Take As Directed

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

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 disp

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

…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

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

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 Sc

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, soci

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 r

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-el

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 Evalu

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 Geogra

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 P

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 t

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).