The CommonHealth

Dr. Stephanie Psaki—a newly minted CSIS Senior Adviser—shares the story of her personal evolution as a scholar, NGO policy data expert, senior political appointee at the HHS Office of Global Affairs and the White House National Security Council, and now faculty at Brown University School of Public Health. She reflects on the lessons, good and bad, from her 900 days at the White House, and what the first 100 days of the Trump second term reveal, in particular how science has become politicized. We are seeing a “a huge departure from the role the United States has played for decades.” While the Mpox outbreak in both Europe and the United States (2022-2023) had a promising outcome, the ongoing outbreak in central Africa (which began in 2023) leave many uncomfortable, unanswered questions of why leadership, coordination, finance and speed remain so problematic. The surprise, recent completion of the Pandemic Treaty is encouraging, up to a point. As we turn inevitably to chart a vision for the future, we will have to think in fundamentally different ways about the different world we now occupy.

Major General Paul Friedrichs (ret.), the inaugural director of the White House Office of Pandemic Preparedness and Response Policy (OPPR), is now a Senior Adviser at CSIS. In this conversation, Paul reviews the multiple changes in health security now unfolding in the first 100 days of the second Trump term. In biodefense, there is a wide-ranging degradation across different departments and agencies. The assault on the scientific research enterprise is leading to a retrenchment of innovation and US leadership in generating new technologies. That will lower our ability to subdue deliberate biological threats, rising accidental lab leaks, and the continued proliferation of naturally occurring biothreats. Resilience in America’s health infrastructure remains an open question, with shortages of 20,000-30,000 physicians and 300,000 nurses. Where does this all leave us? “It is as if you took all the health security plans of the past administration and asked: what can we do to make this country more vulnerable?” And what are we likely to see as early manifestations? Shortages of pharmaceuticals, higher prices, higher external dependence, especially upon China. Give a listen to hear more, including on the state of the two dangerous outbreaks in America—measles and avian flu (H5N1).

Dr. Tom Frieden, Resolve to Save Lives (CDC Director 2009-2017,) details the dangerous implications of deep changes underway at CDC—on tobacco, environmental toxins, and communications. It is no less dangerous that CDC should only focus on infectious diseases and not be focused on global threats. What explains CDC’s exceptional vulnerability to attacks and the deep skepticism towards CDC? What to make of the Administration for a Healthy America (AHA) advanced by HHS Secretary Robert F. Kennedy Jr.? What of the Trump administration response to the measles outbreak in Texas, New Mexico, and beyond?

Tom Bollyky, CFR, walks us through his recent incisive work on two fronts: Will China supplant US leadership in global health, in the wake of the US retreat? Listen to learn why the answer is a definitive "No!" and the dangers that foretells. Second, what might the US exit mean for Latin America?

Dr. Katelyn Jetelina joins us at the fifth anniversary of the newsletter she has spearheaded,Your Local Epidemiologist (YLE). “An incredibly wild ride,” YLE reaches 370,000 subscribers, while social media accounts reach 700,000. To cross the political divide, we need to listen more, be more selective in the choice of words. The YLE operation now includes a team of 15 managing the newsletter, podcasts, speaking engagements, and social media—and trusted messengers. She’s joined Dean Megan Ranney at the Yale School of Public Health focused on social listening and upgrading communications. Two months plus into the Trump second term, have we rebounded back to mistakes and abuses allegedly committed during Covid-19? It has become a “proxy war” of multiple societal battles and “pandemic revisionism.” Is there a path out of this widening polarization? Perhaps, but “we’re going to have to move backward in order to move forward.” Secretary RFK Jr.’s ideas on chronic diseases are promising; it remains to be seen how far he can go, and how progress there measures up against what damage is imposed on vaccines. Her biggest worry? Erosion of the public health workforce.

Dr. Jeffrey Gold, President of the University of Nebraska system, testified recently before the House Committee on Veteran Affairs Health Subcommittee on plans to replace a 1950 VA hospital with a hospital on the university grounds, with projected savings of half a billion dollars. Since the Trump administration began two months ago, it has been “a day-by-day, week-by-week course adjustment,” featuring ongoing court deliberations, cuts to programs, and the rollout of tariffs, amid great uncertainty. Anxiety has risen due to the unusual speed of change, which has permitted little time to prepare. In the meantime, the decline in the price of corn and soy jeopardizes the economy. The university system and hospitals account for 8.5-9% of the state’s GDP, the highest level per capita in the country. They also depend on $700 million of extramurally funded research. For the past nine years, Dr. Gold has led the highly successful weekly cable broadcast, ‘Rural Health Matters’ on Monday nights on RFD TV. Its mandate is to create awareness among farmers and ranchers, reaching over 15 million households, of the most impactful health matters.

Politico’s global health correspondent Carmen Paun offers her insights into the White House decision on March 13 to withdraw the nomination of David Weldon to be the next Director of CDC. CDC, while vulnerable, has not seemed to be a priority target of the Trump White House, though it is “not totally out of the woods” and is proceeding cautiously in Texas in response to the measles outbreak. There may be factors shaping the Trump White House decisionmaking that we do not yet see or understand. Carmen shares her reflections on how it is possible that USAID could be so swiftly annihilated. The foreign aid constituency is weak. “We are witnessing a whole new world.” “The initial reaction was paralysis and fear.” “We still do not know what will be left of USAID.” “New things arise from shocks and crises.” Carmen closes with the implications of the U.S. withdrawing from WHO.

In a special crossover episode with CSIS's The Truth of the Matter, Andrew Schwartz and Steve discuss the recent measles outbreak and risks associate with it. The United States is experiencing the worst measles outbreak in 30 years and the highest rate of contraction in the past six years after nearly eradicating the disease. Cases have surged in communities with low immunization coverage, raising concerns about further transmission. Hospitals are reporting an increase in severe cases, particularly among young children and immunocompromised individuals. Experts urge immediate action, emphasizing that vaccination remains the most effective defense against the highly contagious virus.

Dr. Elizabeth (Beth) Cameron, Professor, Brown University, and former senior official in global health security and biodefense at the White House and USAID, kindly shares her thoughts on the radical changes unfolding inside the U.S. government surrounding biothreats. Two internal factions within the Trump administration vie with one another. “It’s a bleak picture” in the accumulating damage to the federal workforce, programs, and the protective shield inside and outside our borders. Elon Musk alleges USAID is producing bioweapons, a patent lie. “It’s preposterous” and “dangerous.” More responsibilities will now fall to governors. What to make of the Trump administration’s recent $1B announcement on H5N1 to assist the poultry industry, and its decision to revisit the $590m contract with Moderna for a mRNA human vaccine for H5N1? We don’t know much on what is going to happen in Congress and DOD. And when emergency crises will strike next. Where to find hope? Our civil servants.

Dr. Vanessa Kerry, founder of Seed Global Health, Associate Professor, Harvard School of Medicine, and since June 2023 the WHO Director-General’s Special Envoy on Climate Change and Health, joined The CommonHealth to unpack her recent article ‘Health is a Cornerstone of Global Security,’ published February 14 in Foreign Policy. In it, she argues the need to rethink health as the first line of defense, with a heavy emphasis on economics, equity, and migration. We need to broaden the definition of the health security agenda; introduce health metrics into any discussion of economic growth; see health as an investment with high returns—a growing sector of national economies, in job creation, markets, and a larger tax base; and focus on finance e.g. special drawing rights, social bonds, and swaps. At the same time we need to engage internationally through strong moral leadership and humane policies, and upgrade our communications in an apolitical, non-partisan way that people see, understand, and feel. It is imperative to create opportunity in America that starts with protecting people’s health and well-being, and to create a new pathway, built on humility, to pull us out of the current confusing moment of crisis surrounding foreign aid.

In the eighth episode of the CommonHealth Live! series, J. Stephen Morrison sits down with Loyce Pace, Assistant Secretary for Global Affairs at the U.S. Department of Health and Human Services. Assistant Secretary Pace discusses the newly released HHS Global Strategy and its implications for U.S. climate and health policy.

Dr. Elizabeth (Betsy) Bradley, President of Vassar College, shares her thoughts on the fusillade of Executive Orders signed by President Trump directed at educational institutions, including the apparent special animus toward elite private institutions. In this moment of heightened scrutiny across multiple fronts, the first step is to circle back to core values and the return on investment, to communicate strategy better beyond campus to the broader community, including elected officials of all persuasions, and to spotlight jobs and financial and other vital contributions. The threat of a dramatic increase in taxes on endowments, as part of a Congressional reconciliation measure this spring, “would definitely deal a blow.” Anti-foreigner rhetoric is having a “chilling effect” on recruitment and retention of international students. “Ambidextrous leadership” is essential: be proactive, have the data you need, don’t overreact, and be ready to act quickly when needed.

Apoorva Mandavilli, the award-winning New York Times science and global health reporter, is on the front lines of several fast-breaking stories. “We should be worried” about the President’s Emergency Plan for AIDS Relief (PEPFAR). It was “already on the chopping block” before the hugely disruptive Trump pause on national grants and contracts. Secretary Rubio did issue a waiver, but there has been no follow-up clarification. PEPFAR remains in peril. Many bad things happen rapidly when a sensitive, complex program of this scale is disrupted. “The virus comes roaring back.” Though Robert F. Kennedy Jr.’s confirmation hearing to be HHS Secretary appears inconclusive, Apoorva was “not expecting the level of fireworks.” RFK Jr. was “damned by his own history” of false statements on vaccines, which “haunted him.” U.S. withdrawal from WHO is bad news for Americans in several concrete ways that will harm U.S. national interests. She has brought to our attention that scientists believe we have entered a new, far more dangerous phase in the evolution of the H5N1 threat, while the U.S. response remains woeful.

The renowned expert on vaccine confidence, Dr. Heidi Larson, London School of Hygiene and Tropical Medicine, explains why there has been a precipitous escalation in the past four years, especially among 18-24 year-olds, of vaccine skepticism and resistance. During Covid-19, “everybody got vaccinated,” everyone was exposed to the “digital swarm,” the “wildfire” on social media of mis- and dis-information regarding vaccines. Antivaccine groups amalgamated and rose in power. Public health officials were hesitant to compete on social media. Young parents were unhappy with public health sources of information and looked elsewhere. RFK Jr., his Children’s Health Defense, and the affiliated Informed Consent Action Network (ICAN), have had “massive, massive influence” as amplifiers of doubt and fear of vaccines. What to do? There is an urgent need to engage young leaders, increase public health communications budgets and change their practices and outlook, mobilize local communities, and create new communications partnerships. It requires a “huge effort.”

Since the start of her tenure in July 2023, Dr. Mandy Cohen, Director of the U.S. Centers for Disease Control and Prevention (CDC), has pursued several reforms intended to make CDC a stronger, nimbler agency better able to protect Americans from domestic and global public health threats and rebuild trust. She is joined in conversation with former Senator Richard Burr, Co-Chair of the CSIS Bipartisan Alliance for Global Health Security and Principal Policy Advisor and Chair, Health Policy Strategic Consulting Practice, DLA Piper, and J. Stephen Morrison, CSIS Senior Vice President and Director, Global Health Policy Center. They discuss the agency’s achievements, what has worked and not worked, the core challenges that persist, and how to best position the agency to sustain progress in 2025.

In the tenth episode of the CommonHealth Live! series, Katherine E. Bliss will sit down with Stacy Aguilera-Peterson, Deputy Director for Research, U.S. Global Climate Change Research Program, White House Office of Science and Technology Policy, and Josh Glasser, Assistant Director for Combatting Antimicrobial Resistance & Integrated Health Innovation (One Health), White House Office of Science and Technology Policy. The discussion will focus on how the Biden administration has sought to define the relationship between climate change and health, the extent to which climate-related impacts on health can be seen as threats to national security, and opportunities for stakeholders in research, program implementation, service delivery, and the private sector to collaborate with U.S. government agencies and international partners on addressing global challenges at the intersection of climate change and health. This event is made possible by the generous support of the Wellcome Trust and GSK.​​​

In the ninth episode of the CommonHealth Live! series, J. Stephen Morrison will sit down with Rahul Gupta, Director of the White House Office of National Drug Control Policy. Dr. Gupta will discuss the surprising 15 percent decline in overdose deaths in 2024, 70 percent of which are caused by fentanyl overdose, and what factors are driving this change. He will discuss measures taken nationally on treatment access and internationally on interdiction and related measures to reduce the flow of fentanyl. What more needs to be done to sustain progress and save more American lives?

Dan Diamond, the national health reporter at the Washington Post, reflects on the shock of both United Health executive Brian Thompson’s tragic murder and the subsequent tsunami of anger and glee on social media. We’ve entered “a staggering moment” that does not feel real, but nonetheless reveals the remarkable depth of discontent with the American health system, in particular insurers. “Everything feels grey to me.” This moment is grounded in the collapse of trust, including trust in the media. United Health, America’s fourth largest firm, and the most powerful firm in the health sector, inevitably attracts—and will continue to attract—tough scrutiny and enduring questions over why the U.S. health system is so dysfunctional. This week Robert F. Kennedy, Jr. ventures to the Senate, where many Senate members simply do not know what to make of him. He has issued so many different statements on so many topics at different times to different audiences. While RFK Jr.’s vaccine positions will get the greatest play and are likely to remain a red line for Democrats, his pivot to chronic disease prevention and healthy food has rallied many to his side. Perhaps DOGE will be a vehicle for introducing progressive and budget reform ideas into the Republican Party in a new way. Will there be progress in changing the seasonal clock in America, a lighter, perennial topic? Probably not. There “is not a real path forward.”

Sheryl Gay Stolberg, the NYT health correspondent, feels her decades of health and political reporting prepare her well for understanding this remarkable moment in American history. “What we are seeing now puts us in a really unique place.” Anger and alienation against the health sector and science are surging, drawing both on historical roots and current dynamics. Robert F. Kennedy, Jr., nominated to be HHS Secretary, taps into a profound mistrust that he has indeed stoked, aided by the platform Covid gave him to mobilize “vaccine resisters.” RFK Jr.’s nomination has several advantages, including his pivot to prevention, the root causes of chronic diseases, processed foods, and declining life expectancy. He has moved past the extremes (heroin addiction, sexual patterns, conspiracies) to claim redemption and resilience. He appeals to populist dissatisfaction with “regulatory capture” by big pharma and big food. Opposition can be loud. Michael Bloomberg has declared RFK Jr. “beyond dangerous," “medical malpractice on a mass scale.” Scott Gottlieb, AEI, has issued similarly scathing statements. Opposition can be muted. While there is “terror” among industry, public health, academic centers, opponents “don’t want to poke the bear” out of fear of retaliation. Jay Bhattacharya, Stanford, nominated to lead NIH, and other critics of the Biden administration feel they were marginalized during Covid and treated unfairly. “I think it is important that we engage with people on their ideas.“ “Humility is a word I hear a lot in public health.”

How do we explain the peril that global health faces? Covid and the post-Covid backlash. The Biden years’ “status quo” approach. Less support in Europe. Excessive debt in Africa. The generational shift in Congress and aging of the flagship programs: “Time has passed.” “We never really dealt with PEPFAR’s treatment mortgage.” Dealing with the conservative critique of US global health funding Is essential to revitalize bipartisanship. 2025 could be rocky, should resources shrink. “We need to be creative, and realistic.” What should we make of the emerging Trump leadership team, most significantly, Senator Rubio, Elise Stefanik, RFK Jr., and Jay Bhattacharya?