Take As Directed

Andi L. Fristedt, former senior official at CDC, FDA and the Senate HELP Committee, heads up a newly established Washington, D.C. office of the Parkinson’s Foundation. The Foundation acts in close allegiance with Michael J. Fox and his foundation; advocates; scientific and policy leaders such as Professors Okun and Dorsey; and new voices such as Harvard Professor Sue Goldie. It supports research on the genetic underpinnings of Parkinson’s Disease: 13% of Americans have genetic variants that place them at considerable risk. The foundation focuses on therapies and improving the quality of care; education of the public; and strengthening prevention against environmental toxins. The Washington office’s mandate is to “connect the dots” between science with those in Congress and the administration able to be champions and shape policy. There is progress: “We just know a lot more. And how to tell our story.”  A paramount concern is the pesticide paraquat, which continues to be used widely in the United States, while

Keith Poulsen, professor at the University of Wisconsin and director of the Wisconsin Veterinary Diagnostic Laboratory, provides an update on the status of highly pathogenic avian influenza (H5N1), as pertains to dairy cattle, poultry, wildlife—and humans. Are we making progress in biosecurity in the dairy industry? Dairy may be decades behind, but keep in mind: “Cows are like walking tanks.” Keeping boots and clothes clean is essential to contain viral spread. Vaccines are often not a viable solution, given trade, economics and political realities. What forces are most impacting the affordability of eggs, beef, and other items? Impacting access to rural workforces, especially migrants? What have been the implications of major recent disruptions at USDA, CDC and FDA?

Over the past year, outbreaks of measles, a highly transmissible virus, have affected thousands of unvaccinated people across Canada, Mexico and the United States. With more than 5,000 cases and sustained transmission during 2025, Canada lost its measles elimination status in October. And the United States and Mexico could lose elimination certification later this year. To what extent are current outbreaks driven by changing immunization practices or attitudes towards vaccination? How might losing measles elimination status impact health security in North America and beyond? What will it take to stop the current outbreaks and re-ignite progress towards global measles elimination? Listen to this broadcast from the CSIS Bipartisan Alliance for Global Health Security with Natasha Crowcroft, Vice President, Infectious Diseases and Vaccination Programs, Public Health Agency of Canada; William Moss, Professor and Executive Director of the International Vaccine Access Center (IVAC) at the Johns Hopkins University B

Jane Halton, chair of CEPI, the Coalition for Epidemic Preparedness Innovations, walks us through CEPI's evolution since its founding in early 2017, and the launch on February 14, at the Munich Security Conference, of CEPI 3.0, fitted to the current era of heightened threat of dangerous bioevents, scarcer resources, and a pivot to security partners, including NATO.

John-Arne Røttingen, CEO of Wellcome Trust, is a Norwegian leader whose expertise has a remarkable span, encompassing medicine, science, research, clinical trials, negotiations, diplomacy, philanthropy, financing of global health, and governance of international institutions. He shares with us his assessment of what prior factors, during and post-Covid, set the stage for the shocks of 2025; the implications borne by 2025’s sudden crises, and the essential, urgent changes in outlook and strategy unfolding in 2026. Give a listen to this timely and incisive conversation. 

Keith Humphreys, a leading expert on addiction psychiatry, based at Stanford University, unpacks his January article in Science examining the steep reduction in overdoses deaths—between May 2023 and the end of 2024—in the United States and Canada. It likely stemmed from a supply shock, linked to steps taken by China to disrupt the supply of fentanyl and precursor chemicals. Underneath, US-China diplomacy was essential. This story was lost during the 2024 US presidential election cycle. Subsequently, President Trump’s overt threats to China, including the imposition of a 20% tariff tied to fentanyl, changed the negotiating context. Some progress followed on October 30 when Presidents XI and Trump met on the margins of the APEC summit in South Korea.

Amb. (ret) Karl Hofmann is CEO of the recently launched Health X Partners (HXP), a parent company under which Population Services International (PSI) and the Elizabeth Glazer Pediatric AID Foundation (EGPAF) now operate. He explains his personal story—from a successful diplomatic path centered in Africa to a pivot and second career as President and CEO of PSI starting in 2007. And he explains the logic by which PSI and EGPAF agreed in 2024 to form HXP to achieve greater efficiencies and prepare prudently for the end of the 25-year era, begun around 2000, that has generated an “amazing chapter of human progress” in health but which, it had become increasingly obvious, would not last indefinitely. As the unforeseen tsunami of Trump 2.0 hit in early 2025, it was both fortuitous and doubly-risky for HXP, as it stood itself up. The new leadership at FSI and EGPAF suddenly had to come to terms with 50% reductions in staff, budgets, and programs, while consolidating and integrating audit, HR, and IT teams. Change ha

Dr. Chris Murray, IHME, co-chairs the Lancet Commission on 21st Century Global Threats to Health, which will launch its report in February at the Munich Security Conference. It is the “Commission of Commissions,” a novel, highly ambitious three-year effort to forecast what are to be the biggest, most costly problems by taking a broadened non-traditional view. It focuses on 16 factors plus hypertension, each forecast to exact over one billion life years over the next 75 years. These include the familiar big three – pandemics, climate, and conflicts – but includes other factors that rank surprisingly high: education, inequality and low economic growth, obesity, tobacco, and AMR. A wildcard such as malicious use of AI has to be taken into account. “We excluded meteors” and mirror life, the latter too early to include. The Commission calls for a rolling, annualized review, and for higher investment by governments in both promising innovative technological solutions and building better threat-ready health systems.

In the second episode of the Prevention Intention mini-series, Katherine speaks with Wafaa El-Sadr, University Professor in Epidemiology at Columbia University and the director of ICAP. They discuss El-Sadr’s formative experience treating AIDS patients in New York City in the early 1980s, as the global HIV epidemic began to emerge; her decision to found ICAP in order to bring HIV treatments to patients worldwide; and ICAP’s contributions to HIV prevention research. They also cover the evolution of PEPFAR, the challenges and opportunities associated with current efforts to reform U.S. global health assistance, and El-Sadr’s emphasis on ensuring people and their communities are at the heart of all health research and service delivery endeavors.

In the first episode of the Prevention Intention mini-series, a series featuring conversations with leading female HIV clinical researchers, Katherine speaks with Linda-Gail Bekker, a medical doctor and director of the Desmond Tutu HIV Centre at the University of Cape Town.  They discuss Bekker's decision to focus her work on HIV as well as her involvement in the PURPOSE 1 clinical trials, which demonstrated the efficacy of long-acting pre-exposure prophylaxis (PrEP) among adolescent girls and young women in South Africa and Uganda. They also cover why it’s important to approach research as a highly collaborative endeavor that both contributes to scientific understanding and improves people’s lives.

Erika Elvander served her country as a federal career health diplomat for 27 years, including as the U.S. Health Attache in Beijing from the spring 2021 until the end of 2024. Her Asia passion ignited while a student in Hong Kong and traveler to Beijing in the late 1980s. And carried forward for the following decades. As Health Attache in Beijing during COVID, she witnessed China “digging in,” pursuing its 18 months of the fierce controls imposed under “static management.” "Achievements with China are incremental.” She was able to maintain dialogues with Chinese health officials, despite the fraught US-China relationship. Today, the COVID origins quagmire does persist and impede the U.S.-China relationship, six years after the advent of Covid. But “there has to be a path forward,” built on many opportunities in health.

Marian Wentworth, President & CEO, Management Sciences for Health (MSH), at age 13 started working in a local factory. Attended the famous Latin School in Chicago. Studied math at Harvard. Then joined Merck as it was "growing ferociously fast." Stayed 27 years, grew and led the vaccine business to $6 billion. Was the "quant jock." Spearheaded the launch of Gardasil, the HPV vaccine. Then pivoted to MSH. It was important "not having a pharmaceutical company on my business card." Now as she reflects on the stunning year of 2025, a series of radical pivots for MSH, is there space for MSH in the America First Global Health Strategy? Yes. Excited by the Accra Reset? Yes. Where does this leave MSH? "I believe this time is a crucible."

Listen to the recent CSIS Bipartisan Alliance for Health Security discussion with Congressman Adam Smith (WA-09), Ranking Member of the House Armed Services Committee, on his experience leading a Congressional delegation to China in late September 2025. Rep. Smith’s bipartisan delegation—the first House delegation to travel to China since 2019—pressed for high-level military-to-military dialogue between the world’s leading superpowers. What reception did they receive from their Chinese counterparts, what messages did they impart, and how has the dialogue with his colleagues evolved since his return to Washington? What did the trip reveal and how does he expect to see the bilateral relationship evolve—including on key issues such as the debate over fentanyl—into the new year?  Following welcoming remarks from John J. Hamre, CSIS CEO and Langone Chair in American Leadership, J. Stephen Morrison, Senior Vice President and Director of the CSIS Global Health Policy Center, moderates the discussion.

Dr. Rick Brennan, an acclaimed Australian humanitarian leader who led WHO and NGO crisis response in multiple conflicts over several decades, walks us through his personal story. He then unpacks the scale and gravity of what is now unfolding in Darfar—featuring the “F word” (famine), the “G word”( genocide, affirmed by the US Senate), and the “C word” (cholera). The crisis requires political action from the UAE—and President Trump’s attention. “There is an obligation to act.” And yet it occurs as global humanitarian needs have soared while humanitarian funding has dropped by half—the US by over 80%. It is a wake-up call, a rude awakening.

Listen to the recent CSIS Bipartisan Alliance for Global Health Security book launch of Fair Doses: An Insider’s Story of the Pandemic and the Global Fight for Vaccine Equity by Seth Berkley. As the gravity and magnitude of the Covid-19 pandemic became apparent in the first half of 2020, how did the vision for a mechanism to ensure equitable access to new vaccines come together and what role did organizations including Gavi, the Vaccine Alliance; the Center for Epidemic Preparedness Innovations (CEPI); and the World Health Organization (WHO) play in enabling the COVAX Facility to distribute nearly two billion doses of COVID-19 vaccines to people in 146 countries, the majority of which were low-income countries, by the end of  2022? This event featured conversation between Katherine Bliss, Senior Fellow and Director of Immunizations and Health Systems Resilience, CSIS Global Health Policy Center, and Dr. Seth Berkley, author of Fair Doses and CEO of Gavi, the Vaccine Alliance, from 2011 to 2023  regarding the

Keizo Takemi, recent Japan Minister of Health, Labour and Welfare (September 2023-October 2024), shares his personal story that took him to Taiwan, CNN/Japan, the Diet, Harvard, back to the Diet, and recently into the cabinet of then Prime Minister Kishida. Along the way he became a leading force in charting Japan's approach to global health. As Minister he put a spotlight on the thousands of single, isolated elderly who die alone in Japan, unnoticed for days. Though expensive, wearable digital technologies can help connect the elderly better to community health services. Covid-19 exposed the lack of digitalized data and the need for a national mechanism to integrate patient and hospital data. That became a priority for him as Minister, as well as the creation of the Japan Institute of Health Security, a merger that promises far greater capabilities in preparing for and responding to dangerous outbreaks. By 2035, Japan will have 10 million citizens above 85 years of age. "Speedy aging" is raising demands for

Dr. Debra Houry joined the podcast, following her resignation from CDC on August 25, upon the firing of CDC Director Susan Monarez, and shortly after her September 17 testimony before the Senate HELP Committee. What does she make of President Trump’s September 22 press conference on Tylenol, its alleged connection to autism, and the potential use of leucovorin? While serving as CDC’s senior most leader, how did she navigate the period from President Trump’s inauguration on January 20 until the arrival of Susan Monarez as the new CDC Director on July 31? How was the armed attack upon CDC on August 8 experienced? What are the downstream impacts? How did she plan and carry out her resignation in league with other CDC leaders? What did the September 17 Senate HELP Committee meeting accomplish? What is the state now of CDC? “I have grave concerns about what is coming out of that agency.” How to stabilize CDC? It needs permanent scientific leadership, a stable budget, more truth and oversight of advisory committees

The renowned global health leader, Peter Piot, LSHTM, opens this conversation with reflections on what drove the historic global health successes, including “a brilliant coalition” and U.S. bipartisan leadership grounded in statecraft and strategic thinking. That “twenty-five years of historical anomaly” has however now ended. In Europe, that shift has resulted from populism combined with intense migratory pressures, the costs of battling the threat of Russia, and the high costs of providing a social safety net for a rising elderly population. Global Health 2.0 will be built on health sovereignty in Africa, Latin America and Asia. The shock scarcities of the Covid pandemic had already awakened the need for greater self-reliance; the sudden and abrupt decline in donor funding for global health is the latest shock. We will see “sunset clauses” and “mergers and acquisitions” across many familiar international institutions. AI promises innovations in R&D and delivery, aided by philanthropies. Centers of excellenc

Listen to the recent CSIS Bipartisan Alliance for Health Security book launch of The Big One: How We Must Prepare for Future Deadly Pandemics. As bad as Covid-19 was, the next pandemic could be worse. While the world learns to live with Covid-19 and continues to recover from its worst effects, how do we prepare for the next pandemic lurking around the corner?   The event includes a panel moderated by CSIS Senior Vice President and Director J. Stephen Morrison, featuring co-authors Michael T. Osterholm, Director, Center for Infectious Disease Research and Policy (CIDRAP), University of Minnesota, and Mark Olshaker, Emmy Award-winning documentary filmmaker and New York Times #1 bestselling author.

Dr. Celine Gounder, Editor-at-Large, KFF Health News, explains how the U.S. vaccine enterprise could be damaged so swiftly by the Trump administration, with so little apparent resistance: it was a "shock and awe" blitz, while hesitation and fear dominated. "Silence was paralysis." It is too early to estimate the true scope of damage. The middle tier of professionals in government and scientific research has certainly paid a high price. While Secretary Kennedy's firing of CDC Director Monarez was a thunderclap, it remains to be seen if or when President Trump changes his view of the Secretary's performance. What lies ahead? Regional alliances of states setting policy on vaccines will be "the laboratories of public health." The Supreme Court may be called upon to revisit the balance between individual liberty versus public health. If pediatric hospitals are overrun with children suffering from dangerous vaccine-preventable illnesses, public outcry could escalate.