What’s Happening With Your COVID Booster? (with CDC Director Dr. Mandy Cohen)

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CDC Director Dr. Mandy Cohen sits down with Andy to answer your most pressing questions about this year’s new COVID booster. When will the new vaccine be available to everyone who wants it? How will it hold up against new variants like XBB.1.5, EG.5, and BA.2.86? When should I get vaccinated to best protect me and my loved ones this holiday season? Dr. Cohen answers all this and more. Plus, Andy asks Dr. Cohen about the DeSantis administration’s decision to advise against COVID shots for Florida residents under 65.

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Andy Slavitt, Dr. Mandy Cohen

Andy Slavitt  00:22

This is in the bubble with Andy Slavitt. Welcome to the show. I apologize if my voice sounds a little grating to you. Some would say sexy, but others would say a little bit under the weather. But I hope that it’s pleasant in your ears. So COVID cases are up. And that’s kind of familiar feeling. We all remember what that feels like. And in the past that has meant situation that has been unpredictable out of control. And we all remember how it brought life to a standstill. Is this different? Is this different? Well, my guest today is the brand new head of the CDC, Mandy Cohen. And she’s going to answer that question. And all of the advice that you want a lot with it, such as what should you do about it? What should we expect? We also have a new vaccine formulation coming out in a little over a month. I’m going to ask Mandy about that, and advice on whether and when you should be getting the new vaccine update and what it means. So that and more, I also want to take the opportunity to really introduce Mandy Cohen, to you and to the country. This is her first podcast interview her first in depth sit down. And she’s a pretty remarkable person. And I think it will be useful to get to know her and how she looks at coming into a role like this at a moment like this. You know, it is a beleaguered agency. But so are almost all of our institutions, the FBI, the FDA, our justice system, our Supreme Court, you know, we have real doubts and question marks around the things that used to be really solid parts of our society. So how do you take over the CDC at a time like that? We’ll talk to Mandy about that. Now, as you will hear, Mandy and I kind of got back together, we used to work together. So you will notice that in the conversation, but beware. Let me just tell you a little bit about Mandy Cohen. She is a Yale educated, Harvard practice physician, public health professional. She was most recently the health secretary for the state of North Carolina, where she got great marks for how she handled COVID and pretty much everything else. And she also worked at the Centers for Medicare and Medicaid Services with me in my tenure there, we had a great go of it. And she’s done a number of other things. All in all, I don’t think you can find someone who’s more qualified, both from a resume standpoint and temperamentally to lead an agency at a moment like this. So enough of my voice, and what you’d hear from her and get some of these important questions answered.

Andy Slavitt  05:26

Well, we just got through reading my like very, very flowery introduction to your biography and who you are, and a little bit about our relationship. So I’m sure that everybody is wondering like, Okay, why would a great, smart, kind, decent person want to take a job that basically everybody in the country thinks they’ve got an opinion and how it should be done, but only one person actually has to do it?

Dr. Mandy Cohen  05:58

Well, first, Andy, it’s wonderful to be in the bubble. I’m excited that you invited me in today, I listened to the podcast. And I’m big fan, And as you know, I just want to make sure your your listeners know that I have learned a ton from you, not just from the podcast, but I’m sure you’ve mentioned that you and I work together at the Centers for Medicare and Medicaid Services. And honestly, there has been no boss that I have worked for that I have learned more about how to run large, complex organizations from then, then then, Andy, he’s a tremendous leader. And I felt very lucky to get to work as closely as I did. And I bring a lot of the lessons I saw him using at CMS when we were there together, I bring them to the CDC. So when you asked me, why would I want to come and take this this role? One, the mission of the CDC is so incredible, right? The opportunity to run an agency whose mission is to protect the health of this country, and frankly, the world, I was so excited to be able to return to government to be part of a team charged with that mission, I think I bring some unique background to the role having led both at the federal level and at the state level. I think that gives me a unique perspective that I hope I can bring to the agency. I’m a physician by training, and obviously led through the COVID pandemic in North Carolina. And I’m really proud of the work I hope we’ll get into a bit of it. But I think bringing all of that to bear felt like that I felt like I could make an impact for positive change here. And frankly, I think I am and I say I’m a few weeks in and I’m loving the job. So far, the people here at the CDC are incredible, just really amazing scientists passionate, and I’m thrilled to be able to pick up the baton from Dr. walensky and run this next regular list.

Andy Slavitt  08:10

You know, now I think people are pretty sure I’m at a softball you. Because of all the things you have the nice things you said about me. But instead, I’m just going to lay play what you said over and over to my kids, since the head of the CDC said nice things about me. So you should be nicer to your dad. But I do want to get into some of the what drives you because I think you laid out something that is really clear and purposeful. But man requires a lot of courage, a lot of courage. And I will I’d love for people to help get to know you a little bit better to help understand how you brought that to bear and how you bring that to the table throughout your career. But maybe the best place to start is with what’s on people’s minds right now today, which is it COVID cases are up Welcome to the job. And we all have this sort of traumatic effect when we see COVID cases go up. Because we remember in the last few years, that feeling of panic and out of control fear when we saw cases go up. And I’m sure where to place that where many of us know people who have COVID cases, I would suspect and hope certainly that for many people that is mild, and they’re getting through it. But still it causes people to go I remember that feeling. So what are you seeing at a national level tell us what’s really going on.

Dr. Mandy Cohen  09:40

It’s really important for folks to know that as we sit here in August of 2023, how we experienced COVID is very different than how we experienced it in August of 2020. Not only is the the virus different but we are different and the tools we have vailable to protect everyone are very different, which is wonderful. I mean, it’s just incredible work that has happened in the last number of years. Let me start in the ladder in terms of tools. And I think you know this, but it’s no small feat that not only do we have vaccines and boosters that protect folks, but we have testing that is widely available and over the counter, where folks can know right away, if they’re, they’re feeling under the weather, they can test themselves right away and know if they have COVID. Because importantly, we have treatment, a pill that you know, works and can keep people out of the hospital, which is wonderful, but you got to use it quickly. So we are smarter than we were two years ago, three years ago, we have more tools than we were than we’ve ever had before. But we are living with COVID. Right it is here to stay write similar to how we live with flu, we are now living with COVID. And so we’re going to see ups and downs in this. And it means that we’re going to have to dial up at different periods of time, our tools, right that we have, and we’ll have to bring them to bear in different ways, at different times. So what we’re seeing right now, and in August of 2023, are small increases in folks getting COVID, we’re still at some of the lowest hospitalizations that we’ve been at in the past three years. So even a 10% increase on a very, very small number is very small. And that’s good news. So right, these are small increases on a small number. So overall, right, my, my level of concern continues to be low. But just like you’re saying, Andy, I think all of us now are getting to a place where I will say in the last month, there are folks, you know, in my own family that have had COVID in the last month, my aunt and uncle who live in Florida, got COVID in the last month. So it’s circulating it is still there. Luckily they were vaccinated. They also both got tested right away. And they both got Paxil COVID. Right away. So even though they’re both over 75, they they did well. And that’s that’s the top line here is they did well as others can if they use the tools we now have to protect ourselves.

Andy Slavitt  12:20

Yeah, I think I counted as well. Like just like you, I think there’s two co workers and four friends of friends have covered all of them been vaccinated, all them feeling kind of yucky. None of them anywhere close to feeling like anything worse is going to happen. And that does feel like a difference. Interesting, you know, you talk about how this is with us now and will be with us. Influenza we’re used to seeing in the winter. And so is should it be surprising to us? Or should we expect that we will be seeing occasional summer and spring waves may be driven by you know, air conditioning and people going indoors? Or what can we sense this in terms of building our own expectations.

Dr. Mandy Cohen  13:13

If we look at the last three years, we still do see a seasonality to the virus, meaning it is still we are seeing this virus spread more in the fall and winter months and spread less in the spring and summer months. That doesn’t mean that it’s not still circulating in those other months. And that’s exactly what we’re seeing here in the summer is that we are seeing this virus circulate. And there are a number of reasons why we may be seeing an uptick now. And again, this is where science is continually evolving. And we are learning about this virus, the virus, you know, yes, I think you were mentioning one, which is it’s not surprising that we saw this virus go up first in places where folks are indoors in the air conditioning. Right. So we also know folks are doing more travel. We also are watching the changes in the virus itself. So we’re watching the new variants of the virus and seeing how they spread. Luckily, right now what we’re seeing with the changes in the viruses, they’re still susceptible to our vaccine, they’re still susceptible to our medicines. They’re still picked up by the tests. So all of our tools still work as the virus changes, but we’re going to have to keep watching it.

Andy Slavitt  14:34

So we’re not seeing some new four letter, you know, thing SBB WC, YMCA thing we’re seeing the same thing, relatively speaking, occurring, again, not abroad. Difference in in variants?

Dr. Mandy Cohen  14:51

We’re seeing small changes that are that I would call subtypes of what we’ve seen before. So nothing yet that we are Jumping on and saying that there is a shift here. So we’re sort of in in the same place. But that’s today. And I want folks to understand we are, that’s why we are vigilant. That’s why we are looking for new changes to this virus. And that while we have a lot of tools that work right now, today, we need to keep evaluating, as this virus changes are those tools still working the way we want them to work, and new things could crop up. So we’re gonna keep vigilant and keep making sure we’re watching really closely?

Andy Slavitt  15:35

To remind us what we’re supposed to do when cases go up in our community? You know, I’ve been on an airplane a bunch recently. I don’t think I saw anybody wearing a mask. I’ve been grocery stores. I don’t think people are wearing masks. I think in general, there may be parts of the country where that’s not as true. But But I think in general, we’re sort of back pretty close to pre pandemic levels. Are there things that we should be thinking about? You know, let’s say you’re somebody who’s at risk, a little older, maybe have some reasons to want to be concerned because you or someone in your family? Just remind us what, what we’re supposed to be thinking about if if cases start to move up?

Dr. Mandy Cohen  16:17

Well, I think embedded in your question is exactly the first thing folks need to think about is their own risk. What What is your age? Do you have underlying medical conditions? Do you live with someone who is immunocompromised or going through cancer treatment? Are you going to see someone who is elderly and visiting them, right? So you may want to think about both yourself as well as who’s around you in terms of risk and then change what you do depending on that. So there’s a number of things that folks can do. And I will tell you, you know, members of my my family and friends, those who are older, or have underlying conditions, they do wear masks in more crowded indoor settings, like being on an airplane or an in an airport. But it doesn’t keep them from living their lives. And but they take a little bit of additional precaution, what I would also say, for example, if you are going to, you know, you’re taking the kids to see see the grandparents, you know, and one of the kids has has a little something, you know, you can whip out one of the rapid COVID tests. And so you can there’s another level of protection that you can provide there by testing

Andy Slavitt  17:29

Expert, speaking as an expert, don’t kids always have a little sub? Exactly, they always have

Dr. Mandy Cohen  17:33

A little something. So if you want to just be sure, write a little, little quick, rapid test, you know, 15 minutes later, and you can feel, you know, is this a common cold? Or is this something COVID That I could bring to someone who has a more weakened immune system? Or is that more risk? So again, whether it’s masks or tests or making sure you’re getting to rapid treatment, we have more ability? And don’t forget washing hands, I think we skip right past that. I’m a big hand washer, please carry around your hand sanitizer, right. All of these things are layers of protection that we should be doing. You know, and again, assessing our own risk as we move through our day.

Andy Slavitt  18:12

So let’s talk about the other question people have in their mind, which is the vaccine. I think most people are aware that there’s a new formulation of the vaccine that’s due to come out sometime in the fall. I think the questions that I get are, oh, do rise of COVID cases. Should I be waiting for that vaccine? Should I be getting that vaccine? When is it going to be available? And what is it what can you tell us and recognizing you may need to tell us that we’re not finalized on all the approvals yet. But what can people expect? Yep.

Dr. Mandy Cohen  18:49

So the short version is while we are not finalized on all the approvals yet, so FDA still needs to do its final work with the manufacturers, as well as the CDC do its final job to make sure we are making full recommendations on who should get those COVID shots. What I would say is that we anticipate that they are going to be available for most folks, by the third or fourth week of September. So in in in the near term. So there’s work being done. Now. We think by the end of September, they’ll be available, but there’s some work to do. And again, we got to make sure we hit all the right marks for it to be available. What we are anticipating right now as we look at the data, and we see how the virus is changing, we see how immunity changes over the course of the year, similar to flu shots, right, which we get every year annually. We are likely to see this be and again, I don’t want to get ahead of the scientists that are going to do their work in the next few Few weeks, but we are likely to see this as a recommendation as an annual COVID shot just like we have an annual flu shot. And I think that will give more folks clarity about should they get one or not? Because the answer is like, Well, did you get one this year, if not, go go get the new, the new COVID shot, assuming all of that, you know, again, we’re waiting for the FDA to do its work, we’re waiting for CDC as experts to do its work in terms of recommendations, but likely where we are headed. So folks can start to think about it is that well, this will be an annual vaccine. And again, to make sure that you stay protected.

Andy Slavitt  20:43

So basically, four to five to six weeks from now, the shot should start to become available. And so for people who are looking at the case count and saying, Should I wait for the new vaccine is that what we’re basically how people should think about it.

Dr. Mandy Cohen  21:01

So again, I think this goes back to assessing your own risk. So if you are someone who is over 65, or has multiple underlying chronic conditions, and you are overdue, meaning it’s been more than six to eight months, since your last booster, you may want to think about talking with your doctor about getting a a booster. Now with the current booster. If you don’t fall in that category, meaning that you’re under 65, you don’t have multiple chronic conditions, there is going to be a new booster available that is again, more tailored to some of the changes we were seeing in the virus. So you might you may fall in that category of waiting on, you know, the next, you know, eight weeks until a new booster is ready. If you have questions about what category you fall in, talk to your doctor, right? Talk to your nurse practitioner about this. So sometimes it might be right to get protected sooner with one of the COVID shots that’s available. Now, sometimes it might be right to wait, depending on what group you fall into.

Andy Slavitt  22:06

That’s very clear, actually. And it sounds like it sounds like good news. And to me anything that accommodates a routine for people, as far as we know, is helpful and

Dr. Mandy Cohen  22:19

Andy, the other thing I think is good about this is it is a best practice to get both of these vaccines, flu and COVID shots at the same time. So if you’re thinking about making your appointment for your flu shot, and you’re doing that, you know first week of October, make sure you’re making it for both your flu and your your COVID Booster assuming that is where all the recommendations come out. But again, this is more me just getting you to start to think about it know that there’s still a few steps that are required from the FDA and the CDC. But that is likely where we are we are headed.

Andy Slavitt  22:53

All right, let’s take a quick break and come back. And let’s delve in a little more to our new CDC director and what brought her where she is today. We’ll be right back. Okay, we’re back. So as you can tell, my voice is a little scratchy. So I did a COVID test. Thankfully, I’m feeling fine. But you know what? I think it’s just part of what you’re saying. It’s sort of part of the training that you know, you’ve started feeling under the weather. We’ve got a test lying around. You take it because you want to protect the people around you. And you just want to know, and you kind of don’t know. But I’ll get all good. So I want to get a little bit back to where we started the conversation. Dr. Cohn, it’s so unnatural for me to call you Mandy, call you, commissioner, Director gets what they want to ask you is, because it’s the one thing I don’t know about you is What kind of kid were you? Are you sure of yourself? Are you an idealistic kid? Were you trying to make your parents happy? Were you creative? What? What were you all about? I,

Dr. Mandy Cohen  27:19

I was a combination of, I think a pretty confident kid who doesn’t want to make their parents happy. My parents are so wonderful. So of course, I want to make them happy. And you know, my mom just retired with a nurse practitioner in emergency room. My dad was a middle school guidance counselor. Like they are folks who went into service careers, and very much instilled that in us. But they also instilled in us a bit of fix the system, right? It wasn’t just serve. But we always had the mentality of thinking about how can we make the system around us work better. And it’s interesting that my mom ended up working in an emergency room, because actually emergency room is often when you see all the broken parts of the system show up in the emergency room. And but she would talk to us about that all the time to say like, oh, imagine if we could get ahead of this, then we wouldn’t see, you know, folks be in this circumstance in the emergency room. And that definitely influenced my thinking of like, how do we shape a system, frankly, that works for everyone. And so that was very much part of what what my parents instilled in me, but I was I was a, I was a confident kid who liked to talk to adults.

Andy Slavitt  28:37

I’m fascinated by this idea of not just setting an example for you, or teaching you about service, but almost as sort of engineering elements to it. Like, no, don’t just go into service, but go into fixing the problem systematically. Like that seems like an incredibly unusual kind of thing for a parent. Back when you were a kid back when I was a kid, to even think about, because it’s like, more specific than changed the world. It’s like, prevent all these people from showing up in my emergency room by going upstream. Did you? Did you grasp that thought as a kid and like it did that grab hold of you and guide you in some in some way?

Dr. Mandy Cohen  29:23

Well, it’s certainly the fact that they let me think big and said that you could do anything and sort of instilled in me that we want to build a world that that works for everyone was very much an undercurrent of everything that we did and being curious about why things wouldn’t work, so that we can get behind it and think about how to fix it. I’ll share one more story about my my mom. I also saw her as an advocate as well so my mom was isn’t is a nurse practitioner. And she was in one of the very, very early classes of being a nurse practitioner in New York before, there was even a term nurse practitioner. So they were, they were doing graduate level training for nurses, and they didn’t even have a term for it yet. So she had this training and actually would go to Albany, New York, the capital of New York to, to talk to lawmakers and decision makers about what she was seeing in the work that she did, and the skills that she had, and was a pioneer, really, in creating this the profession of nurse practitioners, as well as the sort of structure and scope of practice that now exists. So I watched her not just be a woman who was, you know, working and had a career, but paving the way and pioneering to say like, you know, things can be different. And there are, there’s a cadre of folks who can fill an important role, particularly in primary care and being an additional clinician on the team. So I think I definitely picked up a lot of that from from her.

Andy Slavitt  31:07

What was the conversation, like when you said, Mom, I’m going to be the new Director of the CDC.

Dr. Mandy Cohen  31:15

She was so proud, they were tears and pride, because she knew that I would be able to join an agency, like I said, with an incredible mission. And, you know, I’ve had incredible experiences through some hard times. And she knows that I very much am a, I’m a listener, I try to listen to a lot of folks and find the place where there’s common ground and to move folks forward, and to just to be thoughtful and pragmatic. And so she was she, you know, she would say, I feel better knowing that you’re, you’re at the helm of CDC. That’s what she said, Imagine

Andy Slavitt  31:52

What that feels like as a parent who was a bit of a pioneer in her own right. And who, who, along with your dad believed the things that they believed about what they want you to do in life to see that actually happen, which is like a one in a million thing. Well, it’s a perfect note for us to come back after this final break and talk about which is how we should all be thinking about the CDC. What you want to see happen what to expect from it what you inherited, we’ll be right back with Mandy Cohen. So I think the way that I want to frame up the conversation is why should people listen to what the CDC has to say? versus, you know, their own doctor, what they read on the internet, whoever they whoever they choose to believe. And I’ll give you a little bit of context. And it isn’t entirely to do with just the CDC. It’s trust in institutions. I really eroding. The Justice Department is attacked every day, every day, the CDC has been attacked. And look, I’m not saying for a second that these institutions can’t improve. But the very fabric of the institution itself, the very nature of being either a government funded or some other important institution, our country is undermined. I think there’s trust in the Supreme Court is lower. You know, it’s coming in, it’s coming from from all kinds of places, some of which are obvious, but I don’t want to make this political question. But that that is a that is a place that CDC finds itself in as does a lot of society. So help us right, you know, rise above that a little bit and understand what What the job of the agency is and why people should put the confidence in it.

Dr. Mandy Cohen  35:07

Yeah. So CDC, I think, is an incredibly important tool for the United States to protect its health. And what I mean by that is that we have to be in order for us to stay safe. As a country, we need to be identifying threats, threats here at home threats abroad, to prevent those threats from then coming here. And what the CDC is able to do is both amass data, as well as monitor a lot of different ways to understand what’s happening out in the world and pick up concerns and make sure that we respond to them before they become a problem. And that’s the the whole reason why we need to make sure that folks understand that the CDC is able to identify those threats, bring the best science and scientists together to understand that problem, and then respond quickly. So that threat doesn’t become larger than if we couldn’t identify it early. So we need to be investing behind the CDC in order to have that asset for us to be strong. I think we all know, right, what was we went through COVID, that we COVID impacted us more as a country than others because we went into the pandemic sicker, right COVID impacts people who have more chronic diseases, right here in the United States, we have more chronic diseases than other countries like at baseline. And so if we are sicker as a country, and then we have a threat put on top of us, we’re not going to do as well,

Andy Slavitt  36:47

I really, by the way, like very much this context of protecting our security, because I think it’s something we all relate to. And, you know, in in a way it feels like a bit of the need for a rebranding, in a sense, because maybe, for a long time, we didn’t know what the CDC was, maybe we’d vaguely heard of it, then we heard of it. And everybody has reason to be critical, because CDC was in the limelight, and some of it is somebody that’s well earned criticism, some of it is not well earned criticism. And some of it is just, we went through something bad and CDC was the people around. And so it didn’t feel good to people. But but for whatever reason, and I think a lot of it also has to do with people’s general attitude towards institutions now for for a rebranding to occur, really occur as opposed to just being, you know, something that the Ad Council puts out? You know, presumably there’s a sense that something there’s work going on inside. And I think this is what people are probably curious about, is to people in the CDC, behind closed doors, have the ability to say, we can learn and improve and get better and be committed to this mission. Or, to a lot of people, they felt public health officials looked like they were on the defensive, trying to defend what they already said and why they said it, you’re coming with with a fresh set of eyes, I know you well, you’re looking at every bit of data talking to every single individual, is your sense that those are the ingredients that you’re seeing in order to have the agency move to where you want it to move to, if we get where you want it to move to where you think it needs to be for the country.

Dr. Mandy Cohen  38:32

Yeah, we’re again, in order to be that national security asset that I think it that our country deserves, I do think that the CDC has some work to do to improve some of that is in its own way of how it collaborates internally, even on things like data. Right. So in order for us to identify threats, we all have to be even internally here at CDC making sure that we are sharing good information across the way so that if one team is identifying someone, and then there’s an expert on the different part of the agency that we can all work together. So there’s a collaborative, there needs to be more collaboration with weavin within CDC, and then we need to collaborate with our external partners, right? Because we are only as good as the collaboration that we can have with our health care system, our public health partners, even with the business community or schools, right, though, these are all critical partners. So collaboration is certainly one that you know, and that’s a muscle that’s not something you just say you have to do. You have to build that you have to build processes and systems that allow for collaboration. So you’re going to see us focus on that a lot of that will be some of that is data pipes and data systems to make sure we can have visibility and transparency. The other part of that is in communication. Right? I think definitely folks have said cow can we we simplify what we are doing in How we communicate, CDC has to look at a lot of threats. But they’re all not the same level of risk. Right? There are a lot of threats out there. Some are very, very tiny threats, that could be a big thing. Some are very big threats, but don’t really impact you that much. So Right? How do we talk about those different the different nature of those, so we have to communicate in a simple and clear way. So we’re giving folks common sense solutions to protect themselves, just like we were talking about COVID, right? We want folks have common sense solutions to get vaccinated, you know, get tested, get get treatment, over and over, right? Wash your hands, like those kinds of things, like how can we do that for it for each and every type of risk that we might see out there. But importantly, we can’t just go for threats, right threats is one part of the work and CDC has to get better and be more collaborative, and more transparent and better communicator, to do that work. But then we also have to get upstream, we have to get upstream and prevent things before they become problems, we can respond to problems, and that’s fine. But we always know it’s more expensive to respond in a crisis than to prevent that crisis from happening. And so like, that’s the work also of the CDC. So for example, you’re gonna see us focusing in three areas. One is in responding to the threat, right, the threat of COVID, flu and RSV, this fall in winter, you’re gonna see us spend a lot of time on that threat that is right there and us responding well to it. But then we need to get to some of the underlying issues that that drive us. And those two other areas that you’re you’ll see us focus on. One is in the mental health and opioid space, and making sure that we are tending to and bringing to bear all of the research and data and best practices about how we think about mental health, but not just about treating mental health, but preventing, like how do we prevent suicides? How do we make sure to use all the data that we can to prevent opioid overdoses? We have we know how to do that. But how do we execute on it? So that’s one bucket of work. And then the last area of focus is really one to focus on young families, I think we can be the healthiest country in the world. We are not that right now. But we could, we could do that. But we have to start when our kids and families are starting out because it’s when our brains are developing. It’s when kids are establishing their lifelong eating and health patterns. It’s where we established so much of what will happen to you as an adult over your lifetime is happening to you as a kiddo. And so how do we support our young families so that we can be that healthiest country, in the world in the future? That’s going to take investment right now. And we have a lot of tools here at the CDC to bring to bear for that. But those are going to be the areas that we want to focus again, all in service of being that national security asset, how do we identify those threats? But then how do we make ourselves the healthiest country we possibly can be? So we can be competitive so that we can fight off threats even more easily?

Andy Slavitt  43:08

Well, that’s, that’s a really interesting vision. And it’s, it’s particularly interesting, on the backs of a scare, right? Because, you know, maybe that creates a teachable opportunity. And I know we’re dealing with gonna have political reactions and so on. But, but I do, I do think that you’re right, that we shouldn’t lose sight of the fact that until we set the goal of basically, you being better taking care of one another, that you don’t get there. I was also reflecting Mandy had something you said, which is that you want to go upstream and focus on prevention, it’s hard to get credit for the story that doesn’t ever break. Right. It’s hard to get credit for preventing something that didn’t happen. But there were a few kind of things that could have happened this year. After COVID on the on the infectious disease front, and you get a chance to see the agency perform. Tell us about those things and what it tells us about what we don’t know about what the agencies actually getting done.

Dr. Mandy Cohen  44:14

Right. So the story of public health is that you don’t hear about it when it’s working, which is great. But that also makes it hard for folks to understand why it’s such an important investment. And such a security asset. Let me tell you about one story. You may have heard that there were a few cases this year of domestically acquired malaria. They were the first nine cases that we’d seen in 20 years. So we haven’t seen domestic malaria in 20 years this year. We saw nine cases, seven of them in Florida, two in Texas, and I was so impressed with the team here at the CDC that really jumped on this. This issue. We sit down CDC deals with malaria and other country So that’s again, where we are working abroad to prevent a threat from coming here. And so all the work we do in other countries to prevent malaria is why we don’t have malaria here, we need to continue that work abroad. But we have that expertise. Because we work abroad, we brought it to bear here in Florida, and Texas. So to support the state in everything that they were doing, and they, they did very good work here. And but we were able to offer support to the clinicians in the area to make sure they could identify malaria, right, rarely, or is not common, which is a good thing here. But we need to then help clinicians know how to identify and test we were able to offer lab capacity and testing there is treat we made sure treatment was going to be available. And again, we have tools that we can can utilize, we know how to, to, you know, get rid of the mosquitoes that transmit malaria. So we brought all those tools to bear. And now we’re not out of the window yet. But the good news is, is it’s been, you know, four to five weeks now, and we have not seen another case.

Andy Slavitt  46:09

So illustrates the point, because I bet most of us listening, when he even aware didn’t focus on it. And, you know, I think it is, it is an expectation that people are responding to security threats that hopefully, you know, you’d ever need to learn about.

Dr. Mandy Cohen  46:25

I’d say, don’t, we are worrying for you, right, that’s why you want us there. You want the CDC there to be the warrior, the warrior, the detector there responder for you, so that you know that you can be protected. And that’s what but we have work to do across the board to make sure we’re doing that over and over and over and executing. But just like investing in our national defense takes resources, it takes resources to do that kind of of vigilance where we can detect and respond to threats. So we need to make sure folks understand it. And we’re gonna have to get better at telling stories like, hey, we we’ve been preventing domestically acquired malaria here. That’s what you get when you invest in public health.

Andy Slavitt  47:08

Right? It’s sort of like, hey, Senator, hey, Congressman, how about that big malaria problem? Oh, you’re not aware of it? Well, guess why? Guess what? Guess why. And by the way, you know, monkey pox was something which could have been much more devastating. And it took a lot of quick work. And then when it goes away, we all go, Oh, it went away. Of course, it went away. Well, just gonna say it doesn’t sound of course, there’s somebody in the other end, doing a lot of work, a lot of work. So I want you to invite you to come back in the fall, when you’ve done you know, kind of your kind of thorough review kind of where we are, it may be what kind of advice we have for people going into the fall and winter, on COVID, or anything else. And it’s a really, I think, a really refreshing perspective that you brought, I guess, maybe if I went I had one more question is a challenging question. I don’t know that there’s an answer to it. But you had me thinking when you were talking about the career professionals, and it feels like, there are maybe two different views in this country. One view, which says, we really do trust rely on and believe in investing in the resources that are protecting us. And another view, which wants to make science and the CDC and the FDA and everything else with it, kind of a scapegoat, and a punching bag. And it can’t help but feel like the upcoming 12 months are going to be an election cycle filled with pretty opposing views. You know, I won’t say anything, put words in Ron DeSantis, his mouth, or Donald Trump’s mouth, but they’ve got a very different perspective. Part of your I think track record is going into a place like North Carolina, which has very different political views, and saying, Hey, wait a minute, there’s some fundamental connection points for all of us here. Don’t just think about this in terms of politics. You know, for people who don’t know, you know, your name, the Tar Heel of the year, you were one person who had 100% of Republicans supporting you and your role during COVID, where everybody had all kinds of opinions on all sides. You got a lot of credit from all sides of the aisle for listening and for managing decisions in a way that people supported. So what, what early wisdom might you have about how to create some commonality among people who really want to make public health into a more divisive issue than I think it should be?

Dr. Mandy Cohen  49:45

Well, maybe if public health is divisive, health is not. I think every one that I have talked to on every side of any aisle, wants themselves, their families and their communities to be healthy. They want the tools to be able to keep themselves and their family healthy. And that’s the consensus point. And so I’m going to start from there to say, like, look, we have a range of tools to protect you to keep you healthy. And again, our intent is to is to do just that is to make sure that you can live a, a full and prosperous life. And we want to be your partners in keeping you healthy. And try to walk, you know, and not to to sort of relive the last number of years of divisive issues, but really to focus on the place those places of consensus, how do we build places of health for everyone. So that’s, that’s where I start from. And it’s not surprising why the three areas of focus are also places where I see consensus, I think everyone wants to make sure that we don’t overrun our hospitals this fall in winter, right? We want our hospitals to be there, if you get in a car accident, or have a heart attack, we don’t want them to be overrun with COVID, or flu or RSV patients we want, it will particularly because we have all these tools to keep you out of the hospital. So that’s number one, I see a lot of consensus on using all the tools we have to keep people healthy and protected this winter. Second, I see I hear a lot of consensus on knowing that mental health is an issue. We’re seeing more unfortunately, more suicides, more opioid use. But we have tools that we can bring to bear to do that we have ways of getting upstream from that. And then I also see consensus around helping young families to be successful. Many of us can can think back to those moments when we were young parents, and wanting and needing support in that moment. And so I think that there’s a lot of work we can do in consensus build there. So it’s not surprising that I chose those places, because I believe that there is consensus around health on both sides of the aisle, whether that’s urban or rural. And so that’s what we’re going to focus on again and show folks that we can be a trusted partner for common sense solutions to protect your health. That’s what we’re going to show folks. But we have to do that transparently. We have to do that with simple communication. And we have to do that with great performance to meet folks where they are.

Andy Slavitt  52:15

Well, Mandy, thank you so much for spending some time on talking this through with me, in us. Fascinating, I think, to hear what is a really kind of clear grip on what you want to have happen. And I think a clear understanding of how we should be thinking about what the CDC brings to us in a way that’s really relevant to us. And look, I think people from the outside think these are plum jobs, because you’re in the news and the median seven, I could just tell you that there’s way more sacrifice, and way more hardship, and yes, their psychic pay. And I think everyone who has you served in these kinds of roles, like giving the opportunity to do feels grateful and comes out of it more patriotic than they went in. But personally, the sacrifice is enormous. And so I’m really grateful that you’re doing this. I’ve said before, I think you’re the best person in the country to be in this chair right now. And so I’m glad we have the best person in the country, at least in my opinion, doing the job.

Dr. Mandy Cohen  53:29

Well, thank you, Andy, for the support your ongoing support for the work, I will just close by saying you know, protecting the health of this country cannot happen alone from the CDC, it is a team sport. Everyone needs to be involved, whether you sit in the business community or the medical community or the media. So I’m grateful for that partnership across the board, because I appreciate your support and saying that I’m a good leader, but I cannot do it alone. I need everyone support in in doing this for for us to make sure that we are successful. So I’m grateful for the partnership. And again, thanks for having me on.

Andy Slavitt  54:10

That is pretty much everything your mother and father wanted you to be when you were a kid what you just said. Thank you systematic leader service. I love it. I love it. Thank you.

Dr. Mandy Cohen  54:22

Thanks, Andy. Always great to be in the bubble.

Andy Slavitt  54:36

Thank you, Mandy. Boy, do I have good news for you. That’s right. I do two episodes next week. If everyone got a number of great episodes coming up, and I’ll tell you bout them. My Monday we’ve got an episode which is a follow up to our earlier episode on the housing crisis, the lack of affordable housing. We’ve got two wonderful experts to talk specific Basically zeroing in on California, which is becoming a big visible national issue, and I think something we need to pay attention to because we have really outsized homelessness challenges in Los Angeles and San Francisco. That will be Monday, Wednesday. Sam B. Don’t know if you know Sam B she is a comedian from The Daily Show and her own special. She is hilarious. They will be even funnier than the housing episode. That’s that’s a dad joke. And beyond that, Representative Susan del bene from Washington, talking about healthcare policy choices. And Dan Buettner, the man who introduced us to the blue zones will be on the show. So a little something for everybody, or I like to think a little bit of everything for all of us. Think about that one for a while I talk to you Monday.


Thanks for listening to IN THE BUBBLE. We’re a production of Lemonada Media. Martin Macias and Kyle Shiely produced our show, and they’re great. Our mix is by Noah Smith and James Barber, and they’re great, too. Steve Nelson is the vice president of the weekly content, and he’s okay, too. And of course, the ultimate bosses, Jessica Cordova Kramer and Stephanie Wittels Wachs, they executive produced the show, we love them dearly. Our theme was composed by Dan Molad and Oliver Hill, with additional music by Ivan Kuraev. You can find out more about our show on social media at @LemonadaMedia where you’ll also get the transcript of the show. And you can find me at @ASlavitt on Twitter. If you like what you heard today, why don’t you tell your friends to listen as well, and get them to write a review. Thanks so much, talk to you next time.

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