Take As Directed

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

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

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

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

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

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

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

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

Matt Goodman, CSIS SVP and Simon Chair in Political Economy, unpacks the several striking developments at the recent G7 Summit in Hiroshima. Russia’s invasion of Ukraine has unified and energized the G7, with side benefits in economic security, nuclear disarmament, food security, health and climate. With the Ukrainian counteroffensive imminent, the G7 made multiple specific commitments on Ukraine. On China, “economic coercion” and “de-risking” were the watchwords. Paragraph 51 of the communique laid out nine specific items on China, an unprecedented step. On health, President Biden committed an additional $250m to the Pandemic Fund, nudging his G-7 peers. The G-7 reaffirmed in detail its consensus on UHC, global health architecture, R&D of new technologies. Antimicrobial resistance (AMR) enjoyed higher salience, as did health reconstruction in Ukraine and violence in multiple wars targeting the health sector. The Covid origin stalemate was deliberately downplayed, while the Global Health Emergency Corps merit

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

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

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

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

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

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

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

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

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

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

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