Take as Directed

Dan Diamond, Washington Post, reflects on big emerging themes. The administration’s scientific, biomedical, and public health leadership has emptied. What should we make of Mandy Cohen’s appointment to be the next Director of CDC? With the turnover, who will be the “quarterback” of government during the next crisis? Congressional panels are raising “uncomfortable” questions about Covid's origins. It is an “open question” what happens with the reauthorization of PEPFAR and the Pandemic All-Hazards Preparedness Act (PAHPA). The shift of opinion against NIH and CDC will leave “the brands damaged.” Presidential campaigns—Governor DeSantis’ attacks against “Faucism” and RFK Jr’s anti-vaxxer efforts— offer “nothing good for public health.” Attacks upon science and public health have far more energy than the defenders. “Easier to play offense than defense.”

Twenty years after President George W. Bush signed the U.S. Leadership Against HIV/AIDS, Tuberculosis and Malaria Act of 2003, establishing PEPFAR, David Kramer, the Executive Director of the George W. Bush Institute in Dallas, Texas, discusses the process of establishing the multi-billion dollar program at the Department of State; how ensuring equitable access to health care services for vulnerable and marginalized populations is important for national security; how investing in HIV services and partnering with countries to strengthen health care improves the relationships of the United States with countries overseas; and why it’s important that Congress reauthorize PEPFAR later this year. 

Jeremy Konyndyk, President of Refugees International, is a humanitarian leader, emergency operator, and policy innovator. He joins us to share his thoughts on diverse crises. During the Turkey/Syria earthquake, donors failed to surge resources to Syrian civil groups, something that is indefensible a decade plus into Syria’s war. U.S. policy on the southern border is narrowly understood to be law enforcement versus protection of rights of individuals in flight, a disappointment not expected of the Biden administration. USAID has struggled to overcome its internal divisions to begin building an enduring emergency health security response capability. American opponents of public health and science are winning the battle for opinion and influence, with little political leadership pushing back from the opposing side. After the Russian invasion of Ukraine, many low- and middle-income countries rejected the West’s appeals for solidarity. The West had shown “zero solidarity” for their needs during the pandemic. With Ukraine, those countries are now responding “in kind.”

Matt Goodman, CSIS SVP and Simon Chair in Political Economy, unpacks the several striking developments at the recent G7 Summit in Hiroshima. Russia’s invasion of Ukraine has unified and energized the G7, with side benefits in economic security, nuclear disarmament, food security, health and climate. With the Ukrainian counteroffensive imminent, the G7 made multiple specific commitments on Ukraine. On China, “economic coercion” and “de-risking” were the watchwords. Paragraph 51 of the communique laid out nine specific items on China, an unprecedented step. On health, President Biden committed an additional $250m to the Pandemic Fund, nudging his G-7 peers. The G-7 reaffirmed in detail its consensus on UHC, global health architecture, R&D of new technologies. Antimicrobial resistance (AMR) enjoyed higher salience, as did health reconstruction in Ukraine and violence in multiple wars targeting the health sector. The Covid origin stalemate was deliberately downplayed, while the Global Health Emergency Corps merited a mention.

Adam Havey, Executive VP, Emergent BioSolutions, speaks to the “great unwinding” with the end of the Public Health Emergency, including the outstanding work to bring about adequate sustained funding for preparedness capabilities. To keep long-term bipartisan investment front and center, “lead with the facts.” 8 in 10 voters favor government action. There were several hard lessons at the Bayview facility in Baltimore, where over 500 million Covid vaccine doses were contaminated. How do we rebalance the Strategic National Stockpile? Over-the counter sale of Narcan (naloxone spray, used to reverse opioid overdoses) will face several challenges but overall be a net positive. The Pandemic All-Hazards Preparedness Act (PAHPA) will be critical to predictable funding, strengthened ties with industry, and workforce development. 

Dr. Ashish Jha, the White House Covid Response Coordinator, speaks to the “great unwinding” of the $4.6 trillion pandemic wartime transformation of America into a temporary social democracy. As we rush to the exits, are we emerging stronger? We do see huge turnover of public health leadership across the country, a real loss. We also see that cities and states, the front lines, have “learned a ton” about Test to Treat, mass vaccination. Will we transition out of this “collective trauma” of anger and “amnesia?” How will this pandemic transform public health itself? The White House is to stand up a new office to lead pandemic preparedness, at a time when U.S. scientific and public health leadership is depleted. What can we realistically expect? As he prepares to exit, what has Dr. Jha learned in the past year?

Joe Grogan, former Assistant to the President and Director, White House Domestic Policy Council in the Trump Administration, shares his insights on several outstanding policy challenges. How has the Inflation Reduction Act (IRA) reshaped innovators’ investment patterns in new drugs, and what adjustments might improve outcomes? It will be difficult to keep the proposed Next Gen $5 billion for Covid vaccines and therapies at the top of the agenda on the Hill, in the absence of strong figures like Senators Burr and Kennedy. While the NIH budget needs to be re-prioritized, CDC needs “massive cultural change.” Progress on anti-microbial resistance and steering the Pandemic All-Hazards Preparedness Act to a successful re-authorization each rest ultimately on leadership.

“Not all U.S. states struggled equally.” Thomas Bollyky, CFR, led an ambitious, nuanced effort to break down Covid outcomes across 50 states and Washington DC, published in the Lancet in April. There is a striking four-fold difference between the best and worst performing U.S. states. Some of the best states, led by Republican and Democrat governors alike, rivalled the best performers in Europe. High-performing states provide a formula for success which may be helpful in the future. Pre-pandemic differences were decisive—poverty, education, and race. Partisanship and politics skewed results. “Trust plays an outsized role.” The current hardening of opinion today in America remains a cause for worry.

As World Immunization Week gets underway, Professor Heidi Larson, anthropologist, founder of the Vaccine Confidence Project, and co-founder of The Global Listening Project, discusses the importance of closing the gaps in routine immunization coverage that have widened during the Covid-19 pandemic; describes why trust in health care providers has declined as beliefs about health and scientific expertise have become more polarized; and explains that in order to reach people with information that can help them respond effectively to crises, whether pandemics, climate change, or other emergency situations, it's important to really listen to people's concerns and articulate practical solutions that directly respond to people's needs. 

Sachiko Imoto, SVP, Japan International Cooperation Agency (JICA), is the lead on JICA’s human development work. In our conversation, she illuminates several key dimensions of Japan’s policy. What health gains will the Japanese Presidency of the G7 in 2023 generate? Both the U.S. and Japanese governments are committed to supporting the Pandemic Fund, Universal Health Coverage/primary care, surveillance, and equity and access to new countermeasures. What are the areas where Japanese-U.S. cooperation in health security could most profitably deepen? What concrete benefits could result from this alignment? How does the U.S. decision to launch a regional CDC office in Tokyo fit within the evolving geopolitical environment in Asia? How to address the intersection of health and climate change, Misinformation, conspiracy, decline of trust, and, of course, China? Give it a listen!