Take As Directed

Dr. Jeffrey Gold, Chancellor of the University of Nebraska Medical Center (UNMC), joins J. Stephen Morrison for this 140th episode. How did UNMC evolve over the past decades to become such a lead national institution in advancing America’s health security, through its Global Center for Health Security? In 1997, UNMC created a public health lab with the state of Nebraska, followed by 2004-2005 with the establishment of one of the country’s first containment units, following the 9/11 anthrax attacks, capable of handling people exposed to high-risk pathogens. These life-saving capacities were put to dramatic use during Ebola 2014-2105, and during Covid-19 when UNMC repatriated patients from the Diamond Princess cruise ship and U.S. citizens evacuated from Wuhan. Proactive communications skills proved essential to winning public trust in Nebraska and beyond. Multiple partnerships with executive branch civilian and military institutions – and private sector health providers -- proved equally invaluable. What next?

In this 139th episode, Dr. Deborah Birx joins J. Stephen Morrison to discuss her new book, Silent Invasion. On that day, former President Trump responded to the book by, among other things, lamenting oddly that “Debbie Birx does not have a lot of dresses.” In her inside account, Deborah details the repeated failures both to acknowledge the power of silent transmission by fully vaccinated, asymptomatic infected individuals, and the need to keep a relentless focus on testing, masks and limiting the size of gatherings. The Trump administration’s catastrophic failures stemmed from the president himself and those around him, including their prevailing worries about the economy and the quest for reelection. Her journey to 44 states and 30 universities brought home the fragility of the rural health system in much of America and the need to engage far more closely with local communities. In the Biden administration, repeated stumbles in guidance and communications have weakened public trust and confidence.

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 injunc

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. H

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 c

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

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

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

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 f

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

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

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 yourse

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-posi