Take as Directed

Sheryl Gay Stolberg, New York Times, offers her reflections on HHS Secretary Robert F. Kennedy Jr’s tenure over the past fifteen months. His vaccine agenda has always been an “outlier”—“an unpopular agenda”—yet it remains at the core of his identity. He has now “hit a wall.” Casey Means’ nomination to be U.S. Surgeon General is stalled; the recruitment of a CDC Director is stalled; Judge Murphy has put a hold on the ACIP and changes in the children’s vaccine regimen. Why did the White House not see the downside? “Fundamentally President Trump does not really care about health.” The MAHA movement, most interested in pesticides and eating healthy foods, “took a leap of faith,” signing on to Trump, yet is now outraged by the White House Executive Order declaring phosphorous—the base of the pesticide glyphosate—as a national security matter. Divorce may follow. “Rumors have been flying” that Secretary Kennedy may be leaving after the midterms. Who will replace him? “Mehmet Oz.”

Since January 2025, the United States has confirmed more than 3,000 cases of measles across multiple states - with South Carolina reporting nearly 1000 cases in just the first two months of 2026. The economic costs of these outbreaks pose a burden to local and state health agencies through hospitalizations, surveillance, and contact tracing, among other measures. Cases of pertussis are similarly high, with nearly 30,000 cases in 2025. Immunization coverage has stalled, and data indicate a rising trend of non-medical exemptions in states throughout the country. What is driving the resurgence of some vaccine-preventable diseases in the United States? Are we heading into a future of endemic measles, pertussis, and other disease outbreaks? How do the domestic outbreaks connect to global issues around immunization coverage and health security? Listen to the recent CSIS Bipartisan Alliance for Global Health Security broadcast conversation with Katherine E. Bliss, Senior Fellow and Director, Immunizations and Health Systems Resilience, with the CSIS Global Health Policy Center and J. Stephen Morrison, Senior Vice President and Director, CSIS Global Health Policy Center, regarding the current outbreaks, the threats posed by sustained disease transmission, and opportunities for regional and international collaboration to prevent and respond to health security challenges.

Gilead Sciences, the Trump administration, and the Global Fund have joined in partnership to bring lenacapavir, the new twice-yearly injectable prevention tool against HIV/AIDS, to two million persons at-risk in ten African countries in three years. Emily Gibbons, Gilead Sciences, explains the back story—the determined work of the previous two and a half years to plan an effective launch that would have speed, support from communities, access to affordable volumes of the medicine, and implementation to deliver. She also speaks to the challenges ahead to see lenacapavir reach a meaningful scale to drive HIV infections down, especially among the most vulnerable populations.

This episode of The CommonHealth features a discussion of the recently published book, Deployed: A Physician on the Front Lines of Global Health, by Kevin M. De Cock. In Deployed, De Cock details an insider’s perspective confronting infectious disease crises from the AIDS pandemic to Ebola to Covid-19. He explores the intersections between medicine, global public health, and epidemiology throughout decades of public health evolution across continents and crises. De Cock draws from his experiences in diverse settings to offer practical guidance to a new generation of health leaders.

Andi L. Fristedt, former senior official at CDC, FDA and the Senate HELP Committee, heads up a newly established Washington, D.C. office of the Parkinson’s Foundation. The Foundation acts in close allegiance with Michael J. Fox and his foundation; advocates; scientific and policy leaders such as Professors Okun and Dorsey; and new voices such as Harvard Professor Sue Goldie. It supports research on the genetic underpinnings of Parkinson’s Disease: 13% of Americans have genetic variants that place them at considerable risk. The foundation focuses on therapies and improving the quality of care; education of the public; and strengthening prevention against environmental toxins. The Washington office’s mandate is to “connect the dots” between science with those in Congress and the administration able to be champions and shape policy. There is progress: “We just know a lot more. And how to tell our story.” A paramount concern is the pesticide paraquat, which continues to be used widely in the United States, while outlawed in dozens of countries. Over 40 years of scientific research has made very clear the danger paraquat poses, especially to children. The EPA is currently revisiting paraquat, while many states spring into action.

Keith Poulsen, professor at the University of Wisconsin and director of the Wisconsin Veterinary Diagnostic Laboratory, provides an update on the status of highly pathogenic avian influenza (H5N1), as pertains to dairy cattle, poultry, wildlife—and humans. Are we making progress in biosecurity in the dairy industry? Dairy may be decades behind, but keep in mind: “Cows are like walking tanks.” Keeping boots and clothes clean is essential to contain viral spread. Vaccines are often not a viable solution, given trade, economics and political realities. What forces are most impacting the affordability of eggs, beef, and other items? Impacting access to rural workforces, especially migrants? What have been the implications of major recent disruptions at USDA, CDC and FDA?

Over the past year, outbreaks of measles, a highly transmissible virus, have affected thousands of unvaccinated people across Canada, Mexico and the United States. With more than 5,000 cases and sustained transmission during 2025, Canada lost its measles elimination status in October. And the United States and Mexico could lose elimination certification later this year. To what extent are current outbreaks driven by changing immunization practices or attitudes towards vaccination? How might losing measles elimination status impact health security in North America and beyond? What will it take to stop the current outbreaks and re-ignite progress towards global measles elimination? Listen to this broadcast from the CSIS Bipartisan Alliance for Global Health Security with Natasha Crowcroft, Vice President, Infectious Diseases and Vaccination Programs, Public Health Agency of Canada; William Moss, Professor and Executive Director of the International Vaccine Access Center (IVAC) at the Johns Hopkins University Bloomberg School of Public Health; and Daniel Salas, Executive Manager, Comprehensive Immunization Special Program, Pan American Health Organization (PAHO), regarding measles outbreaks and elimination in the North American context and the implications of sustained measles transmission for regional and global health security. Katherine E. Bliss, CSIS Senior Fellow and Director, Immunizations and Health Systems Resilience with the Global Health Policy Center, will moderate.

Jane Halton, chair of CEPI, the Coalition for Epidemic Preparedness Innovations, walks us through CEPI's evolution since its founding in early 2017, and the launch on February 14, at the Munich Security Conference, of CEPI 3.0, fitted to the current era of heightened threat of dangerous bioevents, scarcer resources, and a pivot to security partners, including NATO.

John-Arne Røttingen, CEO of Wellcome Trust, is a Norwegian leader whose expertise has a remarkable span, encompassing medicine, science, research, clinical trials, negotiations, diplomacy, philanthropy, financing of global health, and governance of international institutions. He shares with us his assessment of what prior factors, during and post-Covid, set the stage for the shocks of 2025; the implications borne by 2025’s sudden crises, and the essential, urgent changes in outlook and strategy unfolding in 2026. Give a listen to this timely and incisive conversation.

Keith Humphreys, a leading expert on addiction psychiatry, based at Stanford University, unpacks his January article in Science examining the steep reduction in overdoses deaths—between May 2023 and the end of 2024—in the United States and Canada. It likely stemmed from a supply shock, linked to steps taken by China to disrupt the supply of fentanyl and precursor chemicals. Underneath, US-China diplomacy was essential. This story was lost during the 2024 US presidential election cycle. Subsequently, President Trump’s overt threats to China, including the imposition of a 20% tariff tied to fentanyl, changed the negotiating context. Some progress followed on October 30 when Presidents XI and Trump met on the margins of the APEC summit in South Korea.

Amb. (ret) Karl Hofmann is CEO of the recently launched Health X Partners (HXP), a parent company under which Population Services International (PSI) and the Elizabeth Glazer Pediatric AID Foundation (EGPAF) now operate. He explains his personal story—from a successful diplomatic path centered in Africa to a pivot and second career as President and CEO of PSI starting in 2007. And he explains the logic by which PSI and EGPAF agreed in 2024 to form HXP to achieve greater efficiencies and prepare prudently for the end of the 25-year era, begun around 2000, that has generated an “amazing chapter of human progress” in health but which, it had become increasingly obvious, would not last indefinitely. As the unforeseen tsunami of Trump 2.0 hit in early 2025, it was both fortuitous and doubly-risky for HXP, as it stood itself up. The new leadership at FSI and EGPAF suddenly had to come to terms with 50% reductions in staff, budgets, and programs, while consolidating and integrating audit, HR, and IT teams. Change had been expected, but it “turned out there was a lot more change” than anticipated. How to view 2026? Profound uncertainty. Yet there is also one clear message to NGO implementers: focus even more on cost effectiveness; and get much closer to needs on the ground, networked and connected to leverage scale and innovation.

Dr. Chris Murray, IHME, co-chairs the Lancet Commission on 21st Century Global Threats to Health, which will launch its report in February at the Munich Security Conference. It is the “Commission of Commissions,” a novel, highly ambitious three-year effort to forecast what are to be the biggest, most costly problems by taking a broadened non-traditional view. It focuses on 16 factors plus hypertension, each forecast to exact over one billion life years over the next 75 years. These include the familiar big three – pandemics, climate, and conflicts – but includes other factors that rank surprisingly high: education, inequality and low economic growth, obesity, tobacco, and AMR. A wildcard such as malicious use of AI has to be taken into account. “We excluded meteors” and mirror life, the latter too early to include. The Commission calls for a rolling, annualized review, and for higher investment by governments in both promising innovative technological solutions and building better threat-ready health systems.

In the second episode of the Prevention Intention mini-series, Katherine speaks with Wafaa El-Sadr, University Professor in Epidemiology at Columbia University and the director of ICAP. They discuss El-Sadr’s formative experience treating AIDS patients in New York City in the early 1980s, as the global HIV epidemic began to emerge; her decision to found ICAP in order to bring HIV treatments to patients worldwide; and ICAP’s contributions to HIV prevention research. They also cover the evolution of PEPFAR, the challenges and opportunities associated with current efforts to reform U.S. global health assistance, and El-Sadr’s emphasis on ensuring people and their communities are at the heart of all health research and service delivery endeavors.

In the first episode of the Prevention Intention mini-series, a series featuring conversations with leading female HIV clinical researchers, Katherine speaks with Linda-Gail Bekker, a medical doctor and director of the Desmond Tutu HIV Centre at the University of Cape Town. They discuss Bekker's decision to focus her work on HIV as well as her involvement in the PURPOSE 1 clinical trials, which demonstrated the efficacy of long-acting pre-exposure prophylaxis (PrEP) among adolescent girls and young women in South Africa and Uganda. They also cover why it’s important to approach research as a highly collaborative endeavor that both contributes to scientific understanding and improves people’s lives.

Erika Elvander served her country as a federal career health diplomat for 27 years, including as the U.S. Health Attache in Beijing from the spring 2021 until the end of 2024. Her Asia passion ignited while a student in Hong Kong and traveler to Beijing in the late 1980s. And carried forward for the following decades. As Health Attache in Beijing during COVID, she witnessed China “digging in,” pursuing its 18 months of the fierce controls imposed under “static management.” "Achievements with China are incremental.” She was able to maintain dialogues with Chinese health officials, despite the fraught US-China relationship. Today, the COVID origins quagmire does persist and impede the U.S.-China relationship, six years after the advent of Covid. But “there has to be a path forward,” built on many opportunities in health.

Marian Wentworth, President & CEO, Management Sciences for Health (MSH), at age 13 started working in a local factory. Attended the famous Latin School in Chicago. Studied math at Harvard. Then joined Merck as it was "growing ferociously fast." Stayed 27 years, grew and led the vaccine business to $6 billion. Was the "quant jock." Spearheaded the launch of Gardasil, the HPV vaccine. Then pivoted to MSH. It was important "not having a pharmaceutical company on my business card." Now as she reflects on the stunning year of 2025, a series of radical pivots for MSH, is there space for MSH in the America First Global Health Strategy? Yes. Excited by the Accra Reset? Yes. Where does this leave MSH? "I believe this time is a crucible."

Listen to the recent CSIS Bipartisan Alliance for Health Security discussion with Congressman Adam Smith (WA-09), Ranking Member of the House Armed Services Committee, on his experience leading a Congressional delegation to China in late September 2025. Rep. Smith’s bipartisan delegation—the first House delegation to travel to China since 2019—pressed for high-level military-to-military dialogue between the world’s leading superpowers. What reception did they receive from their Chinese counterparts, what messages did they impart, and how has the dialogue with his colleagues evolved since his return to Washington? What did the trip reveal and how does he expect to see the bilateral relationship evolve—including on key issues such as the debate over fentanyl—into the new year? Following welcoming remarks from John J. Hamre, CSIS CEO and Langone Chair in American Leadership, J. Stephen Morrison, Senior Vice President and Director of the CSIS Global Health Policy Center, moderates the discussion.

Dr. Rick Brennan, an acclaimed Australian humanitarian leader who led WHO and NGO crisis response in multiple conflicts over several decades, walks us through his personal story. He then unpacks the scale and gravity of what is now unfolding in Darfar—featuring the “F word” (famine), the “G word”( genocide, affirmed by the US Senate), and the “C word” (cholera). The crisis requires political action from the UAE—and President Trump’s attention. “There is an obligation to act.” And yet it occurs as global humanitarian needs have soared while humanitarian funding has dropped by half—the US by over 80%. It is a wake-up call, a rude awakening.

Listen to the recent CSIS Bipartisan Alliance for Global Health Security book launch of Fair Doses: An Insider’s Story of the Pandemic and the Global Fight for Vaccine Equity by Seth Berkley. As the gravity and magnitude of the Covid-19 pandemic became apparent in the first half of 2020, how did the vision for a mechanism to ensure equitable access to new vaccines come together and what role did organizations including Gavi, the Vaccine Alliance; the Center for Epidemic Preparedness Innovations (CEPI); and the World Health Organization (WHO) play in enabling the COVAX Facility to distribute nearly two billion doses of COVID-19 vaccines to people in 146 countries, the majority of which were low-income countries, by the end of 2022? This event featured conversation between Katherine Bliss, Senior Fellow and Director of Immunizations and Health Systems Resilience, CSIS Global Health Policy Center, and Dr. Seth Berkley, author of Fair Doses and CEO of Gavi, the Vaccine Alliance, from 2011 to 2023 regarding the challenges of vaccine equity and the lessons from the COVID-19 pandemic that can inform preparations for inevitable future health crises. This event is made possible through the generous support of the Gates Foundation.

Keizo Takemi, recent Japan Minister of Health, Labour and Welfare (September 2023-October 2024), shares his personal story that took him to Taiwan, CNN/Japan, the Diet, Harvard, back to the Diet, and recently into the cabinet of then Prime Minister Kishida. Along the way he became a leading force in charting Japan's approach to global health. As Minister he put a spotlight on the thousands of single, isolated elderly who die alone in Japan, unnoticed for days. Though expensive, wearable digital technologies can help connect the elderly better to community health services. Covid-19 exposed the lack of digitalized data and the need for a national mechanism to integrate patient and hospital data. That became a priority for him as Minister, as well as the creation of the Japan Institute of Health Security, a merger that promises far greater capabilities in preparing for and responding to dangerous outbreaks. By 2035, Japan will have 10 million citizens above 85 years of age. "Speedy aging" is raising demands for different care, at considerable expense. Achieving a stable number of skilled caregivers requires better wages and work conditions, and the entry of far more migrants into the workforce. Japan's biopharmaceutical industry requires a wholistic industrial policy. That sector is hollowing out, as Takeda and Astellas locate their operations in the United States.

Dr. Debra Houry joined the podcast, following her resignation from CDC on August 25, upon the firing of CDC Director Susan Monarez, and shortly after her September 17 testimony before the Senate HELP Committee. What does she make of President Trump’s September 22 press conference on Tylenol, its alleged connection to autism, and the potential use of leucovorin? While serving as CDC’s senior most leader, how did she navigate the period from President Trump’s inauguration on January 20 until the arrival of Susan Monarez as the new CDC Director on July 31? How was the armed attack upon CDC on August 8 experienced? What are the downstream impacts? How did she plan and carry out her resignation in league with other CDC leaders? What did the September 17 Senate HELP Committee meeting accomplish? What is the state now of CDC? “I have grave concerns about what is coming out of that agency.” How to stabilize CDC? It needs permanent scientific leadership, a stable budget, more truth and oversight of advisory committees, better trust in CDC staff, and more voice by CDC staff and scientists in partnership with communities.

The renowned global health leader, Peter Piot, LSHTM, opens this conversation with reflections on what drove the historic global health successes, including “a brilliant coalition” and U.S. bipartisan leadership grounded in statecraft and strategic thinking. That “twenty-five years of historical anomaly” has however now ended. In Europe, that shift has resulted from populism combined with intense migratory pressures, the costs of battling the threat of Russia, and the high costs of providing a social safety net for a rising elderly population. Global Health 2.0 will be built on health sovereignty in Africa, Latin America and Asia. The shock scarcities of the Covid pandemic had already awakened the need for greater self-reliance; the sudden and abrupt decline in donor funding for global health is the latest shock. We will see “sunset clauses” and “mergers and acquisitions” across many familiar international institutions. AI promises innovations in R&D and delivery, aided by philanthropies. Centers of excellence are now in place “everywhere.” It is “no longer a one-way street.”

Listen to the recent CSIS Bipartisan Alliance for Health Security book launch of The Big One: How We Must Prepare for Future Deadly Pandemics. As bad as Covid-19 was, the next pandemic could be worse. While the world learns to live with Covid-19 and continues to recover from its worst effects, how do we prepare for the next pandemic lurking around the corner? The event includes a panel moderated by CSIS Senior Vice President and Director J. Stephen Morrison, featuring co-authors Michael T. Osterholm, Director, Center for Infectious Disease Research and Policy (CIDRAP), University of Minnesota, and Mark Olshaker, Emmy Award-winning documentary filmmaker and New York Times #1 bestselling author.

Dr. Celine Gounder, Editor-at-Large, KFF Health News, explains how the U.S. vaccine enterprise could be damaged so swiftly by the Trump administration, with so little apparent resistance: it was a "shock and awe" blitz, while hesitation and fear dominated. "Silence was paralysis." It is too early to estimate the true scope of damage. The middle tier of professionals in government and scientific research has certainly paid a high price. While Secretary Kennedy's firing of CDC Director Monarez was a thunderclap, it remains to be seen if or when President Trump changes his view of the Secretary's performance. What lies ahead? Regional alliances of states setting policy on vaccines will be "the laboratories of public health." The Supreme Court may be called upon to revisit the balance between individual liberty versus public health. If pediatric hospitals are overrun with children suffering from dangerous vaccine-preventable illnesses, public outcry could escalate.

In the fifteenth episode of the Common Health Live!, Katherine E. Bliss talks with Dr. Jarbas Barbosa, Director of the Pan American Health Organization (PAHO), about challenges related to health security in the Americas, the importance of regional cooperation in building resilient health systems and strengthening preparedness for future health emergencies, and opportunities for advancing efforts to improve the health of the region’s population through the upcoming UN High-Level Meeting on the Prevention and Control of Noncommunicable Diseases and the Promotion of Mental Health and the 10th Summit of the Americas, scheduled to take place in the Dominican Republic in December.

Dr. Andriy Klepikov, the founder and executive director of the Alliance for Public Health (Ukraine), reflects on the Alliance's remarkable evolution over the past 25 years into a major Ukrainian—and regional—non-governmental force in HIV, TB, and harm reduction programs. Foundational to its early success was the exemplary partnership with the Global Fund and PEPFAR. Ukraine, in the midst of war, cannot at present soon transition to self-reliance. In the past three and a half years of war following the Russian invasion, the Alliance has become a provider of mass emergency humanitarian relief to the most vulnerable in Ukraine. It now serves five times the numbers it served before the war. Recovery will draw on telemedicine and mobile clinics, and prioritize mental health, war veterans who are blinded, have lost limbs, and struggle with long-term trauma. The United States remains indispensable to Ukraine's future—for peace and social justice.

Dr. Heidi Larson, the acclaimed expert on vaccine confidence at the London School of Hygiene and Tropical Medicine – and CSIS Senior Associate – speaks to how the external world is reacting to the changes in the United States in vaccine policy, the scientific R&D biomedical enterprise, and public health. “What has shocked people is the abruptness of these measures with little consideration of the implications.” An abrupt drop in trust has followed. The United States has for decades been seen as the most stable and trusted collaborator, based in scientific evidence. People are now turning inward and to other countries. For those scientists whose U.S. grants have been disrupted, “You can’t turn your lab off for six months.” We are seeing the outmigration of US-based scientists to Europe and elsewhere. The multilevel siege of American universities is fundamentally a matter of values. It has raised the question of whether it will be possible to sustain transatlantic scientific partnerships. How to break out of a liberal bubble? Finding a common space is most critical. Sometimes you just have to keep your head down and keep moving forward …. keep our center.

In this episode of The CommonHealth Live!, Dr. Christopher J.L. Murray, Director of the Institute for Health Metrics and Evaluation (IHME) and Stephanie Psaki, CSIS Global Health Policy Center Senior Adviser, will discuss IHME’s new report on Financing Global Health, also released in a paper in The Lancet, and its implications for the way forward in a constrained financial environment. Who and which countries are those most affected by the sharp drop in development assistance for health between 2024 and 2025? How will recipient governments and other global stakeholders respond to fill the gaps? This event is made possible by the generous support of The Gates Foundation.

Dr. Ken Staley, Palantir, has served in health security positions in the George W. Bush and first Trump administrations, with time in-between in private sector biopharma. Palantir was founded after the 9/11 Commission to bring together data streams to enhance security and protect liberties. As director of the President’s Malaria Initiative in the Trump first term, Ken oversaw an effort to use data faster and in a more integrated way, to understand outbreaks, supply chains, and health impacts. He participated in the Lancet Commission as it looked forward on how to make malaria eradication a strategic end-goal. As Covid-19 coordinator at USAID during the 2020 Covid-19 outbreak, Ken shifted communications to the cloud to permit continuity of operations. Technology innovations in malaria control – vaccines and bacteria to disrupt mosquitoes – hold considerable promise. “We have a lot of cool stuff on the horizon.” In regard to WHO, the pandemic treaty, and reforms of the International Health Regulations (IHR), “missions are sacred, organizations are not.” On foreign aid, “the context has changed.”

Dr. Ifedayo Adetifa is a pediatrician and tuberculosis expert who led the Nigerian Centre for Disease Control during the Covid-19 pandemic. A year ago, he became the CEO of FIND, the global alliance for diagnostics, a product development partnership based in Geneva. A major innovation gap was FIND’s initial focus – and remains a pressing priority. And over time, the access gap has become much more conspicuous and urgent. A 2021 Lancet Commission and recent update have proven highly valuable. The sudden decline in U.S. financing is having impact, directly and indirectly, upon FIND, but its diversification of funders has provided a cushion. FIND engages directly with over 100 US-based businesses. AI provides an opportunity for closing gaps in diagnosis, when combined with digital tools. However, there is a serious risk of low-income countries being left behind in the AI transformation. And a risk that diagnostics fall off the priority list.

Michael Osterholm, on July 21, spoke with us on the Vaccine Integrity Project that he is spearheading in response to vaccine-related actions taken by the second Trump administration. “We are in totally unprecedented times.” He explores the VIP’s genesis and mission, its steering committee and partner medical associations, and the VIP’s forthcoming scientific brief on vaccines for RSV, flu and Covid, scheduled for release in early August. “Someone has to stand up and deal with the dis- and mis-information.” While the VIP is not a shadow of the Advisory Committee on Immunization Practices (ACIP), many actors who are witnessing the ACIP’s decline—insurers, medical societies, states and others—are now seeking reliable, alternative scientific data. If VIP comes under attack, will it be possible to mobilize strong bipartisan support? “This is not a fight between Mike Osterholm and Secretary Kennedy. It is about supporting the science. … All we are trying to do is save the vaccines that we know are so important.” It will be critical to manage carefully the risk that we are heading into a confusing, balkanization of the vaccine enterprise—and to restore the integrity of the ACIP.

Beth Cameron, Senior Advisor and Professor of the Practice at the Brown University Pandemic Center and a Senior Adviser and non-resident fellow at CSIS, hosts this inspiring July 14 conversation with Richard Hatchett, the CEO of CEPI, the Coalition for Epidemic Preparedness Innovations. Richard first came to Washington DC in the aftermath of 9/11 to create the U.S. Medical Reserve Corps. There was no looking back. He served in several administrations as a leading expert in bio preparedness and left government to lead CEPI at its creation in 2017, its mission to support the accelerated development of vaccines and other countermeasures against future biothreats. With the Covid-19 pandemic, health security has become an enduring global concern, with now a fierce focus on access to new technology, and regional manufacturing capabilities. “You have to design your programs with your access goal in mind from the very beginning,” Preparedness is “not a static achievement.” It is “a dynamic state of readiness” that evolves through practice – “train, train, train.” CEPI’s signature big idea is the 100 Day Mission, in which vaccine designs and delivery platforms are ready to spring into action when new biothreats appear. Cuts in finances and programs by the Trump administration and others will compromise disease surveillance, detection and containment measures, increasing the risks to Americans and beyond. Cuts are also forcing reflection, the setting of priorities, and finding ways to finance and achieve better and more efficient outcomes. The remarkable speed in which a vaccine was introduced during the Marburg outbreak in Rwanda in September 2024 rested not on luck. It built on CEPI’s pre-existing partnerships with the Rwanda government and several other institutions, including WHO and key US agencies. CEPI has invested since 2017 in over $1 billion in the US biotech sector, and has just concluded an agreement to work with DOD.

Joe Grogan, former senior official of the George W. Bush administration and the first Trump administration, operates an active consultancy, hosts a podcast, writes commentaries for USC Schaeffer Center, and is an active member of the CSIS Bipartisan Alliance for Global Health Security. Drug shortages remain a real problem, with the potential to scale and impose political costs. What to make of the Big Beautiful Bill? It might provoke a backlash. How to understand the rising vulnerability of the aging foundational programs—PEPFAR, Gavi, the Global Fund? And how to understand what happened during Covid-19? It was a “toxic brew.” We need to be “radically transparent.”

Fabrizio Carboni, head of the ICRC delegation to the US and Canada, speaks to his vast experience in the wars of the past two decades, including the profound impact of 9/11 (2001) in integrating humanitarian action into battlefield strategies—including the targeting of humanitarian operations. Today, almost 25 years later, we are witnessing unrestrained violence, limitless war, and flagrant disregard for International Humanitarian Law. The emotional, psychological dimensions are poorly understood. Political leadership is essential whenever soldiers are asked to respect IHL. The most dangerous moment is when states argue that they are fighting a "survival war" that they believe is exceptional. Does the Trump administration honor IHL or seek a "realist" American First alternative? It is too early to reach a conclusion: "There is no rupture." It is also too early to know how deep cuts in US foreign assistance will impact ICRC and the broader global response to humanitarian crises. ICRC does remain a "soft target," increasingly exposed. It is striking how a single actor—the United States—can be so "steep" in changing its course. It shifts the ground towards deeper burden-sharing and inspires a debate on what the new architecture will be, with far less money. ICRC has just recently repatriated the remains of 6,000 persons killed in the Russian war against Ukraine. In Gaza there is no way for ICRC to avoid getting hit from all directions. 2,200 Gazans were recently shot or hit with shrapnel while approaching the Gaza Humanitarian Foundation food distributions. "Those numbers are unacceptable."

In the thirteenth episode of The CommonHealth Live!, Katherine E. Bliss and J. Stephen Morrison discuss the outcomes of the June 25 Health and Prosperity through Immunization Global Summit, co-hosted in Brussels by Gavi, the Vaccine Alliance, the European Union and the Gates Foundation. During the Summit, Gavi aimed to secure pledges of $11.9 billion to save at least 8 million lives and protect at least 500 million children from vaccine preventable diseases between 2026 and 2030. While several countries maintained longstanding commitments to the Alliance, and new donors, including current and former implementing countries, stepped up to contribute, Gavi still faces a funding shortfall. U.S. Secretary of Health and Human Services Robert F. Kennedy, Jr.’s video statement expressing concern over Gavi’s approach to vaccine safety before stating that the United States would not renew its support raises questions about how the Alliance can close the funding gap to meet the ambitious goals set forth in the next phase of work. The conversation highlights takeaways from the pledging session outcomes from the CDC’s Advisory Committee on Immunization Practices (ACIP) meeting the same day, and what recent events mean for the future of U.S. approaches to global immunization programs.

Sheryl Gay Stolberg, NYT, delves into what direction HHS Secretary Kennedy is taking US policy. He operates along two divergent strands – vaccines and the Make American Healthy Again (MAHA) agenda. “Kennedy is by nature a skeptic” and has a “love of nature, and all things holistic.” He has expanded the power of the office, specifically with regard to Covid vaccines, with the CDC leaderless. The newly released MAHA commission report on chronic disease among children, “the sickest generation in American history,” spotlights ultra-processed food—the strongest and most bipartisan argument contained in the report. While the report is restrained on childhood vaccines and pesticides, it is likely to lead to more work on mental health disorders among children. Sheryl ventured to Texas recently to visit with the founders of Texans for Vaccine Choice, “mad moms in minivans” committed to medical freedom with longstanding links to RFK Jr. For a decade they have scored wins in the Texas legislature. “Defiant” and “entitled,” the Secretary asserts that Americans should not ask any medical advice from him, a deliberate deflection. Dr. Casey Means, nominated to be US Surgeon-General, has already demonstrated she is a strong communicator. It would not be surprising if Kennedy runs in 2028 for the Presidency.

For Helen Branswell, the celebrated Stat News reporter, the SARS outbreak of 2003, while she was based in Toronto, was a thunderclap moment. Jump forward 22 years: Secretary Kennedy on May 28, posted a one-minute video on X announcing he is not recommending Covid vaccines for healthy children and pregnant women -- an “unprecedented” unilateral decision without any normal process. “It came out of the mind of the individuals who wrote it.” What does this bold step signal? The public is voting with its feet in the low uptake of Covid vaccines by the older and more vulnerable population. Yet it is not clear why the government has to take active measures to make vaccines less available to healthy individuals. CDC should play a lead role in deliberations but is cut out. The CDC director position is vacant, and no acting director is in place. Will vaccine producers need to run new field trials for updated boosters? “They (the Trump administration) have been quite unclear in what they are asking for.”127 days into the second Trump administration, how to characterize things? “I would characterize it as exhausting.” “The change has been massive, and it is not over.” What gives you hope? “That is a very hard question.”

In this episode, Dr. Kate O’Brien, Director of the Department of Immunization, Vaccines, and Biologicals at the World Health Organization (WHO) shares her perspective on the state of global immunization programs halfway through Immunization Agenda 2030; the challenges associated with current measles outbreaks in the United States and around the world; why people who have never seen children die from preventable diseases may seem complacent about vaccines; steps that can be taken to strengthen vaccine confidence while ensuring equitable access to immunization programs; and what’s at risk as the United States and other funders cut support for biomedical research and development at a moment when there are numerous promising products to prevent infectious diseases in the research and development pipeline.

“I studied hard. Hated the lab, loved the field.” Dr. Maria Van Kerkhove, Acting Director, WHO Department of Epidemic and Pandemic Threat Management, reveals her early, personal passions as a student of epidemiology. After a stint as a young PhD investigator in Cambodia, she was “desperate to work at WHO. I wanted a seat at the table.” As the technical lead at WHO during the Covid-19 outbreak in early 2020, she spoke at hundreds of press conferences, duly tracked by her mother. The value proposition for WHO? To help governments prepare for emerging biothreats, detect and rapidly share information on outbreaks, and convene the world’s experts to produce guidance. “In my wildest dreams, I did not expect the politicization of Covid throughout the past five years.” WHO’s recent dramatic restructuring will better focus WHO on its core functions, as its two-year budget drops from $6.8 billion to $4.2 billion. As the United States withdrew in January from WHO, it stopped its funding and ceased technical and scientific exchanges. “Since January, U.S. government officials have been instructed not to talk to us.” That is unprecedented and dangerous: “If American expertise is not at the table, there is a gap.” It puts Americans at-risk. Her conclusion: “Restore that link immediately.”

Dr. Margaret (Peggy) Hamburg, former FDA Commissioner, describes the profound impact the HIV epidemic has had on her personally and in terms of her career choices. She discovered in her six years as FDA Commissioner how vitally important FDA is to the safety and protection of Americans, at home and abroad. FDA has oversight responsibility for fully 20% of the American economy. She is deeply worried at the level of destruction visited upon FDA recently, but cautions that it is critical to wait until the dust has settled. “Corporate capture” of FDA has been an issue for a long time, tied to user fees and industry participation on advisory panels. What is most important is to engage the right expertise and experience, with effective guardrails. The Trump administration has instructed FDA to expand overseas unannounced inspections, expedite the creation of a centralized AI platform across all FDA units, and lower the barriers to the pharmaceutical industry building new facilities on US soil. In each of these ambitious goals, a step-by-step approach is needed, along with attention to the “disconnect” between big, new goals versus uncertain, or declining FDA capabilities in staff, financing, and dedicated offices. She is very concerned at the worsening threat to vaccines and the need somehow to earn back public trust. The same is true for the U.S. “biomedical research and innovation enterprise”—the envy of the world—that has been struck by a “wrecking ball.”

Dr. Jennifer Kates, SVP and Director, Global Health and HIV Policy Program, KFF, provides a tour d’horizon of how global health and health security look at day #98 of the Trump revolution. “The DOGE factor was not on my bingo card,” as it became the battering ram decimating institutions, programs, budgets and staff, far beyond what was environed in Project 2025. It went against what many Republicans favor—just look at the recent dismantling of the Millennium Challenge Corporation. The desire to vanquish likely emanates from the White House OMB. As the budget process, including recissions, advances, the power dynamic may shift to Congress. It may become possible to think about new ways to do foreign assistance. There will be no restoration of the status quo ante. It requires fresh thinking and clear principles, and most importantly, new forms of leadership.

In the twelfth episode of The CommonHealth Live! which falls during World Immunization Week, Katherine E. Bliss talks with Dr. Adam Ratner, a member of the American Academy of Pediatrics Committee on Infectious Diseases and author of Booster Shots: The Urgent Lessons of Measles and the Uncertain Future of Children's Health, and Dr. Ephrem T. Lemango, Associate Director of Immunization at UNICEF, about measles outbreaks in the United States and abroad; how to bolster measles vaccination coverage in a period of reduced financing for domestic and global programs; and why routine immunization programs are critical to global health security.

In the eleventh episode of The CommonHealth Live! Katherine E. Bliss talks with the Republic of Indonesia’s Minister of Health, H.E. Budi Gunadi Sadikin, about Indonesia’s experience expanding routine immunization coverage and prioritizing attention to non-communicable diseases, as well as how public-private sector collaboration can help ensure sustainable access to health services, including primary health care.