The CommonHealth

Sheryl Gay Stolberg, the NYT’s health policy correspondent, returned to our podcast to reflect on the first month of the Biden administration. Its approach “could not be more different” than that of the Trump administration. The transition has “brought order,” the pieces are “ a lot more buttoned-down.” Caution is a watchword: the President does not want to overpromise, aware of the race against variants, and the unpredictability of the virus. Much of the change in tone stems from President Biden’s personality: his desire to move past the high toxicity, create a “more compassionate conversation,” be “ a healer, a consoler” who “lowers the temperature” and wins Americans’ trust -- and passage of the $1.9 trillion rescue plan. Problems and challenges do persist. The United States is missing an important diplomatic moment in not taking an international leadership position and moving fast to guarantee vaccines reach low and middle-income countries. “The absence of data is a problem” when it comes to tracking disparities in the delivery of vaccines across America. Delivery of vaccines at the state level is still today “a mad scramble.” America remains dangerously divided. But overall, the trajectory is hopeful in the fight against the virus.  Sheryl Gay Stolberg is the Washington health correspondent for the New York Times. Over the course of the past 24 years at the Times, she has covered the White House, Congress, and national affairs. She shared in two Pulitzer prizes awarded when she was at the Los Angeles Times.

Chris Murray kindly returned to the podcast for another round. We know now that variants increase transmissibility “by quite a bit,” and have the potential to increase the fatality rate and escape vaccines, lowering efficacy rates. The Novavax trial, ominously, showed that one variant can reinfect individuals previously infected. It’s a new, uncertain world in which SAR-COV-2 is not overcome and eliminated, but rather becomes endemic, a “seasonal flu only ten times worse.” We know that accelerating vaccination campaigns, with excellent vaccines, combined with seasonality (end of winter, arrival of summer) can drive the pandemic down. But a lot of virus remains in the community, variants will take off in America in another month or so, and relaxation of controls too early will trigger spikes in the spring and lay the groundwork for another bad winter at year’s end. Politicians, scientists, policy advisors are just beginning to get their heads around what this means, short and long-term, and what to communicate to a public which has just heaved “a giant collective sigh of relief” in hope that the pandemic is finally over. Chris Murray is the Director of the Institute for Health Metrics and Evaluation at the University of Washington in Seattle, where he is also Chair and Professor in the UW Health Metrics Sciences Department.

…if you are fed misinformation from the top of the US government. Former Senate Majority Leader Bill Frist joined us to reflect on his life and where our country is. “I have radically changed my life … for the better. Refocused my life on nature.” In his 12 years in the Senate, he was the only doctor who had taken care of a patient… the only scientist. It was tough selling his 2005 Manhattan Project plan for pandemic preparedness. Today with Covid-19: “We have failed as a country.” Trump failed at communications by spreading false information, undermining scientists, downplaying the severity. In Tennessee, “hundreds of people died unnecessarily.” “If there is a fire in the forest, you have to know where it is.” And test. “Health security is national security, And we have to treat it as such.” The January 6 insurrection? “For me it was very personal. Took me back to 23 years ago when a man came into the Capitol and assassinated two police.” Does the Republican Party have a future? “ It is in search of a leader.” Listen to hear the full answer.  Bill Frist, a renowned heart and lung transplant surgeon, served two terms in the Senate, including as the Senate Majority Leader 2003-2007. Today he remains a highly influential health policy expert, at home and abroad, a medical innovator, advocate, businessman, and naturalist. He hosts a very active podcast, ‘A Second Opinion.’ He lives on a farm in Franklin, Tennessee.

We were delighted to join this week with Scott Kirby, the CEO of United Airlines. The impact of the pandemic upon the airline industry has been “devastating,” the worst in its history. Luckily, bipartisan broad-based support for the industry – contained in the CARES Act and the December $900 B emergency measure – has preserved this critical infrastructure. Variants are a stark threat: “We’re giving the virus a large playing field upon which to mutate, for variants to become more deadly, more transmissible, or to evade vaccines.” United is actively working with partners to develop vaccine passports: passports are “the key not just to reopening borders and travel, but to reopening segments of the economy that have been closed.” “It is the right thing to do to make vaccines mandatory” though United has not yet taken that step. 1,000 passengers who refused masks have been banned from flying on United. Immediately after the January 6 violent insurrection against the Capitol, United took several “tactical steps” in its flights in and out of Washington. Decarbonization remains a personal passion. United has joined the world’s largest “air capture and carbon sequestration” project and led the industry in biofuels. Scott Kirby became the CEO of United Airlines in May of 2020. From 2016-2020, he was United’s President.

Dr. Alisha Kramer, a CSIS alum and young doctor serving poor, black, pregnant women in Atlanta hospitals, rejoins us for a second podcast. One year into the pandemic, a “new normal” has arisen that is still jarring, a “disconnect” in the changes in medical practice. Vaccine hesitancy is a “shocking” matter among nursing staff. Black persons “have every right to be distrustful” of the health system. If we give the “microphone back to the experts… based on the science,” if we rely on neighbor to neighbor communications, trust will return. We have not yet learned much about Covid-19 infection in pregnant women. It is up to the pregnant individual and her provider to determine whether to go ahead with a vaccine. Her thoughts on her husband Jonathan Ossoff’s successful quest for a Senate seat? “We can all agree 2020 has been incredibly surreal.” Black women in Georgia carried the day. Dr. Alisha Kramer, a revered former colleague at the CSIS Global Health Policy Center, graduated in 2019 from Emory University School of Medicine. She is currently a resident specializing in obstetrics and gynecology at Atlanta public and private hospitals.

Dr. Céline Gounder, a member of the Biden-Harris Transition Covid-19 Advisory Board, takes a look at where we are, less than one week after President Biden assumed power. Deborah Birx and Tony Fauci have each come forward, unshackled, to discuss the moral and professional quandaries they faced, including threats and coercion, as Trump erected false narratives, intensifying in the fall electoral season and beyond, steering Americans into a human catastrophe. “Proximity to power is intoxicating. It corrupts judgment.” “I was impressed by Dr. Birx’s road trip.” It was “a smart pivot.” President Biden has shifted to unification and healing: “That is the way to get to the other side.” It is “calming” when public health and science leaders speak directly to the American people, aided by trusted messengers – the local sheriff, the faith leader, the soccer coach. There was chaos during the vaccine introduction, as the incoming administration was handed a “black box.” The way forward is through continued masking, social distancing, hand washing, along with patience, realism and an optimistic determination in expanding vaccine coverage, amid shortages.  Dr. Céline Gounder is Assistant Professor at the NYU Grossman School of Medicine, President/CEO and founder of Just Human Productions, and host of the Epidemic and American Diagnosis podcasts. She served as a member of the Biden-Harris Transition Covid-19 Advisory Board.

Chef Jose Andres sat down with us to reflect on his life, the organizations he has founded, and his unique, powerful vision for using food to transform communities, battle inequities, advance unity and strengthen economies. When he landed in America as a young man, “I became an American way before I became an American by a passport.” Two years later, at age 23, he chose Washington to be his home: it is the “place where things can happen.” He created relief organization World Central Kitchen to operate in “the limbo between emergency and reconstruction.” “People feel forgotten.” In response to Covid-19 in American and Spain, WCK has served over 36 million meals by partner restaurants converted to community kitchens across America. “We move very quickly.. it is in our DNA.” He has become increasingly convinced that “food is a national security issue” requiring a U.S. “Food Czar” next to the President, with “real power” and a “real budget.” “Hunger is something that cannot wait.” What’s next for 2021? Focus on revitalizing his businesses, the ThinkFoodGroup: “when it is safe.. bring the restaurants back..” Keep moving forward with WCK, changing our national conversation on food. Unity is the key: “I believe in lower walls and longer tables.”Chef Jose Andres, based in Washington, D.C., is the renowned chef, founder and head of both the ThinkFoodGroup restaurant group and the rapid-response humanitarian organization, World Central Kitchen.

Dr. Luciana Borio, a member of President-elect Biden’s Covid-19 Advisory Group and the transition team, scanned the horizon. On the development of Covid-19 vaccines: “All in all, this has been a spectacular success.” Special tribute goes to the FDA career staff, the “heroes” who charted the path forward. Now most worrying: ensuring large scale manufacturing of the MRNA vaccines, and fixing logistics - “the gaping hole” created by a wholesale lack of planning. Vaccine hesitancy, equity, and the ”extraordinary” complexity of delivery all demand high attention. “We don’t have visibility” into the new variants of the virus, due to inadequate genomic surveillance. Development of therapies was hindered by “a lot of noise” surrounding hydroxychloroquine and convalescent plasma: a more rigorous, less political approach will deliver better results. In the next year, while “it’s gonna be hard,” there is “no better team” than the one assembled to begin work on January 20.  Dr. Luciana Borio is a member of President-elect Biden’s Covid-19 Advisory group and the transition team. She is a Vice President at In-Q-Tel in Washington, DC. She previously served as Director for Medical and Biodefense Preparedness at the National Security Council under both Presidents Obama and Trump.

Chris Murray, the renowned modeler, joined us to share his year-end reflections. In this year unlike any other, Covid-19 pushed modeling onto new ground, as forecasting of individual and governmental behavior became essential to inform decisions in the near to medium term. It’s been “a steep learning curve.” Looking ahead to 2021, in Q1 and 2 we will see a profound pivot, as vaccinations are scaled, winter ends, government policies evolve, and immunity within the population rises. We should arrive at “a surprisingly decent place in June or July.” As we “bounce back to pre-Covid behavior,” it will be a “balancing act.” Success in reaching herd immunity rests on a campaign to get “the maybes,” upwards of 30 percent of the population, while the 15-20 percent of “straight refusers” won’t budge. A vitally important “lingering question:” will we have attained enough vaccine coverage that nothing terrible happens in the winter of 2021-2022? Chris Murray is the Director of the Institute for Health Metrics and Evaluation (IHME) at the University of Washington.

Steve and Andrew had the good fortune to catch Suzanne Firstenberg shortly after the recent conclusion of her stunning public art installation, ‘In America…. How could this happen?,’ a dramatic tribute to those lost to Covid-19. This “awakening,” comprised of 267, 080 white flags, stood on the parade grounds of the Washington DC National Guard Armory between October 23 and November 30. What motivated her to act so boldly, and how was it possible to succeed so rapidly, moving in just a few weeks from concept to creation? What were the key messages she was conveying, and what was the human experience of those who participated in it? As she explains, she could not do this alone. Several key partners joined with her, most notably Ruppert Landscaping and Jose Andres and World Central Kitchen. Others from the Smithsonian and National Geographic acted to preserve and capture this achievement.  Suzanne Firstenberg is a social action artist based in Bethesda, Maryland. Her installation was covered by National Geographic, among other outlets, and you can find a Nat Geo video of the installation here.