The CommonHealth

On October 7, Andrew and Steve sat down with a close friend, Georgetown’s Prof. Larry Gostin, for a lively live-cast conversation about his new book, ‘Global Health Security: A Blueprint for the Future.” The podcast captures that rich, vivid exchange. The big messages: We underestimate the power of the SAR-CoV-2 virus: it is wily and pernicious and will continue to surge. We cannot forget anti-microbial resistance. A fundamental shift is needed in the US international approach – away from charity and towards advancing technology transfer to manufacture vaccines in low and middle-income countries to create resilience. That requires far greater pressure upon Moderna and Pfizer to cooperate in meeting urgent global needs. The USG has the legal authorities to make that happen but has not yet followed through. USG health communications have been “pitiful” and left the public “utterly confused.” That too can be corrected.  Professor Lawrence O. Gostin is University Professor at Georgetown University where he directs the O’Neill Institute for National and Global Health Law.

Dr. Leana Wen joined us this week to explore her personal history and its revelations, laid out in remarkably candid detail in her newly released memoir, Lifelines: A Doctor’s Journey in the Fight for Public Health.  And to speak to the most pressing current challenges posed by the Covid-19 pandemic. Her childhood struggles, as a young immigrant Chinese girl living amid insecurity, taught powerful lessons about poverty, race, and health. Her tenure as Health Commissioner in Baltimore, operating in close partnership with the late Congressman Elijah Cummings, opened the way to confront opioid addiction, stigma, maternal and infant mortality, and the acute vulnerabilities of youth. In her new life in the print and cable mediascape, she follows the advice of former Senator Barbara Mikulski: “do what you are best at – and needed for.” The Biden administration needs to up its game with the public: “It’s not enough just to get the science right.” It is about values, communication, and public trust. America’s hardened polarization -- surrounding vaccines, masking, and distancing -- is too advanced to fix: it is best to focus on engaging individual by individual. Listen to learn more. Dr. Leana Wen is an emergency physician and public health professor at George Washington University. She is a contributing columnist at the Washington Post and a CNN medical analyst. She’s served as Baltimore’s Health Commissioner.  

Carmen Paun, a dynamic, fresh media voice on global health in Washington, shares her personal and career journey from Romania to Brussels, and on to her arrival in Washington D.C. one year ago, amid the pandemic, to launch POLITICO Global Pulse. This past summer, while visiting family in a small village in the Romanian countryside, she was “shocked” to discover only 10% vaccinated at that time, the pandemic seen as “all just a conspiracy.” The pandemic was the trigger in creating POLITICO Global Pulse. In its first year, it did find its audience and voice quickly. What to make of the U.S. Global Covid Summit? It re-established that “the U.S. was in charge,” now the challenge lies in execution. Faith in American leadership has diminished, while African officials remain frustrated by slow delivery and the West’s export restrictions. Will the EU-US Task Force bring great transparency and accountability? “Hard to say… How fast is this going to happen?” The turn to boosters likely creates “a vicious cycle” that could leave low and lower-middle-income countries still struggling to access vaccines. Will Africa be left far behind? No. Vaccines are finally arriving. India is reopening exports. Don’t expect the push by South Africa and India to suspend intellectual property to succeed. Her overall prognosis? “It is hard to be optimistic” Give a listen to learn more.Carmen Paun is a health writer at POLITICO and author of POLITICO Global Pulse.

In a recent New Yorker ‘Letter from Biden’s Washington,’ Susan Glasser delivers a stark indictment: Trumpists and Republican leadership are consciously keeping enough people resisting the Biden administration’s efforts to control the virus “to keep the disease wreaking havoc.” Why that conclusion now? “It is no accident” that 1 in 500 Americans have died, now totaling over 687,000. It’s becoming obvious that President Biden cannot inoculate Americans against Fox News. In the meantime, the Biden administration, “on both foreign and domestic fronts, remains a jumble of aspirations and retains a haze of uncertainty about how to achieve them.” That directly shapes its international approach to Covid-19, including the recent Global Covid-19 Summit organized by President Biden on the margins of the UN General Assembly. It is “a statement of the obvious” that nearly half of the country is dedicated to the failure of the Biden administration. When a “flaming dumpster fire” pandemic continues in the United States -- the fourth wave fueled by vaccine refusals – the resulting domestic crisis gravely limits the ability of the United States to be a world leader on Covid-19. On the pandemic as well as Afghanistan and other foreign policy priorities, the administration is taking an approach that is far less multilateral, alliance-focused, and consultative than expected. Why? The answer is not yet clear: if the administration is simply overwhelmed by demands, or if this approach is a conscious internal “predilection.” Does she agree we are drifting inexorably towards a US-China cold war bifurcation of the world? “Yes, I do.” Do we urgently need a national commission on the pandemic? “Absolutely.” “You cannot escape history.” Please listen to know more.Susan Glasser is a staff writer at The New Yorker, author of Letters from Biden’s Washington

Dr. Monica Gandhi toured the landscape with us. The recent recall of California Governor Gavin Newsom has bipartisan roots, in dissatisfaction with the “lockdown mentality” that closed playgrounds and parks, and kept San Francisco’s schools shuttered for 18 months. It was to a significant degree a “referendum on the illiberal liberals.” Once “the power of vaccines” came into force, however, California pioneered mandates, passports, and expanded testing; achieved over 80% vaccine coverage; and drove cases and deaths to exceptional lows. The future? “Immunity is the path out” to achieve control over Covid-19. Big concerns? Confused messaging around boosters terrifies the vaccinated and makes the unvaccinated believe less in vaccines. We are also witnessing rising intolerance: in our politically polarized debates over schools, vaccines, masks, and boosters, scientific discourse has lost balance and nuance.  Dr.Monica Gandhi is Professor of Medicine and Associate Chief of the Division of HIV, Infectious Diseases and Global Medicine at UCSF/San Francisco General Hospital. She also serves as the medical director of the HIV Clinic at SFGH, the famous “Ward 86.”

Dr. LaQuandra S. Nesbitt, Director of the DC Department of Health, returned as our guest to share her reflections. Her view of President Biden’s six-point plan? Tying vaccination to sustained employment is the next phase: mandates will bring about an uptake in vaccines. The rising emphasis on monoclonal antibodies is a “huge initiative” that brings about a reduction in hospitalizations. The President negotiating access at-cost to over-the-counter test kits is a similarly big step. DC has avoided the worst outcomes seen elsewhere in the United States by “planning for the worst.” Plus there has been relative unity: “residents have done what we have asked them to do.” “At times of adversity, this city rises to the occasion.” Top challenges? Vaccine disinformation regarding infertility creates “myths” that remain “inexplicably” powerful. Managing confusion over boosters is “tricky” in the absence of a “single voice, single message.”Dr. LaQuandra S. Nesbitt has served since January 2015 as Director of the District of Columbia’s Department of Health in Washington, D.C.

Tom Bollyky joined us on the occasion of our 100th episode to reflect on President Biden’s six-point re-set of US pandemic policy, unveiled September 9, and to discuss what can be done to break the deadlock over determining the origin of SARS-CoV-2. President Biden’s patience has clearly run out, and the new approach, heavily reliant on mandates, will stir political blowback, litigation, and defiant disobedience which may slow progress versus accelerate momentum. It’s “not a happy day” when people will be “pushed into a corner.” It’s disappointing that the private sector did not earlier do far more. Our national narrative may however improve, as higher rates of hospitalization of children deflate the individual freedom argument. On the origins controversy, it is “utterly unsurprising” that the US intelligence review was inconclusive. The origin issue is indeed terribly important, at this historic “policy moment,” since without resolution, we are blocked in our prevention approaches. We are in a “dark environment” and there is no prospect for progress in global health unless we find a basis for cooperation between the US and China. In the meantime, we should prioritize moving ahead with more rigorous lab safety standards and end wildlife trade and wet markets.Thomas J. Bollyky is the Director of the Global Health Program and Senior Fellow for Global Health, Economics, and Development at the Council on Foreign Relations.

Professor Larry Gostin joined us for a spirited conversation of where America as a country stands today, almost two years into Covid-19. Human ingenuity and scientific gains have been “astounding,” while our preparedness, in the face of such a “wily enemy,” has too often been “abysmal.” We experienced shock when the first wave that began in Wuhan landed at our shores, CDC bungled tests, the Trump administration stoked anti-Asian hatred and politicized essential tools – masks, vaccines, and temporary lockdowns. Public health messaging too often has been “appalling," as CDC’s scientific leadership has stumbled. Now, in late 2021, we face the danger of dividing our society into two opposing camps, the vaccinated versus the unvaccinated. The Biden administration has refused to take up vaccine credentialing, a significant mistake. It has also shown remarkable leadership in trying to overcome vaccine hesitancy and refusal, and now must turn increasingly to mandates. Larry Gostin is University Professor and Director of the O’Neill Institute for National and Global Health Law at Georgetown Law.

In conversation with Steve Morrison on August 3, Dr. Fauci began by laying out the $3.2b Antiviral Program for Pandemics. Its dual aims are quick and long-term wins. The optimal antiviral: a single pill, oral, that early in infection stops replication. Any solution has to be grounded in equity of access, at home and abroad; requires a massive increase in testing; and will rest on combination therapy to combat variants. The initial $3.2b, it is hoped, achieves success that fuels higher future investments. Private industry and academic partners are key to rapid gains and building sustainable R&D capacity. Beyond the APP, how to arrest the “pandemic of the unvaccinated? We need a national “uniformity of approach” on masks, vaccination levels of at least 1-2 million per day, quick full approval of mRNA vaccines, boosters, and vaccines available for kids “not beyond the fall.”Dr. Anthony Fauci is the Chief Medical Adviser to President Joe Biden and Director of the National Institute of Allergy and Infectious Diseases (NIAID).

Chris Murray, director of IHME, joined our podcast once again, at this major moment of reset of expectations – of our ability to control the pandemic, of policy decisions, data gaps, political attitudes and behavior, hitting the wall of hesitancy and refusal to vaccinate, and public confusion. We cover the full gamut: the forecast for the fall surge, missteps on masking, the need for greater transparency in data, and how much room exists to overcome resistance to vaccines. Chris Murray is the Director of the Institute for Health Metrics and Evaluation, and Chair and Professor, Department of Health Metrics Sciences, at the University of Washington in Seattle.