The CommonHealth

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. First, will China supplant US leadership in global health in the wake of the U.S. retreat? Listen to learn why the answer is a definitive "No!" and the dangers that foretells. Second, what might the U.S. 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 associated 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.