Take as Directed

Dr. Richard Lessells is among the exceptional South African experts on the front lines of discovering and investigating Omicron in South Africa. Alarm bells went off within the scientific community, as it became clear after just a few days that “an extraordinary number of mutations” are clustered in the key regions in the genome for immune protection and transmissibility. It was a “gut feeling. ” Omicron is highly transmissible, spreading very efficiently in a population with high levels of immunity gained from previous infection and in some cases from vaccination. How long to know just how dangerous Omicron is? It’s “too early to tell.” Lab work is underway to understand whether the virus affects T cells which are central to immune protection against severe disease. Why do we see such an unusual variant in South Africa? One theory, which Omicron may shed light on, is that the SARS-CoV-2 virus finds hosts who are very immune-compromised, persons living with HIV but not on anti-viral therapy. These individuals have difficulty clearing the virus, which permits it to replicate constantly over a very long period. Is this moment a pivot in the pandemic? That depends on whether Omicron significantly sets back vaccine protection, which would be a “step change.” Will this moment shock the world into more concerted global action, superseding the pattern of “vaccine apartheid”?  “I remain skeptical.” In the meantime, we have to fight against Omicron being fitted to a politicized narrative: by anti-vaccine groups, to tell the story that vaccines do not work. By others, to argue that there is nothing to worry about, that the virus is becoming less pathogenic, based on anecdotal evidence. 

Dr. Richard Lessells is an infectious disease physician at the University of KwaZulu-Natal, in Durban, South Africa. He is a member of the Network for Genomic Surveillance in South Africa, and a researcher at CAPRISA, the Centre for the AIDS Programme of Research in South Africa.

Dr. Taison Bell, MD, an acclaimed African-American doctor, educator, and emergency medicine director in Charlottesville, Virginia, shares his personal story of how medicine – back home in Virginia – became the center of his life. “Success was not assumed in my neighborhood.” As a child with asthma, he connected with his physician, as he did also with his Black dentist and several teachers. Such “affirmative experiences” made the dream “seem like it was achievable.” In retrospect, “so many things had to align at the right place and right time.” The pandemic now puts a premium on doctors becoming communicators. “Things will not be the same from this moment forward.” “People arrive in my ICU because they are unvaccinated… People are generally willing to trust their local provider in their community regardless of what side of the aisle they are on.” But “everyone has an opinion, some spread by misinformation.”A recent conspiracy alleges doctors put patients on ventilators to intentionally make them sicker. “That has become one of the toughest parts of care.” You have to have a “therapeutic alliance” and trust with the patient and family. When those do not exist, it almost always does not end well. Boosters a good thing? Yes, though “everyone has good points.” Talking openly about how he makes decisions with his family during the pandemic makes him “relatable.” It opens a window into how he is processing things. 

Dr. Taison Bell, MD, is an assistant professor of medicine in the divisions of Infectious Diseases and International Health and Pulmonary and Critical Care Medicine at the University of Virginia. He is also the Director of the medical intensive care unit (ICU) and director of the UVA Summer Medical Leadership Program.

We asked Cary Funk, Pew Research Center, to make sense of how the pandemic has impacted our society and American opinion as we approach the pandemic’s two years. “It can be confusing.” Polarization now increasingly aligns between the vaccinated versus the unvaccinated, versus simple partisan identity. At the fundamental level, Americans are split over whether Covid-19 is a common problem. Does the “Big Lie” bleed over into the field of public health? “It’s all complicated.” “The political lens” increasingly encompasses so much of public health, accelerating the erosion of public trust and confidence in science, a trend that had already been underway for years. False statements can travel the globe in 48 hours, but knowing the impact is much more difficult. Are we at a turning point, a softening of polarization? “We need to wait and see.” Heightened US international engagement enjoys majority support and has not become politicized. What is the impact of the loss of 757,000 lives on opinion? We have to continue looking at that. 

Cary Funk is director of science and society research at the Pew Research Center.

From September 17-October 1, Suzanne Brennan Firstenberg created the largest participatory art installation on the Washington National Mall since the AIDS quilt of 1996, entitled ‘In America: Remember,’ composed of 700,000 white flags, in the shadow of the Washington Monument. A stunning achievement. Listen to her reflections on listening to those among the 16,000 who personalized a flag to memorialize their loss. “So many of these deaths happened in isolation.” The project unfolded amid our bitter divisions: “ We are tearing ourselves apart as a society.” 35,000 died unnecessarily over the two-week course of the installation. Remarkably, though, she succeeded in creating a solemn, quiet, respectful space where it was “safe to bring one’s grief” and escape our politics. Does this memorial create a lasting constituency that will press for a national commission? Any memorialization has to include an in-depth examination of what happened.

Suzanne Brennan Firstenberg is an artist based in Bethesda Maryland.

Dr. Richard Brennan, WHO Emergency Operations, sat down this week with Steve and Professor Leonard Rubenstein, Johns Hopkins Bloomberg School of Public Health. Rick has been at the very center of urgent efforts, following the Taliban’s coming to power in mid-August, to avoid the collapse of Afghanistan’s health system, through fast-moving negotiations to bring emergency funding, opening air links, resuming Covid-19, polio, and measles immunization programs, and delivering emergency medical supplies. The political and security complexities to achieving these short-term, emergency stop-gap measures remain formidable, and the space for striking deals exceedingly narrow. How has the Taliban leadership seen things, and how did they agree to these initial measures which have to operate outside their control, a precondition of donors? What is the space in which he and others can find financing solutions that will sustain the health system long-term? Pressures upon WHO Emergency Operations in Afghanistan, combined with demands in Lebanon, Yemen, and Syria, have escalated to levels that greatly exceed capacities. What is to be done now?  

Dr. Richard Brennan is Regional Emergency Director, Eastern Mediterranean Region, World Health Organization.

Dr. Jennifer Nuzzo has emerged as a forceful expert voice making sense of the complex and times confusing, shifting shoals of the pandemic. ”All of us have had to step into this sphere,” filling “a power vacuum.” It has however been chaotic. Public communication is essential “to move the needle” but the experience can be “tough.” Vocal experts are the subject of attacks, the worst during the Black Lives Matter protests. The field of public health needs to invest more in how to message on vaccines. People are "swimming in disinformation.” Though she is “cautiously optimistic” for the United States, “no one is going to run out the clock on this virus.” For poor countries, which increasingly are in desperation abandoning a response, the future is “bleak.” Are we numb to the more than 700,000 dead Americans? Perhaps. It’s impossible to wrap our minds around this scale of death in America. There is a need for a “national reckoning” through a commission, “a true opening of the books that goes deep.” Have we entered a new era of high-level diplomacy? “No.” “We don’t have a Covid control strategy” at home or abroad. The lack of strategy is causing people to disengage. Can we be optimistic? “It can feel like there’s an unraveling” but that in fact is not happening.  A “civic spirit” among citizens is buoying America.

Dr. Jennifer Nuzzo is a Senior Scholar at the Johns Hopkins Center for Health Security and an Associate Professor in the Department of Environmental Health and Engineering at the Johns Hopkins Bloomberg School of Public Health. She is also a Senior Fellow for Global Health at the Council on Foreign Relations.

On October 7, Andrew and Steve sat down with a close friend, Georgetown’s Prof. Larry Gostin, for a lively live-cast conversation about his new book, ‘Global Health Security: A Blueprint for the Future.” The podcast captures that rich, vivid exchange. The big messages: We underestimate the power of the SAR-CoV-2 virus: it is wily and pernicious and will continue to surge. We cannot forget anti-microbial resistance. A fundamental shift is needed in the US international approach – away from charity and towards advancing technology transfer to manufacture vaccines in low and middle-income countries to create resilience. That requires far greater pressure upon Moderna and Pfizer to cooperate in meeting urgent global needs. The USG has the legal authorities to make that happen but has not yet followed through. USG health communications have been “pitiful” and left the public “utterly confused.” That too can be corrected.  

Professor Lawrence O. Gostin is University Professor at Georgetown University where he directs the O’Neill Institute for National and Global Health Law.

Dr. Leana Wen joined us this week to explore her personal history and its revelations, laid out in remarkably candid detail in her newly released memoir, Lifelines: A Doctor’s Journey in the Fight for Public Health.  And to speak to the most pressing current challenges posed by the Covid-19 pandemic. Her childhood struggles, as a young immigrant Chinese girl living amid insecurity, taught powerful lessons about poverty, race, and health. Her tenure as Health Commissioner in Baltimore, operating in close partnership with the late Congressman Elijah Cummings, opened the way to confront opioid addiction, stigma, maternal and infant mortality, and the acute vulnerabilities of youth. In her new life in the print and cable mediascape, she follows the advice of former Senator Barbara Mikulski: “do what you are best at – and needed for.” The Biden administration needs to up its game with the public: “It’s not enough just to get the science right.” It is about values, communication, and public trust. America’s hardened polarization -- surrounding vaccines, masking, and distancing -- is too advanced to fix: it is best to focus on engaging individual by individual. Listen to learn more. 

Dr. Leana Wen is an emergency physician and public health professor at George Washington University. She is a contributing columnist at the Washington Post and a CNN medical analyst. She’s served as Baltimore’s Health Commissioner.

Carmen Paun, a dynamic, fresh media voice on global health in Washington, shares her personal and career journey from Romania to Brussels, and on to her arrival in Washington D.C. one year ago, amid the pandemic, to launch POLITICO Global Pulse. This past summer, while visiting family in a small village in the Romanian countryside, she was “shocked” to discover only 10% vaccinated at that time, the pandemic seen as “all just a conspiracy.” The pandemic was the trigger in creating POLITICO Global Pulse. In its first year, it did find its audience and voice quickly. What to make of the U.S. Global Covid Summit? It re-established that “the U.S. was in charge,” now the challenge lies in execution. Faith in American leadership has diminished, while African officials remain frustrated by slow delivery and the West’s export restrictions. Will the EU-US Task Force bring great transparency and accountability? “Hard to say… How fast is this going to happen?” The turn to boosters likely creates “a vicious cycle” that could leave low and lower-middle-income countries still struggling to access vaccines. Will Africa be left far behind? No. Vaccines are finally arriving. India is reopening exports. Don’t expect the push by South Africa and India to suspend intellectual property to succeed. Her overall prognosis? “It is hard to be optimistic” Give a listen to learn more.

Carmen Paun is a health writer at POLITICO and author of POLITICO Global Pulse.

In a recent New Yorker ‘Letter from Biden’s Washington,’ Susan Glasser delivers a stark indictment: Trumpists and Republican leadership are consciously keeping enough people resisting the Biden administration’s efforts to control the virus “to keep the disease wreaking havoc.” Why that conclusion now? “It is no accident” that 1 in 500 Americans have died, now totaling over 687,000. It’s becoming obvious that President Biden cannot inoculate Americans against Fox News. In the meantime, the Biden administration, “on both foreign and domestic fronts, remains a jumble of aspirations and retains a haze of uncertainty about how to achieve them.” That directly shapes its international approach to Covid-19, including the recent Global Covid-19 Summit organized by President Biden on the margins of the UN General Assembly. It is “a statement of the obvious” that nearly half of the country is dedicated to the failure of the Biden administration. When a “flaming dumpster fire” pandemic continues in the United States -- the fourth wave fueled by vaccine refusals – the resulting domestic crisis gravely limits the ability of the United States to be a world leader on Covid-19. On the pandemic as well as Afghanistan and other foreign policy priorities, the administration is taking an approach that is far less multilateral, alliance-focused, and consultative than expected. Why? The answer is not yet clear: if the administration is simply overwhelmed by demands, or if this approach is a conscious internal “predilection.” Does she agree we are drifting inexorably towards a US-China cold war bifurcation of the world? “Yes, I do.” Do we urgently need a national commission on the pandemic? “Absolutely.” “You cannot escape history.” Please listen to know more.

Susan Glasser is a staff writer at The New Yorker, author of Letters from Biden’s Washington