Q&A with CDC Director Mandy Cohen: On communication, trust, and getting things done

The new director of the Centers for Disease Control and Prevention, Mandy Cohen, is only two weeks into her new job. But already she hears the clock ticking.

If all goes well, Cohen — the successor to Rochelle Walensky, who stepped down at the end of June — will have about 18 months at the helm of the world’s premier public health agency before the next U.S. president is sworn in. If the 2024 election goes one way, her term could be extended — pending Senate confirmation. If it goes the other way, there’s a very good chance someone else will take her place.

In an interview Tuesday with STAT — only her second since taking the job — Cohen likened her new position to running a leg in a relay. She took the baton from Walensky, whose work Cohen thinks was a great start to long-needed reform of the CDC. Her plan? “I’m going to run as hard and as fast as I can for as long as they let me run,” the former secretary of health for North Carolina said.

It’s clear the agency is in for some changes. Cohen has already told staff, who have been largely working remotely since early in the Covid pandemic, that she wants people back on the CDC’s Atlanta campuses more often.

It’s also clear she’s already working both sides of the aisle, looking to fend off potential budget cuts that could target the CDC’s new Center for Forecasting and Analytics. As she puts it, the CDC is a national security asset, one that needs funding to protect the health of Americans.

“Folks want us to be ready to know of threats and to respond quickly. Well, we need data and visibility to do that,” she said flatly.

The following conversation has been lightly edited for length and clarity.

Are you going to be encouraging or even requiring CDC staff to come back into the office? I take it that a lot of people are still working remotely?

I think in-person work is extremely important. I think it’s how you build relationships. I talked at my very first all-hands meeting that I did in my very first week; we had 9,000 folks join that. And one of the very first things we talked about was building trust. And that starts here, within our own team. And the only way I know how to build trust is building relationships.

But it has to be purposeful. So I don’t want folks just braving the Atlanta traffic to sit here alone in a cubicle. So what I’ve been asking my team to go through is a plan to say: Can we establish core days when we bring folks here? When we bring folks here, how do we be intentional about that time together?

We’re in that process now. And I am very focused on making sure that we’re purposeful about our in-person work. It does take us a bit of time to make sure we do that well. But it is top of mind for me.

Are you physically moving to Atlanta with your family? You have young kids.

I do have young kids, so obviously it takes a little bit of time. So right now they’re ensconced in summer things. When I got this call, summer was already planned out. But I’m here in Atlanta. I plan to be here whenever I’m not in D.C. or, frankly, traveling around the country or around the world to see our work.

But in terms of your family? Will they be moving to Atlanta too?

I’m working on it. I have two kids. So we have some things to unwind. So give me a little bit of time as we work on that piece.

I know that you’ve been meeting with former CDC directors. Have you gone through the whole list?

I think I’ve gone through the list, from everyone from Bill Foege to Jeff Koplan to Julie [Gerberding] … and who am I forgetting? Obviously Tom Frieden and Bob Redfield and others. So, yes, they’ve been incredibly helpful.

I think it’s important to understand what’s happened in the past so that you can learn from things that went well, things that didn’t go well, and where do you need to go in the future. Bill Foege was the leader who eradicated smallpox. I absolutely wanted to understand how he thought about that work. But at the same time, understanding Bob Redfield, who was here when Covid hit and how he approached that work. So all of it has been incredibly helpful.

The CDC has a lot of work to do. I think the world is very different in 2023 than it was just in 2019. I think the time has changed. And so I do think it’s time for a new chapter. And that’s what I’m thinking about. How do we operate at the most effective that we can to fulfill our mission?

Did any of them give you particularly sage pieces of advice?

So many pieces of advice. Be here. Be present. Get to know the wonderful team that is here. We have some of the most incredible experts, important scientific work that’s going on here.

But also making sure that one of the things that’s incredibly important for CDC is to remember it’s one piece in a larger U.S. government approach to protecting health. And that is where my experience comes into play. Obviously I worked at the federal level for seven years at [the Center for Medicare and Medicaid Services], and I worked at the state level. So thinking about where does CDC play both across the U.S. federal government, but how does it make sure to be one team with our state and local partners as well?

Obviously, we talked a lot about trust. That is a common theme I talked about with past folks who ran the CDC but that I’ve heard a lot from members of the Hill and others is about trust.

The CDC has taken quite a battering over the pandemic. And trust in the CDC and its competency has been challenged. Do you think that’s fair?

I think that the CDC has lost trust during an incredibly historic pandemic. But I think that there is a tactical way to go about rebuilding that trust. And that’s what we’ve been talking about here.

I think that starts with transparency — clear communication that is simple and easy to understand. Second is good execution — making sure that we do what we say we’re going to do. And then the third is about building relationships.

Those are all competencies I see here at the CDC. We just need to make sure that we’re focused on them every day and that we are one team here at CDC so that we see what we want to see in the world — which is great collaboration. Because the work of protecting the public’s health is a team sport. CDC is clearly a hugely important player in that, but certainly not the only one.

A House subcommittee looking at the CDC budget recently proposed zeroed out funding for the new Center for Forecasting and Analytics. Another thing they proposed was zeroing out funding for the End the HIV Epidemic Initiative. I know the budget process is a process and it isn’t done yet. But are those signals concerning to you, that people might be looking to cut into potentially the competency that helps the CDC protect the country from the next infectious disease event?

CDC has a critical mission of protecting the health of this country. It is an important national security asset. And so we need to think of it in that way. And that means it needs resources to do its job. I’ve started a process of talking to members of both the House and Senate to make sure that they understand the CDC and what kind of resources are needed in order to be that national security asset.

Let’s talk about the Center for Forecasting and Analytics. Folks want us to be ready to know of threats and to respond quickly. Well, we need data and visibility to do that. And so that is money that will help us to see threats and respond to threats faster. And that’s what I think the American people want and deserve. But it takes resources to do that.

Another one of the words we talked about as a team was stewardship. We know that we need to be good stewards of taxpayer dollars. So we want to show folks that the money they are putting here is delivering for the American people each and every day.

Is the CDC looking at layoffs of staff? I have heard that there may be layoffs. Is that correct?

What I would say is that, as you well know from the federal budget process, there are programs that start, there are programs that end with funding cycles. Right now, we do not see that in the near term. But again, it takes resources to make sure we have the workforce needed to carry out our work.

So I don’t want to say that’s not possibly on the horizon, but nothing immediate.

There is great fatigue, I think, in the country in terms of infectious disease threats. People want Covid to be the one-in-100 year storm, and we don’t have to worry about this for the next hundred years. But of course, that is not true. And I wonder how you feel about how the country is positioned to respond to something else if it were to happen in the near term, and the CDC’s capacity to respond?

I recognize everyone’s fatigue around the pandemic. Unfortunately, viruses don’t get tired. So we have to maintain our vigilance. But the good news is we have more tools than ever before to be able to protect ourselves from the currently circulating viruses. So as we go into the fall and winter, we’re going to see Covid and flu and RSV. We are going to see them all together. But we have tools for all of them. Vaccines and treatments and good protocols. So we have the ability to respond.

And what we need to do is use those tools. We just need folks to use tools like vaccination to prevent illness or to make sure that they’re getting tested when they’re not feeling well and to take treatment that we have for those viruses. So we have the tools we need right now for the viruses that we know about.

But we need more investment in being able to respond to something new. There was certainly room for improvement on how things went during the pandemic. And our ability to do that the next time is going to require investments, particularly in data as well as in our workforce, to be able to have the people to actually respond. And of course, making sure that we’re improving our communication and being crisp and clear about guidance as we go forward. We’re building that now. We’re working away at it.

In reality there is a finite period of time between now and the next election. And after the next election, the CDC director will have to be Senate-confirmed. Are you looking at this job as the next 18 months? And how much can one do in 18 months?

I’ve been in these kinds of roles before at the federal level, at the state level, and I always know that we’re always running a leg of the race. So I picked up the baton from Dr. Walensky, who did a ton of work to really think about how she could put the CDC on a path of success to really meet its mission. I think a ton of that work was exactly right. You’re not going to see me change that work.

So I really picked up the baton. I’m going to run as hard and as fast as I can for as long as they let me run. But I have to think about it in chapters to make sure that we can be focused. But I do have a sense of urgency, whether that’s 18 months or five and a half years. I feel the time ticking. We have to prioritize. We can’t do it all, all at once. And so I’m working with the team now to try to understand how do we focus and prioritize to make sure that we’re doing the most important things for the American people.