Take as Directed

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 G7 Summit in Hiroshima. Russia’s invasion of Ukraine has unified and energized the G7, with side benefits in economic security, nuclear disarmament, food security, health and climate. With the Ukrainian counteroffensive imminent, the G7 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. Antimicrobial 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.