A Conversation with CDC Director Mandy Cohen | Milken Institute Global Conference 2024

Context and Strategic Shift:

• CDC Director Mandy is entering her tenth month in the role, marking a transition to a "new chapter" in public health where health security, national security, and economic stability are recognized as inextricably linked.
• The CDC emphasizes that over 50% of global economic growth over the last two centuries is attributable to public health and medical research.
• Mandy highlights that demographic shifts are critical, noting that the ten countries with the highest birth rates are all in Sub-Saharan Africa, with Nigeria alone accounting for more births than all of North America and Europe combined.

Global Health Security and Forward Deployment:

• The CDC is prioritizing the identification and containment of health threats at their source abroad to prevent transmission to the U.S. via international travel.
• Recent visits to Ethiopia, Zambia, and Kenya were driven by specific needs to address rising measles cases linked to internal conflict and vaccination gaps in Ethiopia, which have directly impacted U.S. case numbers.
• CDC strategy includes "forward deploying" personnel internationally to detect genetic changes in viruses, such as avian influenza, before they reach U.S. borders.

Domestic Health Priorities and Inequities:

• CDC is focusing on two primary domestic areas beyond infectious disease response: improving mental health and supporting young families (ages zero to ten).
• Mental health initiatives are urgent in response to last year's statistics: 100,000 overdose deaths and 50,000 suicide deaths.
• The agency is addressing stark life expectancy disparities driven by geography, such as a 10-year difference over a 20-minute subway ride in New York and up to a 20-year difference between wealthy suburbs and inner cities in Baltimore.
• Zero-to-ten age is identified as the critical period for establishing lifelong health patterns, necessitating interventions in maternal health, vaccination, food security, and housing.

Workforce, Business Partnerships, and Economic Impact:

• CDC is engaging the business community (controlling over 3,000 companies and tens of millions of employees) to promote healthy workforces, arguing that a healthier workforce reduces productivity losses from seasonal illnesses like RSV and flu.
• For self-insured large employers, improved workforce health is framed as a financial imperative that frees capital for other business investments.
• Public health advocates urge businesses to act as advocates for vaccination, drawing parallels between public health investment and military defense spending.

Data, Technology, and AI Integration:

• A major strategic push is underway to eliminate data silos between health delivery systems and public health, moving away from legacy processes (e.g., faxing lab data in North Carolina during the pandemic) toward electronic case reporting.
• CDC Director Mandy has challenged Electronic Health Record (EHR) partners to prioritize data interoperability, noting that current fragmentation hinders rapid threat response.
• The agency is exploring AI applications for public health, specifically using large language models to detect signals in noise, analyze social media conversations for emerging community problems, and improve diagnostic speed.
• Mandy explicitly requested Congressional support to secure necessary resources and authorities to accelerate data modernization and AI adoption.

Vaccine Communication and Trust Building:

• While acknowledging the scientific marvel of rapid vaccine development (such as during COVID-19), Mandy emphasizes that vaccines require robust trust to be effective; technology alone is insufficient if the public hesitates.
• Strategy to combat misinformation involves expanding the "voices" in the conversation, personalizing the narrative (e.g., Mandy discussing her own daughters), and linking to trusted community figures.
• CDC aims to update the population's understanding of vaccine value, acknowledging that trust-building is a long-term process requiring continuous engagement.

Organizational Culture and Visibility:

• The CDC is described as a "small but mighty" team relying on a "team sport" approach, utilizing partners to provide eyes and ears globally since CDC personnel are the emergency responders with the highest readiness levels (bags packed).
• Mandy notes that security constraints often limit public visibility of CDC capabilities, such as the global situation room, but emphasizes the organization's evolution in diagnostic capability and data visibility following lessons from the pandemic.