The CommonHealth

In the fifteenth episode of the Common Health Live!, Katherine E. Bliss talks with Dr. Jarbas Barbosa, Director of the Pan American Health Organization (PAHO), about challenges related to health security in the Americas, the importance of regional cooperation in building resilient health systems and strengthening preparedness for future health emergencies, and opportunities for advancing efforts to improve the health of the region’s population through the upcoming UN High-Level Meeting on the Prevention and Control of Noncommunicable Diseases and the Promotion of Mental Health and the 10th Summit of the Americas, scheduled to take place in the Dominican Republic in December.

Dr. Andriy Klepikov, the founder and executive director of the Alliance for Public Health (Ukraine), reflects on the Alliance's remarkable evolution over the past 25 years into a major Ukrainian—and regional—non-governmental force in HIV, TB, and harm reduction programs. Foundational to its early success was the exemplary partnership with the Global Fund and PEPFAR. Ukraine, in the midst of war, cannot at present soon transition to self-reliance. In the past three and a half years of war following the Russian invasion, the Alliance has become a provider of mass emergency humanitarian relief to the most vulnerable in Ukraine. It now serves five times the numbers it served before the war. Recovery will draw on telemedicine and mobile clinics, and prioritize mental health, war veterans who are blinded, have lost limbs, and struggle with long-term trauma. The United States remains indispensable to Ukraine's future—for peace and social justice.

Dr. Heidi Larson, the acclaimed expert on vaccine confidence at the London School of Hygiene and Tropical Medicine – and CSIS Senior Associate – speaks to how the external world is reacting to the changes in the United States in vaccine policy, the scientific R&D biomedical enterprise, and public health. “What has shocked people is the abruptness of these measures with little consideration of the implications.” An abrupt drop in trust has followed. The United States has for decades been seen as the most stable and trusted collaborator, based in scientific evidence. People are now turning inward and to other countries. For those scientists whose U.S. grants have been disrupted, “You can’t turn your lab off for six months.” We are seeing the outmigration of US-based scientists to Europe and elsewhere. The multilevel siege of American universities is fundamentally a matter of values. It has raised the question of whether it will be possible to sustain transatlantic scientific partnerships. How to break out of a liberal bubble? Finding a common space is most critical. Sometimes you just have to keep your head down and keep moving forward …. keep our center.

In this episode of The CommonHealth Live!, Dr. Christopher J.L. Murray, Director of the Institute for Health Metrics and Evaluation (IHME) and Stephanie Psaki, CSIS Global Health Policy Center Senior Adviser, will discuss IHME’s new report on Financing Global Health, also released in a paper in The Lancet, and its implications for the way forward in a constrained financial environment. Who and which countries are those most affected by the sharp drop in development assistance for health between 2024 and 2025? How will recipient governments and other global stakeholders respond to fill the gaps? This event is made possible by the generous support of The Gates Foundation.

Dr. Ken Staley, Palantir, has served in health security positions in the George W. Bush and first Trump administrations, with time in-between in private sector biopharma. Palantir was founded after the 9/11 Commission to bring together data streams to enhance security and protect liberties. As director of the President’s Malaria Initiative in the Trump first term, Ken oversaw an effort to use data faster and in a more integrated way, to understand outbreaks, supply chains, and health impacts. He participated in the Lancet Commission as it looked forward on how to make malaria eradication a strategic end-goal. As Covid-19 coordinator at USAID during the 2020 Covid-19 outbreak, Ken shifted communications to the cloud to permit continuity of operations. Technology innovations in malaria control – vaccines and bacteria to disrupt mosquitoes – hold considerable promise. “We have a lot of cool stuff on the horizon.” In regard to WHO, the pandemic treaty, and reforms of the International Health Regulations (IHR), “missions are sacred, organizations are not.” On foreign aid, “the context has changed.”

Dr. Ifedayo Adetifa is a pediatrician and tuberculosis expert who led the Nigerian Centre for Disease Control during the Covid-19 pandemic. A year ago, he became the CEO of FIND, the global alliance for diagnostics, a product development partnership based in Geneva. A major innovation gap was FIND’s initial focus – and remains a pressing priority. And over time, the access gap has become much more conspicuous and urgent. A 2021 Lancet Commission and recent update have proven highly valuable. The sudden decline in U.S. financing is having impact, directly and indirectly, upon FIND, but its diversification of funders has provided a cushion. FIND engages directly with over 100 US-based businesses. AI provides an opportunity for closing gaps in diagnosis, when combined with digital tools. However, there is a serious risk of low-income countries being left behind in the AI transformation. And a risk that diagnostics fall off the priority list.

Michael Osterholm, on July 21, spoke with us on the Vaccine Integrity Project that he is spearheading in response to vaccine-related actions taken by the second Trump administration. “We are in totally unprecedented times.” He explores the VIP’s genesis and mission, its steering committee and partner medical associations, and the VIP’s forthcoming scientific brief on vaccines for RSV, flu and Covid, scheduled for release in early August. “Someone has to stand up and deal with the dis- and mis-information.” While the VIP is not a shadow of the Advisory Committee on Immunization Practices (ACIP), many actors who are witnessing the ACIP’s decline—insurers, medical societies, states and others—are now seeking reliable, alternative scientific data. If VIP comes under attack, will it be possible to mobilize strong bipartisan support? “This is not a fight between Mike Osterholm and Secretary Kennedy. It is about supporting the science. … All we are trying to do is save the vaccines that we know are so important.” It will be critical to manage carefully the risk that we are heading into a confusing, balkanization of the vaccine enterprise—and to restore the integrity of the ACIP.

Beth Cameron, Senior Advisor and Professor of the Practice at the Brown University Pandemic Center and a Senior Adviser and non-resident fellow at CSIS, hosts this inspiring July 14 conversation with Richard Hatchett, the CEO of CEPI, the Coalition for Epidemic Preparedness Innovations. Richard first came to Washington DC in the aftermath of 9/11 to create the U.S. Medical Reserve Corps. There was no looking back. He served in several administrations as a leading expert in bio preparedness and left government to lead CEPI at its creation in 2017, its mission to support the accelerated development of vaccines and other countermeasures against future biothreats. With the Covid-19 pandemic, health security has become an enduring global concern, with now a fierce focus on access to new technology, and regional manufacturing capabilities. “You have to design your programs with your access goal in mind from the very beginning,”  Preparedness is “not a static achievement.” It is “a dynamic state of readiness” that evolves through practice – “train, train, train.”  CEPI’s signature big idea is the 100 Day Mission, in which vaccine designs and delivery platforms are ready to spring into action when new biothreats appear.  Cuts in finances and programs by the Trump administration and others will compromise disease surveillance, detection and containment measures, increasing the risks to Americans and beyond.  Cuts are also forcing reflection, the setting of priorities, and finding ways to finance and achieve better and more efficient outcomes. The remarkable speed in which a vaccine was introduced during the Marburg outbreak in Rwanda in September 2024 rested not on luck. It built on CEPI’s pre-existing partnerships with the Rwanda government and several other institutions, including WHO and key US agencies.  CEPI has invested since 2017 in over $1 billion in the US biotech sector, and has just concluded an agreement to work with DOD.

Joe Grogan, former senior official of the George W. Bush administration and the first Trump administration, operates an active consultancy, hosts a podcast, writes commentaries for USC Schaeffer Center, and is an active member of the CSIS Bipartisan Alliance for Global Health Security. Drug shortages remain a real problem, with the potential to scale and impose political costs. What to make of the Big Beautiful Bill? It might provoke a backlash. How to understand the rising vulnerability of the aging foundational programs—PEPFAR, Gavi, the Global Fund? And how to understand what happened during Covid-19? It was a “toxic brew.” We need to be “radically transparent.”

Fabrizio Carboni, head of the ICRC delegation to the US and Canada, speaks to his vast experience in the wars of the past two decades, including the profound impact of 9/11 (2001) in integrating humanitarian action into battlefield strategies—including the targeting of humanitarian operations. Today, almost 25 years later, we are witnessing unrestrained violence, limitless war, and flagrant disregard for International Humanitarian Law. The emotional, psychological dimensions are poorly understood. Political leadership is essential whenever soldiers are asked to respect IHL. The most dangerous moment is when states argue that they are fighting a "survival war" that they believe is exceptional. Does the Trump administration honor IHL or seek a "realist" American First alternative? It is too early to reach a conclusion: "There is no rupture." It is also too early to know how deep cuts in US foreign assistance will impact ICRC and the broader global response to humanitarian crises. ICRC does remain a "soft target," increasingly exposed. It is striking how a single actor—the United States—can be so "steep" in changing its course. It shifts the ground towards deeper burden-sharing and inspires a debate on what the new architecture will be, with far less money. ICRC has just recently repatriated the remains of 6,000 persons killed in the Russian war against Ukraine. In Gaza there is no way for ICRC to avoid getting hit from all directions. 2,200 Gazans were recently shot or hit with shrapnel while approaching the Gaza Humanitarian Foundation food distributions. "Those numbers are unacceptable."

In the thirteenth episode of The CommonHealth Live!, Katherine E. Bliss and J. Stephen Morrison discuss the outcomes of the June 25 Health and Prosperity through Immunization Global Summit, co-hosted in Brussels by Gavi, the Vaccine Alliance, the European Union and the Gates Foundation. During the Summit, Gavi aimed to secure pledges of $11.9 billion to save at least 8 million lives and protect at least 500 million children from vaccine preventable diseases between 2026 and 2030. While several countries maintained longstanding commitments to the Alliance, and new donors, including current and former implementing countries, stepped up to contribute, Gavi still faces a funding shortfall. U.S. Secretary of Health and Human Services Robert F. Kennedy, Jr.’s video statement expressing concern over Gavi’s approach to vaccine safety before stating that the United States would not renew its support raises questions about how the Alliance can close the funding gap to meet the ambitious goals set forth in the next phase of work.  The conversation highlights takeaways from the pledging session outcomes from the CDC’s Advisory Committee on Immunization Practices (ACIP) meeting the same day, and what recent events mean for the future of U.S. approaches to global immunization programs.

Sheryl Gay Stolberg, NYT, delves into what direction HHS Secretary Kennedy is taking US policy. He operates along two divergent strands – vaccines and the Make American Healthy Again (MAHA) agenda. “Kennedy is by nature a skeptic” and has a “love of nature, and all things holistic.” He has expanded the power of the office, specifically with regard to Covid vaccines, with the CDC leaderless. The newly released MAHA commission report on chronic disease among children, “the sickest generation in American history,” spotlights ultra-processed food—the strongest and most bipartisan argument contained in the report. While the report is restrained on childhood vaccines and pesticides, it is likely to lead to more work on mental health disorders among children.  Sheryl ventured to Texas recently to visit with the founders of Texans for Vaccine Choice, “mad moms in minivans” committed to medical freedom with longstanding links to RFK Jr. For a decade they have scored wins in the Texas legislature. “Defiant” and “entitled,” the Secretary asserts that Americans should not ask any medical advice from him, a deliberate deflection. Dr. Casey Means, nominated to be US Surgeon-General, has already demonstrated she is a strong communicator. It would not be surprising if Kennedy runs in 2028 for the Presidency.

For Helen Branswell, the celebrated Stat News reporter, the SARS outbreak of 2003, while she was based in Toronto, was a thunderclap moment. Jump forward 22 years: Secretary Kennedy on May 28, posted a one-minute video on X announcing he is not recommending Covid vaccines for healthy children and pregnant women -- an “unprecedented” unilateral decision without any normal process. “It came out of the mind of the individuals who wrote it.” What does this bold step signal?  The public is voting with its feet in the low uptake of Covid vaccines by the older and more vulnerable population. Yet it is not clear why the government has to take active measures to make vaccines less available to healthy individuals. CDC should play a lead role in deliberations but is cut out. The CDC director position is vacant, and no acting director is in place.  Will vaccine producers need to run new field trials for updated boosters? “They (the Trump administration) have been quite unclear in what they are asking for.”127 days into the second Trump administration, how to characterize things?  “I would characterize it as exhausting.”  “The change has been massive, and it is not over.”  What gives you hope? “That is a very hard question.”

In this episode, Dr. Kate O’Brien, Director of the Department of Immunization, Vaccines, and Biologicals at the World Health Organization (WHO) shares her perspective on the state of global immunization programs halfway through Immunization Agenda 2030; the challenges associated with current measles outbreaks in the United States and around the world; why people who have never seen children die from preventable diseases may seem complacent about vaccines; steps that can be taken to strengthen vaccine confidence while ensuring equitable access to immunization programs; and what’s at risk as the United States and other funders cut support for biomedical research and development at a moment when there are numerous promising products to prevent infectious diseases in the research and development pipeline.

“I studied hard. Hated the lab, loved the field.”  Dr. Maria Van Kerkhove, Acting Director, WHO Department of Epidemic and Pandemic Threat Management, reveals her early, personal passions as a student of epidemiology. After a stint as a young PhD investigator in Cambodia, she was “desperate to work at WHO. I wanted a seat at the table.” As the technical lead at WHO during the Covid-19 outbreak in early 2020, she spoke at hundreds of press conferences, duly tracked by her mother. The value proposition for WHO? To help governments prepare for emerging biothreats, detect and rapidly share information on outbreaks, and convene the world’s experts to produce guidance. “In my wildest dreams, I did not expect the politicization of Covid throughout the past five years.” WHO’s recent dramatic restructuring will better focus WHO on its core functions, as its two-year budget drops from $6.8 billion to $4.2 billion. As the United States withdrew in January from WHO, it stopped its funding and ceased technical and scientific exchanges. “Since January, U.S. government officials have been instructed not to talk to us.” That is unprecedented and dangerous: “If American expertise is not at the table, there is a gap.” It puts Americans at-risk. Her conclusion: “Restore that link immediately.”

Dr. Margaret (Peggy) Hamburg, former FDA Commissioner, describes the profound impact the HIV epidemic has had on her personally and in terms of her career choices. She discovered in her six years as FDA Commissioner how vitally important FDA is to the safety and protection of Americans, at home and abroad. FDA has oversight responsibility for fully 20% of the American economy. She is  deeply worried at the level of destruction visited upon FDA recently, but cautions that it is critical to wait until the dust has settled. “Corporate capture” of FDA has been an issue for a long time, tied to user fees and industry participation on advisory panels. What is most important is to engage the right expertise and experience, with effective guardrails. The Trump administration has instructed FDA to expand overseas unannounced inspections, expedite the creation of a centralized AI platform across all FDA units, and lower the barriers to the pharmaceutical industry building new facilities on US soil. In each of these ambitious goals, a step-by-step approach is needed, along with attention to the “disconnect” between big, new goals versus uncertain, or declining FDA capabilities in staff, financing, and dedicated offices. She is very concerned at the worsening threat to vaccines and the need somehow to earn back public trust. The same is true for the U.S. “biomedical research and innovation enterprise”—the envy of the world—that has been struck by a “wrecking ball.”

Dr. Jennifer Kates, SVP and Director, Global Health and HIV Policy Program, KFF, provides a tour d’horizon of how global health and health security look at day #98 of the Trump revolution. “The DOGE factor was not on my bingo card,” as it became the battering ram decimating institutions, programs, budgets and staff, far beyond what was environed in Project 2025. It went against what many Republicans favor—just look at the recent dismantling of the Millennium Challenge Corporation. The desire to vanquish likely emanates from the White House OMB. As the budget process, including recissions, advances, the power dynamic may shift to Congress. It may become possible to think about new ways to do foreign assistance. There will be no restoration of the status quo ante. It requires fresh thinking and clear principles, and most importantly, new forms of leadership.

In the twelfth episode of The CommonHealth Live! which falls during World Immunization Week, Katherine E. Bliss talks with Dr. Adam Ratner, a member of the American Academy of Pediatrics Committee on Infectious Diseases and author of Booster Shots: The Urgent Lessons of Measles and the Uncertain Future of Children's Health, and Dr. Ephrem T. Lemango, Associate Director of Immunization at UNICEF, about measles outbreaks in the United States and abroad; how to bolster measles vaccination coverage in a period of reduced financing for domestic and global programs; and why routine immunization programs are critical to global health security.

In the eleventh episode of The CommonHealth Live! Katherine E. Bliss talks with the Republic of Indonesia’s Minister of Health, H.E. Budi Gunadi Sadikin, about Indonesia’s experience expanding routine immunization coverage and prioritizing attention to non-communicable diseases, as well as how public-private sector collaboration can help ensure sustainable access to health services, including primary health care.

Dr. Stephanie Psaki—a newly minted CSIS Senior Adviser—shares the story of her personal evolution as a scholar, NGO policy data expert, senior political appointee at the HHS Office of Global Affairs and the White House National Security Council, and now faculty at Brown University School of Public Health. She reflects on the lessons, good and bad, from her 900 days at the White House, and what the first 100 days of the Trump second term reveal, in particular how science has become politicized. We are seeing a “a huge departure from the role the United States has played for decades.” While the Mpox outbreak in both Europe and the United States (2022-2023) had a promising outcome, the ongoing outbreak in central Africa (which began in 2023) leave many uncomfortable, unanswered questions of why leadership, coordination, finance and speed remain so problematic. The surprise, recent completion of the Pandemic Treaty is encouraging, up to a point. As we turn inevitably to chart a vision for the future, we will have to think in fundamentally different ways about the different world we now occupy.