Take as Directed

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.