Take As Directed

Dr. Scott Rivkees served under Governor DeSantis as Florida’s Surgeon General and Secretary of Health for 27 months during the pandemic, in what became a rocky political experience. Behind the scenes, what was he able to achieve, in serving Florida’s 67 counties, and in particular, in protecting seniors, managing schools, setting early vaccine priorities? What were the hard lessons for public health professionals, as vaccine hesitancy grew, and morphed into refusal? How well did CDC fare in this period? In his current position as a Professor of Practice at the Brown University School of Public Health, how has he used his columns to push against misinformation and conspiracy theories and urge medical professionals to be more vocal?

As part of our series on China post-COVID-19, Chris Murray reflects on where things stand, almost two months after President Xi threw off Zero-Covid controls.  A huge Covid-19 wave has likely led thus far to a million deaths. It is likely not over. Don’t expect greater Chinese government transparency on numbers. That remains a highly sensitive matter domestically and, no less important, an integral component of China’s foreign policy image and prestige. The Chinese government is driving to get through the outbreak as fast as possible, tough it out, and reopen the economy. China's elderly bear the biggest toll. 

In our continued series on China post-Zero Covid, Dr. Scott Kennedy recounts the revelations from his six weeks in Beijing and Shanghai in late 2022, and reflects on what has transpired – societally, politically, medically -- since President Xi suddenly threw off the Zero-Covid controls in early December.  What is the “toll” for not preparing for the colossal speak of Covid? What to make of a “crisis of confidence” that the government has to face, that is going to “hurt?” What can we expect in the spring in terms of “normalization?’

As 2023 opens, Yanzhong Huang, Council on Foreign Relations/Seton Hall University, kicks off our new podcast series focused on China. Over the past month, since Xi threw off Zero-Covid, China has experienced an extraordinary pace and scale of infection. “The worst is yet to come” as Lunar New Year migration rush – 200 million – spreads the virus into the countryside. Why should Americans care? Are travel restrictions counter-productive? How should we think about what lies on the other side of this extraordinary outbreak?

In this 153rd episode, Doctors Kristina Box and Judy Monroe walk us through the recently concluded Indiana Governor’s Commission on Public Health. Why Indiana? What are the Commission’s mandate, methods, findings and recommendations? How did Commissioners navigate the polarization and anger? Indiana’s $55 per capita investment in public health lags far behind the $91 national average: how is Indiana to catch up? What’s CDC’s special value to Indiana’s public health? How important is the Commission to the rest of the nation?   

In Episode 152, we share the audio of the one-hour conversation J. Stephen Morrison held at CSIS on October 19 with Dr. Raj Panjabi, Special Assistant to the President and Senior Director for Global Health Security and Biodefense at the National Security Council. The focus is the launch of the new U.S. National Biodefense Strategy and Implementation Plan and the issuance of the President’s National Security Memorandum-15. What do these steps promise, in strengthening the protection of Americans and advancing U.S. leadership globally? What is it going to take to ensure success, in terms of high-level sustained political will, sustained finances, and the partnership and mobilization of state and local authorities, industry, university researchers and others?

In this special CCU episode, #151, we bring you the audio of a conversation that J. Stephen Morrison held with Dr. Ashish Jha on September 27. How is the bivalent vaccine launch going? How does the White House navigate the wildly divergent realities of the pandemic? We are living a tale of two cities: the drive to normality, built on major achievements that have lowered the threat of severe illness and death, versus persistent danger and uncertainty, and the multiple accumulating barriers to action: the fiscal, political and technological impasses, and our frayed institutions. What are his reflections, six months into the job, on the role of the White House Coordinator? Will the White House exit an emergency context in early 2023? Give a listen!

In episode 150, Dr. Daskalakis, White House Deputy Coordinator of the monkey pox response, has been at his job for six weeks, attempting an urgent turnaround of a response that went very badly initially. He looks at “his medium term crystal ball” and sees several causes for cautious optimism: a deceleration of spread, changed behavior, greater vaccine availability, greater flexibility in use of HIV and STD resources, improved communications. But much progress still hangs on far more funding, better data flows, and bipartisan political support. Listen to hear more!

In this special episode, we bring you the audio of a broadcast interview that J. Stephen Morrison held on Monday, September 19 with Dr. Fauci, Chief Medical Advisor to President Biden and Director, the National Institute of Allergies and Infectious Diseases. Dr. Fauci addresses the multiple tough challenges that confront us, as we approach year 3 of the pandemic, as well as the historic achievements that give us hope. 

Dr. Krishna Udayakumar, founding director of the Duke Global Health Innovation Center, shares his trenchant insights into this confusing moment of transition in the global response to Covid-19. What should be the priorities and the principles to guide action? How to take account of the profound changes in the pandemic, while not losing focus on equity? Please give a listen!

On this 147th episode, we are offering the fireside chat, held on August 30 at CSIS, at which CDC Director Rochelle Walensky laid out her newly announced reform agenda, moderated by Julie Gerberding and Tom Inglesby. Julie is former director of the CDC and current director of the Foundation of the National Institutes of Health, and co-chair of the CSIS Commission on Strengthening America’s Health Security. Tom is Director of the Johns Hopkins University Center on Health Security and co-chair of the Commission Working Group on CDC.  

On this 146th episode, Dr. Chris Murray, IHME, delivers several sharp messages. Tracking Covid is increasingly difficult, a function of both underreporting of cases and overreporting of incidental hospital admissions. Studies are emerging which suggest that protection against severe ill and death may be waning after 20 weeks. Without far better data on hospital admissions, however, we are “flying blind.” Essential “big” investments in next-generation vaccines that block infections and address multiple variants are expensive. Without ample funding, we will “muddle through.” The case for Paxlovid as a lead global tool is strong, but production is expensive. Is Monkeypox “a really scary thing? No!” China clings to Zero-Covid for more than health reasons. That choice is “part of a broader geopolitical strategy.” Hope rests on strong and vibrant scientific cooperation, amid multiple crises.

Dan Diamond, Washington Post, joins J. Stephen Morrison, CSIS, for a tour d’horizon of rapidly unfolding Monkeypox developments: How to explain the early egregious USG stumbles? Are we correcting course in testing, vaccines, and therapies rapidly and effectively enough to head off the entrenchment of Monkeypox? Does the math surrounding vaccines and demand add up? Or are we sailing into a profound gap? How should we be thinking strategically about the global response?

Dr. Marci Nielsen, Vice President for Policy and Advocacy at Resolve to Save Lives, joins J. Stephen Morrison for episode 144. For an 18 month period beginning in the fall of 2020, Dr. Nielsen served as Chief Advisor for COVID-19 Coordination for Kansas Governor, Laura Kelly, where she led outreach efforts across the state to advance dialogue, access to data, and transparency. Regular public fora on schools – when to close or open, promotion of tests, vaccinations, masks – were a key tool to counter rising political tensions and disinformation. Over her career, the public health sector has “never been political” to this extent, fostering a significant “lack of understanding.” “Great hope” lies in strengthening communications, the determined commitment of public health and elected officials, and youth.

Dr. Celine Gounder, senior fellow & editor-at-large for public health at KFF's Kaiser Health News, joins J. Stephen Morrison and Andrew Schwartz for this 143rd episode. Monkeypox has spread beyond the endemic regions, and is rapidly becoming a pandemic. It has already become de facto politicized in the United States because of the community affected, but monkeypox per se is not a gay disease and I will soon reach beyond men-who-have-sex-with- men and endanger the immunocompromised, pregnant women and newborns. Covid-19 taught us that we need to invest in public health infrastructure and move rally fast in introducing tests, data collection, vaccines and therapies, but the U.S. government is not moving quickly enough and at the scale required to avoid monkeypox becoming a permanent fixture in the United States. BA.5, the latest Covid variant, is moving very quickly because its spike proteins are so different from other variants that people are losing residual immunity. New vaccines are in development, but BA.5

Dr. Margaret Bourdeaux, Research Director of the Global Public Policy and Social Change Program, Harvard School of Medicine, joins J. Stephen Morrison for Episode 142. Her mentor Dr. Paul Farmer, who recently passed, inspired her with his exhortation to “do hard things together” even when the odds are against you. Her project, the Covid Academy, is developing a locally-informed model for standardized health security outbreak investigation and response. Though the United States is deeply divided politically, Dr. Bourdeaux believes the situation is not as dire as it seems. Common sense can win. “I don’t believe that Americans can’t see reason on this”.

Apoorva Mandavilli, a science and global health reporter at The New York Times, joins J. Stephen Morrison and H. Andrew Schwartz for this 141st episode. Apoorva unpacks the sudden spread of Monkeypox into Europe and now the United States, outside African states where it is endemic, and the challenges this poses to Americans and Europeans weary of Covid-19, as well as to Africans who fear gross inequities in access to vaccines and therapies, which are presently quite limited in supply. Containment of rising numbers of cases will be through ring vaccination of close contacts, which is doable but requires effective communication which up to now has been wanting. Much transmission is through men having sex with men, which raises the complex specter of stigmatization and politicization. The virus, far less severe and transmissible than smallpox, is nonetheless dangerous for infants, pregnant women, persons living with HIV and others who are immunocompromised. Case counts in Europe top 1,000 (very low numbers thus

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.