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Lemonada.

1:35

This is In The Bubble with Andy Slavitt. Welcome

1:37

to the show. I apologize

1:39

if my voice sounds a little grating

1:41

to you. Some would say sexy, but

1:45

others would say a little bit under the

1:47

weather. But I hope that it's

1:49

pleasant in your ears. So

1:52

COVID cases are up and

1:54

that's kind of a familiar feeling.

1:57

I'll remember what that feels like. in

2:00

the past that has meant

2:03

situation that has been

2:05

unpredictable, out of control, and

2:08

we all remember how it brought life to a standstill.

2:12

Is this different? Is this different?

2:15

Well, my guest today

2:18

is the brand new head of the CDC, Mandy

2:21

Cohen,

2:21

and she's gonna answer that question. And

2:24

all of the advice that you want along

2:26

with it, such as what you should you do about it,

2:29

what should we expect? We

2:32

also have a

2:34

new

2:35

vaccine formulation coming out

2:37

in a little over a month. I'm

2:39

gonna ask Mandy about that and advice

2:42

on whether and when you

2:44

should be

2:46

getting the new vaccine update

2:49

and what it means. So

2:51

that and more. I also wanna

2:53

take the opportunity to really

2:56

introduce

2:57

Mandy Cohen

2:59

to you and to the country. This

3:02

is her

3:03

first podcast interview, her first in-depth

3:05

sit down.

3:06

And she's

3:09

a pretty remarkable person. And

3:12

I think it will be useful

3:14

to get to know her and how she looks

3:17

at coming into a role like this at a moment

3:19

like this. It is a beleaguered

3:21

agency.

3:23

But so

3:25

are almost all of our institutions, the

3:28

FBI, the FDA, our

3:30

justice system, our

3:36

Supreme Court. We

3:38

have real

3:39

doubts and question marks

3:42

around the things that used to be really

3:44

solid

3:45

parts of our society. So

3:48

how do you take over the CDC at a time like

3:50

that? We'll talk to Mandy

3:52

about that. Now

3:55

as you will hear, Mandy and I

3:57

kinda go back together. We used to work together.

4:01

So you will notice that in

4:03

the conversation, but be aware. Let

4:07

me just tell you a little bit about Nandi Cohen.

4:11

She is a Yale

4:12

educated

4:13

Harvard practice position,

4:15

public

4:18

health professional. She

4:22

was most recently the health secretary

4:25

for the state of North Carolina, where

4:27

she got great marks for how she handled

4:29

COVID and pretty much everything else. And

4:33

she also worked

4:36

at the Centers for Medicare and Medicaid services with me.

4:39

In my tenure there, we

4:41

had a great go of it.

4:43

And she's done a number of other things. All

4:45

in all,

4:46

I don't think you can find someone who's more qualified, both

4:49

from a resume standpoint and temperamentally

4:52

to lead an agency at a moment like this. So

4:56

enough of my voice, I

4:58

want you to hear from her and get some

5:00

of these important questions answered.

5:11

Well, we just got through reading my very,

5:15

very flowery introduction to

5:17

your biography and who you are and

5:19

a little bit about our relationship.

5:23

So I'm sure that everybody is wondering, okay,

5:26

why would a great, smart, kind,

5:29

decent person

5:31

want to take a job that

5:33

basically everybody in the country thinks

5:37

they've got an opinion on how it should be done, but

5:39

only one person actually has to do it. Well,

5:43

first, Andy, it's wonderful

5:45

to be in the bubble. I'm excited

5:47

that you invited me in today.

5:50

I listened to the podcast

5:53

and I'm a big fan.

5:54

You send me notes, you send me notes. And

5:58

as you know, I just want to thank you. to

6:00

make sure your listeners know that

6:02

I have learned a ton from you,

6:05

not just from the podcast, but I'm sure you've mentioned

6:08

that you and I work together at the

6:10

Centers for Medicare and Medicaid Services. And

6:13

honestly, there has been no boss

6:16

that I have worked for that I have learned more about

6:18

how to run large complex organizations

6:21

from than Andy. He's

6:24

a tremendous leader, and I felt

6:26

very lucky to get to work as closely as I

6:28

did. And I bring a lot of the lessons I

6:31

saw him using at CMS

6:33

when we were there together, I bring them to the CDC. So

6:35

when you asked me, why would I want to come and

6:37

take this role, one, the mission

6:40

of the CDC is so incredible,

6:43

right? The opportunity to run an agency

6:45

whose

6:45

mission is to protect the health of this

6:47

country and frankly the world. I

6:51

was so excited to be able

6:53

to return to government to

6:55

be part of a team charged

6:57

with that mission I think I bring some

7:00

unique background to

7:02

the role having led both at the federal level

7:05

and at the state level. I think that gives

7:07

me a unique perspective that

7:10

I hope I can bring to the agency. I'm

7:13

a physician by training and

7:15

obviously led through the COVID

7:17

pandemic in North Carolina and I'm really

7:19

proud of the work. I hope we'll get into a bit of it.

7:22

But I think bringing all of that to bear

7:25

felt like

7:28

I could make an impact

7:30

for positive change here and frankly

7:32

I think I am, and

7:35

I'm a few weeks in and I'm loving the

7:37

job so far. The people here at the CDC

7:40

are incredible, just really

7:43

amazing scientists, passionate

7:46

and I'm thrilled to be able to pick

7:48

up the baton from Dr.

7:51

Walensky and run this next regular life.

7:54

nice

8:00

things you said about me, but instead, I'm

8:02

just gonna play what you said over and over

8:04

to my kids. Said the head of the CDC

8:06

said nice things about me. So you should be

8:09

nicer to your dad. But

8:11

I do wanna get into some of what

8:13

drives you because I think you

8:15

laid out something that is

8:19

really clear and purposeful,

8:22

but man requires a lot of courage, a

8:25

lot of courage. And I'd love for people

8:27

to help get to know you a little

8:29

bit better, to help understand how

8:31

you brought that to bear and how you bring that to the table

8:34

throughout your career. But maybe the

8:37

best place to start is with what's on people's minds right

8:39

now today, which is that

8:41

COVID cases are up, welcome to the job.

8:44

And we all have this sort of traumatic

8:47

effect when

8:50

we see COVID cases go up because

8:52

we remember in the last few years that

8:55

feeling of panic

8:57

and out of control fear

9:01

when we saw cases go up.

9:03

And I'm sure we're at a place now where many of

9:05

us know people who have COVID cases. I

9:08

would suspect

9:09

and hope certainly that for many people

9:11

that is mild

9:13

and they're getting through it, but still it

9:16

causes people to go, huh, I remember that feeling.

9:19

So what are you seeing at

9:21

an actual level? Tell us what's really going on.

9:25

It's really important for folks to know

9:27

that as we sit here in August

9:30

of 2023, how

9:32

we experience COVID is very different

9:35

than how we experienced it in August of 2020. Not

9:39

only is the virus different, but

9:41

we are different and the tools

9:43

we have available to protect

9:47

everyone are very different, which is wonderful.

9:50

I mean, it's just incredible work that has happened

9:52

in the last number of years. Let me start

9:54

in the latter in terms of tools. And I think

9:56

you know this, but it's no small feat that

9:59

not only do we have... have vaccines

10:01

and boosters that protect

10:03

folks. But we have testing

10:06

that is widely available and over

10:08

the counter, where folks can know

10:11

right away if

10:12

they're feeling under the weather. They

10:14

can test themselves right away and know if they have COVID

10:16

because, importantly, we have treatment

10:19

uphill that works and can

10:22

keep people out of the hospital,

10:24

which is wonderful, but you gotta use it quickly.

10:27

So

10:27

we are smarter than we were two

10:30

years ago, three years ago. We have

10:32

more tools than we've ever

10:34

had before, but we are living

10:36

with COVID, right? It is here to stay,

10:39

right? Similar to how we live with flu,

10:41

we are now living with COVID. And

10:44

so we're gonna see ups and downs in

10:46

this, and it means that we're gonna have to dial up

10:49

at different periods of time. Our

10:52

tools, right, that we have, and we'll have to bring

10:54

them to bear in different ways at

10:56

different times. So what we're seeing right now in

10:58

August of 2023 are small

11:00

increases

11:02

in folks getting COVID. We're

11:05

still at some of the lowest hospitalizations

11:08

that we've been at

11:09

in the past three years. So even

11:12

a 10% increase on a very,

11:14

very small number is very small. And

11:16

that's good news. So these are small increases

11:19

on a small number. So overall,

11:22

my level of concern continues

11:25

to be low.

11:26

But just like you were saying, Andy, I

11:28

think all of us now are getting to a place where

11:30

I will say in the last month, there are

11:32

folks in my own family

11:35

that have had COVID in the last month.

11:37

My aunt and uncle who live in Florida got

11:40

COVID in the last month. So

11:42

it's circulating, it is still there. Luckily,

11:44

they were vaccinated. They also both got

11:47

tested right away and they both got Paxilovid

11:49

right away. So even though they are both

11:51

over 75, they did well. And

11:56

that's the top line here is they did well

11:58

as others.

11:59

can if they use the tools we now

12:02

have to protect ourselves. Yeah,

12:05

I think I counted as well, like just like you, I

12:07

think there's two coworkers

12:10

and four friends of friends

12:13

have COVID, all of them have

12:15

been vaccinated,

12:17

all of them feeling kind of yucky,

12:19

none of them anywhere close to feeling

12:22

like anything worse is going to happen. And

12:25

that does feel like a difference.

12:27

It's interesting, you know, you talk about how

12:29

this is with us now and will be with us. Influenza,

12:33

we're used to seeing in the winter.

12:36

And so is, should it

12:38

be surprising to us or should we expect

12:41

that we will be seeing occasional

12:44

summer and spring waves

12:47

maybe driven by air conditioning

12:49

and people going indoors or what

12:52

can we sense just in terms of

12:55

building our own expectations? If

12:58

we look at the last three years,

13:01

we still do see a seasonality

13:04

to the virus, meaning it is still,

13:06

we

13:07

are seeing this virus spread more

13:10

in the fall and winter

13:12

months and spread less in

13:15

the spring and summer months. That doesn't

13:17

mean that it's not still circulating

13:20

in those other months. And

13:22

that's exactly what we're seeing here in the summer

13:25

is that we are seeing this virus

13:27

circulate and there are

13:29

a number of reasons why we may be seeing an uptick

13:31

now. And again, this is where science

13:33

is continually evolving and we are learning

13:36

about this

13:37

virus. The virus, you know, yes,

13:39

I think you were mentioning one, which is it's

13:42

not surprising that we saw this virus go up

13:44

first in places where folks are indoors in

13:46

the air conditioning, right? So

13:49

we also know folks are doing more

13:51

travel. We also are watching

13:54

the changes in the virus itself.

13:56

So we're watching the new variants of

13:58

the virus. And so, seeing how they spread.

14:01

Luckily, right now what we're seeing with

14:03

the changes in the viruses, they're still

14:06

susceptible to our vaccines, they're still

14:08

susceptible to our medicines, they're still

14:10

picked up by the tests. So all

14:12

of our tools still work as

14:15

the virus changes, but we're gonna have to keep watching

14:17

it.

14:18

So we're not seeing some new four

14:20

letter,

14:21

you

14:23

know, thing XBBWZYMCA

14:26

thing. We're

14:29

seeing the same thing, relatively

14:31

speaking, occurring again, not

14:34

a broad difference in invariance.

14:36

We're seeing small changes that are, that

14:38

I would call subtypes of what we've seen

14:41

before. So nothing yet

14:43

that we are jumping on and

14:45

saying that there is a shift

14:47

here. So we're sort of in the

14:50

same place, but that's today.

14:52

And I want folks to understand that's

14:54

why we are vigilant. That's why we are looking

14:57

for new changes

14:59

to this virus. And that while

15:02

we have a lot of tools that work right

15:04

now today, we need to keep

15:07

evaluating as this virus changes,

15:09

are those tools still working the way

15:11

we want them to work? And new things

15:14

could crop up. So we're gonna keep

15:16

vigilant and keep making sure we're

15:18

watching really closely.

15:19

So remind us what we're supposed to do when

15:22

cases go up in our community.

15:25

I've been on an airplane a bunch recently.

15:27

I don't think I saw anybody wearing a mask. I've

15:30

been in grocery stores. I don't think

15:32

people are wearing masks. I think in general,

15:35

there may be parts of the country where that's not

15:37

as true, but I think in general, we're

15:40

sort of back pretty close to

15:42

pre-pandemic levels.

15:45

Are there things that

15:47

we should be thinking about? Let's say you're

15:49

somebody who's at risk, a

15:51

little older, maybe have some reasons

15:53

to wanna be concerned because you were someone in

15:55

your family. Just remind us

15:57

what

15:58

we're supposed to be thinking.

15:59

about if cases start to move up?

16:02

Well, I think embedded in your question is

16:04

exactly the first thing folks need to think about

16:06

is their own risk. What

16:09

is your age? Do you have underlying

16:11

medical conditions? Do you live

16:13

with someone who is immunocompromised

16:16

or going through cancer treatment? Are you going

16:18

to see someone who is elderly

16:20

and visiting them, right? So you may want to think

16:23

about both yourself

16:25

as well as who's around you in terms of risk

16:27

and then change what you do depending on

16:29

that. So there's a number of things that folks can

16:32

do. And I will tell you, you know, members

16:34

of my

16:35

family and friends, those who are older

16:37

or have underlying conditions, they

16:40

do wear masks in more

16:42

crowded indoor settings like being

16:45

on an airplane or in an airport. But

16:47

it doesn't keep them from living their lives. But

16:50

they take a little bit of additional precaution.

16:53

But I would also say, for example, if

16:55

you are going to, you know, you're taking the kids

16:58

to see the grandparents, you

17:00

know, and one of the kids has a

17:03

little something, you know,

17:05

you can whip out one of the rapid COVID tests.

17:07

And so you can there's another level

17:09

of protection that you can provide

17:12

there by testing yourself.

17:13

As an expert, speaking as an expert, don't kids

17:16

always have a little something? Exactly. They

17:18

always have a little something. So if you want to just be sure, right? A

17:21

little, little quick rapid test,

17:23

you know, 15 minutes later and you can feel,

17:26

you know, is this a common cold or

17:28

is this something COVID that I could bring to someone

17:31

who has a more weakened immune system or

17:33

is at more risk? So again, whether it's

17:35

masks or tests or making sure you're

17:38

getting to rapid treatment, we have more

17:40

ability. And don't forget washing hands. I think we

17:42

skip right past that. I'm a big hand

17:44

washer. Please carry around your hand sanitizer.

17:47

All

17:47

of these things are layers of protection

17:49

that we should be doing, you know,

17:52

and again, assessing our own risk as

17:55

we move through our day.

17:57

So let's talk about

17:59

the other side.

17:59

other question people have in their mind which is vaccine. I

18:03

think most people are aware that there's a

18:06

new formulation of the vaccine

18:08

that's due to come out sometime in the fall.

18:12

I think the questions that I get are, oh,

18:15

new rise of COVID cases,

18:17

should I be waiting for that vaccine?

18:20

Should I be getting that vaccine? When is it going

18:22

to be available? And

18:25

what can you tell us? And recognizing you

18:27

may need to tell us that we're not finalized

18:29

on all the approvals yet, but what

18:32

could people expect? Yeah. So

18:34

the short version is while we are not finalized

18:37

on all their approvals yet, so FDA

18:39

still needs to do its final

18:41

work with the manufacturers as

18:44

well as the CDC do its final

18:47

job to make sure we are making

18:49

full recommendations on who should

18:51

get those COVID shots.

18:54

What I would say is that we anticipate

18:57

that they are going to be available for

18:59

most folks by the third

19:02

or fourth week of September. So

19:05

in the near term. So there's work

19:07

being done now. We think by the end of September,

19:10

they'll be available, but there's

19:12

some work to do. And again,

19:14

we got to make sure we hit all of the

19:16

right marks for it to be available. What

19:19

we are anticipating right

19:22

now as we look at the data and

19:25

we see how the virus is changing, we

19:27

see how immunity changes

19:29

over the course of the year, similar

19:32

to flu shots, right, which we get

19:34

every year annually. We

19:37

are likely to see this be,

19:39

and again, I don't want to get ahead of the scientists

19:42

that are going to do their work in the next few weeks,

19:45

but we are likely to see

19:47

this as a recommendation as an annual

19:50

COVID shot, just like we have an annual

19:52

flu shot. And I think that will

19:55

give more folks clarity about

19:57

should they get one or not, because the answer is like,

19:59

well,

19:59

did you get one this year? If not, go get

20:02

the new COVID shot,

20:05

assuming all of that. Again,

20:07

we're waiting for the FDA to do its work.

20:10

We're waiting for CDC's experts

20:12

to do its work in terms

20:14

of recommendations, but likely

20:16

where we are headed so folks can start to think

20:19

about it, is that this will

20:21

be an annual vaccine

20:24

and, again, to make sure

20:26

that you stay protected.

20:28

So basically, four to five to six

20:30

weeks from now, the shot should start

20:32

to become available. And so for

20:34

people who are looking at the case

20:36

count and saying, should I

20:39

wait for the new vaccine?

20:41

Is that what we basically,

20:44

how people should think about it?

20:45

So again, I think this goes back to assessing

20:48

your own risk. So if you are someone

20:51

who is over 65, or

20:53

has multiple underlying chronic conditions,

20:56

and you are overdue, meaning

20:58

it's been more than six to eight months since

21:01

your last booster, you

21:03

may want to think about talking with your doctor about

21:05

getting a booster now with

21:07

the current booster. If you

21:09

don't fall in that category, meaning that you're

21:12

under 65, you don't have multiple

21:14

chronic conditions,

21:15

there is going to be a new booster

21:18

available that is, again, more tailored to some

21:20

of the changes we were seeing in the virus.

21:23

So you may fall in that

21:25

category of waiting on

21:27

the next eight weeks until

21:29

a new booster is ready. If

21:32

you have questions about

21:33

what category you fall in, talk to your doctor,

21:36

talk to your nurse practitioner about this.

21:39

So sometimes it might be right to get protected

21:42

sooner with one of the COVID

21:44

shots that's available now. Sometimes it

21:47

might be right to wait, depending

21:49

on what group you fall into.

21:51

That's very clear, actually. And it sounds

21:53

like good news. And

21:56

to me, anything that

21:58

accommodates a routine.

21:59

for people as

22:01

far as we know is

22:03

helpful. Andy, the other thing I

22:05

think is good about this is it

22:07

is a best practice to get both of these

22:09

vaccines, flu and COVID shots

22:11

at the same time. So if

22:13

you're thinking about making your appointment for your flu

22:16

shot and you're doing that,

22:18

you know, first week of October, make sure

22:20

you're making it for both your flu and your

22:22

COVID booster, assuming that is where all

22:24

the recommendations come out. But again, this is

22:27

more me just getting you to start to think

22:29

about it, know that there's still a few steps

22:31

that are required from the FDA and the CDC,

22:34

but that is likely where we are headed.

22:37

All right, let's take a quick break and come back

22:40

and let's delve in a little more

22:42

to our new CDC director and

22:44

what brought her where she is today. We'll be right back.

22:46

In summer, I feel like my calendar

22:52

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Okay, we're back. So as

25:52

you can tell, my voice is a little scratchy. So

25:54

I did a COVID test. Thankfully

25:56

negative. I'm feeling fine, but

25:59

you know what? I think it's

26:02

just sort of part of what you're saying. It's sort of part of the training

26:05

that, you know, you start feeling a little

26:07

under the weather, we've got a test lying

26:09

around, you take it because you

26:11

want to protect the people around you and you

26:13

just want to know and you kind of don't

26:16

know. But all good, all good.

26:19

And so I want to get a little bit back to

26:22

where we started the conversation. Dr.

26:24

Cohn, it's so unnatural for me to have to call

26:26

you Dr. Cohn. Call me Mandy. Call you

26:29

Mandy. Call you commissioner,

26:32

director. Guess what

26:34

I want to ask you is,

26:36

because it's the one thing I don't know about you, is

26:38

what kind of kid were you?

26:40

Were you sure of yourself? Were you an idealistic

26:42

kid? Were you trying to make your parents

26:45

happy? Were you creative? What

26:47

were you all about?

26:48

I was a combination

26:51

of, I think, a pretty confident

26:53

kid.

26:55

Who doesn't want to make their parents

26:57

happy? My parents are so wonderful. So of course, I

26:59

want to make them happy. Oh,

27:01

I love that. And my mom just retired, was

27:05

a nurse practitioner in an emergency room. My

27:07

dad was a middle school guidance

27:09

counselor. Like they are folks who

27:11

went into service careers and

27:13

very much instilled that in us. But

27:18

they also instilled in us a bit of fix the system. It

27:21

wasn't just serve, but it was a little

27:23

bit of serve, but we

27:25

always had the mentality of

27:27

thinking about how can we make

27:30

the system around us work better? And

27:32

it's interesting that my mom ended

27:34

up working in an emergency room, because actually

27:36

an emergency room is often when you

27:38

see all the broken parts of the system show

27:40

up in the emergency room. But she would talk to

27:42

us about that all the time to say like, ugh, imagine

27:45

if we could get ahead of this. Then we wouldn't

27:47

see folks be

27:49

in this circumstance in the emergency room. And

27:52

that definitely influenced my, my

27:54

thinking of like,

27:55

how do we shape a system, frankly,

27:57

that works for everyone?

27:59

And so that was very much part of what

28:02

my parents instilled in me, but I

28:04

was a confident kid who

28:06

liked to talk to adults.

28:07

I'm fascinated by this idea

28:10

of not just setting an example for

28:12

you or teaching you about service, but

28:15

almost this sort of engineering element

28:17

to it. Like, no,

28:19

don't just go into service, but

28:22

go into fixing the

28:23

problem systematically. Like,

28:26

that seems like an incredibly unusual

28:30

kind of thing for a parent

28:33

back when you were a kid, back when I was a

28:35

kid, to even think about.

28:38

Because it's more specific than

28:40

change the world. It's like, prevent all

28:42

these people from showing up in my emergency room

28:45

by going upstream.

28:47

Did you grasp that thought

28:50

as a kid, and did that grab hold of you

28:52

and guide you in some way?

28:54

Well, it's certainly the

28:56

fact that they let me think

28:59

big and said that you could do

29:01

anything and sort of instilled in me that

29:04

we want to build a world

29:07

that works for everyone was

29:10

very much an undercurrent of everything

29:12

that we did. And being curious

29:14

about why things wouldn't work

29:17

so that we can get behind it and think about

29:19

how to fix it. I'll

29:21

share one more story about my mom. I

29:25

also saw her as an advocate

29:27

as well. So my mom is

29:30

a nurse practitioner, and she was

29:32

in one of the very, very early

29:34

classes of being a nurse practitioner in New York

29:37

before

29:37

there was even a

29:39

term nurse practitioner. So they

29:42

were doing graduate-level training for nurses,

29:44

and they didn't even have a term for it yet. So she

29:46

had this training and actually would

29:48

go to Albany, New York, the capital

29:51

of New York, to talk

29:53

to lawmakers and decision-makers about

29:56

what she was seeing and the work that she did

29:58

and the skills that she had.

29:59

and was a pioneer really in

30:02

creating the profession

30:04

of nurse practitioners

30:07

as well as the sort of the structure and scope

30:09

of practice that now exists. So I

30:12

watched her not just be

30:15

a woman who was, you know, working

30:17

and had a career, but

30:19

paving the way and pioneering to say like, you

30:22

know, things can be different. And there's a cadre

30:24

of folks who can fill an important role,

30:26

particularly in primary care and being

30:28

an additional clinician

30:31

on the team. So I

30:34

think I definitely picked up a lot of that

30:36

from her.

30:38

What was the conversation like when you said, mom,

30:41

I'm going to be the new director of the CDC?

30:46

She was so proud. There were tears

30:48

and pride because she knew

30:50

that I would be able

30:53

to join an agency,

30:55

like I said, with an incredible mission. And,

30:57

you know, I've had

30:59

incredible experiences through some hard

31:02

times. And she knows that

31:05

I very much am a listener. I try

31:07

to listen to a lot of folks and find

31:09

the place where there's common ground and to move

31:11

folks forward and just

31:14

to be thoughtful and pragmatic. And so she

31:16

was, you know, she would say, I

31:18

feel better knowing that you're at the

31:21

helm of CDC. That's what she said.

31:23

Imagine what that feels like as a parent who

31:25

is a bit of a pioneer in her own right and

31:28

who, along with your dad, believed

31:31

the things that they believed about what they wanted you to do in life

31:33

to see that actually happen, which is like

31:36

a one in a million thing. Well, that's a perfect

31:38

note for us to come back after this final break

31:40

and talk about, which is

31:42

how we should all be thinking about the CDC,

31:45

what you want to see happen, what to expect from it, what you

31:47

inherited. We'll be right back with Mandy Cohen.

31:50

I'm Shankar Vidya.

31:58

Danthem, host

32:00

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33:10

So I think the

33:13

way that I want to frame up this

33:15

conversation is, why

33:18

should people listen to what the

33:20

CDC has to say versus,

33:25

you know, their own doctor, what they read

33:27

on the internet, whoever they

33:29

choose to believe? And I'll

33:31

give you a little bit of context. And it doesn't entirely

33:34

have to do with just the CDC.

33:36

Its trust in institutions are

33:39

really eroding. The Justice

33:41

Department is attacked every day. Every

33:44

day. The CDC has been

33:46

attacked. And look, I'm not saying

33:49

for a second that these institutions can't

33:51

improve, but the very fabric

33:54

of the institution itself, the very nature

33:57

of being either

33:58

a government funded or...

33:59

or some other important institution

34:02

in our country is undermined.

34:04

I think there's trust in the Supreme Court is lower. You

34:07

know, it's coming from all

34:09

kinds of places, some of which are

34:12

obvious, but I don't wanna make this

34:15

political question, but that

34:17

is a place that CDC finds itself in as

34:22

does a lot of society. So

34:26

help us rise above

34:28

that a little bit and understand what

34:31

the job of the agency is and

34:33

why people should put

34:36

their confidence in it. Yeah, so

34:39

CDC, I think is an incredibly

34:42

important tool for the United

34:44

States to protect its health. And what I mean

34:46

by that is that we have to

34:49

be, in order for us to stay

34:51

safe as a country, we

34:53

need to be identifying threats.

34:56

Threats here at home, threats

34:58

abroad to prevent those threats

35:01

from then coming here. And

35:03

what the CDC is able to do is both amass

35:06

data as well as

35:08

monitor a lot

35:09

of different ways to understand

35:12

what's happening out in the world and pick up

35:14

concerns and make sure

35:16

that we respond to them before

35:20

they become a problem. And

35:22

that's the whole reason

35:24

why we need to make sure that folks

35:27

understand that the CDC

35:29

is able to identify those threats,

35:31

bring the best science and scientists

35:34

together to understand

35:36

that problem and then respond quickly

35:39

so that threat doesn't become larger

35:42

than if we couldn't identify it early.

35:44

So we need to be investing

35:47

behind the CDC in order to have

35:49

that asset for us to be strong. I think

35:51

we all know, right, as

35:53

we went through COVID, that

35:56

COVID impacted us more as a country

35:58

than others because we went into it.

35:59

to the pandemic sicker, right?

36:02

COVID impacts people who have more

36:04

chronic diseases, right? Here in the

36:06

United States, we have more chronic diseases than

36:08

other countries like at baseline. And

36:11

so if we are sicker as a country,

36:13

and then we have a threat put on top

36:15

of us, we're not going to do as well.

36:17

I really, by the way, like very

36:20

much

36:21

this context of protecting

36:24

our security,

36:25

because I think it's something we all relate to.

36:28

And, you know, in a way, it feels

36:30

like a bit of the need for

36:33

a rebranding, in a sense, because

36:35

maybe for a long time, we didn't know

36:37

what the CDC was, maybe we'd vaguely heard

36:40

of it. Then we heard of it. And

36:42

everybody has reason to be critical,

36:44

because CDC was in a limelight. And some of it

36:47

is, some of it is well earned criticism,

36:49

some of it is not well earned criticism.

36:52

And some of it is just, we went through something

36:54

bad and CDC was the people around. And

36:57

so it didn't feel good to people. But

36:59

but for whatever reason, and

37:01

I think a lot of it also having to do with people's general

37:03

attitude towards institutions. Now,

37:06

for before rebranding to occur,

37:09

really occur, as opposed to just being, you know,

37:11

something that the ad council puts out, you

37:14

know, presumably there's a sense

37:14

that something there's work going on inside.

37:17

And I think this is what people are probably curious about

37:21

is, do people in the CDC behind

37:23

closed doors,

37:24

have the ability to say, we can

37:27

learn and improve and get better and be

37:29

committed to this mission? Or

37:32

to a lot of people, they

37:35

felt public health officials look like they were on the

37:37

defensive, trying to defend what they already

37:39

said and why they said it. You come in

37:41

with with a fresh set of eyes.

37:43

I

37:44

know you while you're looking at every bit of data

37:46

talking to every single individual is

37:49

your sense that those are the ingredients

37:52

that you're seeing in order to

37:56

have the agency move to where you want it

37:58

to move to. If we

37:59

get where you want to move

37:59

to move to where you think

38:01

it needs to be for the country.

38:03

Yeah, we're again, in order to be that

38:05

national security asset that I think it, that

38:08

our country deserves, I do think that the

38:10

CDC has some work

38:13

to do to improve. Some of that is

38:16

in its own way of how

38:18

it collaborates internally, even on things

38:21

like data, right? So in order

38:23

for us to identify threats, we all have

38:25

to be even internally here at CDC,

38:27

making sure that we are sharing

38:29

good information across the way

38:32

so that if one team is identifying someone and

38:34

then there's an expert on a different

38:36

part of the agency that we can all work together.

38:39

So there's a collaborative, there needs to

38:41

be more collaboration with, even

38:44

within CDC. And then we need to collaborate

38:47

with our external partners, right? Because we

38:50

are only as good as the collaboration

38:52

that we can have with

38:54

our healthcare system, our public

38:56

health partners, even with the business community

38:59

or schools, right? These are all critical

39:01

partners. So collaboration is certainly one

39:03

that, you know, and that's a muscle. That's not

39:05

something you just say, you have to do, you

39:08

have to build that, you have to build processes

39:10

and systems that allow for collaboration.

39:12

So you're going to see us focus

39:14

on that. A lot of that will be, some of that is data

39:17

pipes and data systems to make sure we can

39:19

have visibility and transparency. The

39:22

other part of that is in communication, right?

39:24

I think definitely folks have said, how

39:26

can we simplify

39:28

what we are doing and how we communicate?

39:31

CDC has to look at a lot of

39:33

threats, but they're all not

39:35

the same level of risk, right?

39:37

There are a lot of threats out there. Some are very,

39:40

very tiny threats that could be a big thing.

39:42

Some are very big threats, but don't really

39:44

impact you that much. So, right, how do we talk

39:47

about those different, the different nature of those?

39:49

So we have to communicate in a simple and clear

39:51

way. So we're giving folks common sense

39:54

solutions to protect themselves. Just

39:56

like we were talking about COVID, right? We want folks

39:58

to have common sense solutions together.

39:59

get vaccinated, get tested,

40:02

get treatment over and over,

40:04

wash your hands. Like those kinds of things, like how

40:06

can we do that for each and every

40:08

type of risk that we might see out there?

40:11

But importantly, we can't just go for

40:14

threats. Threats is one part

40:16

of the work and CDC has to get better and be

40:18

more collaborative and more transparent

40:21

and better communicator to do

40:23

that work. But then we also have to get upstream.

40:26

We have to get upstream and prevent

40:29

things before they become problems. We

40:31

can respond to problems and that's fine, but

40:34

we always know it's more expensive to respond

40:36

in a crisis than to prevent that

40:38

crisis from happening. And so like that's

40:41

the work also of the CDC. So

40:43

for example, you're gonna see us focus

40:46

in three areas. One is in responding to

40:48

the threat, right? The threat of COVID

40:50

flu and RSV this fall and winter,

40:52

you're gonna see us spend a lot of time on that threat

40:54

that is right there and us responding well to it.

40:57

But then we need to get to some of the underlying

40:59

issues that drive us. And

41:02

those two other areas that you'll see

41:05

us focus on, one is in the

41:07

mental health and opioid space and

41:09

making sure that we are tending to

41:12

and bringing to bear all of the research

41:15

and data and best practices about how

41:17

we think about mental health, but not just about

41:19

treating mental health, but preventing. Like

41:21

how do we prevent suicides? How

41:24

do we make sure to use all the data

41:26

that we can to prevent opioid overdoses?

41:30

We know how to do that, but how do we execute

41:32

on it? So that's one bucket of work. And

41:34

then the last area of focus is

41:36

really one to focus on young

41:39

families. I think we can

41:42

be the healthiest country in the

41:44

world. We are not that right now, but

41:46

we could. We could do

41:48

that, but we have to start when

41:51

our kids and families

41:54

are starting out because it's when our brains are

41:56

developing. It's when kids are establishing

41:58

their lifelong eating. and health patterns.

42:01

It's where we establish so much

42:03

of what will happen to you as an adult

42:05

over your lifetime is happening to

42:07

you as a kiddo. And so how do we support

42:10

our young families so that we can be

42:12

that healthiest country in the

42:14

world in the future? That's

42:16

gonna take investment right now. And we have a lot

42:18

of tools here at the CDC to bring to bear for

42:20

that. But those are gonna be the areas that

42:24

we wanna focus. Again, all in service of being

42:26

that national security asset. How do we

42:28

identify those threats? But

42:30

then how do we make ourselves the healthiest country we possibly

42:33

can be so we can be competitive

42:35

so that we can fight off threats even

42:38

more easily?

42:39

Well, that's a really interesting vision. And it's

42:41

particularly interesting on

42:43

the backs of a scare, right? Because

42:47

maybe that creates a teachable opportunity.

42:51

And I know we're dealing with kind of political

42:53

reactions and so on. But

42:55

I do think that you're

42:57

right, that we shouldn't lose sight of the fact

43:00

that

43:01

until we

43:02

set the goal of basically being

43:05

better taking care of one another, that

43:07

you don't get there. I was also reflecting, Mandy,

43:10

on something you said, which is

43:12

that you wanna go upstream and focus

43:14

on prevention. It's hard

43:16

to get credit for the story that

43:19

doesn't ever break, right? It's

43:21

hard to get credit for preventing

43:23

something that didn't happen. But

43:25

there were a few kind of

43:28

things that could have happened this year after

43:31

COVID on the infectious

43:33

disease front. And you

43:35

get a chance to see the agency perform.

43:39

Tell us about those things and what it tells us about

43:41

what we don't know about what the agency

43:43

is actually getting done.

43:44

Right, so the story

43:47

of public health is that you don't

43:50

hear about it when it's working, which is great. But

43:52

that also makes it hard for folks to understand

43:55

why it's such an important investment and

43:57

such a security asset. Let me tell you about one story.

44:00

You may have heard that there were a few cases

44:02

this year of domestically

44:05

acquired malaria. They were

44:08

the first nine cases

44:10

that we'd seen in 20 years. So we

44:12

haven't seen domestic malaria in 20

44:14

years. This year, we saw nine

44:16

cases, seven of them in Florida, two in

44:19

Texas. And I was so

44:21

impressed with the team here at

44:23

the CDC that really jumped

44:26

on this issue. Now,

44:28

CDC deals with malaria in other countries. That's

44:31

again, where we are working abroad

44:34

to prevent a threat from coming

44:36

here. And so all the work we do in other

44:38

countries to prevent malaria is

44:40

why we don't have malaria here.

44:42

We need to continue that work abroad, but we

44:44

have that expertise because we work abroad.

44:47

We brought it to bear here in Florida and

44:50

Texas. So to support the

44:52

state in everything that they were doing. And they did

44:55

very good work here. But we were

44:57

able to offer support to

44:59

the clinicians in the area to make sure they

45:01

could identify malaria. Like malaria is

45:03

not common, which is a good thing here, but

45:06

we need to then help clinicians know

45:08

how to identify and test. We were able

45:10

to offer lab capacity and testing.

45:14

There is treat, we made sure treatment was gonna

45:16

be available. And again, we

45:18

have tools that we can

45:20

utilize. We know how

45:22

to get rid of the

45:25

mosquitoes that transmit malaria.

45:27

So we brought all those tools to bear. And now we're

45:29

not out of the window yet, but

45:32

the good news is, is it's been four

45:34

to five weeks now and we have not seen

45:37

another case.

45:39

It so illustrates the point, because

45:41

I bet most of us listening, weren't

45:44

even aware, didn't focus on it.

45:46

And I think it is that

45:49

expectation that people

45:51

are responding to security threats that hopefully

45:54

you never need to learn about.

45:55

And I'd say, don't, we are worrying for

45:57

you, right? That's why you want us there.

45:59

You want the CDC there to be the warrior,

46:02

the detector, the

46:05

responder for you, so that you

46:07

know that you can be protected. And that's

46:09

what, but we have work to do across the board to make sure

46:11

we're doing that over and over and over and executing.

46:13

But just like investing in our

46:16

national defense takes

46:18

resources, it takes resources to do

46:21

that kind of vigilance

46:23

where we can detect and respond to threats.

46:26

So we need to make sure folks understand it and we're going

46:29

to have to get better at telling stories like, hey, we've

46:31

been preventing domestically

46:34

acquired malaria here. That's what

46:36

you get when you invest in public health.

46:38

Right, it's sort of like, hey,

46:41

Senator, hey, Congressman, how about that big malaria

46:43

problem? You're not aware of it? Well, guess why?

46:46

Guess what? Guess why? And by the way, Monkeypox

46:49

was something which could have been much more devastating and

46:52

it took a lot of quick work. And then when it goes away,

46:54

we all go, it went away. Of course it went

46:56

away. Well,

46:58

I just gotta say it doesn't sound, of course, there's

47:01

somebody on the other end doing a lot of work, a

47:03

lot of work. So I

47:05

want you to invite you to come

47:07

back in the fall when you've

47:10

done

47:10

kind of your kind of thorough

47:13

review kind of where we are. It may be what kind

47:15

of advice we have for people going into the fall and the

47:18

winter on COVID or anything else. And

47:22

at the really, I think a really refreshing

47:26

perspective, that you brought,

47:28

I

47:29

guess maybe if I had one more

47:31

question, and it's a challenging question, I don't know that there's

47:33

an answer to it. But

47:36

you had me thinking when you were talking about the career

47:38

professionals. And it

47:40

feels like

47:42

there are maybe two different views in

47:44

this country.

47:46

One view which says

47:48

we really do

47:51

trust, rely on, and believe in investing

47:53

in the resources that are protecting us.

47:55

And another view

47:57

which wants to make

47:59

science

48:00

and the CDC and the FDA and everything else

48:03

with it, kind of a scapegoat

48:05

and a punching bag.

48:07

And it cannot but feel like the

48:09

upcoming 12 months are gonna be an election

48:11

cycle filled with pretty opposing

48:14

views.

48:15

You know, I won't say anything, put words in Ron DeSantis'

48:17

mouth or Donald Trump's mouth, but they've

48:19

got a very different perspective. Part

48:23

of your, I think, track record is

48:25

going into a place like North Carolina, which has

48:28

very different political views, and saying,

48:30

hey, wait a minute, there's some fundamental

48:33

connection points for all of us here. Don't

48:36

just think about this in terms of politics. You

48:39

know, for people who don't know, you

48:41

were named the Tar Heel of the Year. You

48:43

were one person who had 100% of Republicans supporting

48:46

you in your role during COVID,

48:48

where everybody had all kinds of opinions

48:51

on all sides. You got a lot of credit

48:54

from all sides of the aisle for listening and

48:56

for managing decisions in

48:58

a way that people supported. So

49:02

what early wisdom might

49:04

you have about how to

49:06

create

49:07

some commonality among people who

49:09

really wanna make

49:11

public health into a more divisive issue than I think

49:14

it should be?

49:15

Well, maybe if public

49:17

health is divisive, health

49:19

is not. I think everyone

49:22

that I have talked to on every side

49:24

of any aisle wants themselves,

49:27

their families, and their communities to be healthy.

49:31

They want the tools to be able

49:33

to keep themselves and their family

49:35

healthy, and that's the consensus point.

49:38

And so I'm gonna start from there to say, look,

49:40

we have a range of tools to

49:43

protect you, to keep you healthy. And

49:46

again, our intent is to do

49:48

just that, is to make sure that

49:49

you can live a full

49:52

and prosperous life and

49:55

we want to be your partners in

49:57

keeping you healthy. And try to walk.

50:00

And not to sort

50:02

of relive the last number of years

50:04

of divisive issues, but really to focus

50:06

on those places of consensus. How do

50:09

we build places of health

50:11

for everyone? So that's

50:13

where I start from, and it's not surprising why

50:15

the three areas of focus are also

50:18

places where I see consensus. I think everyone

50:20

wants to make sure that we don't overrun

50:22

our hospitals this fall and winter. We

50:24

want our hospitals to be there if you get in a car accident

50:27

or have a heart attack. We don't want them to be overrun

50:29

with COVID or flu or RSV

50:31

patients. We want, particularly because we have

50:33

all these tools to keep you out of the hospital. So

50:36

that's number one. I see a lot of consensus

50:38

on using all the tools we have to keep

50:40

people healthy and

50:42

protected this winter. Second, I

50:45

hear a lot of consensus on knowing that

50:47

mental health is an issue. We're

50:49

seeing more, unfortunately, more suicides,

50:52

more opioid use, but we have

50:54

tools that we can bring to bear to do that.

50:56

We have ways of getting upstream from

50:59

that. And then I also see consensus

51:01

around helping young families to be

51:03

successful. Many

51:05

of us can think back to those moments

51:07

when we were young parents and

51:10

wanting and needing support in

51:12

that moment. And so I think that there's a

51:14

lot of work we can do in consensus

51:17

build there. So it's not surprising that I chose

51:19

those places because I believe

51:21

that there is consensus around

51:23

health on both sides of the aisle,

51:26

whether that's urban or rural. And so that's

51:28

what we're gonna focus on again and show

51:30

folks that we can be a trusted

51:33

partner for common sense solutions to

51:35

protect your health. That's what we're gonna show

51:37

folks, but we have to do that transparently. We have

51:39

to do that with simple communication. And we have to do that

51:41

with great performance to meet folks

51:43

where they are.

51:45

Well, Mandy, thank you so

51:48

much for spending some time on

51:51

talking this through with me and

51:53

us. Fascinating,

51:56

I think, to hear what is happening.

51:59

really kind of clear grip on what

52:02

you want to have happen

52:04

and I think a clear understanding

52:06

of how

52:07

we should be thinking about what the CDC

52:10

brings to us in a way that's really relevant

52:13

to us and look

52:15

I think people from the outside think

52:17

these are plum jobs

52:20

because you're in the news and the media and stuff and I could

52:22

just tell you that there's way

52:24

more sacrifice

52:26

and way more hardship and

52:29

yes there's psychic pay and I think everyone

52:32

who was you served in these kinds of roles

52:35

like hearing that person to do feels grateful

52:38

and comes out of it more patriotic

52:40

than they went in but

52:43

personally the sacrifice is enormous

52:46

and so

52:48

I'm really grateful that you're doing this

52:50

I've said before I think you're the best person in the country

52:52

to be in this chair right now and

52:55

so I'm glad we have the best person in the

52:57

country at least in my opinion

52:59

doing the job well thank you Andy

53:01

for the support your

53:03

ongoing support for the

53:06

work I'll just close by saying

53:08

you know protecting the health

53:11

of this country cannot happen

53:13

alone from the CDC it is a team sport

53:16

everyone needs to be involved whether you

53:19

sit in the business community or the medical community

53:21

or the media so I'm grateful for

53:24

that partnership across the board because like

53:27

I appreciate your support and saying that I'm a good

53:29

leader but I cannot do it alone I need everyone

53:31

support in in doing this for

53:34

for us to make sure that we are

53:36

successful so I'm grateful for the partnership

53:38

and again thanks for having me

53:40

on that is pretty much everything

53:42

your mother and father wanted

53:44

you to be when you were a kid what you just said thank

53:47

you systematic leader service I

53:49

love it I love it thank

53:52

you

53:52

thanks Andy always great to be in the bubble

54:00

Thank you, Mandy. Boy, do I have good news

54:02

for you.

54:11

That's right.

54:12

I do. Two episodes next

54:14

week.

54:15

In fact, we've got a number of great episodes coming

54:17

up and I'll tell you about them. Monday

54:20

we've got an episode, which is a follow-up to

54:22

our earlier episode on the housing crisis,

54:25

the lack of affordable housing. We've

54:27

got two wonderful experts

54:29

to talk specifically zeroing

54:32

in on California, which is becoming

54:34

a big, visible national issue. And

54:36

I think something we need to pay attention to because we have

54:38

really outsized homelessness challenges

54:41

in Los Angeles and San Francisco.

54:43

That would be Monday, Wednesday.

54:46

Sam B. I don't know

54:48

if you know Sam B. She is a comedian

54:52

from The Daily Show and her own special.

54:55

She is hilarious. It

54:57

will be even funnier than the housing episode. That's

55:00

a dead joke. And

55:02

beyond that, Representative Susan Del Bene

55:05

from Washington

55:06

talking about healthcare policy choices

55:09

and Dan Butner,

55:10

the man who introduced

55:13

us to the Blue Zones, will be

55:15

on the show. So, a little something for everybody,

55:18

or I like to think a little bit

55:20

of everything for all of us. Think

55:24

about that one for a while.

55:26

We'll talk to you Monday.

55:32

Thank you for listening in the bubble. If

55:35

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