Take as Directed

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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