Take As Directed

Dr. Raquel Bono, a recently retired, highly accomplished 3-star Admiral as 2020 opened, unexpectedly found herself advising Washington State Governor Inslee at the very advent of the pandemic. What did she experience and learn over the next six and a half months? Subsequently she became the chief medical officer for Viking Cruises, as it reopened its operations. What did that reveal, in particular about its interactions with CDC? Her views on Congress rescinding the mandate for Covid vaccines among US servicemen and women?

Sheryl Gay Stolberg, the iconic health policy/politics reporter at the New York Times, helps us inaugurate The CommonHealth podcast, companion to the newly launched CSIS Bipartisan Alliance for Global Health Security. Her recent prodigious output delves deeply into the evolving – and thoroughly confusing – story of the swirling debate over Covid origin in China. The Biden administration will soon declassify what intelligence it has on the Wuhan Institute of Virology: what might that mean? Will it cast light on the Institute’s cooperation with the Chinese military? Is a legitimate civil debate possible in America? Will we ever get the evidence to reach serious conclusions? Yikes! Give it a listen.

Welcome to The CommonHealth, the podcast of the CSIS Bipartisan Alliance for Global Health Security. The CommonHealth replaces the Coronavirus Crisis Update. In it, we delve deeply into the puzzle, at home and abroad, that connects pandemic preparedness and response, HIV/AIDS, routine immunization, primary care, and the geopolitical impacts these have on human and national security.

Sam Radwan, founder of Enhance International, has worked on health developments inside China for two decades. He shares his insights and raises some difficult questions. Over 80 year olds continue to be highly vulnerable; only 66% have been vaccinated. China’s 400 million rural poor live with starkly different medial support realities, and we have little visibility into what they are experiencing. An increasing number of Chinese will be traveling abroad to seek medical care, as medical literacy rises. Hong Kong is gearing up as a medical center. Can we imagine a radical decoupling in the health sector, between China and the United States? The deterioration of the US-China relationship is pushing in that direction and will have consequences for reform of the health care sector in China. We need to watch the Chinese government’s drive to restore economic growth. His hope: “cooler heads will prevail” as we realize we need one another in health.

In this newest episode in our series on China, Mike Osterholm reflects. There is no easy explanation for why the Chinese government did so little to prepare while knowing Zero-Covid was failing. Even as Omicron reached an R-naught of up to 16, and 8 million elderly above 80 had received no vaccine. We are now seeing progress by the Chinese in data sharing through George Gao’s recently published Lancet paper. Luckily, there Is no evidence of a dangerous new subvariant emerging, though we have to be cautious and humble. China has experienced a massive increase in deaths. After the Omicron surge that swept the United States in 2022, Omicron settled into a “high plains” continued outbreak of 380-550 deaths per day. That pattern may be seen in China. On the Covid origin controversy, we will likely never know the source. Prospects for an informed U.S.-Chinese dialogue on preparing for the next pandemic? “We are back in the 1970s.”

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