The CommonHealth

Dr. LaQuandra Nesbitt, director of the Washington DC Department of Health, shares her insights into battling the pandemic. Washington is the opposite of self-contained. Protesters of many stripes transport their grievances to Washington, often stoking “strife and agitation” with little regard for the health of the community. Emergency preparations intensified beginning in 2015: “We were ready” in 2020 but had “still so much to learn” as the pandemic unfolded. Messaging in the fog of a pandemic is difficult, in need of constant refinement. Testing got off to a halting start. But as swabs, reagents, and skilled staff became available, the city quickly scaled its testing. It also raised a caution: testing is costly and long-term. How to sustain? Vaccine distribution, including to high numbers of non-residents who work in the Capitol, has been a challenge. Equity and accountability concerns continue to dominate. One reality persists: “We simply do not get enough vaccine here in the District.” And when doses move through retail pharmacies and hospitals with insufficient oversight and coordination, equity suffers. Luckily, ”demand is so high” for vaccines. Dr. LaQuandra Nesbitt is Director of the District of Columbia Department of Health in Washington, D.C., a position she has held since January 2015.

Helen last joined us on April 2, 2020, a dark moment. She returned to explore with us whether the joy, relief, and gratitude that millions are experiencing through Covid vaccines generate gains in other disease areas, where adult vaccination “is a hard field.” “These vaccines have been extraordinary” with “very few side effects.” Among Republicans, especially in rural areas, “a good chunk of people are not intending to be vaccinated.” It was a lost opportunity when President Trump did not go on camera when he was vaccinated. The search is now fully on for trusted influencers to reach Republicans. What lies ahead is a “bumpy period,” and progress is going to take time, but the rapid development of vaccines and today’s surge in production provide hope.   Helen Branswell is a Senior Writer, Infectious Diseases, at STAT. She is the winner of a George Polk Award in Journalism in 2020 for her remarkable coverage of SARS-CoV-2.

Peter Hotez joins us for a Texas-centered conversation. After 11 years in Washington DC, Peter migrated to Texas where over the past several years he has established himself as a leading research scientist, public voice on infectious disease, including SARS-CoV-2, vocal advocate of vaccines, and opponent of anti-science, anti-vaccine voices. How did this happen? How has this changed his life? In recent days, Governor Abbott made his sudden, unforeseen decision to lift the mask mandate and restrictions on businesses. How to make sense of that? Viral variants dominate the conversation, in Texas and beyond. What does that portend? Peter Hotez is Dean of the National School of Tropical Medicine at Baylor College of Medicine and Co-Director of the Texas Children’s Center for Vaccine Development.

Ashish Jha, a determined optimist, gives the Biden administration an A- for its first six weeks. The picture today is “dramatically better.” “A light switch went on after January 20,” when states could suddenly ask for – and receive – help. An “extraordinary bump-up” in vaccinations is underway: “We have more vaccines coming than we will know what to do with.” More needs to happen in building out testing, developing strategies for variants, and planning for when variants may escape vaccines. “The equity agenda is not going well.” While it may be “easy to look like a superstar compared with Trump,” the Biden administration “needs to lean in heavily” with its political and diplomatic power to shape the international environment to control outbreaks, bridge the dangerous vaccine gap, and increase manufacturing. Surplus vaccines will be key: “The problem is not money, it is vaccines.” Ahead of us lies “a really good summer and fall.” Ashish Jha is Dean of Brown University’s School of Public Health.

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.