Take As Directed

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 environm

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 Direct

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 Dis

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

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 t

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.

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 Challen

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 abl

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

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

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

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 t

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.