New CDC director tries to build trust in a battered agency

Dr. Mandy K. Cohen stopped by the Fox affiliate in Dallas in November, just days after the Texas governor signed a bill into law exclude private employers of requiring Covid-19 shots. Thinking that promoting vaccination in a ruby ​​state would be a hard sell, Dr. Cohen, the new director of the Centers for Disease Control and Prevention, has no indication.

“Not only am I the CDC director, I’m also a mother,” she said cheerfully. take note on live television that her daughters, 9 and 11, had already received the latest Covid and flu shots. She added: “So I wouldn’t recommend something to the American people that I wouldn’t recommend for my own family.”

It was the kind of stock phrase that Dr. Cohen has used repeatedly in pursuit of a task that some public health experts fear is impossible: rebuilding Americans’ faith in public health and its battered institution. Five months into her term, with the public health emergency officially over, the CDC’s new leader is relentlessly delivering a message.

Americans trust in the agency, and in science more broadly, has been severely damaged by the coronavirus pandemic, and the loss of confidence has been especially pronounced among Republicans. In a recent survey According to the Pew Research Center, 38 percent of Republicans said they had little or no confidence in scientists to act in the best interests 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 a warning warning that low vaccination rates for flu, Covid and the respiratory syncytial virus, known as RSV, could lead to “severe illness and increased pressure on healthcare capacity in the coming weeks.” And the partisan divide over vaccination persists: A KFF poll In September, it emerged that seven in 10 Democrats, but only a quarter of Republicans, planned to get the updated Covid shot.

Dr. Cohen, who was selected by President Biden to appoint Dr. Rochelle P. Walensky responds with a national media blitz. Since taking the helm of the CDC in July, she 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,” which usually begin with a variation on the same greeting: “Hello everyone, this is Mandy Cohen! ”

In a video Recorded on Long Island, Dr. Cohen and a county health official, wearing hard hats and vests, discuss how wastewater can help scientists track viruses and diseases. In Dallas, they 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 stood by the president of the American Medical Association while promoting vaccination.

When she speaks to reportersshe often raises her children.

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

Dr. Cohen takes over an agency that is in transition. Her predecessor, Dr. Walensky, who began serving at the start of the Biden administration and resigned in June, ordered a review of the CDC, which found serious deficiencies in areas ranging from testing to data collection and communications. She then initiated an overhaul of the agency.

Dr. Cohen has said she is committed to carrying out that plan, including creating a new one forecasting and analysis center, as well as structural changes intended to enable the agency to quickly translate its science into coherent policy recommendations. But even her closest allies say her top priority should be to change the way the public views her agency.

“Rebuilding trust is probably the biggest challenge right now,” said Dr. Judith Monroe, president and chief executive of the CDC Foundation, an independent nonprofit organization created 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 have made serious reporting errors during the pandemic. Officials fostered distrust by “speaking with certainty when there was none” and later changing their recommendations, said Brian C. Castrucci, the president and CEO of the de Beaumont Foundation, a nonprofit public health organization that collaborates with Frank Luntz, a pollster and political strategist, to study attitudes toward public health.

Mr. Luntz, who rose to prominence working for Republicans, said his research found that a significant portion of the public — as much as 20 or 25 percent — was now inaccessible because public health officials used language that “sounded as if it gave lectures’. , and almost insulting to people who had legitimate doubts.”

Based on Mr. Luntz’s research and focus groups, the foundation has developed messaging guidelines, including: “communication cheat sheet,” to help public health officials reach Americans of all political backgrounds. Dr. Tom Frieden, who served as CDC director under President Barack Obama and participated in the project, said Dr. Cohen agreed with its findings.

“You’re there to provide people with information, not to berate people to change their behavior,” he said. “I think Dr. Cohen understands that.”

The morning before she was to leave for a two-day, three-city trip across Texas, Dr. Cohen joined her top aides and her infectious disease team at CDC headquarters in Atlanta for an update on the flu, Covid and RSV — which are circulating during what the agency is now calling the “winter respiratory virus season.” One advantage of that name: winter viruses are politically less toxic than Covid.

The news was mixed. The number of hospital admissions due to the flu had increased slightly compared to last year. The Covid vaccination rate was much lower than the flu vaccination rate among healthcare workers – not a good sign. There was a shortage of new monoclonal antibodies to prevent RSV in infants, but another 77,000 doses had just been released. Texas saw an increase in RSV

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

To this end, Dr. Cohen the language the CDC uses to describe itself. Testified last month before a House subcommittee, in what was her first appearance before Congress in her new role, she described the agency as a “critical national security asset” — a phrase that could be especially appealing to Republicans in the House of Representatives, who have proposed cutting funding for the CDC. with $1.6 billionor about one sixth of the budget.

But M. Anthony Mills, a senior fellow at the conservative American Enterprise Institute, who studies public trust in sciencesaid the national security frame may not appeal to ordinary Americans who distrust the CDC and other agencies such as the National Institutes of Health and the Food and Drug Administration.

“For Americans who believe the NIH lied about funding research that caused the pandemic, who suspect the pharmaceutical industry is in bed with the FDA and see public health efforts as an infringement on their freedom, that constellation of concerns doesn’t have much to do with national security,” he said.

Unlike Dr. Walensky, who had no previous government experience and made headlines find media trainingDr. Cohen is no stranger to Washington or the spotlight.

She was a top official at the Centers for Medicare & Medicaid Services during the Obama administration. Later, as North Carolina Secretary of Health and Human Services, she laid the groundwork for the Republican-controlled Legislature to pass a Medicaid expansion, and helped guide the state through the pandemic.

After news reports that Mr. Biden planned to Dr. Cohen for the position of director, more than twenty Republicans in Congress signed a letter accuses her of politicizing science. They cited her tenure in North Carolina, where she urged students and staff at elementary schools to wear masks and threatened legal action against a school district over its Covid policies.

But while her relations with North Carolina Republicans may have been tense, they never descended into vitriol, said state Rep. Donny Lambeth, a Republican and chairman of the Health Committee in the North Carolina House of Representatives.

“She was cool, calm and collected almost every time we had her in front of us,” Mr Lambeth said. “She wasn’t upset.”

There were few fireworks during her testimony in Congress last month. When Rep. Daniel Crenshaw, Republican of Texas, pushed her to admit that the CDC had been wrong during the pandemic, she politely ignored the request.

Rep. Jeff Duncan, Republican of South Carolina, wanted to know if she had any regrets about Covid restrictions from her time in North Carolina. Dr. Cohen has not admitted that. When he she asked pointedly If she were to impose such restrictions today, she dodged the question and instead told him she was looking forward to a new chapter at the CDC

“The good news,” she said, “is that we’re in a new place.”