The CommonHealth

Dr. Matt Hepburn of the White House Office of Science and Technology Policy joins Steve and CSIS Senior Associate Tom Cullison for this 130th episode. Beginning as an Army infectious disease researcher and DARPA project manager, Dr. Hepburn’s visionary leadership was instrumental in the rapid availability of Covid vaccines through Operation Warp Speed. The world continues to face catastrophic consequences with the highly contagious BA2 variant. Hong Kong, Singapore, South Africa, and others are in the midst of spikes, while China wrestles with the strong likelihood of widespread outbreaks. Africa is largely unvaccinated, adding Covid to the list of diseases that burden the continent. Although he suggests summer will not save the United States from another surge, Dr. Hepburn remains positive. He’s posed seemingly impossible challenges like “let’s create a vaccine against an unknown disease in 60 days”, then won over skeptics by creating a solution. “We have to change the culture of our government to escape the cycle of crisis and complacency”

In this 129th episode, Steve joined in frank conversation with University of Wisconsin-Madison Chancellor Rebecca Blank as she approaches the conclusion of a nine-year tenure that dramatically tested her leadership and the university itself. There is considerable progress -- an increased graduation rate, shorter time to graduation, student debt reduction, improved diversity. The financial foundation of the university’s $3.6 billion budget has been systematically strengthened, through innovative fundraising and new partnerships with the private sector. But those gains are fragile, the university faces fierce competition from its peer institutions, serious financial and governance challenges persist, and changes in culture are difficult and require time. Worsening political polarization in the state is quite problematic. The university finds itself a “pawn” in partisan battles, and Republican legislators lag far behind in supporting sustained investments in the university. Covid-19 remains a live matter – it is not over – but the university has built better systems – ventilation, testing, vaccination, safety protocols, hybrid instruction – and created trust and commitment within the university community. Even without a vaccine mandate, the university achieved 96% vaccination coverage. The university responded to the shock of rising racist incidents and the drive for racial justice, in the aftermath of George Floyd’s death. Most significant has been changes in the recruitment and retention of students, faculty, and staff. Much work still remains: UW remains predominantly White in a predominantly White state.

Two years later, Dr. Richard Hatchett, CEO of the Coalition for Epidemic Preparedness Innovations rejoins Steve for the second iteration of our Live From Munich mini-series. Dr. Hatchett reminds us that having just had a pandemic does not prevent outbreak from another, and that pandemic preparedness needs to be “viewed as a security challenge, not as a health challenge, not as a development challenge”. He points to lessons in vaccine manufacturing and financing arrangements that incentivize disease surveillance that can better prepare us for the next pandemic. “Many of the high-income countries see the value from a geopolitical and security perspective in making these investments. The challenge for the long term, obviously, will be whether these facilities can be successful, sustainable, and be sustained.”Richard J. Hatchett, MD, is Chief Executive Officer of the Coalition for Epidemic Preparedness Innovations (CEPI).

In this 127th episode, an edited version of a live event recorded on March 2, Scott Kirby, CEO of United Airlines, joins Steve for a fireside chat. Scott Kirby has been a health security leader in the private sector, achieving a 99.7% employee vaccination rate in eight weeks. The Covid-19 pandemic forced a major change in internal culture “about leading, about doing the right thing, about a customer service culture that didn’t really exist before”, including abandoning some policies like flight-change fees. After getting news of the second Covid-19 related employee death, he decided to implement the mandate “just because its the right thing to do”. Despite pushback, he does not regret it: “Saving lives? There’s never a decision I’ll make in my career that is as important as that one, or one I’ll ever feel as good about”. This change in company culture extends to climate change too. United is going green by 2050 with sustainable aviation fuels for long flights and investing in electric and hydrogen solutions for short flights. They have also partnered with Occidental Petroleum Corp to invest in carbon capture sequestration, which will offset United’s annual emissions without traditional carbon offsets.  Scott Kirby is the Chief Executive Officer of United Airlines Holdings, Inc.

In the fourth episode of our Live From Munich Mini-Series, Steve is joined by Tom Bollyky, the Senior Fellow for Global Health, Economics, and Development and Director of the Global Health Program at the Council on Foreign Relations. Mr. Bollyky attended the Munich Security Conference “to keep the conversation about the response to the COVID crisis still on the national security agenda”. National security and global health have been historically linked, as exemplified with the birth of PEPFAR. Could the war in Ukraine lead to a similar program for Covid-19? And what are the major obstacles in creating pandemic preparedness policy?Tom Bollyky is the Senior Fellow for Global Health, Economics, and Development and Director of the Global Health Program at the Council on Foreign Relations. 

Two years ago, Dr. Jeremy Farrar joined Steve for the first iteration of Live From Munich, when the Covid-19 Pandemic was just emerging. Today, for episode #125 and the third installment of this Live From Munich mini-series, he returns to discuss this murky transition into the next stage of the pandemic. Dr. Farrar predicts that “political interest will wane from the pandemic because other events take over.” Politics are turning towards an exhausted, frustrated, even sometimes violent public. “We all feel fed up with this pandemic. But our emotional state doesn't determine the outcome of the pandemic.” We must be prepared for all scenarios, not just the ones we prefer. Dr. Farrar takes a lesson from the Munich Security Conference: “The truth is that the security community does this all the time. They think of a central scenario that is the most likely and they put most of their planning around it, but they do not ignore the other scenarios.”Dr. Jeremy Farrar is the Director of Wellcome Trust. 

In episode #124, the second episode of our Live From Munich mini-series, Steve is joined by Seth Berkely, CEO of Gavi, The Vaccine Alliance, “the largest purchaser of vaccines in the world”. He speaks on strengthening health security: “Do we prepare for our hopeful future? Or do we prepare for reality?” “The right thing to do is to continue to prepare for worsening variants, worsening disease. And the best way to do that is to make sure high-risk people all over the world are as protected as they can be.” We are only as safe as our neighbors. Longterm, "it hurts the world if new variants appear, get the chance to circulate, and then jump out again, as we’ve seen.” Different vaccines have different advantages for various levels of infrastructure, and “we want to get countries to a place where they can say we have the right vaccine, in the right place, at the right time to meet the needs of our population.” “We’re fools if we don’t keep in mind that we have to protect everyone in the world.”Seth Berkely is the CEO of GAVI, The Vaccine Alliance.  

Dr. Nkengasong, Director of the Africa CDC and soon to be head of PEPFAR joined us for this 123rd episode, and the first episode of our Live From Munich mini-series, a collection of episodes recorded at the Munich Security Conference. He is a leader in the initiative to incorporate global health in security discussions like the Munich Security Conference. “We have seen how an outbreak of a disease can truly be a health security matter, and also human security, as well as even going as far as a national security threat.” The Covid-19 pandemic has shown us “the need for us to look at the security from a human perspective”, that “we are more connected as humanity”, and “the inequalities that we thought existed are more profound within countries between countries and between regions than we thought”. As North America and Europe begin this murky transition to the next stage of the pandemic, Dr. Nkengasong is concerned that we will “begin to refer to COVID as a disease that will soon be over in the US. And then of course, because of that, it becomes one of the neglected tropical diseases where we now have to rely on foundations or charity to take care of.” He recently called for a pause in vaccine donations: “we're saying that we have a lot of vaccines in the country. Now our problem is vaccination”. “I'm a big believer in that we should always pause to evaluate where we are in response, and then make corrective actions”. How will Africa overcome its major challenge of vaccine hesitancy? “I think every good public health practice as you and I know is local. The concepts are global, but in practice is local, which means Africa must take its own socio-cultural context and deal with it and then find the touchpoints”Dr. John Nkengasong is the Director of the Africa Centres for Disease Control and Prevention, and has been nominated by President Biden to be the next head of the Office of the Global AIDS Coordinator in charge of PEPFAR, the President’s Emergency Plan for AIDS Relief.  

John Barry, historian and author of the award-winning The Great Influenza; the Story of the Deadliest Pandemic in History, a study of the 1918 pandemic, joined us for this 122nd episode. He is currently working on a volume on Covid-19: “Writing books makes me happiest and craziest.” He has penned many editorials over the course of the pandemic, drawing lessons from 1918. What has he discovered? “What we learn from history is we learn nothing.” Where are we today? “Until vaccines are widely distributed and there is easy access to antivirals, the virus will rule. … I am optimistic the virus will continue trending to mildness” but there may be intermediate steps. “Mutations are random.” “We are at a potentially dangerous time” if we throw away our defenses and become indifferent or complacent. His high school football coach taught him a lesson for today: late in the game, you are tired and the other guy is tired. “The guy who focuses at the end will win.” That does not mean you “live in a box” and isolate yourself. Aaron Rodgers, while a great football player, “lied” about his vaccination status. He “is a total jackass.” Before becoming a writer, John Barry coached football at the high-school, small college, and major college levels. He is a Distinguished Professor at Tulane University’s Bywater Institute and a professor at the Tulane School of Public Health and Tropical Medicine. 

In 2021, Indiana Governor Holcomb launched the Public Health Review Commission, charged with asking hard questions that cover the waterfront of public health challenges in Indiana and delivering actionable answers this coming summer. Its co-chair, Dr. Judy Monroe, and its director, Indiana State Health Commissioner Dr. Kristina Box, joined us to share what this unusual and promising, fast-moving enterprise is all about. The challenge before Hoosiers is formidable: the state ranks 48th in the country in public health financing. The Commission is off to a quick start staging monthly public meetings and conducting listening tours across the state. It has created a website for public comment and staged outreach to businesses, schools, and universities. Any big surprises? Public health capacities vary enormously across the state – it is “eye-opening.” Indiana’s 49 rural counties especially struggle. Data systems are woeful and antiquated. In the current acutely politicized environment, the Commission is “well-positioned to lift above the politics” and help the state’s citizens focus on the future, especially children’s health. The Commission can contribute to “lifting all the voices.” It can offer space for people who fear mandates are “stripping people of their rights” to vent their frustrations. At the same time, it can convince citizens that public health, when successful, lengthens life expectancy, especially in focusing on chronic diseases. Communications are in urgent need of an upgrade: countering disinformation requires listening carefully to people’s concerns and mobilizing trusted partners in communities, and enlisting and training the next generation of public health professionals. The private sector will be vital partners in any modernization of data systems and in building stockpiles that better meet future needs.Dr. Kristina Box is Indiana State Health Commissioner. Dr. Judy Monroe is the president and CEO of the CDC Foundation.