New CDC director seeks to build confidence in battered agency

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Dr. Mandy K. Cohen stopped by the Fox affiliate in Dallas in November, just days after the governor of Texas signed a law prohibiting private employers from requiring Covid-19 vaccines. If she thought promoting vaccination would be a tough sell in a ruby ​​red state, Dr. Cohen, the new director of the Centers for Disease Control and Prevention, gave no indication.

“I'm not just the director of the CDC, I'm also a mother,” she said cheerfully, noting on live television that her daughters, ages 9 and 11, had already received their latest Covid and flu vaccines. She added: “So I wouldn't recommend anything to the American people that I wouldn't recommend to my own family.”

It was the kind of common phrase that Dr. Cohen has repeatedly invoked as she carries out a task that some public health experts fear is impossible: restoring Americans' faith in public health and its battered agency. Five months into her tenure, with the Covid public health emergency officially over, the CDC's new leader continues to deliver her message.

Americans' trust in the agency, and in science in general, has been severely damaged by the coronavirus pandemic, and the loss of faith is particularly pronounced among Republicans. In a recent survey by the Pew Research Center, 38 percent of Republicans said they had little or no confidence in scientists to act in the best interest of the public, up from 14 percent in April 2020.

At the same time, the CDC's winter vaccination campaign appears to be falling on deaf ears. On Thursday, the agency issued an alert warning that low vaccination rates against flu, Covid and respiratory syncytial virus, known as RSV, could lead to “serious illness and increased strain on healthcare capacity in the coming weeks.” ”. And partisan divisions over vaccination persist: A KFF poll in September found that seven in 10 Democrats, but only a quarter of Republicans, planned to get the updated Covid vaccine.

Dr. Cohen, whom President Biden selected to succeed Dr. Rochelle P. Walensky, is responding with a national media blitz. Since he took over the CDC in July, he has traveled the country promoting vaccination in 19 cities in 13 states. She has visited 22 vaccination sites and participated in dozens of interviews, including an appearance on NBC's “Today” just before Thanksgiving.

She has left a trail of social media posts in her wake, including a series of short videos, called “Check in with Dr. Cohen,” that usually begin with some variation of the same greeting: “Hello everyone, I'm Mandy Cohen ! “

In a video recorded on Long Island, Dr. Cohen and a county health official, wearing hard hats and vests, reported on how wastewater can help scientists track viruses and diseases. In Dallas, she appeared with another county health official to talk about the importance of data and with a nurse at a church health fair. And in Chicago, she supported the president of the American Medical Association while promoting vaccination.

When he talks to reporters, he frequently mentions his children.

“Science is important and yes, data is important,” Dr. Cohen said in an interview with The New York Times. “But at the end of the day, we're all human too. And if we can have a person-to-person conversation about what I would do for my own children, who I love and want to be healthy, maybe that can connect us in a different way.”

Dr. Cohen takes over an agency that is in transition. His predecessor, Dr. Walensky, who started at the start of the Biden administration and resigned in June, commissioned a review of the CDC that identified serious weaknesses in areas from testing to data collection and communications. . He then initiated a review of the agency.

Dr. Cohen has said she is committed to carrying out that plan, which included the creation of a new forecasting and analysis center, as well as structural changes aimed at allowing the agency to quickly translate its science into coherent policy recommendations. But even her staunchest allies say her top priority must be changing the way the public views her agency.

“Restoring trust is probably the number one challenge right now,” said Dr. Judith Monroe, president and CEO of the CDC Foundation, an independent nonprofit organization established by Congress to mobilize private sector support for the work of the agency. “Because where is your platform if people don't trust what you say?”

Experts agree that CDC officials and other public health leaders made serious errors in their messaging during the pandemic. Officials created distrust by speaking “with certainty when there was none” and then changed their recommendations, said Brian C. Castrucci, president and CEO of the de Beaumont Foundation, a public health nonprofit that partners with Frank Luntz, a pollster and political strategist, to study attitudes toward public health.

Luntz, who rose to prominence working for Republicans, said his research had found that a significant portion of the public (up to 20 or 25 percent) was now unreachable, because public health officials used language that “sounded as if he were giving a sermon.” , and almost abusive toward people who had legitimate doubts.”

Drawing on Mr. Luntz's surveys and focus groups, the foundation has developed a messaging guide, including a “communications cheat sheet,” to help public health officials reach Americans of all political stripes. . Dr. Tom Frieden, who was CDC director under President Barack Obama and was involved in the project, said Dr. Cohen's communication style was in line with his findings.

“You're there to empower people with information, not reprimand them to change their behavior,” he said. “I think Dr. Cohen understands that.”

The morning before leaving for a two-day, three-city tour of Texas, Dr. Cohen met with her top advisors and her infectious diseases team at CDC headquarters in Atlanta for an update on the flu, the Covid and RSV. circulating during what the agency now calls the “winter respiratory virus season.” One benefit of that nickname: winter viruses are less politically toxic than Covid.

The news was mixed. Flu hospitalizations increased slightly from last year. The rate of Covid vaccination was much lower than that of flu vaccination among healthcare workers, which is not a good sign. A new shot of monoclonal antibodies to prevent RSV in babies was in short supply, but 77,000 more doses had just been released. Texas was experiencing an increase in RSV

But there was something else on Dr. Cohen's mind. During his travels, he had heard from people who were concerned about the side effects of vaccination and wanted more information about what federal health officials were doing to monitor the safety of the vaccines. The CDC, he told his colleagues, needed to be able to “tell a clear and concise story.”

To that end, Dr. Cohen is changing the language the CDC uses to describe itself. Testifying last month before a House subcommittee, in what was his first appearance before Congress in his new role, he described the agency as a “critical national security asset,” a phrase that could have a particular appeal to House Republicans, who have proposed cutting the CDC's rights. funding at $1.6 billion, or about one-sixth of its budget.

But M. Anthony Mills, a senior fellow at the conservative American Enterprise Institute who studies public trust in science, said the national security framework may not appeal to ordinary Americans who distrust the CDC and other agencies like the Institutes. National Health and Food and Agriculture. Drug Administration.

“For Americans who believe the NIH lied about funding the research that caused the pandemic, suspect the pharmaceutical industry of being in bed with the FDA, and view public health efforts as an infringement on their freedom, that constellation of concerns have little to do with national concerns. safety,” she said.

Unlike Dr. Walensky, who had no prior government experience and made headlines for seeking media training, Dr. Cohen is no stranger to Washington or the spotlight.

She was a senior official at the Centers for Medicare and Medicaid Services during the Obama administration. Later, as secretary of health and human services in North Carolina, she laid the groundwork for the Republican-controlled legislature to agree to a Medicaid expansion and helped guide the state through the pandemic.

After news reports that Biden planned to pick Dr. Cohen for the director's job, more than two dozen Republicans in Congress signed a letter accusing her of politicizing science. They cited her mandate in North Carolina, where she asked students and staff in K-8 schools to wear masks and threatened legal action against a school district over its Covid policies.

But while his relations with Republicans in North Carolina may have been strained, they never turned to vitriol, said state Rep. Donny Lambeth, a Republican and chairman of the North Carolina House Health Committee.

“She was calm, collected and collected almost every time we had her in front of us,” Lambeth said. “She didn't get nervous.”

There were few fireworks during his congressional testimony last month. When Rep. Daniel Crenshaw, R-Texas, pressed her to admit that the CDC had gotten it wrong during the pandemic, she politely ignored his request.

Rep. Jeff Duncan, R-S.C., wanted to know if he regretted the Covid restrictions of his stay in North Carolina. Dr. Cohen admitted none. When he pointedly asked her if she would impose such restrictions today, she avoided the question and told him that she was looking forward to a new chapter at the CDC.

“The good news,” he said, “is that we are in a new place.”



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