The CommonHealth

In this episode, Anuradha Gupta, President of Global Immunizations at the Sabin Vaccine Institute, discusses key findings from the new World Health Organization-UNICEF Estimates of National Immunization Coverage (WUENIC). The latest report shows that countries are beginning to recover from decreases in coverage observed during the pandemic, although there is considerable regional and sub-national variation, and some low-income countries continue to show stalled progress. Gupta emphasizes the importance of examining community experiences to understand where greater effort needs to be made and stresses the need to build coalitions of civil society, patient advocacy groups, the private sector and governments to promote equitable access to, and uptake of, vaccines.

Gary Edson, Covid Collaborative, reflects on the President’s Emergency Plan for AIDS Relief (PEPFAR), now at its 20th anniversary. It originated with a Republican president, George W. Bush, who transformed development assistance. Bipartisanship was vital, and PEPFAR fulfilled moral and geostrategic goals. Now, PEPFAR reauthorization is in peril in the post-Dobbs era. What needs to happen to rescue things? In the toxic, polarized post-Covid era, how do we step over that noise and bring about a new conversation about topline goals to protect Americans on a bipartisan basis? Give a listen!

Sheryl Gay Stolberg, NYT national correspondent on health and politics, unpacks the post-Dobbs era: does it imperil or boost the right to contraception? Or both? Does it put the President’s Emergency Plan for AIDS Relief (PEPFAR) under new scrutiny? Calls to “take a fresh look” at PEPFAR may signal trouble. “Abortion politics is laying over all of our conversations” in this “super-partisan era.” In the post-Covid era, the reporting environment has loosened. Why is it that filling the US leadership gap in science and health is moving along so slowly? What should we make of RFK Jr’s arrival on the scene, a figure in the larger campaign to vilify Dr. Anthony Fauci? What can we expect in the coming battles over Medicare drug pricing following the Inflation Reduction Act? 

Dr. Mitch Wolfe, former CDC Chief Medical Officer, explains the genesis of CDC’s vision for six regional offices as a “long-term permanent overseas presence” that would expand coverage, deploy senior staff to develop regional strategies, and provide specialized technical expertise. Geopolitical security calculations predominate as CDC gets more involved in politics and policies. Proximity builds networks and knowledge. To succeed, the CDC regional offices will need strong leadership, an aggressive mandate with backing from Washington and Atlanta, and serious sustained funding. Mitch also opines on Rochelle Walensky’s legacy leading CDC and living in London these past months amid the UK’s acute economic and political travails. 

Helen Branswell, STAT, unpacks for us important complicated topics that can, frankly, be confusing. She explains why this is a big moment for Respiratory Syncytial Virus (RSV). She illuminates why GAVI is moving ahead with a hexavalent (6-in-1) vaccine that incorporates polio vaccines, and what that signals for the future of global polio control. In her recent profile of Mandy Cohen, the incoming CDC Director, Helen reflects on the changed understanding of what is required to lead CDC effectively. In the post-Covid period, how has health reporting changed?

Dan Diamond, Washington Post, reflects on big emerging themes. The administration’s scientific, biomedical, and public health leadership has emptied. What should we make of Mandy Cohen’s appointment to be the next Director of CDC? With the turnover, who will be the “quarterback” of government during the next crisis? Congressional panels are raising “uncomfortable” questions about Covid's origins. It is an “open question” what happens with the reauthorization of PEPFAR and the Pandemic All-Hazards Preparedness Act (PAHPA). The shift of opinion against NIH and CDC will leave “the brands damaged.” Presidential campaigns—Governor DeSantis’ attacks against “Faucism” and RFK Jr’s anti-vaxxer efforts— offer “nothing good for public health.” Attacks upon science and public health have far more energy than the defenders. “Easier to play offense than defense.”

Twenty years after President George W. Bush signed the U.S. Leadership Against HIV/AIDS, Tuberculosis and Malaria Act of 2003, establishing PEPFAR, David Kramer, the Executive Director of the George W. Bush Institute in Dallas, Texas, discusses the process of establishing the multi-billion dollar program at the Department of State; how ensuring equitable access to health care services for vulnerable and marginalized populations is important for national security; how investing in HIV services and partnering with countries to strengthen health care improves the relationships of the United States with countries overseas; and why it’s important that Congress reauthorize PEPFAR later this year. 

Jeremy Konyndyk, President of Refugees International, is a humanitarian leader, emergency operator, and policy innovator. He joins us to share his thoughts on diverse crises. During the Turkey/Syria earthquake, donors failed to surge resources to Syrian civil groups, something that is indefensible a decade plus into Syria’s war. U.S. policy on the southern border is narrowly understood to be law enforcement versus protection of rights of individuals in flight, a disappointment not expected of the Biden administration. USAID has struggled to overcome its internal divisions to begin building an enduring emergency health security response capability. American opponents of public health and science are winning the battle for opinion and influence, with little political leadership pushing back from the opposing side. After the Russian invasion of Ukraine, many low- and middle-income countries rejected the West’s appeals for solidarity. The West had shown “zero solidarity” for their needs during the pandemic. With Ukraine, those countries are now responding “in kind.”

Matt Goodman, CSIS SVP and Simon Chair in Political Economy, unpacks the several striking developments at the recent G7 Summit in Hiroshima. Russia’s invasion of Ukraine has unified and energized the G7, with side benefits in economic security, nuclear disarmament, food security, health and climate. With the Ukrainian counteroffensive imminent, the G7 made multiple specific commitments on Ukraine. On China, “economic coercion” and “de-risking” were the watchwords. Paragraph 51 of the communique laid out nine specific items on China, an unprecedented step. On health, President Biden committed an additional $250m to the Pandemic Fund, nudging his G-7 peers. The G-7 reaffirmed in detail its consensus on UHC, global health architecture, R&D of new technologies. Antimicrobial resistance (AMR) enjoyed higher salience, as did health reconstruction in Ukraine and violence in multiple wars targeting the health sector. The Covid origin stalemate was deliberately downplayed, while the Global Health Emergency Corps merited a mention.

Adam Havey, Executive VP, Emergent BioSolutions, speaks to the “great unwinding” with the end of the Public Health Emergency, including the outstanding work to bring about adequate sustained funding for preparedness capabilities. To keep long-term bipartisan investment front and center, “lead with the facts.” 8 in 10 voters favor government action. There were several hard lessons at the Bayview facility in Baltimore, where over 500 million Covid vaccine doses were contaminated. How do we rebalance the Strategic National Stockpile? Over-the counter sale of Narcan (naloxone spray, used to reverse opioid overdoses) will face several challenges but overall be a net positive. The Pandemic All-Hazards Preparedness Act (PAHPA) will be critical to predictable funding, strengthened ties with industry, and workforce development.