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‘I’m So Disappointed’ About Abortion Status in the U.S., Says New CDC Director

10 minute read

Dr. Mandy Cohen is the new director of the U.S. Centers for Disease Control and Prevention (CDC). The former health secretary for North Carolina, she led the state’s COVID-19 response and improved Medicaid access for eligible residents. Just one month into her new job, Cohen spoke with TIME about what we can expect next in the ongoing government response to COVID-19, the tumultuous legal battles currently surrounding women’s health, and her vision for the embattled public health agency. The interview has been edited for length and clarity.

TIME: This has been a tough time for those in public health, and the CDC especially has been the target of criticism in terms of how the pandemic was handled. Do you feel that criticism was fair?

Dr. Mandy Cohen: The COVID crisis was just that—a crisis. Nothing goes perfect in a crisis. Were there areas where folks should have done better? Absolutely. And I think that's been well articulated, particularly early on in the pandemic—those first few months were a little rocky. So some of that criticism was rightly founded, but a lot of it was not. And what I want the American people to hear is that, we are working very hard on their behalf every single day to protect their health. The CDC, as well as the whole public health infrastructure, is such an important asset for our country, in order to protect us from threats. Just like we rely on the military to protect us from threats, the CDC is doing the same thing. These are just biologic threats or chemical threats. And so we're working hard to make sure that folks know that they have a trusted partner in the CDC that's looking out for their health.

You just mentioned that you see the CDC as the public’s trusted partner. One of the issues I think people are grappling with right now is a mistrust in science in general, and in the CDC in particular. Now that you're director, how you how you plan to address that?

I think trust is absolutely foundational. I think change happens at the pace of trust. And so it underlies everything that we do. And I will say as health and human services secretary for North Carolina, we called out and named trust as central to how we responded to the COVID crisis. We thought about it every day. We measured it, and over the course of the crisis, we saw trust actually increase in the department that I ran, which was different than in some other parts of the country.

I think we were able to build trust because we focused on three things. One, we focused on really building relationships and two, we were incredibly transparent. We used simple communication. We did 170 press conferences, I think in 18 months. So we were answering questions all the time, because we were learning new things. And then third, we made sure that folks [knew] that we were performing every day for them—that we were delivering the vaccines or the tests that they needed to protect themselves. I'm hoping to bring those that work in those lessons to the work here at CDC.

How, specifically, do you plan to help CDC be more transparent and communicate better with the public?

I think all of us are consuming our information differently now than we even did just a year ago, or five years ago. Maybe it's not in written communication anymore—it's more in videos and short little bites. So that's what you're going to see more from us. We're already starting that—we're doing a series already that we just launched called "Check In with Dr. Cohen," where folks can get just a minute or two of "what's the latest in public health? How can they have common-sense tools to protect themselves?"

It's also making sure that we're thinking about our language being simple, accurate, timely, and repetitive. We know it takes a number of times for folks to hear a particular message before we understand it.

One of the factors driving the mistrust is the politicization of science and public health. As health secretary in North Carolina, did you see political forces impacting health, and how do you plan to address potential political intrusion on decisions and services that affect the public’s health?

I think it's always important for us to have good discourse and good dialogue. I think it's important when we're wrestling with hard issues that we hear from different folks. But what we want to make sure is that that dialogue is respectful. In North Carolina, I had incredibly good relationships across the aisle—I worked for a Democratic governor, but we had a super-majority of Republicans in our state legislature. But we had good relationships. And I think it's because we were willing to answer questions and that we were transparent. It doesn't mean we always agreed on every issue. But we were able to have that respectful dialogue.

As I get to know members of Congress and in my new role, that's what I [hope to] see—as well as building those relationships, being available to answer their questions and focusing on the places where I see a lot of consensus. And I do see consensus on making sure we have an asset for our country that is identifying threats, and responding quickly to them. So if we have a new virus, or a new chemical, or what have you, that we are able to respond quickly.

I also see a lot of consensus on addressing mental health. I was just talking to a couple of members of Congress on how do we work together on suicide prevention, for example. And then the third area of consensus I really see is around young families, thinking about how do we get upstream from some of the issues we see downstream—whether that's diabetes, or mental health issues and addiction, there are ways proven ways [to] prevent [them].

So those are the areas you're going to hear me focus on—making sure we have that asset to respond to threats, that we address our mental health issues, and that we're also doing the prevention to make us the healthiest country we possibly can be.

Especially in the past year, women's reproductive health has been really a hot topic in the country, with the restrictions placed on contraception and abortion. What role does the CDC have in ensuring that women continue to have access to as many healthy, evidence based choices as possible?

The mission of the CDC is to protect and improve health. To do that, we need to make sure folks have access to the tools that can keep them healthy at all moments of their life, whether they're thinking about becoming pregnant, during their pregnancy, [and] when they're young moms. We have a lot of data and best practices and evidence that we can bring to bear to show that when we work with moms, so that they are getting pregnant when they are ready and want to—meaning that they have access to contraception—that means babies have better outcomes, as do moms.

Just this week, there was the appeals court decision backing a Texas judge's ruling on restricting mifepristone. The abortion pill remains available for now, but this is going to continue to be debated in the courts. As a physician, and a public health leader, how does that strike you?

Well, I'm so disappointed that we are here, that we are having the conversation to revisit whether or not women should have access to health care when they need it. And, you know, I will say as a mom of two daughters, a physician, and now the director of the CDC, I'm going to continue to make sure that we are working to make sure women have access to care when they need it, and that they have medical treatment when they need it. We will do everything we can to bring the evidence, the data, the best practices we can and support that. This is obviously an FDA-related issue, but we will support however we can the work that's being done across the government to support women in their reproductive health.

What role can the CDC play? And do you see perhaps forging a new role for the agency on issues like this?

We already play a big role in the women's health space. We have an entire center engaged around birth defects, and around thinking about how we talk to women about maternal health—before they're getting pregnant, while they're pregnant, and after they’re pregnant. And I think this is giving us the opportunity for folks to know that those data and evidence and best practices are there. So you'll see us lift those up more.

Looking ahead to the fall, how concerned are you about the rising number of hospitalizations from COVID-19 that we’re seeing across the country?

We are seeing hospitalizations go up here, and...it's reminding us that we are living with COVID. It is not gone. And that means we need to continue to avail ourselves of the tools that protect us: vaccines, testing, and treatment. Luckily, we have more tools than ever before going into these next seasons. And we're going to have a new booster that comes out in the middle of September. So we have the tools, we just need to use them.

About the current level—I'm not concerned right now. But we're going to continue to watch that. The highest number of hospitalizations we had last year was about 45,000, and [we have] about 10,000 right now. So we're much lower than we were at a peak last year. But we have to keep vigilant and make sure that we're using the tools to protect ourselves. So you're going hear us talk a lot about vaccines, testing, and treatment.

Looking beyond COVID-19, what do you see as some of the priorities in public health for the country?

Obviously, making sure that we're identifying threats—and responding. For example, we saw our first cases in 20 years of malaria that were acquired here in the United States in Texas and Florida. But the good news is that CDC and the teams jumped right on that. And we haven't seen any new cases of malaria, but we need to make sure that we have a well-funded CDC that can continue to identify threats, and respond to them quickly.

Other priorities for us are in the mental health space, and addiction space. If you ask the American people, one of their top concerns is about fentanyl. And making sure that we are hearing that concern and bringing again what CDC can do to bring evidence and data and best practices, so that folks can protect themselves.

And then the last area of focus is really about young families. And this is where we were talking about women's reproductive health, maternal health, child health. Remember, our childhood is where we establish lifelong health patterns. So thinking about making sure we're supporting our young families and our kiddos so that they get off to the best start in life no matter what zip code in this country they live in.

Was there any advice that your predecessor Dr. Rochelle Walensky gave you about heading the CDC?

She told me how wonderful and dedicated the career staff at the CDC are, and she was 100% correct. I see it at every turn—passionate, dedicated folks who have given their lives to protecting this nation and our health. It's really inspiring. [This job[ is an honor of a lifetime. And she said, both enjoy the moment and make sure that you're working with the team around you because they're terrific.

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