In this episode of the CommonHealth Live! series, J. Stephen Morrison sits down with Representative Ami Bera (CA-06) to discuss the future of U.S. global health security strategy in an era of redefined alliances, geopolitical competition, and the rise of transformative but disruptive technologies such as AI. 

What is the future of global health assistance under the new structure created by the U.S. Health Memorandums of Understanding (MOUs)? How is this model reshaping the role of the State Department and the CDC in global health, and how is it playing out in the context of the unfolding Ebola outbreak? How durable is this compact model, and does it align with long-term strategies Congress is pursuing in other foreign assistance domains, including for critical minerals under the DOMINANCE Act? As the United States pursues a more robust industrial policy in the name of stronger national security, how can it maintain reasonable channels for cooperation with China in the highly interdependent bioeconomy?  

Dr. Gerald Parker, an acclaimed biodefense/One Health expert and high-ranking official across several administrations, experienced New World screwworm (NWS) as a boy in Texas while assisting his veterinarian father treat pets invaded by the parasite. Michaela Simoneau, CSIS Fellow, joined the conversation. In the late 1950s, the scaled introduction of sterile male flies — 50 million per week — was a brilliant scientific discovery, combined with a public private partnership with the ranching community. NWS was cleared from the United States by 1966, and from Mexico and Central America by 2006. The barrier began to decay in this decade, a function of migration, illicit cattle trafficking, a decline in the effectiveness of the sterile flies, Covid interruptions, and complacency and bureaucratic inertia. NWS has now arrived in Texas and New Mexico. The race is now fully on to restore control. We need an "Operation Warp Speed" mentality to advance multiple technological innovations, diplomacy, financing, a massive expansion of flies — perhaps as high as one billion per week.

Jamie Bay Nishi, the dynamic CEO of the American Society of Tropical Medicine and Hygiene (ASTMH), is absorbed with the question: how do we navigate all the changes in government policy and programs and hold the global health community together? That includes philanthropies, universities, and companies. OMB’s proposed “Regulation for Federal Financial Assistance,” a 400-page document, would expand political oversight and weaken the authority of scientific advisory groups, changes that would alter the scientific research enterprise and create uncertainties. A 45-day period for comment is too little time to understand what is in the document and the ramifications if its proposed actions were enacted. It could further stigmatize collaboration with China. The June 3 White House Executive Order to reclassify the federal workforce will weaken career protections of GS-15 workers, leaving them open to firing at-will. CDC’s overseas country offices are to transition to a fee-for-service model, as part of the America First Global Health Strategy. This will not be sufficient to guarantee a sustainable work force, which requires a reliable surge capacity in CDC headquarters at Atlanta and stable expert in-country staff. It is incumbent upon Congress to change the funding scheme for CDC overseas experts and its surge capability.

Declan Walsh, the acclaimed New York Times Africa correspondent, visited the hot zone of the Ebola outbreak in Ituri Province in the Democratic Republic of the Congo (DRC) from May 22 to June 12, the "perfect petri dish." How to explain the "enormous lag" in acknowledging the outbreak and responding to it? "It all boils down to two factors, conflict and gold."  Will the outbreak grow exponentially or burn out? Insecurity will dominate, but it is not at all certain how that is to be managed. Things have begun to go better in expanding testing and treatment capacities, while contact tracing lags, at just over 50%. There are worries that the outbreak is spreading already from Ituri into North Kivu province, potentially into areas controlled by the Allied Democratic Forces (ADF), the Uganda-origin Islamist armed group. Interest is rising inexorably in seeking a cease-fire, given the acute vulnerability of health and emergency assistance providers. The United States is now coming in strong with over $700m in investments, but on a parallel track, separate from the incident management mechanism run by WHO and the Africa CDC, which is stirring some tensions with Congolese authorities. The U.S. effort to create a treatment unit on a remote air base in Kenya has generated considerable protests and political challenges for Kenyan President Ruto.

Dr. Salim Abdool Karim, the renowned South African epidemiologist, chairs the Africa CDC Emergency Consultative Group. In that role, he just completed a visit to Bunia, capital of Ituri province in the Democratic Republic of Congo, site of the dangerous Ebola outbreak. His focus included laboratories, test centers, isolation units, along with PPE, safe, dignified burials, contact tracing, the WHO/Africa CDC Incident Management Team, and security challenges. The United States has made major commitments, but US experts and US-funded groups operate outside the IMT. The moment you arrive in Buria, it is very obvious you are inside a conflict zone. Care providers—true heroes—are rushing in. They are "fire fighters running into the fire."

Two years since the launch of the African Vaccine Manufacturing Accelerator (AVMA), a financial mechanism that invests in commercially viable manufacturing efforts on the continent, what progress has been made in the effort to produce 800 million vaccines in Africa by 2035? Where are there opportunities for strengthening access to routine immunizations for vulnerable populations, including the 6.7 million zero-dose children in the region, along with those living in fragile and conflict-affected areas? And how can the AVMA, which was developed in response to the region’s challenges in securing access to Covid-19 vaccines during the global pandemic, help build countries’ resilience in the face of current and future disease outbreaks?

Please join the CSIS Bipartisan Alliance for Global Health Security for a broadcast conversation with Katherine E. Bliss, Director and Senior Fellow, Immunizations and Health Systems Resilience, with the CSIS Global Health Policy Center, Farrah Losper, Chief Commercial Officer at Biovac and Chairperson of the Board of the African Vaccine Manufacturing Initiative, Folake Olayinka, Director of Immunization, Africa CDC, Shanelle Hall, Principal Advisor to the Director General, Africa CDC, and David Kinder, Head of Development Finance at Gavi, the Vaccine Alliance, regarding the progress of the AVMA and contributions to the immunization landscape in the Africa region. 

Dr. Jeffrey Gold, President of the University of Nebraska, details the evolving experience of caring for the 16 Americans evacuated from the Dutch ship, the HV Hondius, following an outbreak on the ship of the Andes strain of the hantavirus. The American passengers were successfully settled May 11 at both the University of Nebraska Medical Center’s National Quarantine Unit (the sole such entity in the United States) and its Biocontainment Unit. These capabilities emerged during the 2014-2015 Ebola outbreak in West Africa and became essential during evacuations of Americans during Covid-19 from Wuhan City and the Diamond Princess cruise ship. Anxiety and uncertainty emerge in every episode within Nebraska that require systematic efforts to reassure communities and sustain their confidence and trust. There is still no clear U.S. policy on whether American emergency workers operating overseas during outbreaks will be permitted to return home to such special care facilities.  

Professor Rebecca Katz, Georgetown University, explains the Health Security Operations Center, the remarkable initiative she has spearheaded with others to enhance protection against dangerous outbreaks during the FIFA World Cup June 11-July 19 in the US, Mexico and Canada. She speaks to its genesis, mission, and coalition partners. Give it a listen! 

On May 20, Professor Paul Spiegel presents in Geneva the report of the Lancet Commission on health, conflict and forced displacement, conducted in partnership with the Johns Hopkins Center for Humanitarian Health (CHH.) The U.S. rollout will take place June 2 at the JHU Washington Center, 555 PA Ave NW. Paul speaks in this podcast to the genesis and mandate of the Commission, and the innovative and comprehensive way it went about its work over the past two plus years. Most importantly, he presents in detail its compelling recommendations and how they are to be advanced: (i) Invert the Power: put communities in charge: (ii) End Impunity: attacks on civilians, health workers and hospitals must have consequences; (iii) Fix the Money: humanitarian financing must follow need – not politics: and (iv) Uphold Health for All: war does not suspend the right to health – it makes it more urgent. Give it a listen!

Priya Basu, head of the Pandemic Fund (est. 2022, based at the World Bank), reflects on the Fund's origin and evolution. "It exists to solve problems no one else was solving."

Its $1.4 B invested over three years in pandemic preparedness and response has attracted seven times that much from partner governments and multilateral development banks. Finances remain fragile and voluntary. The hope is to grow threefold. The Fund, a Biden signature achievement, enjoys continued support from the Trump administration.