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ATLANTA — The new director of the Centers for Disease Control and Prevention has spent days on television and social media urging Americans to get vaccinated against the coronavirus. The new vaccine is the most effective coverage against the shutdown of the viral season, he said. And it’s free.
But until the afternoon of Sept. 21, it was clear to Mandy Cohen that the vaccine rollout, begun nine days earlier, was in trouble, with many Americans temporarily unable to get vaccinated at pharmacies, insurers making false claims about who pays and little explanation from the government.
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Cohen went to a small convention hall in the basement of the beleaguered agency’s headquarters to take inventory of the situation. On the other side of the table, Nirav Shah, senior deputy director of the CDC, defined several issues such as insurance and supply chain. The federal government was no longer overseeing vaccine production and distribution now that the Covid public health emergency was over, so the CDC had less control over the rollout, he explained.
Cohen frowned. I wanted to speak publicly about the delays. “If we don’t say something, it feels like we’re not paying attention to it,” he told Shah. “I don’t need to say ‘supply chain. ‘ I mean genuine words. “
The next day, Cohen recorded a short video acknowledging the problems. “It’s vital to know that a vaccine is available. You’ll be able to get one and it’ll be free for you. Whether you have insurance or not,” he said in the message posted on Twitter. If you’re struggling to locate the vaccine, persevere. “
The exchange exemplifies Cohen’s strategy to lead the once-touted public fitness company as it tries to regain public acceptance as true after its missteps during the coronavirus pandemic. Although the rollout of the updated vaccine has advanced in recent weeks, its adoption remains slow and some Americans are still struggling to find vaccines, mitigating a time when Cohen and his colleagues had hoped to show their ability to repair acceptance in the company.
The Washington Post attended three-day public and face-to-face meetings with Cohen in Atlanta and Washington, D. C. , in September and spoke with three dozen company officials, Biden management leaders and public fitness experts to talk about his first term. The resulting snapshot shows someone acting temporarily and decisively, at odds with the CDC’s traditional culture and generating frustration among staff who say their opportunism led to confusion and redundant work.
Shortly after arriving as an outsider to lead the agency, he sent senior officials a “Mandy Cohen’s User’s Guide,” a two-page document containing points detailing “the most productive user enjoys me. “
Cohen, a physician and former fitness secretary in North Carolina, doesn’t like surprises or “winding meetings,” the consultant warns. It needs to be kept up to date with “SHORT and frequent email updates. “assuming (often wrongly) that nothing is happening. “
Several senior officials said they appreciated his candor and gladly responded when Cohen asked them to fill out a similar document. But their bureaucracy included an assessment of their weaknesses, a category they said they overlooked in Cohen’s “user guide. “
Installed at the CDC through the White House in July, Cohen is tasked with restoring staff morale and public credibility at a time of excessive political divisions and loss of acceptance in government and science. The Atlanta-based 12,000-person firm has become a target in Congress and in the crusade campaign: Republican presidential candidates such as Florida Gov. Ron DeSantis and Vivek Ramaswamy have vowed to gut the CDC if elected next year, insisting that the covid school’s leadership was too cautious and led to excessively long elections. school closures, increased intellectual aptitude, and other social problems.
“We’re in this post-covid moment, where the imperative is to rebuild trust,” J said. Stephen Morrison, senior vice president at the Center for Strategic and International Studies, co-authored a January report on much-needed adjustments. to the CDC.
He noted that Cohen faces more lawsuits as we head into the fall and winter, when respiratory illnesses like influenza, covid and respiratory syncytial virus (RSV) tend to rise: “Americans are asking, ‘How do I behave?Who can I turn to screening to minimize “risk or serious illness” or worse?
The CDC, Morrison said, will have to be in a position to provide answers.
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Prioritizing Covid, Flu, and RSV
When he took over this summer, Cohen told senior managers that his most sensible priority for the company was to prepare for respiratory virus season. Officials said they assumed that meant following a well-established surveillance protocol, as there were no crises similar to any of the above. the diseases now familiar: influenza, RSV, and coronavirus.
But Cohen was looking for more. A month after taking office, he reshuffled the center’s leadership of the company’s response to COVID-19 and other respiratory illnesses, a move he said would make the CDC better stay on top of the next viral season. The company will activate its second-highest emergency point to deal with existing cases of influenza, RSV and COVID-19, just one point below the company-wide mobilization at the height of the pandemic, according to three senior officials who spoke on condition of anonymity for percentage of internal conversations.
CDC officials have long been at a loss to understand why the company has taken such a competitive stance, with some employees tasked with focusing intensely on influenza, RSV and COVID-19 in addition to their day-to-day work, given that none of the viruses have reached the area. “It’s the point of a viral emergency,” one official said, adding that “painting 24 hours a day . . . scientifically it probably wouldn’t make sense. “
Cohen’s focus on breathing viruses has already sparked resentment among some company officials, who say they worry the overload will run out when a true emergency arises.
Cohen’s decision to assign one of his assistants to work on covid messaging was also seen by staff as a duplication and for his expertise, as another CDC team had already begun that work.
“I’m asking the CDC to be other and the groups to be other . . . I think it’s necessary,” Cohen told the Post in reaction to the criticism. “Part of being a leader is making sure you have the right others. “friends on the bus with you. “
Cohen, 45, said government leaders would support the action. He pointed to some “growing pains” in his efforts to provide “a harmonized response” to the three circulating respiratory viruses.
Its urgency stems from a developing public health issue: Many Americans ignored the CDC pandemic. The company has been criticized for the botched rollout of coronavirus tests, when the pandemic first threatened Americans in early 2020; he has been continually mocked for his slow and contradictory recommendation on when to wear masks, isolate when sick, and seek booster shots; and many parents are deeply distrustful of this system and blame the CDC for the learning loss resulting from school closures.
An Axios/Ipsos poll shows that in March 2020, 86% of Americans said they asked the CDC to provide them with accurate data on covid-19. By February 2022, that figure had dropped to 61%.
Cohen has been seeking to regain public acceptance by visiting fitness clinics, pharmacies and senior centers across the country, urging others to get vaccinated against covid, RSV and the flu. This is the first time the country has the equipment to save. You are serious diseases caused by the 3 viruses, he has said continuously. She continually cites the importance of vaccinating her young daughters and elderly parents with the newer, ever-changing coronavirus vaccines.
Despite their efforts, uptake of the current coronavirus vaccine has been low: Only 10 percent of adults and four percent of young people had received the vaccine as of Nov. 8, according to CDC data.
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Dealing with political pressure
Since his early days at the CDC, Cohen has been on the move: playing ping-pong between his family’s home in Raleigh, N. C. , on the weekends, his Atlanta apartment on weekdays, and his regular trips to Washington, D. C. , to meet with Biden officials and members as he tries to build relationships with his exhausted public officials and with his peers who have long watched the company as remote and out of touch.
The CDC leader is well aware that she will have to convince lawmakers and officials that they can decide the agency’s fate, after her predecessor Rochelle Walensky struggled to make her way in Washington and ultimately lost the confidence of the White House.
But unlike Walensky, a Harvard-trained infectious disease expert with limited political experience, Cohen came to the CDC as a figure known to many in the Biden administration. As a top health official in the Obama administration, she helped oversee Medicare, Medicaid, and the Affordable Care Act. His longtime allies include Surgeon General Vivek H. Murthy and the White House’s most sensible physical health official, Christen Linke Young. And its top prominent advocate is White House leader Jeff Zients, who played a pivotal role in its variety to lead the CDC.
But Cohen’s limited experience with the company — and reports that the White House previously considered her to lead the Department of Health and Human Services, a cabinet-level role — has contributed to speculation that the new director is her role as a springboard for higher ambitions.
Cohen says she is “100 percent focused on the work of the CDC” and is making sure the company benefits from its past experience in crisis management in the federal and state governments.
Cohen has also tried to build bridges with congressional Republicans, who are conducting investigations into the CDC on its reaction to the pandemic and other issues. Allies insist Cohen is well prepared for the challenge, saying she is being tested after serving in a GOP-led administration. North Carolina’s legislature for four years as the state’s most sensible health official, guiding the state through the COVID-19 pandemic.
Sen. Bill Cassidy (R-La. ), the most level-headed Republican on the Senate Health Committee that oversees the agency, credited Cohen for being “more open and quick to respond” than previous CDC directors.
“It turns out that she perceives what the disorders are,” said Cassidy, a doctor who has criticized the CDC for its lack of transparency and slow, research-driven culture.
Walensky had begun a radical overhaul of the company last year, seeking faster publication of clinical findings and easier-to-understand guidelines, a more agile and better-trained emergency response workforce, and incentives that praised moves more than the publication of study articles.
Cohen has embraced those fundamental elements, which he reinforces with his team at each and every opportunity.
At a recent virtual town hall aimed at tailoring coronavirus vaccination messages to doctors, Cohen noted that staff presentations contained too much information. Messages should be “short, concise, transparent and objective,” he told attendees. For cardiologists, focus on covid headaches. Directed. To pediatricians, “let them know the ICU numbers” for young people who are hospitalized with COVID-19 but have no underlying medical conditions, he said.
“I need to make sure this gets off the page,” Cohen said, voice emerging to insist, from his 12th floor overlooking the sprawling campus in suburban Atlanta. “I’m concerned that with so much information we’re not going to break with some key points. “
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Trying to win allies, even with a song
Cohen finds that it’s all about making connections, whether it’s convincing more people to get vaccinated or stealing hospital information so the CDC can better track disease threats.
When she recently met for the first time with David J. Skorton, president of the Association of American Medical Colleges, was overjoyed by Cohen’s willingness to sing at the alma mater of Cornell University, where Skorton had been president and where Cohen won. your license.
“Me in the choir,” Cohen explained with a smile.
Then they put her to work. ” We want to have visibility for our country that lets us know what’s going on and how to respond appropriately,” Cohen told him. That means knowing “how many more people are hospitalized, what their vaccine is. “their prestige, what their race and ethnicity is, so we can keep an eye out for emerging trends,” he said.
Skorton pledged to encourage his association’s 157 medical hospitals and 400 training and fitness systems hospitals to work with the CDC in its search for comprehensive data.
The day before, Cohen had emphasized the importance of collaboration at what she called the public “team sport” of fitness, a convention at the Georgia Aquarium in Atlanta. As the belugas swirled in a huge pool along the wall, she, under pressure, wanted to talk. often in layman’s terms, and then suggested to the crowd largely made up of young medical professionals to “follow me on Insta. “
His CDC social media accounts show Cohen visiting nursing homes to emphasize the importance of high-risk Americans getting vaccinated before the holidays. Talking about vaccines on Capitol Hill with Senate Majority Leader Charles E. Schumer (D-N. Y. ). Answer the questions in the “Check-in with Dr. Cohen” video: When is it time to get a flu shot?(Before the end of October) Can you get vaccinated against covid and flu at the same time?(Yes. )
In addition to focusing on respiratory virus season, Cohen decided on two other public fitness priorities aimed at stirring controversy and identifying with average Americans and their GOP critics: opioid use and maternal and infant fitness.
If repeated enough times, in transparent and concise language, he hopes that more Americans will accept his message.
In a video studio in the cavernous basement, Cohen read from a teleprompter, urging pregnant women to vaccinate newborns against RSV.
The words didn’t seem right to him. The script referenced the “RSV season,” but the average user doesn’t know what that means, Cohen told his assistants. “Should we just say. . . Autumn and winter?” He also looked for another adjective to talk about “extensive” clinical trial data. The CDC uses the term “extensive” too often, he said.
“Strong?” An assistant suggested. “Significant?” one offered.
A third assistant intervened. I watched this episode on “Veep” and I hate to say this, but what about “robust”?»
“I agree with ‘robust,’ but I’m going to laugh,” Cohen said, noting the reference to HBO’s political satire in which the word was repeated several times.
The CDC’s communications director chimed in: No adjectives needed. “Let’s say it’s based on knowledge and clinical trials,” he advised.
“Okay, no adjectives,” Cohen agreed. A cameraman combed her hair and took over the shot.
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Diamond reported from Washington.
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