A Pivotal Time for Public Heath

A Conversation with CDC Director Dr. Rochelle P. Walensky

Contagious Conversations  /  Episode 20: A Pivotal Time for Public Heath

“I have a vision and I have hope.”

Welcome to a special episode of Contagious Conversations, in which the new CDC Director Dr. Rochelle P. Walensky joins CDC Foundation President and CEO Dr. Judy Monroe to discuss the agency’s latest work to combat COVID-19 and how public health professionals can help prepare communities for a new normal.



(View full transcript)





Below: CDC Director Dr. Rochelle P. Walensky speaks to the press after visiting the Hynes Convention Center FEMA Mass Vaccination Site in Boston, Mass. (Getty Images North America)





Dr. Judy Monroe: Hello, and welcome to Contagious Conversations. I'm Dr. Judy Monroe, the President and CEO of the CDC Foundation and the host of today's conversation. Every episode, we hear from inspiring leaders and innovators who make the world healthier and safer for all of us. Contagious Conversations is brought to you by the CDC Foundation, an independent nonprofit that builds partnerships to help the Centers for Disease Control and Prevention save and improve more lives. Joining me today is Dr. Rochelle Walensky, director of the Centers for Disease Control and Prevention. Dr. Walensky is an influential scholar whose pioneering research has helped advance the national and global response to HIV and AIDS. Dr. Walensky has served as chief of the Division of Infectious Diseases at Massachusetts General Hospital and professor of medicine at Harvard Medical School. She served on the frontline of the COVID-19 pandemic and conducted research on vaccine delivery and strategies to reach underserved communities.

Dr. Walensky is recognized internationally for her work to improve HIV screening and care in South Africa and nationally recognized for motivating health policy and informing clinical trial design and evaluation in a variety of settings. In this episode, Dr. Walensky discusses the career path that led her to her new role as director of CDC, her experience working on the frontlines to the COVID-19 pandemic, and her vision for the agency that works 24/7 to protect America from health, safety and security threats. Rochelle, welcome to Contagious Conversations.

Dr. Rochelle P. Walensky: I'm so delighted to be here with you, Judy.

Dr. Judy Monroe: So, let's start back in your childhood. We've learned through some other interviews that you've done, that you grew up in Potomac, Maryland, and your father has a doctorate in mathematics and your mother worked in human resources. You mentioned in this article that you were always good at math. Can you walk us through how you decided to work in the field of public health, being so good at math?

Dr. Rochelle P. Walensky: Thank you for going deep into my roots. I was good at math sciences. I came from sort of a pedigree where my father was really good in quantitative methods and my mother had a really high EQ and worked in human resources. I really wanted to combine the skillsets that I had in math and sciences with being a people person. I like to socialize; I like to be with people. And that led me to the field of being a physician. It turns out, even years ago, my pediatrician was a physician and showed me that it was possible for a woman to be a physician. So, I pursued the career of being a physician and really spent a lot of time taking care of patients, one patient at a time. But over time I wanted to do quantitative sciences and think about epidemiology and how it could have an impact larger than just one patient at a time. And that's really what led me to public health and to health policy and the research that I've done.

Dr. Judy Monroe: That's great. And so, Rochelle, thinking back to your childhood or over your career, I think our audience would be interested in knowing, who are the people that have been influential to you? Can you name maybe three people that have really had a great influence on you?

Dr. Rochelle P. Walensky: I think three would be hard. I think maybe more important would be to think about the concepts of what's been important through my parents, my family, my husband, my kids and mentors I've had along the way. And so, what I would say is I've always been encouraged to aspire, to think bigger, to aim bigger, to hope and dream bigger and to really just lean into challenges. That's come from my parents, that comes from my husband. My mentors have always taught me, ask the most important research question that you have. Ask the question that keeps you up at night, that keeps countries and ministries up at night. And so, really pursue the really big questions.

Remember your mentees and remember to ensure, and this was done by example, that sponsor and to give them the light and surround yourself with people who are smarter than you are so that it's easy to do to give you the light, step out of the way and make sure that they get the limelight. And then perhaps most importantly in my own family world is to remember which balls are glass. As you do so much juggling in all of your life and all of the activities that you do, remember in that juggle which balls you really can't drop.

Dr. Judy Monroe: So, going back to your career at Johns Hopkins Hospital while you were in training in the mid-nineties, that was the height of the HIV/AIDS epidemic. And look back on that time with us, and as you think about that, how would you assess the world's fight against infectious diseases since the nineties?

Dr. Rochelle P. Walensky: The reason I'm an infectious disease doc is because of those pivotal times, that pivotal moment that I trained. So, 1995 was my internship. Every day, people were coming into the hospital and they were dying of AIDS. And we spent a lot of time taking care of them, trying to comfort them, holding their hand when they really didn't have a whole lot of hope and there wasn't a lot of treatment for this disease. And in that single year, we had the approval of the cocktail of Highly Active Antiretroviral Therapy. And so really in that single period of time, you saw hope re-emerge. And there were a lot of parallels to what is actually happening today, in the hope that has re-emerged in the context of the vaccines that we have and new treatments that we have for COVID-19.

That really sparked my interest in infectious diseases and one of the things that I've said over many years to our trainees is, there will always be another infectious disease that is our responsibility to address, to pursue. Just if you look at the last decade after HIV, and we're not certainly through with HIV, H1N1, Hepatitis C, Ebola, Zika and now of course COVID-19. So, we will be addressing these infectious threats. I think one of the other pieces that is so influential to me is how quickly, immediately, these infectious threats are focused in underserved populations, in those who are more vulnerable. If you just think of COVID-19, this came to our coastlines through cruise ships and people who traveled, and it quickly traveled into the more vulnerable community. So that is really among the lessons that I learned in my training.

Dr. Judy Monroe: And moving ahead from your training, it hasn't been that long ago that you were on the frontlines of the COVID-19 pandemic as chief of the Infectious Diseases Division at Mass General. So, thinking about that, how are you thinking or planning to incorporate those frontline experiences into your work?

Dr. Rochelle P. Walensky: The past year has been so hard for so many people. As difficult as it was, I think it really did make it real for me to be able to lead this team of this division, to take care of patients and to realize personally what it was like to be fully donned in PPE, masks, goggles, gowns, gloves, and realize you were the only comfort that a patient might have because their family wasn't there. To really understand and read the crisis standards of care and to try—how nauseous you feel when you read that document of how you're going to allocate ventilators or resource constrained drugs, and then sitting on reopening boards at the state level and talking about how we're going to consider trade-offs between lives and livelihoods.

There was just so much that happened in that past year that connected me to individual people, that connected me to policies at the state level. And so, I bring that experience with me. And again, I'm sort of setting the table with health equity as I address CDC and the incredible scientists that are there and how I've really gotten to start to know so many of them and the work that they're doing in trying to address all of these issues at the individual level, the risk-benefit tradeoffs, and then at the policy level.

Dr. Judy Monroe: It's just unbelievable at CDC, how many dedicated professionals and so many of those folks are so very inspiring.

Dr. Rochelle P. Walensky: It's inspiring...I was just going to say it's inspiring.

Dr. Judy Monroe: It is. And humbling, right? So, as I think about having to prioritize on that nauseated feeling, with having to make decisions about who gets medical resources, now you're leading CDC and there are many priorities to balance related to the COVID-19 pandemic. We've got to mitigate the spread of the COVID-19 virus, we've got to track new variants of the virus, vaccine distribution, reopening guidance, and so much more. So, can you talk to us a bit about how CDC is tackling the important challenges?

Dr. Rochelle P. Walensky: I inherited this incredible team of scientists as you've just indicated, and so much was happening when I got here. I think we have to do sort of two things, well we have to do many things, but we have to do several things at once. We have to scale up vaccines in a safe way. We have to provide that guidance, provide those resources at the national federal level, but really also at the state level and at the local level, and to provide the toolkits for people who can sort of reach to the hardest to reach communities. So, we to have sort of our pedal down to the metal in terms of getting vaccine messaging, vaccines, vaccine distribution and allocation and administration out to the people, to the hardest farthest to reach people.

In the meantime, we have to provide guidance on how to sort of start to tiptoe into entering back into society in the context of people getting vaccinated, and how to reopen things in a safe way so that people don't sort of all reopen at once. And when we've seen that happen, we've seen surges, so we don't really want to be burned there again. And then in the context of having guidance and surveillance for variants and for breakthrough infections with vaccines. So those are some of the places where we're spending a lot of our time and energies, making sure we tiptoe into reopening and making sure we do it safely, getting vaccines out to everybody and then continuing, or I should say, scaling up the massive surveillance effort to ensure we're following the variants really closely.

Dr. Judy Monroe: That's such important work. You mentioned health equity. Can you talk to us a little bit about how CDC works with public health partners and others to take on this challenge of health equity?

Dr. Rochelle P. Walensky: And maybe the first thing I'll say is, we have to address issues in health equity related to COVID-19. But as we're doing so, key in my mind is we're making really important connections and really important outreach. And what I really want to do in the meantime is also capitalize on that to make sure we can continue those after COVID-19 is not the most important thing on our radar, because there are so many issues of health in health equity that we need to address so we should really capitalize and make sure we maintain these connections. We have published data, and I think it's important to know and understand, compared to White Americans, Hispanics have been 2.3 times more likely to die during this pandemic; African-Americans two times more likely to die.

The CDC reported on life expectancy just in the first six months of 2020, life expectancy of all Americans dropped one year; of African-Americans dropped 2.7 years; of Hispanic Americans dropped 1.9 years. So, we've seen what this has done from an equity standpoint. And yet as we scale up our vaccinations, 65 percent of the vaccines have gone to Whites, 9 percent to Hispanics, and 7 percent to African-Americans. So, we need to do better in our health equity and our access for vaccines. We had a really amazing vaccine forum, a national vaccine forum, where we brought together people from all 64 jurisdictions, from over 190 tribal communities to really give sort of your best practices, let's learn from one another. We've heard so many inspiring stories. From the city of Chicago, vaccine clinics were open to union members of community colleges. From Levelland, Texas, they opened a new vaccine center at a new public transportation service. And then from the Metropolitan International Church in Nashville, Tennessee, they did some faith-based efforts to reach communities of color.

So, this was really an amazing forum to give people ideas of how they could take some really amazing work and replicate it across the country. The CDC is working very closely with the federal government on several really important efforts. One is the Retail Pharmacy Program. We know these pharmacies; we've been working with these pharmacies for years in terms of flu vaccine scale up. We know where they are, we know where they're trusted. We know which ones the localities have as their trusted, harder to reach communities. And so, we're scaling up vaccines exactly there. We're working closely with the federally qualified health centers, and really scaling out vaccination in FQHCs to reach marginally housed, agricultural workers and whatnot. We're working with FEMA to scale up community vaccination centers that can vaccinate up to 6,000 people per day and we're really strategically placing these vaccination centers, not just in areas of high census, but in areas of both high census and high social vulnerability index. And then from those vaccination centers, we're sending out mobile units.

So, we're really working at a federal level, at a local level and CDC, at the CDC level, to do everything we can to provide toolkits and outreach to our state, tribal, territorial, local partners. And then also at the federal level to make sure that where we are replacing vaccines at the pharmacies, FQHCs, and CDC, we're doing it in the most vulnerable regions.

Dr. Judy Monroe: And all of this of course is aimed at trying to get life back to normal. Folks really want their lives back. And so, when they do ask you, "When is life going to get back to normal?" what are you saying to them? How can those of us working in the field of public health better prepare communities for what might be a “new normal”?

Dr. Rochelle P. Walensky: I think there've been some silver linings here and that normal may not be a better normal. I think the next time we all get into an over-packed subway train, we might say, "Huh, this is different." Right? There may be things we won't do the way we used to do before. And maybe because of that, some of our other respiratory viral diseases will go down. I do really think what happens and how we get to normal so very much depends on, certainly our federal efforts and our efforts at the CDC, but then on each individual. We really do need to get 300 million people vaccinated. And we're not confident yet that 300 million people are confident in our vaccines to roll up our sleeves. So this is going to be a grassroots effort to get everyone vaccinated and to get trusted messages out there. People don't necessarily want to hear from me that your vaccine is safe or that I have been vaccinated. What they want to hear is from their trusted community members, so we really do need to spread that word.

The other thing that's really important as to know when, relates to what happens in the next couple of months and how gingerly we tiptoe through getting reopened in the context of scaling up vaccines. All of us are keeping our eyes on these hyper-transmissible variants that have led to surges in other countries. And so, while we're working to scale up vaccine, we really do need to make sure that viral replication at the population level is kept to a minimum. So that's really why we're a little reluctant to say exactly when that is, but I have a vision and I have hope because I really think we're on our path to getting there.

Dr. Judy Monroe: I agree with you. And we can't overemphasize the importance of trust, that's just so crucial. So, moving a little bit to the rollout of the vaccines and all of the work that needs to be done across the country. I know you've mentioned rebuilding the agency's infrastructure in public health. Can you say a few words about how you're thinking about that?

Dr. Rochelle P. Walensky: The infrastructure of public health across the country I think has suffered over the last decade. TIFA [Trust for America's Health] has done some analyses that have demonstrated that we've lost 56,000 public health jobs in the last 10 years. And all of that happened when we had Zika and Ebola, and H1N1 and now COVID-19. And so, none of us should have been that surprised that our public health system was not prepared for this pandemic. I think we have a lot that we could really leverage in terms of the work that we did by necessity during this last year. And that has really worked in the public health workforce, that is work in data monitorization and our data systems and how they integrate and how we collect data. I heard from numerous data folks in the state level, how they single-handedly were keeping the fax service in business, which is not where it should be from a data standpoint.

And then the public health labs. We've relied so much on the public health labs to tell us where a disease is, to give us rapid turnaround, and we really need to invest in the public health labs as well. So, I really think it's a three-pronged approach that we need the public health workforce, the labs and the data systems. And what's really important is that our funding can't really be a staccato kind of funding with every infectious outbreak we decide to fund this. We really do need longitudinal infrastructure funding. As I've talked to folks in individual states, they say among the biggest challenges is that they can't hire people, both because we need to invest more in our public health infrastructure and pay people more, but also because we can't hire people for a year at a time. We really need a full infrastructure support to be able to do this over a long-term.

Dr. Judy Monroe: Yeah, I couldn't agree more. And so, kind of in that thread, do you have thoughts on, as a society, how we maybe need to look at the role of public health and public health protection differently? Folks understand funding research, but public health is really where those scientific findings are put into action. How do we communicate this differently or increase the value that society sees in public health?

Dr. Rochelle P. Walensky:The wonderful thing about public health is when it's done well, you don't know that it's operating for you, right? It's when you have challenges...

Dr. Judy Monroe: That's right.

Dr. Rochelle P. Walensky: ...that it's a problem. And I think if anything this past year has demonstrated, we can't be back here again. So, I see my job after we get out of this pandemic is to constantly remind people that we had a pandemic because of the lack of infrastructure. Just because we have a COVID-19 pandemic doesn't mean that we are protected from other infectious outbreaks. We do know that there are cases of Ebola currently active in the Congo. We know that there have  been 11 million childhood vaccines that have not happened this past year. And as children go back to school, there will be risks of measles outbreaks if we don't have those occurring. So, I think that my job will be to remind people of where we were, and we got here in part because of the lack of public health infrastructure. And that just because it didn't happen and since we haven't had a pandemic for a hundred years, doesn't mean another one couldn't happen next year if we don't make the proper investments.

Dr. Judy Monroe: Yeah, that's right. So important for folks to remember. So, shifting a little bit. So, I'm of course, with the CDC Foundation and our perspective is that philanthropy plays a really important role in tackling health challenges. Have you in your experience seen philanthropy make a difference in this regard and what do you think philanthropy's role should be in public health?

Dr. Rochelle P. Walensky: Absolutely. I think we've seen it in all sorts of arenas. As we develop public health infrastructure there and as we get federal support in order to do so, there are certain things that federal support works too slowly, or can't necessarily provide, is not nimble enough to provide. So, I think we need to have all sorts of partners in public health. There is a role for philanthropy, there is a role for partnerships with as you said foundations. There's a role for partnerships in industry. For example, we are now partnering with industry to do our genomic sequencing, some of our genomic sequencing. And then there's a role for academic partnerships. So, the government is not going to be able to do public health alone, the CDC is not going to be able to do public health alone. The CDC will be a shining light and an extraordinary pillar in this, but we are going to need support and philanthropic support is going to be high among them.

Dr. Judy Monroe: Yeah, we're all in this together. Public health really does need everyone. So, my final question to you as we wrap up the podcast today. We often like to ask our guests to give advice to future public health leaders of America, to all the students or those aspiring to perhaps pursue a career in public health. What are your final words of wisdom for them?

Dr. Rochelle P. Walensky: Oh, that's like my favorite question because there is no more fulfilling career than knowing that, and it's a reason, we can harken back to the earlier question. We are in this pivotal time right now. I was in this pivotal time in 1995 where you look around you and you know that you can do so much good in the world by addressing public health. You know you can take people who didn't have resources and improve their health, and there is nothing more fulfilling than laying your head on the pillow at night and knowing that your actions of that day improve the health of somebody else or improve the health of tomorrow. And so, it's an incredible career, it's incredibly fulfilling, and I would say you have come to the right spot to do the work that we do.

Dr. Judy Monroe: Thank you for that. Those are very inspiring words. And I again want to congratulate you on your position at CDC. It has been a delight talking to you today on Contagious Conversations.

Dr. Rochelle P. Walensky: Thank you so much Judy. I look forward to working with you.

Claire Stinson: Thanks for listening to this special edition podcast hosted by the CDC Foundation President and CEO. Contagious Conversations is produced by the CDC Foundation and available wherever you get your podcasts. Be sure to visit cdcfoundation.org/conversations for show notes and bonus content. And if you like what you just heard, please pass it along to your colleagues and friends, rate the show, leave a review, and tell others. It helps us get the word out. Thanks again for tuning in and join us next time for another episode of Contagious Conversations.