Dr. Margaret Bourdeaux, Research Director of the Global Public Policy and Social Change Program, Harvard School of Medicine, joins J. Stephen Morrison for Episode 142. Her mentor Dr. Paul Farmer, who recently passed, inspired her with his exhortation to “do hard things together” even when the odds are against you. Her project, the Covid Academy, is developing a locally-informed model for standardized health security outbreak investigation and response. Though the United States is deeply divided politically, Dr. Bourdeaux believes the situation is not as dire as it seems. Common sense can win. “I don’t believe that Americans can’t see reason on this”.

Apoorva Mandavilli, a science and global health reporter at The New York Times, joins J. Stephen Morrison and H. Andrew Schwartz for this 141st episode. Apoorva unpacks the sudden spread of Monkeypox into Europe and now the United States, outside African states where it is endemic, and the challenges this poses to Americans and Europeans weary of Covid-19, as well as to Africans who fear gross inequities in access to vaccines and therapies, which are presently quite limited in supply.

Containment of rising numbers of cases will be through ring vaccination of close contacts, which is doable but requires effective communication which up to now has been wanting. Much transmission is through men having sex with men, which raises the complex specter of stigmatization and politicization. The virus, far less severe and transmissible than smallpox, is nonetheless dangerous for infants, pregnant women, persons living with HIV and others who are immunocompromised. Case counts in Europe top 1,000 (very low numbers thus far in the United States) and are often difficult to confirm because of the resemblance to chickenpox or other rashes. Cases in the United States are projected to rise steeply and be seen in every state over the coming weeks and months.

Dr. Jeffrey Gold, Chancellor of the University of Nebraska Medical Center (UNMC), joins J. Stephen Morrison for this 140th episode. How did UNMC evolve over the past decades to become such a lead national institution in advancing America’s health security, through its Global Center for Health Security? In 1997, UNMC created a public health lab with the state of Nebraska, followed by 2004-2005 with the establishment of one of the country’s first containment units, following the 9/11 anthrax attacks, capable of handling people exposed to high-risk pathogens. These life-saving capacities were put to dramatic use during Ebola 2014-2105, and during Covid-19 when UNMC repatriated patients from the Diamond Princess cruise ship and U.S. citizens evacuated from Wuhan. Proactive communications skills proved essential to winning public trust in Nebraska and beyond. Multiple partnerships with executive branch civilian and military institutions – and private sector health providers -- proved equally invaluable. What next? UNMC stands ready to improve the U.S. surge capacity for managing future pandemic shocks, but that will require expanded partnerships and long-term financing from the federal government, backed by bipartisan action in Congress.

In this 139th episode, Dr. Deborah Birx joins J. Stephen Morrison to discuss her new book, Silent Invasion. On that day, former President Trump responded to the book by, among other things, lamenting oddly that “Debbie Birx does not have a lot of dresses.” In her inside account, Deborah details the repeated failures both to acknowledge the power of silent transmission by fully vaccinated, asymptomatic infected individuals, and the need to keep a relentless focus on testing, masks and limiting the size of gatherings. The Trump administration’s catastrophic failures stemmed from the president himself and those around him, including their prevailing worries about the economy and the quest for reelection. Her journey to 44 states and 30 universities brought home the fragility of the rural health system in much of America and the need to engage far more closely with local communities. In the Biden administration, repeated stumbles in guidance and communications have weakened public trust and confidence.

In this episode, Andrew Schwartz and J. Stephen Morrison are joined by Victor Cha to discuss the Covid-19 outbreak in North Korea - which CSIS predicted back in March, the impact of the pandemic on the unvaccinated country, and the road ahead amidst ongoing health and food crises worsened by an extreme lockdown.

Yana Panfilova, a 24-year-old Ukrainian woman born with HIV, fled Kyiv shortly after Russia’s invasion and is currently based in Berlin with her mother, grandmother and cat. Eight years ago, she helped found Teenergizer, an organization supported by UNAIDS that seeks to end discrimination against youth in Ukraine living with HIV. Over time, its scope widened to include other youth groups and its services expanded into mental health counselling and sexual health training. Affiliates arose across Eastern Europe and Central Asia. In the face of Covid-19 and, most recently, the Russian invasion of Ukraine, Teenergizer greatly enlarged its network in Ukraine from 20 to over 120 counsellors.

Using her experience living with HIV, Panfilova has reached more than 5 million teens living with HIV and those facing other forms of discrimination, providing them with the support she wished she had as an adolescent.

Yasmeen Abutaleb, health policy reporter at The Washington Post, joins Steve Morrison and Andrew Schwartz for this 136th episode.

The Biden administration struggles on multiple fronts, from systemic dysfunction within agencies to increased polarization of virtually every measures to mitigate Covid-19. The administration wants to invest in a long-term vaccine strategy that protects against multiple variants in advance -- but lacks the resources. Omicron taught us: "You can't start buying stuff when the wave has started.” "The disinformation problem is so widespread" that "… everyone in the Biden administration is going to be distrusted by half of America." The US government has not staged a powerful Covid-19 messaging campaign on social media, and a national commission on the pandemic, with real bipartisan leadership, remains out of reach. Courts are exercising considerable sway over health security policy which require a careful political calculations. Would appealing federal Judge Mizell’s April 18 injunction against the national mask mandate on transport ultimately leave the CDC in a weakened position? Americans continue to experience the pandemic in vastly different ways, depending on socio-economic profile. Many who have protections through vaccines and treatments may feel they will be exempt from infection, yet they make up a significant share of those experiencing severe illness.

Dr. Dylan George is the Director of Operations for the Center for Forecasting and Outbreak Analytics (CFA), newly established at the Center for Disease Control and Prevention (CDC). Dr. George joins J. Stephen Morrison and Andrew Schwartz for this 135th episode following the April 19th White House CFA launch. Its mission: Predict, Inform, Innovate. Its data science team will strengthen advance warning of biological emergencies, with a heavy emphasis on improved communications. Building trust is a major challenge, including navigating privacy sensitivities. Sustained funding is essential, and an outstanding question. If successful, CFA will provide the tools people need to keep their families safe while improving decision-making at the local, state, and federal levels. Like extreme weather communications, CFA will make complex models accessible.

Dr. Larry Gostin is a professor of global health law and the faculty director of the O’Neill Institute for National and Global Health Law at Georgetown University. Dr. Gostin joins Steve Morrison and Andrew Schwartz for this 134th episode in the aftermath of the April 18 nationwide injunction to block government mask mandates on public transportation. In Judge Mizelle’s opinion, the C.D.C. has exceeded its legal authority. But if the C.D.C. doesn’t have the power to make someone do something as unintrusive as wearing a mask, what can it do? If this ruling stands, it changes the role of the government, and our regulatory institutions will lose the power to protect us. The C.D.C. has been in a weakened position since the Trump administration but is staffed by strong scientists who want to do their best for Americans. Dr. Gostin argues for a High-Level Commission to take a top-down and bottom-up review of the C.D.C. to determine what systems, data, scientists, funding CDC needs, and what powers are legitimate. He does have hope: the U.S. is approaching higher levels of immunity, and the darkest days of the pandemic may be behind us.

Dr. Yanzhong Huang is Professor at Seton Hall University's School of Diplomacy and International Relations, Senior Fellow for global health at the Council on Foreign Relations, and co-chair of the US-China Working Group of the CSIS Commission on Strengthening America’s Health Security.

He joined Steve Morrison in the our 133rd episode for a wide-ranging conversation: on China’s huge immunity gap; its “dynamic Zero-Covid approach;” the spread of BA-2 beyond Shanghai to 45 cities affecting 25% of China’s population and 40% of its GDP; the acute vulnerability of China’s elderly; and the supply chain disruptions and huge economic consequences experienced inside China and, increasingly, felt across the globe. Deaths are underreported, and popular discontent has risen, even while it remains doubtful that majority opinion has shifted against Zero-Covid.

While the Chinese government has made some modest adjustments to its fierce reliance on mass lockdowns, testing and quarantining, it has not fundamentally changed course. “Zero-Covid will continue.” Opposition is at the highest level -- at the Presidency itself: “the barrier is political.” It remains unclear when if ever the government will move to a mass campaign using a Western mRNA vaccine, a key step to creating immune protection and easing reliance on lockdowns. Successful development of a Chinese mRNA vaccine has thus far been elusive.