44. A Conversation with CDC Director Dr. Mandy Cohen

Contagious Conversations  /  Episode 44. A Conversation with Dr. Mandy Cohen





Judy Monroe: Hello and welcome to Contagious Conversations. I'm Dr. Judy Monroe, president and CEO of the CDC Foundation and host of today's conversation. Every episode we hear from inspiring leaders and innovators who make the world healthier and safer for us all. Contagious Conversations is brought to you by the CDC Foundation, an independent nonprofit that builds partnerships to help the Center for Disease Control and Prevention save and improve more lives.

Joining me today is Dr. Mandy Cohen, director of the Centers for Disease Control and Prevention, and the administrator of the Agency for Toxic Substances and Disease Registry. Dr. Cohen is one of the nation's top health leaders with extensive experience leading large and complex organizations. She has dedicated her career to protecting America's health and safety.

By training, Dr. Cohen is an internal medicine physician and led the North Carolina Department of Health and Human Services, where she was lauded for her leadership during the COVID crisis, focusing on data accountability, transparent communication and health equity. During her tenure, she also transformed the North Carolina Medicaid program through the state's Medicaid expansion. Immediately prior to joining CDC, Dr. Cohen served as executive vice president of Aledade Incorporated and CEO of Aledade Care Solution, which helps independent primary care practices, health centers and clinics deliver better care to their patients and thrive in value-based care.

Dr. Cohen was sworn in as CDC director on July 10th of this year, and she joined CDC at a time of great change as the agency transitions out of the COVID-19 public health emergency.

Welcome, Dr. Cohen.

Dr. Mandy Cohen: Thanks, Judy. Great to be on with you.

Judy Monroe: Congratulations on your new position as CDC Director. I'd like to start the podcast by asking you to share something about yourself that you'd like our audience to know. Walk us through your thoughts as you were deciding to accept the position.

Dr. Mandy Cohen: Well, first, Judy, I wanted to thank you personally for your leadership of the CDC Foundation. The CDC Foundation has been an incredible partner to the CDC for so long, and I don't think folks realize what an important asset you were even as we were responding to the historic COVID pandemic, so just thank you for your ongoing leadership and support of the work and the mission of the CDC. Wanted to start with that.

But as I think about what I hope folks know about me, I think first and foremost, knowing that I'm a mom of two girls, ages nine and 11. When I thought about whether or not this could be a next chapter in my career, it was very much a family conversation for us because I know what this job entails. I've worked for the federal government, I've worked for the state government, and these are big jobs that take a ton of time, rightly so. And so, it was a family discussion for us and with my girls and certainly with my husband, about stepping back into a role like this. I'm so grateful to have a ton of family support, and my girls were 100% 'Of course, why wouldn't you do this?’–particularly when I shared more about the CDC, the mission of the agency and the organization. It's really inspiring to be part of an organization whose mission is to protect the health of this country and really the world.

It was a pretty quick family conversation when we were deciding this, but it's an honor to be part of CDC, particularly at a time where we are seeing unprecedented kinds of threats to our health coming at us from all directions—whether it's viruses or heat or fires, and that's all just in the last week. I'm sure we're going to get into this, but it's never been more important to have an asset for this country that can identify threats to our health and respond quickly and effectively. The fact that I get to take the baton from my predecessor, Rochelle Walensky, who did a terrific job through a historic crisis, I get to take the baton and run this next leg of the race, it's really wonderful and remarkable, and I'm so grateful to be part of this team.

Judy Monroe: Thank you for sharing the story about taking this to your family and talking with your husband and your daughters, and thanks for taking the baton. Here you are, CDC Director. Talk to us about your main priorities for CDC as you start your tenure as director.

Dr. Mandy Cohen: Well, sure. Given CDC's critical importance in protecting health for this country, we really need to focus on a number of things. Foundationally, I believe that we can only change and improve health if we foundationally have trust. I know we're going to get into this more, but we know there's been some erosion of trust, not just in the CDC, but in government, in science, in media recently, and so there's work to do to rebuild trust. That is first and foremost at the top of my mind.

As we look at some of the early priorities that we are focused on, we know we need to be ready for the fall and winter. We will have COVID and flu and RSV as we do now every fall or winter season, we are living with COVID just like we live with flu and RSV, but the best news is we have more tools than ever, and we are in our strongest position ever to protect health as we go into that viral season. I know we'll talk a lot more about that, but that's certainly a first area of focus on how do we use that season to communicate effectively? How can we be transparent and build trust through that effort?

Another area of focus for me is certainly on mental health and particularly what we're seeing with the opioid crisis. After any crisis, whether it's a hurricane or a pandemic, we see mental health unfortunately get strained and get worse, and so we have work to do to make sure we're addressing mental health and the opioid crisis. We unfortunately just put out new data showing suicide rates up a bit, even as we saw them decrease in youth, we're seeing them increase overall, so we have a lot of work to do in the mental health space.

Then the last area of focus for us is supporting young families. As we know, we are only as strong to fight off those threats as we are healthy, and your lifelong health patterns start when you are young, right? We know that your lifelong health is set up in your first five to ten years. All of your brain development is happening then. What can we be doing to support young families, whether that's supporting mom through her pregnancy and making sure she has a healthy pregnancy and a healthy birth, that we are making sure that our little ones have all the support they need to make it through their first year of life? Unfortunately, we're seeing disparities in infant mortality. Then how do we support young families, again, to establish good preventive habits right from the beginning and make sure that we can be the strongest and healthiest country we possibly can be?

Judy Monroe: I like how you think about the tools to protect health. Mandy, you're coming to CDC having served as secretary of the North Carolina Department of Health for five years. What skills did you learn at the state level that you think will translate to this new position at CDC?

Dr. Mandy Cohen: Well, I was incredibly lucky to lead North Carolina's Department of Health and Human Services for three years before the COVID crisis, and then two years as we responded to COVID. I say those two years were really more like ten given everything that was going on, but we learned a ton, and I loved being at the state level. I would say after seven, eight years at the federal level, it was wonderful to work at the state level where you can build deeper relationships where you feel really close to folks who are working in the health delivery system, in the public health departments, in our community health centers, in our faith community. I just loved being able to develop those close relationships within our state.

That was one of the lessons learned from me is that relationships are foundational. We're all humans at the end of the day, and making sure that we can find common ground, that we can sit together even if we don't agree on everything, that we can sit together and have respectful dialogue. I think so much of building trust is showing up. It's just showing up and building those relationships. I saw that in North Carolina, and luckily, like I said, I had three years before we went into the COVID crisis, so to build a lot of relationships, and then we built even more during that crisis, reaching out to communities that are often unrepresented and work with different partners, whether it was the business community, the education community, historically marginalized communities, the faith community, but those relationships were key to us protecting health in the state of North Carolina. That's certainly a strong lesson learned.

The other is about transparency. This is where simple, clear, repetitive, timely communication is so important to build trust. Governor Cooper, who I worked for in North Carolina and I did something like 170 press conferences in 18 months. That's a lot of communication and transparency. We thought it was so important as every day there was a new piece of information and every day we wanted to be out there answering questions so folks could understand how and why we were making hard decisions for our state, so that transparency was foundational.

Then the last is making sure that you're not just saying words, but you're actually showing up in people's lives and performing and saying, "Not just get a test, but here's a test. Here's where you can get it. Here's how I can make sure that this test is available," or, ‘Here is the treatment that works here,’ or, ‘Here is the vaccine,’ and get it to people in real time in their lives and perform and show up. Those are the themes that I keep repeating to our team, it's what I think about in the morning as I think about my day is those three elements that I really learned in North Carolina.

The way we knew in North Carolina that they were working is we measured trust. We measured trust through the pandemic. While we saw trust erode in other places, we were very pleased to see that trust actually increased in our department over the course of the pandemic. We actually increased trust with the work that we're doing. I do take those lessons learned seriously, I'm very proud of that, the ability to build trust even in the midst of a crisis, and so we do take all lessons learned here to the CDC. I see the team already embracing those, doing that work, so I feel really good about the team and where we're headed.

Judy Monroe: Relationships, transparency and performance, those are great lessons. It's been over three years since we all first heard about the outbreak of COVID-19. Can you talk to us about the current status of COVID-19?

Dr. Mandy Cohen: Sure, we are living with COVID. I think we all knew that we would be here, but we are living with COVID. We are seeing an uptick in hospitalizations as we sit here in August of 2023, but to put that in context, we're seeing about 10,000 folks in the hospital right now where last August, we were seeing 40,000 people in the hospital, so we are in a better place. We have more immunity overall. Either people have gotten COVID or have gotten COVID vaccines, so we do have some immunity throughout our communities, and we have more tools than ever before. We have effective vaccines, we have testing, we have treatment, we have common sense solutions to protect ourselves. We just need to use those tools. We need to use them effectively all the time and we cannot get complacent because this virus is currently changing. Just within the last week, we saw a new lineage, which is an even larger change in the virus than we've seen in recent months. We don't know yet what it will really mean–we're watching it closely–but it reminds us that we are living with COVID, but we do have more tools than ever before. We need to use those tools to protect ourselves. We're gearing up and preparing for the season ahead.

Judy Monroe: Looking ahead to the fall, what do you believe public health success looks like, particularly with the nation now having vaccines for the three major respiratory illnesses, COVID-19, RSV and flu?

Dr. Mandy Cohen: Yeah, it's historic. We've never had as many tools as we have right now. The first is making sure everyone knows about these updated tools. We'll have a new COVID booster that is coming out in the middle of September. We will, for the first time, have RSV vaccines for older adults. We have an RSV immunization for infants, and just yesterday, the FDA approved a new maternal RSV vaccine that then transfers that immunity to your baby. Of course, we have annual flu shots. We have tools, and the idea is we need to use them, so you're going to hear a lot from me over the next number of months about making sure that we are using the tools of vaccination because that's the way we can build up our ability to fight off these viruses as we get into the season. We know there's going to be more COVID, we know there's going to be more flu, and we know that there's going to be RSV, so let's get ahead of it with vaccines. But then we also need to make sure that we're rapidly identifying things in our community. Is the virus changing? How well do our tools map to how the virus is changing? From that perspective, we're also in a really strong place. We have more ability to detect and respond than ever before, and we also have to focus on clear communications, simple actions that people can take. Get your vaccine. If you're feeling sick, get tested. You want to be tested so that you can get treatment right away. Again, if vaccine is not your choice, there are other tools. If you choose not to use one of the tools, please go to the toolbox and use one of the others. Use testing, use treatment, use simple things that we can do to protect ourselves. That's what we're going to be focused on and how we can be successful in protecting people's health through this season.

Judy Monroe: I'd like to shift a minute to how our nation is facing considerable political divisions. There are trust gaps between public health organizations, including CDC, and some Americans. How does public health and how does CDC work to regain that trust?

Dr. Mandy Cohen: Well, as we were chatting about the lessons from North Carolina, I certainly will take a playbook from that, and I think, again, it is about building relationships, being transparent, and performing well for the American people.

Certainly on the communication side, we know that we need to make sure we are communicating in a clear, concise, simple manner that folks understand, that it's timely and frankly repetitive. If you start hearing me say the same things over and over, that is intentional because we want folks to understand what's happening and make sure that they have good solutions to protect themselves. Again, relationships–we're working really hard to build relationships and show up in all different kinds of ways for folks, whether it's showing up in our school systems and supporting our schools, or it's showing up in historically marginalized communities and building those relationships or working very hard to make sure we're doing that work. Of course, making sure we have the tools deployed, that the vaccines are equitably distributed, that everyone, no matter what zip code you are in, has access to tests and treatment. That is our goal, and hopefully how we rebuild trust.

Judy Monroe: We'll be right back with Dr. Mandy Cohen.

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Now back to our conversation with Dr. Cohen.

Here we are emerging from one of the hottest summers in recorded history. What is CDC doing to address the health threats of our changing climate?

Dr. Mandy Cohen: Yeah, it is hot, and I am in Atlanta today and it is warm. Yes, it is a record summer of heat, and I think folks are recognizing the impacts of heat in so many different ways and the CDC has an important role to play here. We know that one, you can protect your health from heat. Stay in your air conditioning, wear light and loose clothes, but importantly, please drink water and don't wait until you're thirsty. Get help and make sure you get hydrated and check on those who might not have the ability to be in air conditioning. Look out for your family, friends and community members.

But CDC does a lot of work in this space in terms of studying how climate change and health are connected. We fund public health departments to prepare and address the effects of climate change on health. You can go and check out some of this work on our heat and health tracker. We have a tracker that provides local heat and health information. It's a great tool for folks to understand how extreme heat can affect your community. Then we also fund a number of communities, 11 of them, on how climate change impacts their community's health. We're looking to strengthen that work as we go forward.

It's been really interesting to me to understand how heat also impacts things like mental health and the opioid crisis and suicide rates. All of these things are interconnected in a deep way, and so making sure that we have the evidence and data and best practices that CDC can bring to bear on this, I think is really important. I'm thrilled we have a new leader over this work who is terrific and I think is really rocketing forward our ability to knit all of this together in how heat and climate really impacts our health on a day-to-day basis.

Judy Monroe: Yes, Dr. Ari Bernstein is a wonderful person to be leading CDC's work on the health threats of our changing climate.

Thinking about public health threats, what do you see on the horizon and how will you position CDC to prepare for new challenges that may be coming our way?

Dr. Mandy Cohen: Yeah, it is an unprecedented time, I think good and bad. This is, I think, a new moment where we are seeing more threats than ever before, whether those threats are changing respiratory viruses and a new COVID lineage, or we're seeing higher suicide rates, or we're seeing, unfortunately, more opioid overdoses and new synthetic opioids, unfortunately, on the illicit market, or we're seeing a worsening of our life expectancy in one of the richest countries in the world. We are not living as long as we used to. Someone who is 50 right now is not going to live as long as a 50-year-old would have just 10 years ago.

There are so many threats out there, but at the same time, we have more and more tools, whether that's more vaccines, more data access, more ability to use scientific advancement and innovation to meet this moment. There are a lot of threats out there, we've talked about a number of them that we'll focus on in the near term, whether it's our respiratory viruses, mental health and opioids, or the challenge of making sure that our kids and families are supported, so they get off to the best start in life, and again, living the most prosperous, healthy life they can for as long as they can. Lots of work to do and we'll keep at it and plugging away, but we have more tools than ever before that we can bring to bear to meet the moment.

Judy Monroe: We often hear of the challenges and threats when we discuss public health, but are we winning overall and how are we going to replicate the wins in public health? Dr. Mandy Cohen: Yeah, as I said in a crisis, nothing goes perfectly, but there's been a ton of lessons learned, and I see them already being applied here at CDC. When I look at the Mpox response and the work that was done to mobilize our laboratory efforts, that was directly a lesson learned from our COVID work and the fact that we were able to get out testing and then get vaccines out of our stockpile and to the communities that were impacted so quickly, I think that has been a real success story, and it'll take ongoing work to make sure that we stay vigilant there, but a great success story, particularly in the lab and vaccine space there.

Another great story, Judy, you likely know this, we saw our first cases of domestically acquired malaria that we had seen in 20 years here in the United States, so the first cases in Florida and Texas, and just one in Maryland just last week. This is a place where I'm really proud of the team as I look particularly at where we had the most number of cases, Florida. Again, it was only seven, so the risk is very low here, but I love that the team saw those cases, jumped on it immediately, were able to bring knowledge and resources and work in partnership with the state of Florida who did a terrific job here jumping on this. The good news is we haven't had another case in Florida after those initial seven cases, which is great news. We're not totally out of that window yet, so we're still being vigilant and collecting mosquitoes and analyzing them for malaria, but the good news is we haven't had another new case since early July. I think that is the team showing that when you can have data, have scientific expertise, and deploy it quickly in partnership with state, local public health, as well as the health delivery system, we can be effective as a team.

The reason you're not hearing about a malaria outbreak in Florida? That's because of the CDC and the teams working together on the ground with the Florida folks who did a terrific job there. We have the tools, we have the know-how, but it's a reminder of why we do that work globally. There's malaria globally, and we do that work so that we can prevent having malaria come to our shores, and when it does, we have the knowledge and the know-how to respond quickly. All of it is interconnected here, but I'm really proud of the work the team's been doing in that space in particular.

Judy Monroe: Mandy, I can hear the excitement about the work in your voice. You've only been on the job a few weeks, but as we wrap up the podcast, would you like to share with us the most exciting thing about your position?

Dr. Mandy Cohen: I love the ability to work with the folks here at the CDC every day. They're just such dedicated, experienced, thoughtful experts here at every turn. You see an expert on malaria, an expert on Mpox, an expert on flu, an expert on COVID, and then experts in laboratory science and experts on data collaboration. We are lucky to have those experts.

What I'm excited about and what I think I can offer and bring to the team is bringing all of that expertise sort of together and knit it together in a more aligned way so that if we learn a lesson in COVID, we bring it to Mpox just as we were talking about, or if we learn a lesson in malaria, we bring it to the rest of our global health work, or if we learn a lesson in data collection over here, we do it over there. That's what I'm excited about. I love being able to move organizations to be even greater than the sum of its parts. I see so many incredible parts of this organization that I'm excited that as we even work to knit those closer together and work to build even more relationships and partnerships beyond, because look, protecting the health of this country is a huge job. That is not a job for the CDC alone. Everyone needs to be on Team Protect Health. I'm excited to be able to knit all of those pieces together within the CDC and beyond. That's what excites me because I see the potential there as we get even better at building those linkages and partnerships so that we can be even stronger for the American people because that's what we need, and that's what we deserve, and so that's what I'll work hard every day at.

Judy Monroe: I love that, Team Protect Health. Thank you so much for joining us today on the podcast and sharing your thoughts and your excitement.

Dr. Mandy Cohen: Well, thanks for having me, Judy. Again, thank you for the partnership. Appreciate it.

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