The CommonHealth

“I studied hard. Hated the lab, loved the field.”  Dr. Maria Van Kerkhove, Acting Director, WHO Department of Epidemic and Pandemic Threat Management, reveals her early, personal passions as a student of epidemiology. After a stint as a young PhD investigator in Cambodia, she was “desperate to work at WHO. I wanted a seat at the table.” As the technical lead at WHO during the Covid-19 outbreak in early 2020, she spoke at hundreds of press conferences, duly tracked by her mother. The value proposition for WHO? To help governments prepare for emerging biothreats, detect and rapidly share information on outbreaks, and convene the world’s experts to produce guidance. “In my wildest dreams, I did not expect the politicization of Covid throughout the past five years.” WHO’s recent dramatic restructuring will better focus WHO on its core functions, as its two-year budget drops from $6.8 billion to $4.2 billion. As the United States withdrew in January from WHO, it stopped its funding and ceased technical and scientific exchanges. “Since January, U.S. government officials have been instructed not to talk to us.” That is unprecedented and dangerous: “If American expertise is not at the table, there is a gap.” It puts Americans at-risk. Her conclusion: “Restore that link immediately.” 

Dr. Margaret (Peggy) Hamburg, former FDA Commissioner, describes the profound impact the HIV epidemic has had on her personally and in terms of her career choices. She discovered in her six years as FDA Commissioner how vitally important FDA is to the safety and protection of Americans, at home and abroad. FDA has oversight responsibility for fully 20% of the American economy. She is  deeply worried at the level of destruction visited upon FDA recently, but cautions that it is critical to wait until the dust has settled. “Corporate capture” of FDA has been an issue for a long time, tied to user fees and industry participation on advisory panels. What is most important is to engage the right expertise and experience, with effective guardrails. The Trump administration has instructed FDA to expand overseas unannounced inspections, expedite the creation of a centralized AI platform across all FDA units, and lower the barriers to the pharmaceutical industry building new facilities on US soil. In each of these ambitious goals, a step-by-step approach is needed, along with attention to the “disconnect” between big, new goals versus uncertain, or declining FDA capabilities in staff, financing, and dedicated offices. She is very concerned at the worsening threat to vaccines and the need somehow to earn back public trust. The same is true for the U.S. “biomedical research and innovation enterprise”—the envy of the world—that has been struck by a “wrecking ball.”

Dr. Jennifer Kates, SVP and Director, Global Health and HIV Policy Program, KFF, provides a tour d’horizon of how global health and health security look at day #98 of the Trump revolution. “The DOGE factor was not on my bingo card,” as it became the battering ram decimating institutions, programs, budgets and staff, far beyond what was environed in Project 2025. It went against what many Republicans favor—just look at the recent dismantling of the Millennium Challenge Corporation. The desire to vanquish likely emanates from the White House OMB. As the budget process, including recissions, advances, the power dynamic may shift to Congress. It may become possible to think about new ways to do foreign assistance. There will be no restoration of the status quo ante. It requires fresh thinking and clear principles, and most importantly, new forms of leadership. 

In the twelfth episode of The CommonHealth Live! which falls during World Immunization Week, Katherine E. Bliss talks with Dr. Adam Ratner, a member of the American Academy of Pediatrics Committee on Infectious Diseases and author of Booster Shots: The Urgent Lessons of Measles and the Uncertain Future of Children's Health, and Dr. Ephrem T. Lemango, Associate Director of Immunization at UNICEF, about measles outbreaks in the United States and abroad; how to bolster measles vaccination coverage in a period of reduced financing for domestic and global programs; and why routine immunization programs are critical to global health security.

In the eleventh episode of The CommonHealth Live! Katherine E. Bliss talks with the Republic of Indonesia’s Minister of Health, H.E. Budi Gunadi Sadikin, about Indonesia’s experience expanding routine immunization coverage and prioritizing attention to non-communicable diseases, as well as how public-private sector collaboration can help ensure sustainable access to health services, including primary health care.

Dr. Stephanie Psaki—a newly minted CSIS Senior Adviser—shares the story of her personal evolution as a scholar, NGO policy data expert, senior political appointee at the HHS Office of Global Affairs and the White House National Security Council, and now faculty at Brown University School of Public Health. She reflects on the lessons, good and bad, from her 900 days at the White House, and what the first 100 days of the Trump second term reveal, in particular how science has become politicized. We are seeing a “a huge departure from the role the United States has played for decades.” While the Mpox outbreak in both Europe and the United States (2022-2023) had a promising outcome, the ongoing outbreak in central Africa (which began in 2023) leave many uncomfortable, unanswered questions of why leadership, coordination, finance and speed remain so problematic. The surprise, recent completion of the Pandemic Treaty is encouraging, up to a point. As we turn inevitably to chart a vision for the future, we will have to think in fundamentally different ways about the different world we now occupy. 

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.