where he directs the O’Neill Institute for National and Global Health Law.

Dr. Leana Wen joined us this week to explore her personal history and its revelations, laid out in remarkably candid detail in her newly released memoir, Lifelines: A Doctor’s Journey in the Fight for Public Health.  And to speak to the most pressing current challenges posed by the Covid-19 pandemic. Her childhood struggles, as a young immigrant Chinese girl living amid insecurity, taught powerful lessons about poverty, race, and health. Her tenure as Health Commissioner in Baltimore, operating in close partnership with the late Congressman Elijah Cummings, opened the way to confront opioid addiction, stigma, maternal and infant mortality, and the acute vulnerabilities of youth. In her new life in the print and cable mediascape, she follows the advice of former Senator Barbara Mikulski: “do what you are best at – and needed for.” The Biden administration needs to up its game with the public: “It’s not enough just to get the science right.” It is about values, communication, and public trust. America’s hardened polarization -- surrounding vaccines, masking, and distancing -- is too advanced to fix: it is best to focus on engaging individual by individual. Listen to learn more.  Dr. Leana Wen is an emergency physician and public health professor at George Washington University. She is a contributing columnist at the Washington Post and a CNN medical analyst. She’s served as Baltimore’s Health Commissioner.  

Carmen Paun, a dynamic, fresh media voice on global health in Washington, shares her personal and career journey from Romania to Brussels, and on to her arrival in Washington D.C. one year ago, amid the pandemic, to launch POLITICO Global Pulse. This past summer, while visiting family in a small village in the Romanian countryside, she was “shocked” to discover only 10% vaccinated at that time, the pandemic seen as “all just a conspiracy.” The pandemic was the trigger in creating POLITICO Global Pulse. In its first year, it did find its audience and voice quickly. What to make of the U.S. Global Covid Summit? It re-established that “the U.S. was in charge,” now the challenge lies in execution. Faith in American leadership has diminished, while African officials remain frustrated by slow delivery and the West’s export restrictions. Will the EU-US Task Force bring great transparency and accountability? “Hard to say… How fast is this going to happen?” The turn to boosters likely creates “a vicious cycle” that could leave low and lower-middle-income countries still struggling to access vaccines. Will Africa be left far behind? No. Vaccines are finally arriving. India is reopening exports. Don’t expect the push by South Africa and India to suspend intellectual property to succeed. Her overall prognosis? “It is hard to be optimistic” Give a listen to learn more. Carmen Paun is a health writer at POLITICO and author of POLITICO Global Pulse.

In a recent New Yorker ‘Letter from Biden’s Washington,’ Susan Glasser delivers a stark indictment: Trumpists and Republican leadership are consciously keeping enough people resisting the Biden administration’s efforts to control the virus “to keep the disease wreaking havoc.” Why that conclusion now? “It is no accident” that 1 in 500 Americans have died, now totaling over 687,000. It’s becoming obvious that President Biden cannot inoculate Americans against Fox News. In the meantime, the Biden administration, “on both foreign and domestic fronts, remains a jumble of aspirations and retains a haze of uncertainty about how to achieve them.” That directly shapes its international approach to Covid-19, including the recent Global Covid-19 Summit organized by President Biden on the margins of the UN General Assembly. It is “a statement of the obvious” that nearly half of the country is dedicated to the failure of the Biden administration. When a “flaming dumpster fire” pandemic continues in the United States -- the fourth wave fueled by vaccine refusals – the resulting domestic crisis gravely limits the ability of the United States to be a world leader on Covid-19. On the pandemic as well as Afghanistan and other foreign policy priorities, the administration is taking an approach that is far less multilateral, alliance-focused, and consultative than expected. Why? The answer is not yet clear: if the administration is simply overwhelmed by demands, or if this approach is a conscious internal “predilection.” Does she agree we are drifting inexorably towards a US-China cold war bifurcation of the world? “Yes, I do.” Do we urgently need a national commission on the pandemic? “Absolutely.” “You cannot escape history.” Please listen to know more. Susan Glasser is a staff writer at The New Yorker, author of Letters from Biden’s Washington

Dr. Monica Gandhi toured the landscape with us. The recent recall of California Governor Gavin Newsom has bipartisan roots, in dissatisfaction with the “lockdown mentality” that closed playgrounds and parks, and kept San Francisco’s schools shuttered for 18 months. It was to a significant degree a “referendum on the illiberal liberals.” Once “the power of vaccines” came into force, however, California pioneered mandates, passports, and expanded testing; achieved over 80% vaccine coverage; and drove cases and deaths to exceptional lows. The future? “Immunity is the path out” to achieve control over Covid-19. Big concerns? Confused messaging around boosters terrifies the vaccinated and makes the unvaccinated believe less in vaccines. We are also witnessing rising intolerance: in our politically polarized debates over schools, vaccines, masks, and boosters, scientific discourse has lost balance and nuance.   Dr.Monica Gandhi is Professor of Medicine and Associate Chief of the Division of HIV, Infectious Diseases and Global Medicine at UCSF/San Francisco General Hospital. She also serves as the medical director of the HIV Clinic at SFGH, the famous “Ward 86.”

Dr. LaQuandra S. Nesbitt, Director of the DC Department of Health, returned as our guest to share her reflections. Her view of President Biden’s six-point plan? Tying vaccination to sustained employment is the next phase: mandates will bring about an uptake in vaccines. The rising emphasis on monoclonal antibodies is a “huge initiative” that brings about a reduction in hospitalizations. The President negotiating access at-cost to over-the-counter test kits is a similarly big step. DC has avoided the worst outcomes seen elsewhere in the United States by “planning for the worst.” Plus there has been relative unity: “residents have done what we have asked them to do.” “At times of adversity, this city rises to the occasion.” Top challenges? Vaccine disinformation regarding infertility creates “myths” that remain “inexplicably” powerful. Managing confusion over boosters is “tricky” in the absence of a “single voice, single message.” Dr. LaQuandra S. Nesbitt has served since January 2015 as Director of the District of Columbia’s Department of Health in Washington, D.C.

Tom Bollyky joined us on the occasion of our 100th episode to reflect on President Biden’s six-point re-set of US pandemic policy, unveiled September 9, and to discuss what can be done to break the deadlock over determining the origin of SARS-CoV-2. President Biden’s patience has clearly run out, and the new approach, heavily reliant on mandates, will stir political blowback, litigation, and defiant disobedience which may slow progress versus accelerate momentum. It’s “not a happy day” when people will be “pushed into a corner.” It’s disappointing that the private sector did not earlier do far more. Our national narrative may however improve, as higher rates of hospitalization of children deflate the individual freedom argument. On the origins controversy, it is “utterly unsurprising” that the US intelligence review was inconclusive. The origin issue is indeed terribly important, at this historic “policy moment,” since without resolution, we are blocked in our prevention approaches. We are in a “dark environment” and there is no prospect for progress in global health unless we find a basis for cooperation between the US and China. In the meantime, we should prioritize moving ahead with more rigorous lab safety standards and end wildlife trade and wet markets. Thomas J. Bollyky is the Director of the Global Health Program and Senior Fellow for Global Health, Economics, and Development at the Council on Foreign Relations.

Professor Larry Gostin joined us for a spirited conversation of where America as a country stands today, almost two years into Covid-19. Human ingenuity and scientific gains have been “astounding,” while our preparedness, in the face of such a “wily enemy,” has too often been “abysmal.” We experienced shock when the first wave that began in Wuhan landed at our shores, CDC bungled tests, the Trump administration stoked anti-Asian hatred and politicized essential tools – masks, vaccines, and temporary lockdowns. Public health messaging too often has been “appalling," as CDC’s scientific leadership has stumbled. Now, in late 2021, we face the danger of dividing our society into two opposing camps, the vaccinated versus the unvaccinated. The Biden administration has refused to take up vaccine credentialing, a significant mistake. It has also shown remarkable leadership in trying to overcome vaccine hesitancy and refusal, and now must turn increasingly to mandates.   Larry Gostin is University Professor and Director of the O’Neill Institute for National and Global Health Law at Georgetown Law.

In conversation with Steve Morrison on August 3, Dr. Fauci began by laying out the $3.2b Antiviral Program for Pandemics. Its dual aims are quick and long-term wins. The optimal antiviral: a single pill, oral, that early in infection stops replication. Any solution has to be grounded in equity of access, at home and abroad; requires a massive increase in testing; and will rest on combination therapy to combat variants. The initial $3.2b, it is hoped, achieves success that fuels higher future investments. Private industry and academic partners are key to rapid gains and building sustainable R&D capacity. Beyond the APP, how to arrest the “pandemic of the unvaccinated? We need a national “uniformity of approach” on masks, vaccination levels of at least 1-2 million per day, quick full approval of mRNA vaccines, boosters, and vaccines available for kids “not beyond the fall.” Dr. Anthony Fauci is the Chief Medical Adviser to President Joe Biden and Director of the National Institute of Allergy and Infectious Diseases (NIAID).

Chris Murray, director of IHME, joined our podcast once again, at this major moment of reset of expectations – of our ability to control the pandemic, of policy decisions, data gaps, political attitudes and behavior, hitting the wall of hesitancy and refusal to vaccinate, and public confusion. We cover the full gamut: the forecast for the fall surge, missteps on masking, the need for greater transparency in data, and how much room exists to overcome resistance to vaccines.  Chris Murray is the Director of the Institute for Health Metrics and Evaluation, and Chair and Professor, Department of Health Metrics Sciences, at the University of Washington in Seattle.

Dr. Birx, former Response Coordinator during the Trump administration of the White House Covid-19 Task Force, served also as the Global AIDS Coordinator and Special Representative for Global Health Diplomacy between April 2014 and January 2021. She joined us for an extended conversation on the accelerating changes surrounding us – the Delta variant surge, new discoveries regarding breakthrough infections among the vaccinated, continued vaccine hesitancy, and refusal that has prompted the declaration of “a pandemic of the unvaccinated.” As we speak, newly revised policies on masks and vaccinations are getting unveiled. What to make of this new phase, and where is it heading? We’ll need far higher testing and genomic sequencing, intensified local engagement, a big push on accelerating therapies, and thinking ahead on what the future mix of vaccines will look like.  Dr. Deborah Birx is a Senior Fellow at the George W. Bush Presidential Center

Gary Edson, President and founder of The Covid Collaborative, has for decades been a highly visible and impactful leader across government, business, and the non-profit worlds. While serving in senior White House positions in President George W. Bush’s administration, he played a key role in the design and launch of the President’s Emergency Plan For AIDS Relief (PEPFAR) and in the management of G-7 and other summits. He joins us to explore why the international response to Covid-19 has been so radically different from the response two decades ago to the HIV/AIDS pandemic. He also walks us through the genesis of the Covid Collaborative, how it operates, its impressive achievements in devising plans of action embraced by governors whose constituents account for one-third of Americans, and its rapid, innovative work on testing, masks, vaccine hesitancy, and school reopening. More recently, the Collaborative has focused (with CSIS) on the stark global split between vaccine ‘haves’ versus ‘have nots,’ at the very moment when two Americas have appeared, the vaccinated and unvaccinated. What gives him hope? “America rises to the occasion.”   Gary Edson is the President of The Covid Collaborative.

We’re blessed to sit down with Dr. Charity Dean, the central figure of Michael Lewis’ pandemic book, The Premonition, former Assistant Director of the California Department of Public Health in 2020, and co-founder of The Public Health Company. Her premonition on her birthday in December 2019 — a “giant blue tsunami wave” engulfing the US - prompted her to track what was happening in China “obsessively.” She became part of the executive team that devised Governor Newson’s operational pandemic plan. She also joined in 2020 the Red Dawn group, “a tactical warfare group” of “Wolverines” and other pandemic experts advising state governors as well as the Trump administration. She founded PHC in the spring of this year to create new software platforms for the private sector to manage the risks of future pandemics. Listen to learn more. Dr. Charity Dean, MD, MPH&TM, is co-founder and CEO of The Public Health Company.

Washington Post ace reporters Yasmeen Abutaleb and Damian Paletta take us inside their newly released blockbuster, "Nightmare Scenario: Inside the Trump Administration's Response to the Pandemic That Changed History." A gripping, provocative tour d’horizon. Give a listen.

Steve Morrison, who lives in the shadow of the Capitol, brought together Liz Lynch, a freelance professional photographer who attended the January 6 rally at the ellipse and both sides of the Capitol during the insurrection, and Alex Lazar, an academic pathologist, the University of Texas/MD Anderson, who on January 6 was working inside the Capitol. Listen in to hear their three respective angles on what transpired: the most poignant, vivid, revealing moments and how to digest the gravity and meaning of the siege and its aftermath. 

Rep. Tom Cole (R-OK), the senior House appropriator and a respected national leader on health security at home and abroad, has served on the CSIS Commission on Strengthening America’s Health Security since 2018. In this wide-ranging conversation, he reflects on the 100th anniversary of the Tulsa massacre of the Black Greenwood community; the “successful but mixed bag” of the rollout of vaccines in America; the impressive management by the Native American community of the vaccine challenges; and the continued need for bipartisan support of US health security leadership abroad. China’s behavior on the origin of the virus looks suspicious, like a “coverup.” Attacks on Dr. Tony Fauci are a “dangerous phenomenon.” Dr. Fauci was wrestling in his emails with an evolving crisis. To attack him is like going after American nuclear scientists in the 1950s. Support for CEPI is “money well spent,” the “most modest of insurance.”   Rep. Tom Cole (R-OK) is in his tenth term representing the 4th District of Oklahoma.

Krishna Udayakumar explains how he systematically assembled data to make sense of the fast-moving global marketplace in vaccines, amid the pandemic, building on prior trust with private and public entities, and positioning the Duke Global Health Innovation Center as the go-to source. Starting in late 2020, that meant painting the picture of worsening inequities that reflected the overwhelming power advantages of wealthy states and powerhouse vaccine developers, rhetorical commitments to solidarity notwithstanding. We are now rapidly approaching a pivot point, as supply escalates later this year: estimated western production of 7 billion doses in 2021, 14 billion in 2022. The big worry looking ahead? Lack of delivery capacity and financing in low and lower-middle-income countries, which may, as a result, become “mired” in 20-40% coverage. The G7 summit was a “mixed bag, ” leaving us “nowhere near the end of the story.” The big question 12-18 months out: will it be a western consortium that vaccinates most of the low and lower-middle-income countries? Or will it be the world’s vaccine “workhorse,” China? Or some combination?

Philip Zelikow, former executive director of the 9/11 Commission, has launched an ambitious fast-moving planning effort to scope what a commission on the pandemic in America would examine, how it would be organized, what value it would deliver, how it would navigate our treacherous political terrain, why it needs to move fast to nail down what happened. Listen in to learn more.    Philip Zelikow is an American attorney, diplomat, academic, and author. He is a professor of history at the University of Virginia.

This week the CSIS Schieffer Series hosted a high-energy exchange on “The Next Phase Of Covid-19.” Steve and Andrew were joined by Jeremy Konyndyk, executive director of USAID’s Covid-19 Task Force, who delivered a stirring keynote address outlining USAID’s vision for addressing the burgeoning pandemic crisis while simultaneously investing in long-term health security preparedness in acutely vulnerable low-income countries. A roundtable followed on the historic legacy of US presidential leadership amid global health crises -- and the lessons for the escalating urgent demands unfolding in South Asia, Latin America, and elsewhere. Steve, Andrew, and Jeremy were joined by Julie Gerberding, co-chair of the CSIS Commission on Strengthening America’s Health Security and executive vice president and chief patient officer of Merck; and Gary Edson, president of the COVID Collaborative and former White House official under President George W. Bush who played a pivotal role in launching PEPFAR and the Millennium Challenge Corporation (MCC).  

Dan Diamond has covered health, politics, and the White House for the Washington Post since January 19. What is going on in the international side of the US response to the pandemic? It is “piecemeal,” unclear who is making decisions, lacks a strategy, the approach is “much vaguer” than the domestic response. The US has announced a number of important steps which are “staccato moments.” President Biden came into office with the country “on fire.” His team is still settling, and there is no single person in charge of the international response. The issues are a complex “thicket” full of geopolitical risks. Nonetheless, it feels as if a moment is arriving where the administration is going to pivot to the international arena. Internally, senior officials are “raring to go.” Domestically, Dan has observed closely the four focus groups of vaccine-hesitant people launched by Republican pollster Frank Luntz, one session was a “transformative experience,” another a “total dud.” Perhaps the Community Corps will be able to bring to scale hyperlocal engagement with those who remain hesitant. Perhaps they simply need more information and more time. It’s “heady times,” practicing this form of journalism in Washington. Hypercompetitive, everybody wants a piece of the story.  Dan Diamond is the National Health Reporter at the Washington Post  

Dr. Monica Gandhi has thought deeply about the complex transition we have entered, with many vaccinated, and many not. We need to behave differently in private versus public settings. Being polite and compassionate remain essential. Resistance to vaccines comes from different populations, each requiring a different approach: racial and ethnic minorities; youth; those who ask what will be the rewards for getting vaccinated; and the recalcitrant. There has to be far more “positive motivation,” a form of “proactive, vaccine optimism” based on a concrete blueprint for how our lives will improve through vaccines. CDC guidance during this transition, on travel and outdoor masks, has been confusing but will improve as more people are vaccinated. School closures in the United States have been excessive. “It is political.” We are “not looking at data cleanly.” Global vaccine inequity is the world’s biggest moral challenge: we need to do “whatever it takes” to expand manufacturing and access. The population living with HIV whom she serves in San Francisco suffers from extreme loneliness, “untold mental health effects.” Her advice: “Please go see a friend.” Dr. Monica Gandhi is Professor of Medicine at the University of California San Francisco, Director of UCSF AIDS Research, and Medical Director of the HIV Clinic at San Francisco General Hospital (“Ward 86.”)

Dr. Castrucci joined us to discuss his evolving collaborations with noted Republican pollster Frank Luntz, an expert who is a “master class in communications.” Through a series of surveys and focus groups, they have teamed up to understand how best to engage conservative Republican voters who refuse or are otherwise deeply resistant to getting vaccinated against Sars-CoV-2. “Covid has been politicized since day one” and the question now is how to “change the conversation.” “If this is a political debate, we all lose.” What is the solution? Every health provider has to make engagement with patients on the vaccine a routine part of every patient’s visit. “Good stories and good facts” is “our formula, ” which can educate versus indoctrinate. Give people the facts, and they will “change hearts and minds.”  Dr. Brian Castrucci is the President and CEO of the de Beaumont Foundation, based in Bethesda, Maryland.

We sat down this week with the acclaimed survey expert, Mollyann Brodie who been exceptionally busy in recent months, engaging over 11,000 American adults. She finds it remarkable “how fast and dynamic vaccine confidence has moved” across all population groups, reaching acceptance among two-thirds of Americans. The “moveable middle,” of persons waiting to decide, has been cut by half to 17%. Black and Hispanic populations have moved towards higher acceptance but still account for a large share of those postponing a decision. As for “persistently reluctant” individuals, the 3 in 10 evangelicals and Republicans, particularly younger, male and rural citizens? “Nothing we have thrown at them… has caused them to tell us they are willing to move.” What to do? “At the margins, carrots seem to work for a sliver” of this population: i.e. if vaccines improve the ability to visit family, travel overseas, receive a bonus from an employer. “They have their own set of concerns” over personal liberty, disruption of economic life, distrust of government. Politics needs to be removed from discussions. The focus needs to shift to meeting these individuals where they are. “Hyperlocal efforts,” conversations among themselves, with their own physicians, with their own family members, hold promise.  What gives her hope? “ I have never seen a movement of this kind in my lifetime.. of so many individuals and organizations on the ground trying to help us get to herd immunity.”   Mollyann Brodie is Executive Vice President and Chief Operating Officer at the Kaiser Family Foundation, as well as Executive Director of the Public Opinion and Survey Research Program.

Dr. Deborah Birx, former Trump White House Coronavirus Response Coordinator and renowned global HIV/AIDS leader, spoke to us about a rich assortment of issues: the recent drama surrounding her statements about the Trump administration; her almost 7 months on the road across America, far from Washington, visiting with 44 governors; the corrosive divisions in our society; what might cure vaccine hesitancy; President Biden’s early achievements; DOD’s profound contributions; the secret power of millennials and retailers; the potential value of a 9/11 Commission, and more. “This virus does not recognize party. .. The more we make this pandemic partisan, the more it divides us.”  “I have worked in pandemics that were highly politicized… that creates vulnerabilities, we could not see it here.” In March, 2020, people were listening, responding to science and data, how to stop the spread, what it might do to our health system. Then the focus swiftly morphed to the economy. “For those of us who stayed.. we believed we could recapture how severe this pandemic is.” By the fall, “we were never able to move people to testing as a public health measure in itself.”    On vaccine hesitancy, her message to all mothers: “No matter what age your son, tell him for your peace of mind to get vaccinated.” “To daughters and sons, call your dads.” “Do it for your family.”    Dr. Deborah Birx is Senior Fellow at the George W. Bush Institute. 

Journalist, writer, editor Frances Stead Sellers returned to share new insights. Leaders like Henrietta Fore, UNICEF, struggle with “incredible added burdens” dealing with crises in childhood education and disrupted immunizations while “vaccinating the world” against Covid-19 with Gavi. “Imagine being Henrietta Fore. .. The strains on the organization are enormous.” Francis Collins, head of NIH, faces similar expansive responsibilities, and uses his own voice “as a person of faith” to address vaccine hesitancy. The Washington Post Live series, one-on-one conversations, creates a new “intimacy” where guests are more reflective. Over and over during the pandemic, journalists face the “We don’t know” quandary of scientific uncertainty. “We keep getting ahead of ourselves.” That requires laying out what different experts believe, a form of “service journalism”. Vaccine hesitancy among Republican men is a “new phenomenon,” very “distressing,” that reflects our immense national divisions. People want to hear from their friends, from trusted individuals. It is important for people’s “barber to be seen getting vaccinated.” Her personal hope for the future? “I desperately want to return to real-life meetings… Nothing beats face-to-face meetings.” Frances Stead Sellers is a Senior Writer and Reporter on the National Desk at the Washington Post.

Dr. Jennifer Kates and Josh Michaud, Kaiser Family Foundation, take us on a tour d’horizon. Rapidly accelerating vaccine coverage has resulted in “a huge, huge change.” By the end of June, we will have twice the volume of vaccines needed to inoculate America’s 260 million adults. Improvements in testing and surveillance lag – “We can’t just focus on one intervention.” At the same time, state leaders relax controls, and variants increase transmissibility, concentrated among youth. “We are definitely at risk.” The equity agenda? “It’s not going well yet…. Most states are not doing a good job on equity…. It is the key aspect of this rollout over the next few months.” Many southern states are weak performers on vaccines (AL, TN, TX, GA, AR, SC, MS) while many smaller states are strong performers (AK, ME, SD, ND, RI, WV, CT). 55% of Americans now “want to be vaccinated,” while those who prefer to wait-and-see has dropped from 30% to 22%. But 15% are refusing, and another 7% will take the vaccine only if required. The chief challenge: how to reach Republican voters – especially male, rural, younger – with what message and what messenger? Digital certification of vaccination is “going to happen” but “can be quite fraught” over privacy, discrimination, and civil liberty concerns.  Dr. Jennifer Kates is Senior Vice President for Global Health and HIV Policy; Josh Michaud is Associate Director for Global Health Policy, at the Kaiser Family Foundation in Washington, D.C.  

Dr. LaQuandra Nesbitt, director of the Washington DC Department of Health, shares her insights into battling the pandemic. Washington is the opposite of self-contained. Protesters of many stripes transport their grievances to Washington, often stoking “strife and agitation” with little regard for the health of the community. Emergency preparations intensified beginning in 2015: “We were ready” in 2020 but had “still so much to learn” as the pandemic unfolded. Messaging in the fog of a pandemic is difficult, in need of constant refinement. Testing got off to a halting start. But as swabs, reagents, and skilled staff became available, the city quickly scaled its testing. It also raised a caution: testing is costly and long-term. How to sustain? Vaccine distribution, including to high numbers of non-residents who work in the Capitol, has been a challenge. Equity and accountability concerns continue to dominate. One reality persists: “We simply do not get enough vaccine here in the District.” And when doses move through retail pharmacies and hospitals with insufficient oversight and coordination, equity suffers. Luckily, ”demand is so high” for vaccines.   Dr. LaQuandra Nesbitt is Director of the District of Columbia Department of Health in Washington, D.C., a position she has held since January 2015.

Helen last joined us on April 2, 2020, a dark moment. She returned to explore with us whether the joy, relief, and gratitude that millions are experiencing through Covid vaccines generate gains in other disease areas, where adult vaccination “is a hard field.” “These vaccines have been extraordinary” with “very few side effects.” Among Republicans, especially in rural areas, “a good chunk of people are not intending to be vaccinated.” It was a lost opportunity when President Trump did not go on camera when he was vaccinated. The search is now fully on for trusted influencers to reach Republicans. What lies ahead is a “bumpy period,” and progress is going to take time, but the rapid development of vaccines and today’s surge in production provide hope.     Helen Branswell is a Senior Writer, Infectious Diseases, at STAT. She is the winner of a George Polk Award in Journalism in 2020 for her remarkable coverage of SARS-CoV-2.

Peter Hotez joins us for a Texas-centered conversation. After 11 years in Washington DC, Peter migrated to Texas where over the past several years he has established himself as a leading research scientist, public voice on infectious disease, including SARS-CoV-2, vocal advocate of vaccines, and opponent of anti-science, anti-vaccine voices. How did this happen? How has this changed his life? In recent days, Governor Abbott made his sudden, unforeseen decision to lift the mask mandate and restrictions on businesses. How to make sense of that? Viral variants dominate the conversation, in Texas and beyond. What does that portend?   Peter Hotez is Dean of the National School of Tropical Medicine at Baylor College of Medicine and Co-Director of the Texas Children’s Center for Vaccine Development.

Ashish Jha, a determined optimist, gives the Biden administration an A- for its first six weeks. The picture today is “dramatically better.” “A light switch went on after January 20,” when states could suddenly ask for – and receive – help. An “extraordinary bump-up” in vaccinations is underway: “We have more vaccines coming than we will know what to do with.” More needs to happen in building out testing, developing strategies for variants, and planning for when variants may escape vaccines. “The equity agenda is not going well.” While it may be “easy to look like a superstar compared with Trump,” the Biden administration “needs to lean in heavily” with its political and diplomatic power to shape the international environment to control outbreaks, bridge the dangerous vaccine gap, and increase manufacturing. Surplus vaccines will be key: “The problem is not money, it is vaccines.” Ahead of us lies “a really good summer and fall.”  Ashish Jha is Dean of Brown University’s School of Public Health.

Sheryl Gay Stolberg, the NYT’s health policy correspondent, returned to our podcast to reflect on the first month of the Biden administration. Its approach “could not be more different” than that of the Trump administration. The transition has “brought order,” the pieces are “ a lot more buttoned-down.” Caution is a watchword: the President does not want to overpromise, aware of the race against variants, and the unpredictability of the virus. Much of the change in tone stems from President Biden’s personality: his desire to move past the high toxicity, create a “more compassionate conversation,” be “ a healer, a consoler” who “lowers the temperature” and wins Americans’ trust -- and passage of the $1.9 trillion rescue plan. Problems and challenges do persist. The United States is missing an important diplomatic moment in not taking an international leadership position and moving fast to guarantee vaccines reach low and middle-income countries. “The absence of data is a problem” when it comes to tracking disparities in the delivery of vaccines across America. Delivery of vaccines at the state level is still today “a mad scramble.” America remains dangerously divided. But overall, the trajectory is hopeful in the fight against the virus.    Sheryl Gay Stolberg is the Washington health correspondent for the New York Times. Over the course of the past 24 years at the Times, she has covered the White House, Congress, and national affairs. She shared in two Pulitzer prizes awarded when she was at the Los Angeles Times.

Chris Murray kindly returned to the podcast for another round. We know now that variants increase transmissibility “by quite a bit,” and have the potential to increase the fatality rate and escape vaccines, lowering efficacy rates. The Novavax trial, ominously, showed that one variant can reinfect individuals previously infected. It’s a new, uncertain world in which SAR-COV-2 is not overcome and eliminated, but rather becomes endemic, a “seasonal flu only ten times worse.” We know that accelerating vaccination campaigns, with excellent vaccines, combined with seasonality (end of winter, arrival of summer) can drive the pandemic down. But a lot of virus remains in the community, variants will take off in America in another month or so, and relaxation of controls too early will trigger spikes in the spring and lay the groundwork for another bad winter at year’s end. Politicians, scientists, policy advisors are just beginning to get their heads around what this means, short and long-term, and what to communicate to a public which has just heaved “a giant collective sigh of relief” in hope that the pandemic is finally over.  Chris Murray is the Director of the Institute for Health Metrics and Evaluation at the University of Washington in Seattle, where he is also Chair and Professor in the UW Health Metrics Sciences Department.

…if you are fed misinformation from the top of the US government. Former Senate Majority Leader Bill Frist joined us to reflect on his life and where our country is. “I have radically changed my life … for the better. Refocused my life on nature.” In his 12 years in the Senate, he was the only doctor who had taken care of a patient… the only scientist. It was tough selling his 2005 Manhattan Project plan for pandemic preparedness. Today with Covid-19: “We have failed as a country.” Trump failed at communications by spreading false information, undermining scientists, downplaying the severity. In Tennessee, “hundreds of people died unnecessarily.” “If there is a fire in the forest, you have to know where it is.” And test. “Health security is national security, And we have to treat it as such.” The January 6 insurrection? “For me it was very personal. Took me back to 23 years ago when a man came into the Capitol and assassinated two police.” Does the Republican Party have a future? “ It is in search of a leader.” Listen to hear the full answer.    Bill Frist, a renowned heart and lung transplant surgeon, served two terms in the Senate, including as the Senate Majority Leader 2003-2007. Today he remains a highly influential health policy expert, at home and abroad, a medical innovator, advocate, businessman, and naturalist. He hosts a very active podcast, ‘A Second Opinion.’ He lives on a farm in Franklin, Tennessee.

We were delighted to join this week with Scott Kirby, the CEO of United Airlines. The impact of the pandemic upon the airline industry has been “devastating,” the worst in its history. Luckily, bipartisan broad-based support for the industry – contained in the CARES Act and the December $900 B emergency measure – has preserved this critical infrastructure. Variants are a stark threat: “We’re giving the virus a large playing field upon which to mutate, for variants to become more deadly, more transmissible, or to evade vaccines.” United is actively working with partners to develop vaccine passports: passports are “the key not just to reopening borders and travel, but to reopening segments of the economy that have been closed.” “It is the right thing to do to make vaccines mandatory” though United has not yet taken that step. 1,000 passengers who refused masks have been banned from flying on United. Immediately after the January 6 violent insurrection against the Capitol, United took several “tactical steps” in its flights in and out of Washington. Decarbonization remains a personal passion. United has joined the world’s largest “air capture and carbon sequestration” project and led the industry in biofuels.  Scott Kirby became the CEO of United Airlines in May of 2020. From 2016-2020, he was United’s President.

Dr. Alisha Kramer, a CSIS alum and young doctor serving poor, black, pregnant women in Atlanta hospitals, rejoins us for a second podcast. One year into the pandemic, a “new normal” has arisen that is still jarring, a “disconnect” in the changes in medical practice. Vaccine hesitancy is a “shocking” matter among nursing staff. Black persons “have every right to be distrustful” of the health system. If we give the “microphone back to the experts… based on the science,” if we rely on neighbor to neighbor communications, trust will return. We have not yet learned much about Covid-19 infection in pregnant women. It is up to the pregnant individual and her provider to determine whether to go ahead with a vaccine. Her thoughts on her husband Jonathan Ossoff’s successful quest for a Senate seat? “We can all agree 2020 has been incredibly surreal.” Black women in Georgia carried the day.   Dr. Alisha Kramer, a revered former colleague at the CSIS Global Health Policy Center, graduated in 2019 from Emory University School of Medicine. She is currently a resident specializing in obstetrics and gynecology at Atlanta public and private hospitals.

Dr. Céline Gounder, a member of the Biden-Harris Transition Covid-19 Advisory Board, takes a look at where we are, less than one week after President Biden assumed power. Deborah Birx and Tony Fauci have each come forward, unshackled, to discuss the moral and professional quandaries they faced, including threats and coercion, as Trump erected false narratives, intensifying in the fall electoral season and beyond, steering Americans into a human catastrophe. “Proximity to power is intoxicating. It corrupts judgment.” “I was impressed by Dr. Birx’s road trip.” It was “a smart pivot.” President Biden has shifted to unification and healing: “That is the way to get to the other side.” It is “calming” when public health and science leaders speak directly to the American people, aided by trusted messengers – the local sheriff, the faith leader, the soccer coach. There was chaos during the vaccine introduction, as the incoming administration was handed a “black box.” The way forward is through continued masking, social distancing, hand washing, along with patience, realism and an optimistic determination in expanding vaccine coverage, amid shortages.    Dr. Céline Gounder is Assistant Professor at the NYU Grossman School of Medicine, President/CEO and founder of Just Human Productions, and host of the Epidemic and American Diagnosis podcasts. She served as a member of the Biden-Harris Transition Covid-19 Advisory Board.

Chef Jose Andres sat down with us to reflect on his life, the organizations he has founded, and his unique, powerful vision for using food to transform communities, battle inequities, advance unity and strengthen economies. When he landed in America as a young man, “I became an American way before I became an American by a passport.” Two years later, at age 23, he chose Washington to be his home: it is the “place where things can happen.” He created relief organization World Central Kitchen to operate in “the limbo between emergency and reconstruction.” “People feel forgotten.” In response to Covid-19 in American and Spain, WCK has served over 36 million meals by partner restaurants converted to community kitchens across America. “We move very quickly.. it is in our DNA.” He has become increasingly convinced that “food is a national security issue” requiring a U.S. “Food Czar” next to the President, with “real power” and a “real budget.” “Hunger is something that cannot wait.” What’s next for 2021? Focus on revitalizing his businesses, the ThinkFoodGroup: “when it is safe.. bring the restaurants back..” Keep moving forward with WCK, changing our national conversation on food. Unity is the key: “I believe in lower walls and longer tables.” Chef Jose Andres, based in Washington, D.C., is the renowned chef, founder and head of both the ThinkFoodGroup restaurant group and the rapid-response humanitarian organization, World Central Kitchen.

Dr. Luciana Borio, a member of President-elect Biden’s Covid-19 Advisory Group and the transition team, scanned the horizon. On the development of Covid-19 vaccines: “All in all, this has been a spectacular success.” Special tribute goes to the FDA career staff, the “heroes” who charted the path forward. Now most worrying: ensuring large scale manufacturing of the MRNA vaccines, and fixing logistics - “the gaping hole” created by a wholesale lack of planning. Vaccine hesitancy, equity, and the ”extraordinary” complexity of delivery all demand high attention. “We don’t have visibility” into the new variants of the virus, due to inadequate genomic surveillance. Development of therapies was hindered by “a lot of noise” surrounding hydroxychloroquine and convalescent plasma: a more rigorous, less political approach will deliver better results. In the next year, while “it’s gonna be hard,” there is “no better team” than the one assembled to begin work on January 20.    Dr. Luciana Borio is a member of President-elect Biden’s Covid-19 Advisory group and the transition team. She is a Vice President at In-Q-Tel in Washington, DC. She previously served as Director for Medical and Biodefense Preparedness at the National Security Council under both Presidents Obama and Trump.

Chris Murray, the renowned modeler, joined us to share his year-end reflections. In this year unlike any other, Covid-19 pushed modeling onto new ground, as forecasting of individual and governmental behavior became essential to inform decisions in the near to medium term. It’s been “a steep learning curve.” Looking ahead to 2021, in Q1 and 2 we will see a profound pivot, as vaccinations are scaled, winter ends, government policies evolve, and immunity within the population rises. We should arrive at “a surprisingly decent place in June or July.” As we “bounce back to pre-Covid behavior,” it will be a “balancing act.” Success in reaching herd immunity rests on a campaign to get “the maybes,” upwards of 30 percent of the population, while the 15-20 percent of “straight refusers” won’t budge. A vitally important “lingering question:” will we have attained enough vaccine coverage that nothing terrible happens in the winter of 2021-2022?   Chris Murray is the Director of the Institute for Health Metrics and Evaluation (IHME) at the University of Washington.

Steve and Andrew had the good fortune to catch Suzanne Firstenberg shortly after the recent conclusion of her stunning public art installation, ‘In America…. How could this happen?,’ a dramatic tribute to those lost to Covid-19. This “awakening,” comprised of 267, 080 white flags, stood on the parade grounds of the Washington DC National Guard Armory between October 23 and November 30. What motivated her to act so boldly, and how was it possible to succeed so rapidly, moving in just a few weeks from concept to creation? What were the key messages she was conveying, and what was the human experience of those who participated in it? As she explains, she could not do this alone. Several key partners joined with her, most notably Ruppert Landscaping and Jose Andres and World Central Kitchen. Others from the Smithsonian and National Geographic acted to preserve and capture this achievement.    Suzanne Firstenberg is a social action artist based in Bethesda, Maryland. Her installation was covered by National Geographic, among other outlets, and you can find a Nat Geo video of the installation here.

Dr. Carissa Etienne, Director of the Pan American Health Organization (PAHO), joined Steve Morrison and CSIS Senior Fellow Katherine Bliss for an extended conversation. Why have the Americas become the epicenter of the coronavirus pandemic? What does it signal in terms of deep inequities, weak health systems, and quality of leadership? The region faces cascading crises – debt, extreme poverty, malnutrition, interrupted health services. How are these threats to be blunted? And what role can strengthening primary health care services play? PAHO has a remarkable record of achievement stretching back over a century. How to better make the case to the citizens of the United States of contributions PAHO makes to protecting them? How will the Covax Facility and the PAHO Revolving Fund interact to bring affordable Covid-19 vaccines quickly to the region, at the same time that Russia and China are actively marketing their unproven vaccines to the continent?    Since 2013, Dr. Carissa Etienne has been Director of the Pan American Health Organization. She previously served as chief medical officer and coordinator of the National AIDS Program in her native Dominica, and as Assistant Director-General for Health Systems at the World Health Organization (WHO). 

A renowned medical and public health voice of compassion, personal advice, pragmatism and vision, Dr. Leana Wen joined us for a tour d’horizon of the pandemic, at this moment of “explosive exponential growth.” Why is it so crucial today to have credible, trusted public health voices? Why have so many Americans disregarded the recent Thanksgiving warnings, and why do so many Americans continue to minimize the threat of Covid-19? The Phase 3 vaccine results are “great news” and we now have to attend to the “serious problem” of distrust, and the risk of asking already highly constrained local and state public health officials to run demanding vaccine programs, with an urgent need for new financing. Solutions take different forms. “Messengers often matter more than message.” On vaccines and restoring trust, there is a need to hear from business leaders, pastors and other religious figures, and Republicans. In many areas – schools, business closures, scientific trials –  “moderated” nuanced policies and “radical transparency” of data and decision-making will improve public understanding and support. Dr. Leana Wen is an emergency physician and Visiting Professor of Health Policy and Management at George Washington University School of Public Health. She is a contributing columnist at the Washington Post, and an on-air commentator for CNN. She served previously as Health Commissioner for the City of Baltimore.

Steve and CSIS Senior Fellow Katherine Bliss enjoined Sir Andrew Witty to help us answer a few fundamental question: what exactly is this new, umbrella coalition, the ACT Accelerator; what is its value, six months after its creation; and what are its true prospects of success in battling hyper-nationalism and enhancing access by low and middle income countries to Covid-19 vaccines, therapies and diagnostics? Along the way, we delved into the significance of the November 21-22 G-20 summit, discussed the finance gap, the prospects of massive vaccine surpluses in the hands of the most wealthy and powerful countries, and China’s participation. Is the door open for the United States to join, belatedly? And what would the special value of that be? Andrew Witty is the Co-Lead of the Access to Covid Tools (ACT) Accelerator and WHO Envoy for Covid-19. Between 2008 and 2017, he was the chief executive officer of GlaxoSmithKline. He is currently president, UnitedHealth Group, and chief executive officer, Optum.

We sat down with Mike Osterholm, a member of President-Elect Biden’s Covid-19 Advisory Task Force, a renowned leader in global health security, director of the University of Minnesota’s Center for Infectious Disease Research and Policy (CIDRAP). What does he make of this “most dangerous period since the Spanish Flu in 1918,” fueled by “pandemic fatigue, fatigue anger and indoor air?" Health systems are on the edge of breakdown, as shortages of ICU staff and beds worsen, providers “hit the wall” in locating protective gear, and drug shortages worsen. In his view, America needs a leader who can communicate calmly and effectively to all Americans. “We need Uncle Joe,” we need “fireside chats” that “help us get through this.”        Dr. Michael Osterholm is the founder and Director of the Center for Infectious Disease Research and Policy (CIDRAP) and Professor in the School of Public Health at the University of Minnesota. He is a member of President-Elect Biden’s Covid-19 Advisory Task Force.

In this episode, we are joined by Dorothy Shea, the U.S. Ambassador to Lebanon, along with Jon Alterman, SVP/Director of the CSIS Middle East Program. The Covid-19 outbreak, kicked into high gear following the August 4 Beirut port explosion, is out of control and has triggered a new national lockdown. It is embedded in a web of economic, political and humanitarian crises, which have brought Lebanon to the edge of state failure. Why does Lebanon matter to U.S. national interests? And what impact is the United States having?   Dorothy Shea is the U.S. Ambassador to Lebanon. Jon Alterman is Senior Vice President, Zbigniew Brzezinski Chair in Global Security and Geostrategy, and Director of the CSIS Middle East Program.

In this episode, Jono Quick opens with a sweeping overview of the history of faulty responses to pandemics -- why we “descend into the valley of complacency” so often? What are the essential steps to take now, modeled perhaps after the 9/11 Commission, to remember this profound moment? How do we transcend our divisions, borne of pandemic denial, pandemic fatigue and pandemic anger? He also illuminates the $100m Rockefeller Foundation swift and highly ambitious initiative to press for a national approach on test and trace in the United States. Followed now by the $1 billion three-year Rockefeller Foundation campaign, just unveiled, to catalyze a more inclusive, equitable green recovery from the Covid-19 pandemic.  Dr. Jonathan (Jono) Quick is the Managing Director for Pandemic Response, Preparedness and Prevention at the Rockefeller Foundation. From 2004-2017, he was President and CEO of Management Sciences for Health (MSH).

Helene Gayle sat down with us to reflect on the expert committee that she and Dr. Bill Foege led recently to map out – in record time – a framework and strategy for the phased introduction of a Covid-19 vaccine in America. For this urgent, complex priority, what are the principles that should guide decisions on who comes first, and who comes later? How best to address gross disparities in the vulnerabilities to Covid-19 of Black, Latinx and Native American populations? What are the essential steps to address widespread distrust and vaccine hesitancy? What comes next, how to navigate the uncertainty and turbulence of these times, and what are the roots of optimism and hope?     Helene Gayle is the President and CEO of the Chicago Community Trust. Previously she was the President and CEO of CARE, and a senior leader at CDC and the Bill and Melinda Gates Foundation. From July through October, she co-chaired with Dr. William Foege the Committee on Equitable Allocation of Vaccine for the Novel Coronavirus, organized by the National Academies of Sciences, Engineering and Medicine. Its final report, ‘Framework for Equitable Allocation of Covid-19 Vaccine,’ was issued October 2, 2020. Helene has been a CSIS Trustee since 2007.

Jennifer Kates and Josh Michaud, Kaiser Family Foundation, joined us to discuss their new analysis, ‘Distributing a Covid-19 Vaccine Across the United States – A Look at Key Issues.’ Getting vaccines to Americans is an unprecedented, gargantuan, complex enterprise. Just how ready are we? Financing thus far is a meager $200 million, while an estimated $6-10 billion will be required. Local public health infrastructure is rickety, insurance gaps are many, and building trust and engagement, especially with Black, Latinx and Native American populations remain essential challenges. Some states have identified early phase, prioritized recipients with some precision. Others lag behind. How to manage this enterprise amid deep partisan divisions, the winter surge, our national electoral process? How to judge the performance thus far of Operation Warp Speed? Give a listen!   Jennifer Kates and Josh Michaud are with the Kaiser Family Foundation in Washington D.C.. Jennifer is the Senior Vice President and Director of Global Health and HIV Policy, Josh the Associate Director of Global Health Policy.

Mollyann Brodie, America’s premier health survey researcher, explores the widening bifurcation of America along partisan and ideological grounds, with “wildly different conceptions, wildly different sources of information, sealed off from alternatives.” This advancing politicization, aggravated by the current electoral cycle, is now dominating the response to Covid-19. She also walks us through the “perfect storm” experienced by the Black community in America, its compromised health and financial well-being, distrust and alienation from the health system, as revealed in a moving and powerful recent Kaiser Family Foundation/The Undefeated study.  Mollyann Brodie is the Executive Vice President and Chief Operating Officer, Kaiser Family Foundation, where she also is Executive Director of the Public Opinion and Survey Research Program

In this episode, we are joined by Tom Bollyky of the Council on Foreign Relations. Co-director of a newly released bipartisan CFR Independent Task Force on pandemic preparedness and the response to Covid-19, Tom walks us through the Task Force’s findings, including how China’s lack of transparency in the early days of the pandemic fueled the spread of the virus, subsequently compounded by failures at the federal and others levels of the US government. Even in the midst of the Covid-19 pandemic, we need to prepare for the next ‘once in a century’ pandemic. Two Task Force recommendations stand out: its call for the creation of an international surveillance network coupled with a Health Security Coordination Committee, a new international mechanism to navigate geopolitical pressures and coordinate quick action.    Tom Bollyky is Senior Fellow for Global Health, Economics, and Development and Director of the Global Health Program at the Council on Foreign Relations. The report is the ‘Independent Task Force Report No. 78: Improving Pandemic Preparedness: Lessons From COVID-19’.

As UW-Madison opened in early September, it faced a sudden explosion of Covid-19 cases. Hear from Chancellor Rebecca Blank why this happened, the steps taken to re-stabilize the university amid multiple, deep political divisions across Wisconsin, a very public showdown between the university and county authorities, and a runaway Covid-19 outbreak in the state. Hear also about the impending return of football (“Every game is an away game!”), preparations for the winter and spring, the future of education at UW and beyond. “We have to respond” to achieve greater racial diversity among faculty and students as the movement for racial justice has swept the nation.    Rebecca Blank has served as Chancellor of the University of Wisconsin-Madison since 2013. Prior to that, she served as Acting and Deputy Secretary of Commerce in the Obama administration, Senior Fellow at the Brookings Institution, Dean of the Ford School of Policy at the University of Michigan, and as a member of the Council of Economic Advisors to President Clinton.

We crossed much sensitive and difficult ground in our extended conversation with Rep. Tom Cole (R-OK). President Trump’s bout with Covid-19, the proliferation of White House cases, the claim that the virus is not dangerous: how to make sense of all of this this, and the implications? Why have negotiations over the next Covid-19 emergency spending bill broken down? And how bad are the consequences? How to protect CDC and FDA? Do we need a national conversation on the value and merits of vaccines, and the need to rebuild popular trust and confidence? Should Congress support Gavi to bring vaccines to low and middle income countries? Give a listen.  Rep. Tom Cole (R-OK) is leading force in Congress advocating for strong bipartisan US leadership in health security, at home and abroad. He is the former Chair and now Ranking Member of the Appropriations Subcommittee on Labor, HHS, Education and Related Agencies. He is Ranking member of the Rules Committee and Deputy Whip of the Republican Conference. He is also a member of the CSIS Commission on Strengthening America’s Health Security.

Our longstanding friend and ally Judyth Twigg joins us to survey the rather bumpy ride that America’s colleges and universities are experiencing as they navigate the pandemic. Are these institutions the new super-spreaders? What form of leadership is showing the best results? Are colleges and universities now the center for innovation in testing? How well exactly do we learn when separated into remote settings? What about mental health?  Professor Judyth Twigg is Professor of Political Science at Virginia Commonwealth University and CSIS non-resident Senior Fellow with the Global Health Policy Center and Europe Program.

We sat with Chris Murray for an intense conversation on IHME’s recent, startling (and controversial) forecast that the United States would experience a dramatic surge in Covid-19 infections and deaths by year’s end that will exceed the peak moments of April. Many of the drivers are behavioral – a decline in mask use, rising mobility, lower vigilance and social distancing. But the seasonality is what will truly turbocharge the pandemic. Why is that, and what gives confidence that seasonality will be so powerful? Why do we as a nation appear stuck on a roller-coaster, incapable of learning to stick with actions that work? Chris Murray is Director of the Institute for Health Metrics and Evaluation (IHME) and Chair, Department of Health Metrics Sciences, at the University of Washington

In this episode, we learn from Richard Rossow, CSIS Wadhwani Chair in U.S.-India Policy Studies. India now ranks second in the world in Covid-19 cases, and in a single recent day recorded over 90,000 cases. What explains this dramatic, startling surge that we are witnessing? And how to reconcile that with the Modi’s government’s continued determination to reopen society and the economy? And his continued high public standing? And how does this relate to India’s special place in the world in production of generic vaccines?   Richard Rossow is a senior adviser and holds the Wadhwani Chair in U.S.-India Policy Studies at CSIS.

We gather to discuss with Dr. Heidi Larson about her new book, Stuck: How Vaccine Rumors Start – and Why they Don’t Go Away, a wake-up call and appeal to re-think what drives popular distrust in science and rising levels of vaccine refusal and hesitancy. As the world strives to develop safe and effective vaccines to arrest the Covid-19 pandemic, we should expect widespread resistance. How should our understanding of rumors, risks and uncertainty, digital wildfires, and group think figure in our thinking? Popular trust in vaccines and authority have national security implications, given the urgent, huge stake in getting control of the pandemic and restoring economies: what might that mean? What type of engagement is most needed and appropriate today, if we are to avoid repeating the mistakes of the past?  Dr. Heidi Larson is Professor of Anthropology, Risk and Decision Science and Director of the Vaccine Confidence Project at the London School of Hygiene and Tropical Medicine.

Both the Democratic and Republican Conventions had to give a central prominence to the pandemic, but chose radically different approaches, story lines, and messages. Two conventions, two realities. Listen as Steve and Andrew work through these divergences and what they presage as we head towards November 3.

 In the global scramble for Covid-19 vaccines, dominated by aggressive nationalist approaches, COVAX has emerged as a promising, nascent, international initiative to develop and equitably distribute Covid-19 vaccines to benefit all countries. In this episode, Steve is joined by Nikolaj Gilbert, President and CEO at PATH; Peggy Hamburg, former Commissioner of the FDA; Kendall Hoyt, Assistant Professor of Medicine at Dartmouth University's Giesel School of Medicine; and Nicole Lurie, Strategic Advisor to the CEO at the Coalition for Epidemic Preparedness Innovations (CEPI) for a discussion about COVAX and its prospects for success. How does it work? What will it cost? What will it take for COVAX to succeed? What role can the United States play in that effort? The panelists discuss these issues and the implications they may have on the trajectory of the pandemic in the United States and around the world. This episode is a condensed version of an August 11 event hosted by the CSIS Commission on Strengthening America’s Health Security: “The Scramble for Vaccines and the COVAX Facility.”

Steve joined with CSIS Senior Vice President Heather Conley and Professor Judyth Twigg, Virginia Commonwealth University, to discuss the fast-breaking controversy of this week, as Russia announced it had registered the first Covid-19 vaccine, without first conducting large late-stage human trials, and would soon commence mass immunizations, in Russia and beyond. What domestic and international calculations are motivating Vladimir Putin? What are the risks and barriers? Might the vaccine succeed, might Putin succeed in changing the rules? What might this mean for the United States and China in their respective quest to be victors in the global race? For WHO as it strives to preserve common norms?

In this episode, Steve is joined by two members of the global health team to discuss their new commentary on the race for a Covid-19 vaccine: Katherine Bliss, GHPC Senior Fellow and Anna Carroll, GHPC Associate Fellow. Nationalism among the wealthier and more powerful countries dominates the global scramble for a vaccine. They have locked up much of the future production of promising vaccines, while low and middle income countries are at risk of being left empty-handed and uncertain, at the back of the queue. One emerging and promising initiative is the COVAX vaccine facility, led by Gavi and the Coalition for Epidemic Preparedness Innovations (CEPI), which seeks to ensure timely access and equity to vaccines, under the broad umbrella of the ACT-Accelerator. What’s the rationale for these efforts, how are they structured and financed, and what is required to sustain them and put them on a path to success? Who are its strongest supporters? And what is the national security case for the United States pursuing a blend of both nationalism and internationalism, in support of COVAX. What specifically are we arguing that the United States should do?

What happens at the state level can be profoundly decisive. Steve sat with Rep. Peter Welch to discuss how Vermont became such a dramatic outlier, in its quick and effective control of the coronavirus, and the actions taken to preserve those gains. The conversation quickly migrated to Vermont’s state political leadership, the predisposition to respect science, the centrality of social trust and political culture, and those measures most effective in keeping families and businesses intact. “Everyone is eager for a vaccine.” Dr. Fauci represents “science, public health, and expertise.” Hope rests in solidarity, “collective mutual support.”    Rep. Peter Welch (D-VT) was first elected to represent the citizens of Vermont in 2006.

Steve Morrison sat down with Dr. Beth Cameron, Vice President at the Nuclear Threat Initiative, and former senior White House official responsible for health security and bio defense, to talk through what the accelerating race for vaccines for Covid-19 means. Should we be excited and hopeful? Should we feel cautious, skeptical? Perhaps both. We survey the landscape – the White House ‘Operation Warp Speed,’ China’s program, the ACT-Accelerator initiative launched to ensure the needs of low and lower middle income countries are met. How important is it for the United States to step forward on the world stage? Beth Cameron is Vice President for Global Biological Policy and Programs at the Nuclear Threat Initiative (NTI), based in Washington D.C.

Steve Morrison asks Marc Daalder, an incisive American reporter in New Zealand: how and why did New Zealand succeed in locking down the country, winning public support, and eliminating the virus? So, what now? Can tourists and other visitors ever return, even while the movie industry and other big earning events are exempted? How is New Zealand managing new cases of Covid-19? Marc Daalder is the political reporter at Newsroom in New Zealand.

J. Stephen Morrison, Senior Vice President and director of the CSIS Global Health Policy Center, sat down for a conversation on July 24 with Dr. Anthony Fauci, as America’s runaway crisis continued to unfold. Will a return to basics be enough, or are lockdowns in our future? Do we really have reliable science on how Covid-19 impacts children, as we debate whether to reopen schools? Can we rely exclusively on an ‘America First’ approach to vaccines, when the least wealthy and powerful countries may be left at the side of the road? What happened with that first (wayward) pitch at Nationals stadium? And just how fragile is the return of professional sports? Dr. Anthony Fauci is director of the National Institute of Allergies and Infectious Diseases (NIAID) and a member of the White House Covid-19 Task Force.

Andrew and Steve gathered with David Sanger to discuss the NYT's recent investigative team’s efforts, which chronicled the momentous White House decisions taken in early April to step back and push lead responsibility on to the states. This occurred at the same time that the President balked on any national testing strategy, refused to embrace masks, and persisted in escalating pressure upon states to reopen before they were ready. Overly optimistic scientific models created the false impression that the pandemic had peaked in the United States. A White House slow to recognize its mistakes as summer began permitted the virus to raced out ahead, ushering in today’s crisis, twice the scale of March and April. The NYT team concluded that these decisions are among the most catastrophic undertaken by any White House.  David Sanger is a premier national security correspondent for the New York Times.

Dr. Peter Hotez joins us from Houston. How did Texas and many other wildfire states run so out of control? What needs to change in the federal response? How can scientists and the biomedical research community best contribute to escaping this spiral? Dr. Peter Hotez is Dean of the National School of Tropical Medicine at the Baylor College of Medicine and Director of the Texas Children’s Center for Vaccine Development, both in Houston.

"This is a marathon." Congresswoman Barbara Lee (D-CA), a renowned leader in Congress on racial justice and global health, discusses her proposed Commission on Truth, Racial Healing and Transformation, the George Floyd Justice in Policing Act, the awakening across America, this historic moment for elected Black women leaders, and this week’s virtual ‘AIDS 2020’ International AIDS Conference. Congresswoman Barbara Lee (D-CA) has served in Congress since 1998.

In this episode, Steve and Andrew invite Frances Stead Sellers, senior writer on the American desk at the Washington Post. Frances, through her eyes as an English immigrant to America -- and a renowned, veteran journalist -- has thought hard about what makes America what it is, in these days of a pandemic, economic pain and racial injustice. Her recent experiences in reporting have taught her about the deep divides in American society, the awakening within the business community, including at the Washington Post, people’s fear to come to the hospital, innovations in communications and delivery of medical services, and how journalism has evolved to capture these moments. 

In this episode, Steve and Andrew speak with Senator Patty Murray (D-WA) on the most pressing health issues before America. What is driving the astonishing resurgence of Covid-19 in the south and west, and what is now required? Why are we as a nation still hung up politically over masks and failing to reach the true level of testing we need? What should guide the U.S. in the race for a vaccine? In the current environment, is it possible to avoid a collision between science and politics?  Senator Patty Murray (D-WA) has served in the Senate since 193. She is ranking member of the Senate Health, Education, Labor and Pensions (HELP) Commission, a senior member of Senate Committees on Appropriations, Budget, and Veteran Affairs, as well as a member of the CSIS Commission on Strengthening America's Health Security.

In this episode, the hosts are joined by Julie Gerberding, a senior executive at Merck, a longstanding friend, and generous contributor to CSIS’s work. Congress was highly active the week of June 22 examining across several committees the hard lessons of the past months of the coronavirus pandemic in America and what needs to happen right now -- as the outbreak explodes in the west and south -- and looking into the future. Julie testified at two full Senate hearings. What were the key messages she sought to hammer home to policymakers? What is the status of debate in Congress over where we need to move next?  Executive Vice President & Chief Patient Officer at Merck and Co., and co-Chair of the CSIS Commission on Strengthening America’s Health Security. She was formerly the Director of the Centers for Disease Control and Prevention (CDC) (2002 – 2009).

In this episode, the hosts engage with Sheryl Gay Stolberg, renowned Washington Correspondent at The New York Times. Since early this year she has been charged with unpacking -- in the midst of the pandemic -- the complex intersection of health, policy, politics and culture. She’s dived into the controversy around hydroxychloroquine, a saga that starkly revealed the collision between science and politics. Have Americans reached a point of exhaustion and resignation, in the face of continued high infections and deaths, and unrelenting economic pain? How to make sense of how these twin crises now mix with protests against racism, social injustice and police brutality? Are Americans at a moment of awakening? 

In this episode, Renee DiResta, a prominent expert who studies malign narratives across social networks and what can be done to rebut them, walks Steve and Andrew through her thinking on several provocative questions: Why does the coronavirus pandemic invite pseudoscience, government conspiracy theories and misinformation campaigns? What to make of the recent release of the "Plandemic" video in which the discredited scientist Judy Miskovits makes outlandish, unsubstantiated claims of a secrete plot by global elites – Bill Gates and Tony Fauci – to use the pandemic to grab power, attracting 8 million viewers in short order? Why are CDC and WHO “behemoths” incapable of adapting to new realities? Where are other trusted authoritative sources? As the push accelerates for a vaccine for the planet, can we expect expansive personal attacks upon those developing the solutions? Renee DiResta is the technical research manager at the Stanford Internet Observatory and a regular contributor to Wired magazine. 

In this episode, Steve speaks with Dr. Jean William (Bill) Pape, a renowned public health professor and practitioner appointed in late April by Haitian President Moïse to co-chair the country’s Covid-19 response commission. Having combatted HIV/AIDS, cholera, hurricanes, and an earthquake, Bill deems the coronavirus pandemic as the toughest challenge he has seen, a “perfect storm.” Haiti’s extreme challenges are undeniable – deep political divisions, stigma, economic decline, sudden return of Haitians from the Dominican Republic, gangs and insecurity. What is the urgent way forward? And how is it to be executed?  Dr. Jean William Pape is Director of GHESKIO, based in Port au Prince, and Professor of Medicine at Weill Cornell Medical College. 

In this episode, we speak with Professor Salim Abdool Karim (Slim), a preeminent HIV scientist based in Durban who chairs the scientific Covid-19 advisory group launched by President Cyril Ramaphosa to guide the national response. Looking back to March, Slim bluntly surveys South Africa’s successes and achievements, the acute vulnerabilities of those living with HIV and TB, tough controversies, major constraints, and mistakes that required correction. Early aggressive action by the President slowed the spread of the virus and bought precious time, though excessive reliance on the police and military backfired. An army of 60,000 health workers are the lead element in proactive outreach to communities. Testing has expanded, but lack of access internationally to reagents holds the country back. Modeling has illuminated alarming possibilities, while triggering calls for more transparency. Cape Town remains a dangerous epicenter; others likely lie ahead. The future is a continued, difficult fight to control hot spots and permit the reopening of the economy. Professor Salim Abdool Karim is a clinical infectious diseases epidemiologist, of world renown for achievements in HIV prevention and treatment. He is Director of the Centre for the AIDS Program of Research in South Africa (CAPRISA) in Durban and Professor at the University of Kwa-Zulu Natal and the Mailman School of Public Health at Columbia University.

In this episode, on the day when the number who have died from Covid-19 in America reached 100,000, we speak with special guests Eustace and Carol Theodore, both longtime friends of Steve. After vacationing in England in the first half of March, as the virus was swiftly and invisibly spreading throughout the UK, they returned to Vermont, just prior to President Trump imposing flight bans on Europe, the UK and Ireland. They describe Eustace’s accumulating symptoms, and the uncertain, extended process by which they finally came to discover he had indeed been infected with Covid-19 while abroad. In an extreme condition, Eustace is intubated and placed on a ventilator. How and why did he survive? How has recovery advanced? And what are the larger meanings of their profound, shared experiences?  Eustace Theodore has had a long career in education, as a sociologist and residential at Yale College, Executive Director of the Association of Yale Alumni, and President of the Council for Advancement and Support of Education (CASE). Carol Theodore has had a distinguished career as a corporate lawyer.

In this episode, we are joined by a very special guest: Julien, a wonderfully insightful 13-year-old seventh-grader from Berkeley, California. We talk about his experience of over two months of shelter-in-place: how disruptive has this been to friendships, school, sports? What has he done to get greater control over his life? Are we going to get out from under this pandemic? And what’s a young person’s advice for the adults around him?

In this episode, U.S. Senator Chris Van Hollen of Maryland joins us to talk about what Congress can do to respond to Covid-19 right now, including ensuring access and affordability for new treatments and a vaccine, and building stimulus packages for every level of government. Senator Van Hollen shares his thoughts on how expanding national service could help to ramp up testing and contact tracing and alleviate unemployment. The Senator also unpacks why American global leadership is crucial and how China is taking advantage of this moment to gain strategic advantage.

In this crossover episode with CSIS's The Truth of the Matter podcast, Tulane University professor and historian John Barry, author of the New York Times bestseller The Great Influenza, joins the podcast from his home in New Orleans’ French Quarter to discuss the lessons gleaned from the 1918 Spanish Flu pandemic that speak to today’s coronavirus pandemic sweeping America and the world.

In this episode, we are joined by Director of the Africa CDC Dr. John Nkengasong and U.S. Ambassador to the African Union Jessica Lapenn. Africa CDC is advancing a continental plan to address the dire, burgeoning threat Covid-19 poses to Africa, where testing has been woeful, where the continent stands at the back of the line in access to test kits, protective gear, oxygen, and financing; and where lockdowns can trigger an economic shock, food crises and instability. WHO remains a vital, indispensable partner. South Africa President and AU Chairman Cyril Ramaphosa has led the charge. PEPFAR, the Global Fund, Gavi the Vaccine Alliance have created health infrastructure now adapting to the Covid-19 threat. Jack Ma, Alibaba Foundation, the Gates Foundation and others have moved with remarkable speed to support Africa CDC. 

In this episode, we bring in Alisha Kramer, a star who cut her teeth right after college working with the CSIS Global Health Policy Center. Now a freshly-minted resident doctor, practicing obstetrics and gynecology in Atlanta hospitals, she assists young pregnant women in navigating the new realities of Covid-19. She shares with us reflections on the risks and fears of health providers, the racial and class divisions she sees every day, the dangers of prematurely lifting the shelter-in-place policies, and the acts of generosity from the community that bring her to tears.

In this episode, the conversation takes off from a recent piece published by Steve and Anna Carroll, Global Health Policy Center’s Associate Fellow, that examines President Trump’s decision to suspend U.S. assistance to the World Health Organization. What drives that decision? And with what consequences, at this historic moment in the pandemic? Is there any possibility of a diplomatic solution that might preserve U.S. support of the WHO?

In this episode, the hosts are joined by Scott Dowell, coronavirus response leader at the Bill & Melinda Gates Foundation. They discuss how successful the global response has been in saving so many lives, as well as get Dr. Dowell's thoughts on which response strategy is best when considering herd immunity, lockdowns, intense digital contact tracing, isolation and quarantine. While we wait for a vaccine, how do we exit this phase? Scott tells us how most transmission actually occurs in the household, and that we should focus on protecting the family of patients, and the most vulnerable, to get control of this pandemic.  Dr. Scott Dowell is Deputy Director for Surveillance and Epidemiology and coronavirus response leader at the Bill & Melinda Gates Foundation. 

This week marks World Immunization Week, an annual celebration of vaccines that raise awareness and increase rates of immunization against vaccine-preventable diseases around the world. To mark World Immunization Week, Take as Directed launches a conversation recorded earlier in the year to place immunization within the debate around Universal Health Coverage (UHC). In a world faced by not only a pandemic threat but also continuing infectious disease challenges, immunization and universal health coverage is more important than ever.  In this episode, Senior Fellow Katherine Bliss talks to two immunization experts: Angela Shen, retired Captain from the U.S. Public Health Service with over 22 years of service at the U.S. Department of Health and Human Services; and Lora Shimp, Technical Director for Immunizations at John Snow Inc. They discuss what the difference is between universal health care and coverage, and how including immunizations under a larger package of preventative services means more people benefit for a cheaper cost. In an era of competing priorities, why should we be focusing on immunization? What does the Immunization Agenda provide for, and will it be accepted by the global community? And can this Agenda help us reach complete immunization coverage worldwide?

In this episode, Steve and Andrew are joined by Congressman Ami Bera (D-CA07) to talk about his work on the CSIS Commission on Strengthening America’s Health Security and his impressions of Covid-19, as both a doctor and an elected representative.  They discuss how difficult it’s been to get Congress to spend resources on preparedness, and the work Rep. Bera is doing to build a crisis workforce. His main concerns: when the vaccine is found, how can we ensure the vaccines are distributed equitably to all countries, and who should get it first? Where would the supplies and workforce come from? Congressman Ami Bera has represented California’s 7th Congressional District in the U.S. House of Representatives since 2013. Before joining Congress, Rep. Bera had a twenty-year medical career as a physician, hospital administrator, professor, and as Sacramento County’s Chief Medical Officer. He is also a Member of the CSIS Commission on Strengthening America’s Health Security. Find his recent letter proposing a Covid-19 crisis corps here.

Former Senator Kelly Ayotte, co-chair of the CSIS Commission on Strengthening America’s Health Security, joins Steve and Andrew in explaining how the Commission’s November 2019 core recommendations remain compelling and essential in the midst of the pandemic, if we are to, once and for all, break the cycle of crisis and complacency. She offers her thoughts on the shocks we did not anticipate, such as our weak supply chains, which will now need to be strengthened for the future. Senator Ayotte also discusses China’s highly problematic role in the pandemic, and how the U.S. can reconfigure its dependence, along with a similar rethinking needed to strengthen and reform the World Health Organization. 

In this episode, Peter Sands, executive director of The Global Fund to Fight AIDS, Tuberculosis and Malaria, joins Steve and Andrew in exploring the chasm separating the world of finance and economists from that of public health, the extraordinary threats the pandemic poses to historical gains in development and global health, and the rapidly evolving role of the Global Fund in racing to support partner countries in their response to the coronavirus.  

In this episode, Andrew asks Steve to interpret the guidelines issued by President Trump yesterday in a three-phase process of reopening. Why the pivot away from “total authority” putting responsibility back onto governors? What’s in the guidelines, and what is missing? Amid the intensifying tension between protecting the health and lives of citizens versus the crushing decline of the U.S. economy, how are the calls to accelerate reopening being met across America? If a great gap persist in terms of testing and the capacity to surveil, isolate, quarantine, and contact trace, what are the options?

Dr. Christopher Murray joins Steve Morrison and Andrew Schwartz to discuss the “Murray Model,” what a rolling reopening of the economy would look like and what that would do to the Murray Model projections. Dr. Murray also discusses which states may be ready to reopen and what hotspots he’s worried about most.

In this episode, Susan Glasser, staff writer at The New Yorker, joins Steve and Andrew to discuss the full range of rapidly evolving issues surrounding President Trump and the White House’s engagement with the coronavirus pandemic and the companion economic crisis – from testing, to protecting essential item supply chains, to preparing the way of safely lifting social distancing to allow schooling and businesses to resume. All with the questions – how do we make sense of what is happening, and what does all of this tell us about the nature of this presidency?   Susan B. Glasser is a staff writer at The New Yorker, where she writes a weekly column on life in Trump’s Washington. Ms. Glasser has had a long and distinguished career as a journalist, including founding Politico Magazine, serving as editor-in-chief of Foreign Policy, and a decade at the Washington Post. She is co-author of Kremlin Rising: Vladimir Putin’s Russia and the End of Revolution, written with her husband, Peter Baker.

In this episode, Steve and Andrew are joined by Congresswoman Susan Brooks (R-IN05) to talk about her work on the CSIS Commission on Strengthening America’s Health Security and her experience working through Covid-19. This week with Rep. Ami Bera (D-CA07), Rep. Brooks released a letter calling for the creation of a crisis response corps to manage the pandemic response. They discuss how this could include returned Peace Corps Volunteers, what essential duties this corps could cover, and how these workers could be protected from risk. From there, they move to how Rep. Brooks is now relating to her constituents under these new realities, how Hoosiers are experiencing the pandemic, and where she finds strength and hope.  Congresswoman Susan W. Brooks represents the 5th District of Indiana, and is a Member of the CSIS Commission on Strengthening America’s Health Security. Find her letter on a Covid-19 crisis corps here.

Today’s guest is Ron Klain, former Ebola response coordinator in the Obama Administration and current senior adviser to presidential candidate former Vice President Joe Biden. At the top of this week, when the pandemic is predicted to reach horrific peak levels in the New York/New Jersey region, Steve and Andrew ask Ron to look out in time – what are the conclusions that future observers might make about how we reached this treacherous moment? And what will be the deep structural changes required, post-pandemic, if we are to break the cycle of crisis and neglect and protect Americans, and resume leadership to shape the rest of the world? We round off the conversation with a discussion of former Vice President Biden’s thinking on the pandemic response, and what gives Ron confidence and hope.  ​Ron Klain served as chief of staff to two U.S. vice presidents – Al Gore and Joe Biden, and served as the United States Ebola response coordinator in the Obama Administration. He is currently a Washington Post columnist and adviser to the Joe Biden 2020 presidential campaign.

Steve and Andrew speak with Helen Branswell, a premiere journalist and one of the world’s leading experts on dangerous infectious disease outbreaks, based for the past five years at STAT. The conversation focuses on the acute challenges: as the coronavirus pandemic advances, how do journalists makes sense of this historic moment? As we fail in the United States and elsewhere to protect health workers, in the face of dangerously escalating demands, how are we to understand the profound human and institutional consequences?

Today, Andrew and Steve talk to Dr. Tom Frieden, President and CEO of Resolve to Save Lives and former CDC Director. They discuss why Dr. Frieden has ‘tears in my eyes’ about the infections and deaths in New York and the risk to healthcare workers. While different communities need different responses, there is a need for clear federal guidance. They discuss how political priorities have infiltrated the national approach and sidelined public health experts, and how we can organize to minimize the harm from this pandemic. Dr. Frieden details how every health system should be getting ready to deal with “World War C”, and how we need a global commitment after this pandemic to never let this happen again.  Dr. Frieden serves as President and CEO of Resolve to Save Lives. He was formerly the director of the U.S. Centers for Disease Control and Prevention (CDC), and Commissioner of the New York City Department of Health and Mental Hygiene. 

Today, Andrew and Steve talk to Secretary John Wiesman, Secretary of Health for Washington state. They discuss the testing and hospital capacity in Washington state, the scramble for resources that states are finding themselves in and how Washington is working with the private sector to develop these products, and when social distancing might end.  Dr. John Wiesman was appointed secretary of health by Governor Jay Inslee in April 2013.

In mid-February, Steve Morrison of the CSIS Global Health Policy Center attended the Munich Security Conference. There, he moderated a roundtable on health in disordered settings, a town hall on COVID-19, and a dinner with Norwegian Prime Minister Erna Solberg. He also spoke with a variety of policymakers, donors, and agency heads that are leading the response to the coronavirus epidemic. In this fourth episode, Steve speaks with Paul Stoffels, Vice Chairman of the Executive Committee and Chief Scientific Officer at Johnson & Johnson. They discuss the unknowns surrounding the COVID-19 virus, the Chinese response, and the role J&J is playing in developing a vaccine.

In mid-February, Steve Morrison of the CSIS Global Health Policy Center attended the Munich Security Conference. There, he moderated a roundtable on health in disordered settings, a town hall on COVID-19, and a dinner with Norwegian Prime Minister Erna Solberg. He also spoke with a variety of policymakers, donors, and agency heads that are leading the response to the coronavirus epidemic. In this third episode, Steve speaks with Jeremy Farrar, Director of the Wellcome Trust. They talk about his experience with SARS in Vietnam, the number of unknowns surrounding the coronavirus, China's unprecedented response and its impacts, and the role Wellcome is playing. 

Today, Andrew and Steve are joined by Jude Blanchette, Freeman Chair in China Studies at CSIS. They discuss how the U.S. and China are dealing with the pandemic in their own countries, and how this might affect U.S.-China trade and diplomacy, as well as scientific research partnerships between the U.S. and China.

Today, Andrew and Steve talk to Dr. Margaret "Peggy" Hamburg, foreign secretary of the National Academy of Medicine and member of the CSIS Commission on Strengthening America’s Health Security. They discuss what’s happened with testing in the U.S., the ‘global arms race’ to develop a vaccine, and how the U.S. and the world can develop, produce, and distribute any potential vaccine in an equitable way.  Dr. Hamburg is an internationally recognized leader in public health and medicine. She currently serves as the foreign secretary of the National Academy of Medicine (NAM) and 2018 president of the American Association for the Advancement of Science (AAAS). Dr. Hamburg is a former Commissioner of the U.S. Food and Drug Administration (FDA), known for advancing regulatory science, modernizing regulatory pathways, and globalization of the agency.

In this episode, Steve and Andrew invite CSIS's Kathleen Hicks to discuss how the military can respond to COVID-19, and to what extent that can be done. They also examine how, as President Trump labels himself a 'wartime president,' more and more national guard units are operating at state capacity under the direction of governors, and what the Department of Defense can offer. Kathleen Hicks is senior vice president, Henry A. Kissinger Chair, and director of the International Security Program at the Center for Strategic and International Studies.

In this first remote episode, Steve and Andrew discuss what’s happening with the U.S. response: the wholesale suspension of work and cultural events, the mixed messages coming from the Administration, and the unknown period we’re currently in as we wait for the worst part of the pandemic. They also discuss the role Dr. Tony Fauci is playing in this crisis, the role the military could play in a response, and how people need to remain calm and comfortable.

In today’s episode, Steve and Andrew speak with Stephanie Segal, senior fellow and deputy director of the William E. Simon Chair in Political Economy. They talk about the economic shocks COVID-19 is causing, the so-far inadequate policy response, and the possible prolonged economic crisis to come.

The Center for Strategic and International Studies (CSIS) is closely watching the coronavirus outbreak, also known as COVID-19, as it spreads throughout China and around the world and the United States. As knowledge on COVID-19 evolves, Take as Directed will bring you the latest updates in this miniseries Coronavirus Crisis Update. In today’s episode, Steve and Andrew speak with Heather Conley, senior vice president for Europe, Eurasia, and the Arctic and director of the Europe Program at CSIS. They discuss the quarantine of 16 million people in northern Italy; how it came about, what it will mean for Italy’s economy and politics, and how Italy’s neighbors are responding.

The Center for Strategic and International Studies (CSIS) is closely watching the coronavirus outbreak, also known as COVID-19, as it spreads throughout China and around the world and the United States. As knowledge on COVID-19 evolves, Take as Directed will bring you the latest updates in this miniseries Coronavirus Crisis Update. In today’s episode, Steve Morrison speaks with Julie Gerberding, co-chair of the CSIS Commission on Strengthening America’s Health Security and chief patient officer at Merck. Dr. Gerberding is also the former Director of the CDC (2002-2009). Dr. Gerberding testified on March 4th before the U.S. House Committee on Homeland Security on “Confronting the Coronavirus: Perspectives on the Response to a Pandemic Threat.” They discuss the mood in Congress, the transition in the United States from a phase of containment to one of managing the spread of the virus, and her outstanding concerns and reasons for hope. 

The Center for Strategic and International Studies (CSIS) is closely watching the coronavirus outbreak, also known as COVID-19, as it spreads quickly throughout China and around the world. As knowledge on COVID-19 evolves, Take as Directed will bring you the latest updates in this miniseries Coronavirus Crisis Update. In this episode, CSIS’s Steve Morrison and Andrew Schwartz discuss newly concentrated hotspots and the politicization of COVID-19, and how an adequate response to the outbreak requires more leadership, clarity and trust.

In mid-February, Steve Morrison of the CSIS Global Health Policy Center attended the Munich Security Conference. There, he moderated a roundtable on health in disordered settings, a town hall on COVID-19, and a dinner with Norwegian Prime Minister Erna Solberg. He also spoke with a variety of policymakers, donors, and agency heads that are leading the response to the coronavirus epidemic. In this second episode, Steve speaks with Dr. Mike Ryan, executive director of the World Health Organization’s (WHO) Health Emergencies Programme. They discuss what dynamics are driving this outbreak, why it should be seen as a security risk as well as a health risk, and what the WHO is doing. They also talk about “infodemics”: the online epidemic of misinformation and weaponized social media.

In mid-February, Steve Morrison of the CSIS Global Health Policy Center attended the Munich Security Conference. There, he moderated a roundtable on health in disordered settings, a town hall on COVID-19, and a dinner with Norwegian Prime Minister Erna Solberg. He also spoke with a variety of policymakers, donors, and agency heads that are leading the response to the coronavirus epidemic. In this first episode, Steve speaks with Orin Levine, director of Vaccine Delivery at the Bill & Melinda Gates Foundation. They discuss the investments the Foundation is making into the epidemic response, the urgent need for diagnostics and treatments, and how this infection might play out over the next year.

The Center for Strategic and International Studies (CSIS) is closely watching the coronavirus outbreak, also known as COVID-19, as it spreads quickly throughout China and around the world. As knowledge on COVID-19 evolves, Take as Directed will bring you the latest updates in this miniseries Coronavirus Crisis Update. CSIS’s Steve Morrison, Andrew Schwartz, and Jude Blanchette discuss the scientific, political, and economic ramifications of the virus with top experts in global health, China, international economics, and more.

Late last year, the CSIS Commission on Strengthening America's Health Security released its final report on ending the cycle of crisis and complacency in U.S. global health security. This miniseries of Take as Directed will delve into the detail of some of the Commission's recommendations. In this final episode of the miniseries, Steve talks with Rebecca Martin, Director of the Director of the Center for Global Health at the US Centers for Disease Control and Prevention (CDC). They discuss the CDC’s work on training field disease detectives and laboratory workers worldwide, how the CDC works across the world to respond to outbreaks, and the Commission’s recommendation that the US re-invest in Global Health Security Agenda (GHSA). They also discuss the CDC’s role in communicating credible science and evidence to children and to parents on social media.

Late last year, the CSIS Commission on Strengthening America's Health Security released its final report on ending the cycle of crisis and complacency in U.S. global health security. This miniseries of Take as Directed will delve into the detail of some of the Commission's recommendations. In this second episode of the miniseries, Steve talks with Ambassador Jimmy Kolker, former assistant secretary for global affairs at the US Department of Health and Human Services and a member of the Commission; and Carolyn Reynolds, senior associate at the Center. They discuss trends in global investment in health security, how countries have been preparing themselves for an outbreak, and the Commission’s recommendation that the World Bank establish a Pandemic Preparedness Challenge, that could incentivize countries to invest in their own preparedness.

Late last year, the CSIS Commission on Strengthening America's Health Security released its final report on ending the cycle of crisis and complacency in U.S. global health security. This miniseries of Take as Directed will delve into the detail of some of the Commission's recommendations. In this first episode of the miniseries, Steve talks with Dr. Richard Hatchett, CEO of Coalition for Epidemic Preparedness Innovations (CEPI). CEPI is a new model of partnership to finance and co-ordinate the development of technologies against high priority public health threats and emerging infectious diseases with pandemic or epidemic potential. Richard and Steve discuss the report's recommendation to systematically confront two urgent technology challenges: the need for new vaccines and therapeutics; and the public health communications crisis.

This episode examines the changing nature of war and conflict and why gender-based violence (GBV) has become a central feature in crises around the world. GHPC Senior Associate Janet Fleischman sits down with Melissa Dalton, senior fellow and deputy director of the CSIS International Security Program and Director of the Cooperative Defense Project (CDP); and Fatima Imam, executive director of Rehabilitation, Empowerment, and Better Health Initiative and Network of Civil Society Organizations in Nigeria. They discuss how GBV impacts women and girls in crises, focused especially on the Middle East and northern Nigeria, and how these ubiquitous and traumatizing realities undermine global health security and community resilience. This conversation is linked to a new CSIS report, How Can We Better Reach Women and Girls in Crises? and an October 31 conference on U.S. Action for Women’s and Girls’ Health Security, both under the auspices of the CSIS Commission on Strengthening America’s Health Security.

In this episode of Take as Directed, Nellie Bristol speaks with Dr. John Vertefeuille. Dr Vertefeuille is currently the polio eradication branch chief at the Centers for Disease Control and Prevention (CDC). His long career at the CDC has included stints in Haiti, Tanzania and Nigeria. Nellie and Dr. Vertefeuille discuss why there has been an increase in vaccine-derived polio since 2016, how it differs from wild poliovirus, and how the CDC plans to contain and prevent future outbreaks.

On September 27th, the CSIS Global Health Policy Center hosted a conference focused on Securing Healthy Populations in a New Era of Global Immunization. The program highlighted the progress that has been made in expanding access to immunization, but emphasized the need for a new push to increase global coverage from 85 to 100 percent. On this episode of Take as Directed, Senior Fellow Katherine Bliss walks through some of the conference panelists’ most striking comments and highlights the challenges of equity, trust, delivery, and insecurity that global immunization programs face as they develop new strategies for the next decade.

In 2018, more than 200 million people contracted malaria around the world, and nearly half a million died of it. As countries continue to battle malaria within their borders, the international discussion turns to a loftier goal—complete global eradication of malaria. In this episode of Take as Directed, J. Stephen Morrison sits down with Sir Richard Feachem, Director of the Global Health Group at UCSF Global Health Sciences, and Professor of Global Health at both UC San Francisco and the UC Berkeley. They discuss the Lancet Commission on Malaria Eradication, and their new report that lays out a vision to achieve the eradication of malaria, “Malaria eradication within a generation: ambitious, achievable, and necessary.” Just how plausible is this vision?

In the last decade, Russia has increased its global engagement, while at the same time pursuing policies at home that are giving rise to HIV/AIDS and drug-resistant tuberculosis epidemics that are a risk for its own populations, as well as its neighbors. These developments have unfolded against a backdrop of highly malevolent Russian behavior across many fronts that has resulted in the imposition of extensive sanctions. In this special joint episode of Take as Directed and Russian Roulette, J. Stephen Morrison sits down with Jeff Mankoff, Acting Director of the CSIS Russia and Eurasia Program; and Judyth Twigg, Professor of Political Science at Virginia Commonwealth University and a Senior Associate with the CSIS Russia and Eurasia Program. The three discuss Steve and Judy's recent analysis, “Putin and Global Health: Friend or Foe?” which outlines an opportunity to expand U.S. engagement to promote health security and counter Russian influence in Eastern Europe and Central Asia.

While the world has seen tremendous improvement in the availability of life-saving vaccines, coverage rates have stagnated over the last decade. The U.S. government, a leading player in global immunization, is working with international organizations as they develop new strategies to accelerate progress toward global goals. On Friday, September 27th, CSIS will host a conference on global immunization to explore these issues. As a primer to that event, we take you back to a conversation from last winter between Nellie Bristol and Dr. Orin Levine, Director of Global Delivery Programs and former Director of Vaccine Delivery for the Global Development Program at the Bill & Melinda Gates Foundation. Dr. Levine joined us on this episode of Take as Directed to discuss new innovations in achieving equity, increasing demand for immunization, and reaching the unreached with vaccines to secure the health and stability of all populations.

The population of Africa is expected to double over the next 20 years, which means that many countries are facing either a demographic dividend or potentially a disaster, with critical implications for global health and development. In this episode of Take as Directed, Janet Fleischman sits down with Amb. Mark Dybul, Director of the Center for Global Health and Quality, and Professor in the Department of Medicine at Georgetown University Medical Center, and formerly head of the Global Fund to Fight AIDS, Tuberculosis, and Malaria. They discuss why these demographic trends matter and how U.S. programs can better engage young people, especially adolescent girls and young women, to address their needs and support local innovation.

At the end of June, the Board of Gavi, the Vaccine Alliance, approved their new “5.0” strategy for 2021-2025, with an ambitious set of priorities for this new phase. In this episode of Take as Directed, Nellie Bristol sits down with Amanda Glassman, Executive Vice President and Senior Fellow of the Center for Global Development, and Katherine Bliss, Senior Fellow with the Global Health Policy Center, to discuss these changes and their implications for the broader immunization landscape beyond 2020.

Since its inception in 2017, the Coalition for Epidemic Preparedness Innovations, or CEPI, has come to be seen as among the most promising innovations in global health security. It works to accelerate the development and introduction of new vaccines against known, dangerous pathogens, and to build common platforms for future development of vaccines. In this episode of Take as Directed, J. Stephen Morrison sits down with Richard Hatchett, Chief Executive Officer at CEPI, to discuss the organization’s origins following the West African Ebola outbreak in 2014-15, and its further evolution two years into its mandate.

In this episode of Take as Directed, J. Stephen Morrison sits down with Jason Stearns, Director of the Congo Research Group at the Center for International Cooperation at New York University. Jason is among America’s premier experts on Congolese politics and economics. In this episode, he shares his astute insights into the opaque networks in eastern Congo which are deliberately and violently targeting health providers, paralyzing the international and local response to the Ebola outbreak. This is the second of a pair of episodes that examines what steps are now essential to end violence and win community trust and confidence in eastern Congo.

In this episode of Take as Directed, J. Stephen Morrison sits down with David Gressly, the UN Emergency Ebola Response Coordinator in the Democratic Republic of the Congo (DRC). Gressly was appointed in May by the UN Secretary General to lead a more strategic, coordinated, and better funded effort to arrest the dangerously escalating Ebola outbreak. This is the first of a pair of episodes that examines the root causes of targeted violence against health providers and active community resistance, and what steps are now essential to end violence and win community trust and confidence.

In this episode of Take as Directed, J. Stephen Morrison speaks with Dr. Trevor Mundel, President of the Global Health Division at the Bill & Melinda Gates Foundation. They discuss the arc of Dr. Mundel’s personal career and his remarkable tenure at the Gates Foundation, including the creation of the Medical Research Institute; the launch of CHAMPS, the Child Health and Mortality Prevention Service; and the establishment of CEPI, the Coalition for Epidemic Preparedness Innovations. In closing, they discuss the issues that give him the greatest concern, and the reasons he is hopeful looking to the future.

In this episode of Take as Directed, host Janet Fleischman sits down with Geeta Rao Gupta, executive director of the 3D Program for Girls and Women, former president of the International Center for Research on Women (ICRW), and former Deputy Executive Director of UNICEF. They discuss the new series of The Lancet, of which Geeta was a principal author, that outlines the impact of gender norms and inequalities on health, describes persistent barriers to progress, and provides an agenda for action. They also discuss the recent Women Deliver conference in Vancouver and how to maintain optimism for the future.

In this episode of Take as Directed, Sara Allinder is joined by special guest host Haim Malka, Deputy Director and Senior Fellow of the CSIS Middle East Program, to discuss the future of the United Nations Relief and Works Agency for Palestine Refugees in the Near East (UNRWA). The two interview Dr. Akihiro Seita, Director of Health and WHO Special Representative for UNRWA, and Elizabeth Campbell, Director of UNRWA’s Washington D.C. office, about their concerns for Palestinian refugees’ health as humanitarian aid declines amid continuing political uncertainty in the region.

In this episode of Take as Directed, J. Stephen Morrison speaks with Dr. Heidi Larson, Director of the Vaccine Confidence Project at the London School of Hygiene and Tropical Medicine. They discuss why vaccine confidence is currently in crisis, and how this has fueled outbreaks such as measles and the persistence of polio in Afghanistan and Pakistan. Plus, Dr. Larson walks through her work with the Vaccine Confidence Project, including monitoring public confidence in immunization programs and building an information surveillance system for early detection of public concerns around vaccines.

In this episode of Take as Directed, Steve Morrison speaks with Dr. Christopher Murray, Director of the Institute for Health Metrics and Evaluation (IHME) of the University of Washington. Dr. Murray walks through IHME’s ongoing Global Burden of Disease analysis, as he and his team have been evaluating eating habits and food systems for people in 195 countries. Dr. Murray shares the study’s most important—and surprising—findings about global diet-related issues.

As the decade of vaccines comes to a close, public health experts are busy developing new strategies for the next era of global immunization. Among those efforts is a second version of the Global Vaccine Action Plan — or GVAP — which will cover the period 2021 to 2030. In this episode of Take as Directed, GHPC Senior Fellow Nellie Bristol sits down with Kate Dodson, Vice President of Global Health at the United Nations Foundation; Carmen Tull, Chief of the Child Health and Immunizations Division at USAID; and Craig Burgess, Senior Technical Officer at John Snow Training and Research Institute, to discuss the GVAP 2.0 process and explain why global goals are important to US efforts in improving immunization coverage.

Investing in nutrition is one of the most cost effective health and development programs, yet is often underprioritized in the larger global development agenda. In this episode of Take as Directed, Sara Allinder speaks with Shawn Baker, Director of the Nutrition team at the Bill & Melinda Gates Foundation to discuss how the arc of Vitamin A supplementation fits into the larger story of global health, the need to reinvigorate programs that have stalled, and Shawn’s hopes for long-term, systems-based interventions that can sustain progress.

At the Second International Summit on Human Genome Editing in Hong Kong last fall, Professor He Jiankui made a controversial announcement that he had made heritable genetic changes in human embryos, which resulted in the birth of twin girls. This action has been universally condemned and has sparked intense international debate over whether human germline genome editing should be permitted, and what regulatory or governance framework is needed. In this episode of Take as Directed, host Steve Morrison sits down with Dr. Victor Dzau, President of the National Academy of Medicine, which was one of the conveners of the summit in Hong Kong. Dr. Dzau is a prominent leader in the current conversation as the scientific community seeks the best way forward.

March 24th was World TB Day, a World Health Organization-designated day of advocacy to raise awareness about the devastating health, social, and economic consequences of tuberculosis. In this episode of Take as Directed, host Steve Morrison is joined by Dr. Eric Goosby, the UN Special Envoy on Tuberculosis. Dr. Goosby recently led a Lancet Commission on tuberculosis, a two-year effort that has culminated in a longform report titled “Building a tuberculosis-free world”, and spoke about some of the main findings of the report and what the next steps are in creating a world free of TB.

Women’s health services, including maternal health and family planning, are critical to enable women and girls to access economic empowerment opportunities. In this episode of Take as Directed, GHPC Senior Associate Janet Fleischman speaks with Margaret Schuler, Senior Vice President of the International Programs Group at World Vision, and David Ray, Vice President for Policy and Advocacy at CARE. The three discuss how the current bipartisan momentum around economic empowerment for women provides an opportunity to strengthen linkages with U.S. investments in women’s global health.

The anti-vaccination movement has recently come into the spotlight after the resurgence of measles, a vaccine-preventable respiratory illness, has emerged across the United States in the past year. In this episode of Take as Directed, Steve Morrison speaks with Lena Sun, award-winning national health reporter for The Washington Post to discuss how the anti-vaxxer movement has evolved into what it is today—a small but vocal, social media-savvy, activist group of Americans. Over the course of her career, Lena has written widely on a number of issues related to public health and infectious disease, and her most recent work is on the topic of the anti-vaxxer movement in the U.S., its implications on public health, and state and federal responses to the anti-vaxxer movement.

Improving nutrition is among the most transformative and cost-effective interventions in global health and food security. In this episode of Take as Directed, Sara Allinder speaks with Dr. Robert Mwadime, Chief of Party of the USAID Integrated Community Agriculture and Nutrition Activity in Uganda, a program administered by Abt Associates. Dr. Mwadime has spent his career working with local governments and donors to administer nutrition and agriculture programs, and shares his thoughts on the future of U.S. investments in nutrition and the importance of multisectoral approaches in improving health outcomes. To learn more about U.S. government nutrition investments in Uganda, visit the CSIS Global Health Policy Center program page for our report titled “Improving Nutrition in East Africa’s Bread Basket”.

At this year’s Munich Security Conference, the Ebola outbreak in the Democratic Republic of the Congo was highlighted as top health security threat of international concern. As of February 17th, there have been 840 cases and 537 deaths in the outbreak, and the response effort continues to encounter insecurity on the ground. In this episode of Take as Directed, Steve Morrison speaks with Dr. Mitch Wolfe, Acting Director of the U.S. Centers for Disease Control and Prevention’s (CDC) Washington, D.C. office and the CDC’s Chief Medical Officer. Dr. Wolfe discusses the role and methods of the CDC in the current Ebola response, as well as what to expect from this outbreak as we look ahead.

In this episode, a former Vice Chairman of the Joint Chiefs of Staff joins us to discuss the story of his son Jonathan, who died from a fentanyl overdose last year. Admiral James "Sandy" Winnefeld is a retired four-star Navy admiral, and has become a vocal advocate for opioid death prevention. He heads Stop the Addiction Fatality Epidemic, or S.A.F.E. Project U.S., a national nonprofit organization dedicated to ending the opioid epidemic in the United States. Admiral Winnefeld describes how difficult it was to find treatment for Jonathan and recounts the challenges of recognizing signs of recovery--and signs of relapse.

The global campaign to eradicate polio is focused on three countries that remain polio-endemic: Afghanistan, Nigeria, and Pakistan. In this episode of Take As Directed, Senior Fellow Nellie Bristol is joined by Senator Ayesha Raza Farooq of Pakistan, chairperson of the senate committee on delegated legislation. The senator served as the prime minister’s point person on polio eradication from 2013 through 2018. The senator discusses the evolution of Pakistan’s polio program, the challenges remaining in achieving an end to transmission, and her hopes for the new government in sustaining momentum.

February 6th marks the International Day of Zero Tolerance of Female Genital Mutilation (FGM), a United Nations-sponsored awareness day meant to highlight efforts to eradicate FGM. An estimated 200 million women and girls today have undergone some form of FGM, a practice that can cause irreversible physical and mental health challenges. In this episode of Take as Directed, CSIS Global Health Policy Center Senior Associate Janet Fleischman speaks with Dr. Kakenya Ntaiya, a Kenyan educator, activist, and founder of “Kakenya’s Dream”, a leading nongovernmental organization for girls’ education, health, and empowerment, which also works to end FGM and child marriage. Dr. Ntaiya discusses the personal journey that led her to form “Kakenya’s Dream”, and how her work is helping to develop the next generation of women leaders in her community. Hosted by Janet Fleischman.  

Gavi, the Vaccine Alliance has had unprecedented success helping low income countries purchase and deliver vaccines. This has helped to increase immunization coverage for many underserved populations. But as global immunization rates have stalled over the last few years, the public/private partnership is looking for new approaches to ensure that vaccines are available to all the world’s children. In this episode of Take as Directed, CSIS senior fellow Nellie Bristol sits down with Adrien de Chaisemartin, Director of Strategy, Funding & Performance at Gavi, to discuss Gavi’s continuing work to improve partner engagement, build management capacity, and bolster immunization systems.

Around 47,600 Americans died in 2017 of opioid overdoses. It’s the leading cause of accidental death in the United States, surpassing car accidents. What makes this crisis have such a wide reach and penetrate racial, economic, and geographic lines? Take As Directed host Steve Morrison dives into its origins of the crisis in the first episode of a special miniseries on the American opioid epidemic. Episode produced in 2018 at the Center for Strategic and International Studies in Washington.

While global rates of malaria have been declining over the last fifteen years, those unprecedented gains have recently slowed. In this episode of Take as Directed, we are joined by Dr. Philip Welkhoff, an expert in disease modeling who is the current director for malaria at the Bill & Melinda Gates Foundation. Dr. Welkhoff speaks with guest host Robert Newman, GHPC Senior Associate, to address this plateauing of progress while also discussing data integration, the new malaria strategy of the Gates Foundation, and the importance of U.S. funding and leadership in the malaria endgame.

Greater attention and resources to low-income country vaccination programs over the last decade have resulted in tremendous gains in immunization coverage. But coverage rates have now stalled, calling for new approaches to overcoming enduring barriers to health care access. In this episode of Take as Directed we are joined by Dr. Orin Levine, Director of Vaccine Delivery for the Global Development Program at the Bill & Melinda Gates Foundation, to discuss the potential of new technologies, strategies, and partnerships to improve vaccination rates and strengthen immunization systems even in the most difficult of settings. Hosted by Nellie Bristol.  

The ongoing Ebola crisis in eastern Democratic Republic of the Congo, the first Ebola outbreak in a war zone, is posing unprecedented challenges to responders. Much of the difficulty stems from the difficult security situation in the region, yet the particulars remain a mystery to many. In this episode of Take as Directed, we are joined by Judd Devermont, Director of the CSIS Africa Program, for a conversation that provides critical context on operating in eastern DRC, including clarity on who the Allied Democratic Forces (ADF) are and perspective on the relationship between the Ebola outbreak and the upcoming, highly anticipated elections in DRC. Hosted by J. Stephen Morrison.  

Women’s health services, including maternal health and family planning, are critical to enable women and girls to access economic empowerment opportunities. In this episode of Take as Directed, GHPC Senior Associate Janet Fleischman speaks with Margaret Schuler, Senior Vice President of the International Programs Group at World Vision, and David Ray, Vice President for Policy and Advocacy at CARE. The three discuss how the current bipartisan momentum around economic empowerment for women provides an opportunity to strengthen linkages with U.S. investments in women’s global health, how such an approach fits with USAID’s “Journey to Self-Reliance” framework, and the role of women’s groups and faith-based organizations in promoting access to both economic empowerment programs and women’s health services.  Hosted by Janet Fleischman.

In this episode of Take as Directed, we hear from Peter Sands, Executive Director of The Global Fund to Fight AIDS, Tuberculosis, and Malaria, about his reflections on his first 7 months in that post, takeaways from the UNGA high-level meeting on tuberculosis, as well as his expectations for the lead-up to the 2019 Global Fund replenishment conference, set to take place in France. He also discusses the importance of creative financing needed to achieve The Global Fund’s goal of investing resources to end the pandemics of HIV/AIDS, tuberculosis, and malaria. Hosted by Sara Allinder.

In part two of our series with Dr. Robert Redfield, Director of the Centers for Disease Control and Prevention, he addresses what he calls “the public health crisis of our time” – the ongoing opioid epidemic.  Combating the opioid epidemic has proven to be a challenge with a multitude of complexities, and Dr. Redfield shares his thoughts on where we are in the arc of this epidemic, the gaps that exist in treatment and recovery services, and the dangers of stigma in the midst of a public health crisis.   Hosted by J. Stephen Morrison.

In this episode of Take as Directed, we are joined by Dr. Robert Redfield, Director of the Centers for Disease Control and Prevention (CDC). Since assuming his position as CDC Director in March of this year, Dr. Redfield has led the effort to enhance the CDC’s role in the continuing polio endgame. In part one of our two-part conversation, he discusses the complexities of the polio endgame, and shares what he believes to be the CDC’s most significant contributions to this global effort.    Hosted by J. Stephen Morrison

With the ongoing Ebola outbreak in the Democratic Republic of the Congo rapidly escalating to dangerous levels, the global health community must consider how much progress has been made to prevent and efficiently respond to outbreaks since the 2014-2016 Ebola outbreak in West Africa. In this episode of Take as Directed, we are joined by Gabrielle Fitzgerald, founder and CEO of Panorama, a Seattle based action tank dedicated to solving global problems. Gabrielle discusses the main points of a British Medical Journal piece she recently co-authored, Global epidemics: How well can we cope?, which addresses the gaps that remain in the global capacity to respond to outbreaks from various standpoints such as financing, research and development, and knowledge sharing.  Hosted by J. Stephen Morrison.

Tuberculosis (TB) is a long-standing, urgent threat to global public health, yet it has never been discussed at the highest level of the world stage. That changes this week, as heads of state gather in New York for the UN General Assembly, where they will convene the first-ever UNGA high-level meeting on tuberculosis. After three years of dialogue in advance of this historic event, the meeting will aim to accelerate efforts in ending TB, and it should result in a Political Declaration on TB endorsed by heads of state. On this episode of Take as Directedwe are joined by Dr. Eric Goosby, the current UN Special Envoy on Tuberculosis, to share his hopes and expectations for the meeting, and its potential as an important step towards realizing the WHO global end TB strategy.  Hosted by J. Stephen Morrison.

The Ebola outbreak in the Democratic of the Congo poses unprecedented challenges to emergency responders as the first ever case in an active warzone. The response has had remarkable mobilization and promising achievements thus far, with successful vaccination campaigns, and a constant readjustment of strategies and resource allocation to best contain the virus. However, six weeks into the response, the outbreak sits on the edge of some of the most insecure and inaccessible areas of the country, where the virus could potentially wreak terrifying levels of devastation. In this episode of Take as Directed we are joined by Peter Salama, Deputy Director General of the World Health Organization and Director of the Emergency Programs, to provide an inside look at how the response team is navigating the complex dynamics of a highly dangerous outbreak.   Hosted by J. Stephen Morrison.

Tuberculosis (TB) is the number one infectious disease killer. Yet, pediatric TB is often overlooked as an urgent public health threat, especially in lower- and middle-income countries. In this episode of Take as Directed, we hear from Dr. Farhana Amanullah, a seasoned clinician and expert in pediatric tuberculosis who runs the largest, private-sector TB program for children in Pakistan at the Indus Hospital Karachi. Dr. Amanullah describes the challenges in diagnosing and treating TB in children and adolescents and shares her expectations for the UN High Level Meeting on Ending TB, which is to take place later this month.    Hosted by Sara Allinder.

Since committing to support polio eradication on its 100 anniversary, Rotary International has contributed $1.8 billion to the cause, along with thousands of volunteers, advocacy work, and political leadership. Serving as Rotary’s PolioPlus Committee Chair, Mike McGovern leverages the organization’s unique position as an expansive service network to complement the technical expertise of its partners in the Global Polio Eradication Initiative. McGovern joins us in this episode of Take as Directed to discuss lessons learned from Rotary’s long engagement with the initiative, strategies to sustain eventual eradication while strengthening global health capacity, and next steps for Rotary’s involvement in international public health. Hosted by Nellie Bristol.

Last month, top policymakers, scientists, and activists gathered in Amsterdam for the 22nd International AIDS Conference to examine the current state of global HIV/AIDS response, and how that response should be shaped by the global health community in the years to come. In this episode of Take as Directed, we are joined by Owen Ryan, Executive Director of the International AIDS Society (IAS), which organizes the International AIDS Conference every two years. Owen discusses the main science and policy takeaways from this year’s conference and addresses the concerns raised by activists about holding the conference in the United States in 2020, which is set to take place in San Francisco and Oakland.

In this episode, a former Vice Chairman of the Joint Chiefs of Staff joins us to discuss the story of his son Jonathan, who died from a fentanyl overdose last year. Admiral James "Sandy" Winnefeld is a retired four-star Navy admiral, and has become a vocal advocate for opioid death prevention. He heads Stop the Addiction Fatality Epidemic, or S.A.F.E. Project U.S., a national nonprofit organization dedicated to ending the opioid epidemic in the United States. Admiral Winnefeld describes how difficult it was to find treatment for Jonathan and recounts the challenges of recognizing signs of recovery--and signs of relapse.

Professor Quarraisha Abdool Karim is one of the world’s leading AIDS researchers and has made pioneering contributions to understanding the HIV epidemic in young people, especially among young women. She joined us for a two-part series to explain her latest research into epidemic hot spots in KwaZulu-Natal in South Africa, focusing on both the structural and biological risk factors that facilitate the spread of HIV in young women. In Part 2, she describes her recent findings about biological factors that can simultaneously increase a woman’s risk of HIV acquisition and decrease the efficacy of HIV prevention tools. Hosted by Janet Fleischman. Produced by Alex Bush. Edited by Ribka Gemilangsari.

Professor Quarraisha Abdool Karim is one of the world’s leading AIDS researchers and has made pioneering contributions to understanding the HIV epidemic in young people, especially among young women. She joined us for a two-part series to explain her latest research into epidemic hot spots in KwaZulu-Natal in South Africa, focusing on both the structural and biological risk factors that facilitate the spread of HIV in young women. In Part 1, she discusses the social and economic factors that contribute to the dramatic differences in HIV rates in women and men at different ages. Hosted by Janet Fleischman. Produced by Alex Bush. Edited by Ribka Gemilangsari.

In this episode, Elhadj As Sy, Secretary General of the International Federation of Red Cross and Red Crescent Societies (IFRC), joins us to discuss the different roles that IFRC plays across the vast array of populations they serve, their current work on the Ebola outbreak in the Democratic Republic of Congo, and the lessons they learned from the previous outbreak. Mr. Sy has also been named co-chair of the Global Preparedness Monitoring Board, and he describes to us the current state of the planning for this new independent monitoring body launched by the WHO and the World Bank on May 24th at the 71st World Health Assembly.   Hosted by Steve Morrison. Produced by Alex Bush. Edited by Ribka Gemilangsari.    

In 2016, the World Health Organization announced that a single full dose of yellow fever vaccine would provide lifelong protection from the virus. However, due to global shortages and complicated production requirements, there has not been sufficient supply to meet the demands of recent outbreaks. Angola and the Democratic Republic of Congo in 2016 and now Brazil in 2018 have turned to using fractional doses, or about 1/5 of a full dose, as a stopgap measure—these diluted doses are only known to offer one year of protection against the virus. In this episode of Take as Directed, Daniel Lucey, a senior scholar with the O’Neill Institute for National and Global Health Law at Georgetown University, joins us to discuss the threat of yellow fever, our lack of preparedness, and the potential for a significant outbreak in Asia.   Hosted by Steve Morrison. Produced by Alex Bush. Edited by Ribka Gemilangsari.

Dr. Christos Stylianides serves as the European Commissioner for Humanitarian Aid and Crisis Management and is the European Union Ebola Coordinator. Christos joins us for this episode to discuss how the current Ebola response has differed from the response in 2014 and the leading role that Europe is playing in that response. He also discusses his current work to expand resources for education services for children and adolescents living through crises and emergency situations.   Hosted by Steve Morrison. Produced by Alex Bush. Edited by Ribka Gemilangsari. 

Providing services equitably requires global health practitioners to have detailed data on the populations they are trying to reach. This episode of Take as Directed, hosted by Senior Fellow Nellie Bristol, highlights new initiatives to collect and analyze sub-national data to give a clearer picture of children being missed. Nellie is joined by guests Laurie Werner, Global Director for the Better Immunization Data (BID) Initiative at PATH, and Jon Mosser, a Fellow in pediatric infectious diseases at Seattle Children’s Hospital and the University of Washington and Clinical Fellow with the Institute for Health Metrics and Evaluation. They discuss new initiatives to map vaccine coverage, technical challenges to collecting data in resource poor settings, and the importance of spending development dollars on data collection and analysis.   Hosted by Nellie Bristol. Produced by Alex Bush. Edited by Ribka Gemilangsari.

The world of global health security has been amassed in headlines over the past few weeks—from the Ebola outbreak in the Democratic Republic of Congo, to the elimination of the Global Health Security Directorate within the White House National Security Council staff. For this episode of Take as Directed, we feature three leading health security experts with substantial frontline experience who discuss the current state of preparedness around the world, gaps and priorities looking ahead, and how to maintain pandemic preparedness as a high-level political priority at times of peace. Beth Cameron, Vice President of Global Biological Policy and Programs at the Nuclear Threat Initiative, serves as our guest host for this discussion, alongside featured guests Amadou Sall, CEO of Pasteur Institute in Dakar, Senegal, and Andrew Kitua, Africa Regional Director of the USAID Preparedness and Response project.

Amidst a time of potentially historic talks between the U.S. and North Korea, we take an inside look at the health challenges that North Korea faces and the opportunities for progress that can be made through key diplomatic steps. For this discussion, we turn to Dr. Kee B. Park, Paul Farmer Global Surgery Scholar at Harvard Medical School and Director of North Korea Programs for the Korean American Medical Association. Dr. Park has just returned from another trip to North Korea and joins us to discuss his latest visit, the potential impacts of economic sanctions on humanitarian engagement, and the operating environment that influenced the Global Fund's decision to close its TB and malaria programs. We conclude by hearing about some exciting new initiatives Dr. Park is pursuing to strengthen U.S.-North Korea collaboration in the health sector and his optimism looking forward. Dr. Park is also one of many co-authors on our recent commentary “The Gathering Health Storm Inside North Korea.” Hosted by Steve Morrison. Produced by Alex Bush. Edited by Ribka Gemilangsari.  

Christopher Murray, director of the Institute for Health Metrics and Evaluation (IHME), is a pioneer in the world of global burden of disease measurement. In April, IHME released their annual report on global health financing and two accompanying articles in The Lancet. Chris joins us for today’s episode to discuss the future of financing the global HIV/AIDS pandemic and the efforts to move towards universal health coverage around the world.   Hosted by Steve Morrison. Produced by Alex Bush. Edited by Ribka Gemilangsari.

Despite substantial progress made in expanding access to HIV/AIDS treatment and prevention options, a vaccine for HIV—even an imperfect one—is likely needed to put a durable end to the epidemic. In this episode of Take as Directed, Dr. Mark Feinberg, President and CEO of the International AIDS Vaccine Initiative (IAVI) discusses the landscape of HIV vaccine development and why he thinks a vaccine remains a necessary pursuit. Dr. Feinberg also discusses the facilitating role that IAVI plays in the HIV vaccine development process. Hosted by Sara Allinder. Produced by Alex Bush. Edited by Ribka Gemilangsari.