Flu Update from CDC Dir. Cohen: So Far, Not An Early Flu Season

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Mark Masselli ( 00:04 ):
Right now is the first time the United States has vaccines available for all three respiratory illnesses,
COVID, flu and RSV. We'll ask the new director of the Centers for Disease Control and Prevention how
the rollout of vaccines is going and her ambitious plans for the agency's future.
Dr. Mandy Cohen ( 00:23 ):
It's likely not to be an early flu season, which we didn't know because looking at the Southern
Hemisphere, they actually had an early flu season. We're not seeing that here. So that helps us, again,
refine the model to understand what's going to happen over the course of the next three to four months
to make sure we have the hospital beds so it does continue to inform our work.
Margaret Flinter ( 00:47 ):
Our guest is Dr. Mandy Cohen, while she has been at the helm of CDC for only three months, she has
long been recognized as a top health leader with experience heading up large and complex
organizations and a proven track record of protecting America's health and safety.
Dr. Mandy Cohen ( 01:03 ):
And what I want folks to remember is that more than 70% of the dollars that go to CDC flow then
directly to states and localities, right? They go right to your backyard. So I'm trying to help members of
Congress understand that when they're funding the CDC, they're actually funding their own
communities to be safe and protected, but we have to work together as a system. And that goes back to
making sure that we have the data infrastructure, that we're all having that data flow in a way where we
can identify threats and respond to them quickly.
Margaret Flinter ( 01:35 ):
This is Conversations on Healthcare.
Mark Masselli ( 01:45 ):
Well, welcome Dr. Cohen to Conversations on Healthcare.
Dr. Mandy Cohen ( 01:49 ):
Thank you. Thanks for having me today.
Mark Masselli ( 01:51 ):
Yeah. We know you and the CDC have been very active in recommending everyone six months and older
get an updated COVID vaccine. Yet there are reports from colleagues in the community health center
space have received only a small number of doses they've ordered. There are also stories about some
people having trouble getting their insurance to pay. One pediatrician told the Washington Post, "COVID
vaccine uptake among children has been abysmal, but if we have to fight for payment from insurance
companies, it's going to be even worse." I wonder if you could set the record straight.
Dr. Mandy Cohen ( 02:25 ):
Yeah. Well first, great to have this conversation, super important. As you know, as we get into fall and
winter, we're going to have three viruses circulating this fall and winter COVID, flu and RSV. But for the

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first time in history, we have vaccines against all three of them. But the process is different as we get
into this season than it was in the past, particularly with COVID. So in the last number of years for
COVID, the federal government has both purchased and distributed the COVID vaccine, which means we
didn't have to go through insurance. We didn't have to go through the normal processes that our health
centers and doctors go through to actually get vaccine and deliver it.
( 03:11 ):
This year, it is different. So the private sector is managing the process this year. So the way folks order
and the way that they bill for it is different, particularly for COVID. And there's a couple of different
features of it. If you're working with adults, then there's a certain process and different for children, and
I'll go through both. So for adults, if you have insurance, this should cover your vaccine for free through
your insurance, or there is a program that the CDC runs for COVID for you to get a free vaccine. And
those programs are run through partners like CVS, Walgreens Health Centers and others. So that's if you
are an adult, for children, we do have a Vaccines for Children's program. So if you are uninsured or
underinsured, that program has existed for a long time. So our pediatricians know how to use that
program.
[NEW_PARAGRAPH] And so the ordering is somewhat the same there. So we are in a different place and
we are trying to work with the private sector to make sure that they can get their vaccine out to
providers as quickly as possible, and that they know the new process for going through billing of our
insurance for the first time. Now, there are a number of times where insurance are required to cover
this, but they hadn't set up their computer systems and such. But I think now that we're about three
weeks into this, we've worked out a lot of those operational kinks. So hopefully we've been jumping on
those problems and now we're just in a place where we're encouraging folks to get vaccinated.

Margaret Flinter ( 04:50 ):
Well, thank you for laying all that clear for people. I want to give a name to the program, the CDC Bridge
Access Program, which is how I think we're referring to the vaccines that are coming for uninsured and
underinsured adults in the community. But I really want to ask you, Dr. Cohen, I know CDC and you are
so concerned with the health equity issues. Do you feel like you have a sufficient supply network out
there for the uninsured and underinsured through these pharmacies who are relatively new partners, I
think to the CDC in this business of vaccinating the country when that's called for as well as the health
centers who are more traditional long - term partners? How are you feeling about this as a strategy to get
at the health equity issue around the vaccine?

Dr. Mandy Cohen ( 05:38 ):
Well, look, when we were in the emergency and we had more partners and more ability to direct exactly
where these vaccines would go, I think we had a better ability to both have data to see which
communities might have lower vaccination supply or uptake, and we could adjust. In this time, we just
don't have the same level of ability, but we need to use the partners that are able to vaccinate folks. So
CDC partnered with our major pharmacy chains, which are diverse across the country, but in addition,
our public health departments as always and federally qualified health centers. So they are ones that
already serve often historically marginalized communities, but I don't think it's as many tools as we've
had in the past.
( 06:31 ):
So this is why we need everyone to do everything they can to think about getting the word out and
making access as easy as possible for folks. So we did partner with CVS and Walgreens, two big retail

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chains that are in many, many, many communities, but not all, which is why our public health
departments continue to be an important partner in all of this as well as those health centers. But
remember, call your own doctors, see if they have vaccine as well. If you don't have a doctor, make sure
thinking about those pharmacy chains being one outlet for you.

Mark Masselli ( 07:05 ):
Oh, that's really great advice. And despite all of these efforts, and you reminded us, this is just starting
off, but only 7 million Americans so far have received an updated COVID vaccine. And we hear even
from our good friend, Dr. Paul Hoff at a former member of the CDCs Advisory Committee on
immunization practices says he's not planning to get it. I'm just wondering if you are worried about
hesitancy over the COVID vaccine. Is it going to stop people from getting the flu and the RSV vaccine?

Dr. Mandy Cohen ( 07:38 ):
Well, first, more than 10 million Americans have already gotten the updated COVID vaccine. We're
continuing to see millions of Americans get their updated flu shot. RSV again, is only for our older adults
and we have an immunization for our babies, and that's historic. We've never had that before. But I do
think that folks need to hear from trusted partners, trusted folks in their lives. Often that is their doctor
or maybe it is a nurse practitioner or a nurse that they see. We know from our research, those continue
to be the most trusted messengers related to this information. The most common reason that someone
did not get vaccinated is that their doctor didn't offer it to them and they didn't talk to them about it. So
those are really powerful moments and conversations. So we are doing a lot of talking to our physician
community, to our nurse practitioner community and nursing and others to talk about the importance
of just bringing it up with your patients.
( 08:42 ):
And look, we've looked at this data very closely. I think these vaccines have been studied extensively by
independent bodies and the safety of them has been reviewed. I wouldn't recommend vaccines for the
American people that I wouldn't recommend for my own family. So I've gotten my updated COVID
vaccine, got it last week. I got my updated flu shot. My kids who are nine and 11 just got their updated
COVID vaccine yesterday, in fact. My husband's been vaccinated, my parents who are over 65. So again,
this is something I'd recommend for my own family to keep them safe. And again, what we are seeing in
the data, let me talk about kids for example. We know that yes, this virus does impact older adults most.
So 65 and up, that's where we're spending a lot of time. But if you look even at data for kids,
unfortunately, we're still seeing a number of kids get into the ICU with COVID.
( 09:42 ):
And the striking part is about half of those kids have no underlying conditions. They don't have asthma
or another medical condition that would have put them at higher risk. We just are seeing these kids with
no underlying conditions get very, very sick from COVID. And so if we have a safe vaccine that can
protect them, I want parents to be able to understand that and choose that tool for their children to
keep them safe. So again, that's the word we're trying to get out to folks. That's why we have
committees that review this data, look at the risks and benefits, and that's why we made the
recommendation that everyone over the age of six months get that updated COVID vaccine. But don't
forget your flu shot. Still super important to get that as well. And then for RSV, if you are over 60.

Margaret Flinter ( 10:28 ):

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Great. Well, I do think your healthcare provider is the trusted messenger when you can add to that your
own experience with your family, it carries a lot of weight. So thank you Dr. Cohen for sharing that. I
think over the last couple of years, people in America have gotten more of an education in the whole
world of vaccines and immunizations than they may ever have wanted to since they last thought about
their tetanus shot 10 years ago or their children's vaccines. But I wonder if I could ask you, because it is
new and so important to maybe just say a few words more about the RSV vaccine and the ability to
protect against either with a vaccine given during pregnancy or to a baby after birth. I don't think that
one's on the radar. This is exciting in terms of being able to protect our babies.

Dr. Mandy Cohen ( 11:13 ):
Yes. So we are excited, and there's actually three different types of immunization for RSV. So there's one
for our older adults I was mentioning who are 60 and up, and there is a vaccine for moms who are
pregnant. So between 32 and 36 weeks pregnant. And what happens there, you get vaccinated as a
pregnant mom, you make antibodies and you give those antibodies to your baby. So then the baby is
born with antibodies against RSV and are protected through that first RSV season, which is when they
tend to get exposed and are at the highest risk. They have the tiniest bronchioles and have the most risk
of their lungs not doing well, the RSV. But there is also for the first time, an immunization for our babies.
So for babies who are under eight months of age, we have a new immunization that's a long - acting
monoclonal antibody.
( 12:08 ):
So we actually give the babies antibodies directly. So it's slightly different than a vaccine, but it is an
immunization. It does provide you immunity or protection for your baby. And that protection can last for
the whole first season of RSV. It's called nirsevimab. And again, it's something that you can get through
your pediatrician. So again, something for young families to go talk about with their pediatrician and
getting their kids vaccinated. Again, for those who are under eight months or if they have some
increased risk, sometimes we will also offer that vaccine if they're going into their second RSV season
and they have underlying medical conditions that would make it necessary for them to get it.

Mark Masselli ( 12:52 ):
And Dr. Cohen, I'm wondering if we can turn to long COVID. We've really devoted a lot of our program
time discussing long COVID. We have Dr. Horowitz from NYU Langone who's heading up the NIH study
there and also leads at Yale and Mayo Clinic. And there's been some confusion about if the updated
vaccine can prevent long COVID so I'm wondering if you could just clear that up for our listeners.

Dr. Mandy Cohen ( 13:22 ):
So we know we're still learning about long COVID, but early data does show that there is a decreased
risk of long COVID if you are vaccinated and you continue to get yourself the updated vaccines. So again,
we see a decreased risk if you are keeping yourself updated with your vaccines. So again, still early, still
learning, but I would say that's both with vaccine and with treatment. So the more that we can also get
tested and get treated also reduces your risk of long COVID. But it's still early days, still learning. But
that's another reason particularly why I talk to folks who are my age and in their 40s, they say, "I've had
COVID, why should I get vaccinated again?" I give them a few reasons. One, the virus is changing,
second, your immunity is going down, and third, you are at a risk of long COVID and you don't want
extended symptoms from this disease. And getting vaccinated, getting treatment does help decrease
that risk.

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Margaret Flinter ( 14:29 ):
Well, thank you Dr. Cohen for talking about that. And if I can just stay on the subject for a minute more.
Over the course of many conversations with our guests these past two years, the issue of whether long
COVID really exists, is it a pseudo diagnosis? Crops up in the media, particularly from time to time. And I
understand there's a pretty recent breakthrough in terms of being able to really identify distinct
differences in the blood of people with long COVID. Maybe comment on that and also do you think it
will put to rest some of the skepticism that's been out there, which is very difficult for people suffering
with this condition?

Dr. Mandy Cohen ( 15:05 ):
Yeah, we're still learning a lot. And I think that there are many viral illnesses that have extended
symptoms that I think our study in the long COVID space will actually be able to inform. But we, the
Biden administration, have invested a significant amount of research dollars to understand this better
and I do think we need to. And understand what are the things that cause it, what are the ways to
prevent it or reduce the risk of it? So again, early days here, but we are definitely seeing a constellation
of symptoms that persist for a long period of time. CDC is actually one that tracks some of that data, and
we have recently put out a report on the percentage of folks that are adults that we're seeing long
COVID and about 7% are continuing to see extended symptoms. So we do see it as a phenomena, we
don't fully understand it yet, which is why we need more research to understand what we can do.

Mark Masselli ( 16:00 ):
Well, just one last question on that, because the news from the CDC that research found using paxlovid
during the acute phase of COVID appeared to significantly reduce the risk of post COVID conditions, but
may have increased the risk for adolescents. Would you agree that research has given us some answers,
but we really need to keep working on this through additional studies like the one NIH is conducting? I'm
just wondering, are there enough resources, financial resources focused in on this or is it for so many
people in the rearview mirror in terms of the researcher world?

Dr. Mandy Cohen ( 16:39 ):
Well, look, we have a lot of threats across the board in terms of what's impacting our health. And we
need to make sure we're using our resources to look at all of those threats, whether they are COVID or
others. So we know we need to make sure we're using our research dollars and the heft of not just CDC
and NIH to make sure we're looking at all of those threats. So I do think we've made quite a sizable
investment in research in this space. I'm sure there's always more to do, but I'm looking forward to
learning more from the research that's in the field now.
( 17:14 ):
And again, these are important things I think we can partner with academia on as they are doing
additional work in this space. So more to come, but what we are learning is that folks are having these
extended symptoms. We know that vaccinations and treatment can reduce your risk, but I think early
days, much more to really understand about this disease as we go. And I think we're making pretty
sizable investment to be able to answer more about this. And I'm hopeful this research, like I said, will
help inform postviral syndromes that we're seeing from other viruses as well.

Margaret Flinter ( 17:50 ):

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Dr. Cohen, you have an enormous range of things that you and CDC are concerned with, and certainly
over these last couple of years we've been really struck by the increase in suicide and death rates,
suicide in the United States, just tremendous tragic circumstance across the country. I think you recently
also talked about how heat affects suicide. So we have all these layers of things that are going on in the
country to be concerned about. I think that's a new detail for some, but I wonder if you could share the
initiatives that CDC is undertaking on the mental health front. Just give us a sense of the landscape
there.

Dr. Mandy Cohen ( 18:31 ):
Yes, so very important to make sure we're thinking about health holistically and understanding the
threats to our health in different ways. So mental health, certainly one, and I am new to CDC, but give
credit for actually years of work in the opioid space and overdose space where data has really informed
our ability to understand what was happening in this and to actually give communities the data they
needed to respond to when we were seeing clusters of overdoses. So that's where data can be
incredibly powerful as well as data from CDC work to lift up best practices. So we think about mental
health or preventing suicides, that's where CDC has been doing incredible work to identify those best
practices that we know work. I want to also remind folks that 988 is a resource that folks could use. If
you are struggling right now, 988 is a resource for you to reach out. You are not alone.
( 19:30 ):
So those are the kinds of common sense solutions to meet folks where they are maybe in a moment of
crisis, to give folks information to keep them well. That's where CDC has a big job to keep the health of
this nation protected. And we can't do it alone. It's in partnership. That's why I'm grateful to be on the
show today to talk about these things because it is a team effort that we need to protect health. So
certainly what's going on in the health delivery system, our mental health colleagues at SAMHSA, but
also across the country and our mental health professionals, we all need to be working together on
identifying the best practices and scaling them up to make sure that we're protecting folks.

Mark Masselli ( 20:11 ):
Well, that's such an important message. I do want to pull the thread on your conversation about data.
Your agency is really responsible for collecting a lot of it. You're moving ahead with an outbreak
analytics and disease modeling network, which sounds exciting and other ways really to improve
responses following COVID. Are improvements going to happen in time for this winter's respiratory
season?

Dr. Mandy Cohen ( 20:37 ):
So we are able to already do a bit of modeling of what we think may happen this fall and winter. Not
surprising if all three of these viruses peak and we have bad seasons of all, that's not good, but we
probably didn't need a model to tell us that. So what we're trying to do is with each and every passing
week, we are able to understand the model a bit differently and plan for the future. So for example,
we're sitting here in the middle of October, we already know it's likely not to be an early flu season,
which we didn't know because looking at the Southern Hemisphere, they actually had an early flu
season. We're not seeing that here. So that helps us, again, refine the model to understand what's going
to happen over the course of the next three to four months to make sure we have the hospital beds. So
it does continue to inform our work and stay ahead to be able to plan so we can predict and then plan.

Margaret Flinter ( 21:38 ):

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Dr. Cohen, a poll last year found that overall confidence remains high for CDC. It did show some erosion,
and I think this issue of trust and trustworthiness and confidence is so important at this time in our
history. I understand you have a plan to rebuild or build even higher trust. Tell us about that plan and
what are you hoping to do and what are you expecting to see in terms of results?

Dr. Mandy Cohen ( 22:04 ):
Well, I think trust is fundamental in protecting folks' health, right? So I think if you want to change
behavior, that starts with the pace of trust. If people don't trust you, then they're not going to follow
your advice. So trust is fundamental. And again, I've already seen our team do incredible work to start to
make sure we're coming out of an emergency time and helping folks understand the importance of CDC.
I think they've gotten to know CDC in a particular way, but remind them of the breadth of what CDC
does to protect their health, their community.
( 22:41 ):
Whether it is something like COVID or it's something like, for example, malaria, which we saw for the
first time here in the United States in 20 years, domestic acquired malaria. And the good news is you
probably, those of you didn't hear a lot about it. And that's because the CDC and the state of Florida
worked really hard together to jump on that. We identified it, we responded quickly, we used our best
practices and evidence, and we were able to extinguish what we saw there in Florida. So good results
and that's exactly what the CDC can do for you in terms of working in your backyard.

Mark Masselli ( 23:22 ):
As the new CDC director, you inherited some issues, challenging issues, but probably from your lens now
you've identified more opportunities. But there are the challenges that I want to focus in on. You're
facing at least $1.5 billion in budget cuts and maybe more. And again, just back to how do you juggle all
of these programs and keep employee morale up when it's facing these tight budget constraints?

Dr. Mandy Cohen ( 23:52 ):
Well, I'm actually here in the Washington DC area today to talk to members of Congress to help them
understand the importance of CDC and why being well - funded is so important. And what I want folks to
remember is that more than 70% of the dollars that go to CDC flow then directly to states and localities,
right? They go right to your backyard. So I'm trying to help members of Congress understand that when
they're funding the CDC, they're actually funding their own communities to be safe and protected, but
we have to work together as a system. And that goes back to making sure that we have the data
infrastructure, that we're all having that data flow in a way where we can identify threats and respond
to them quickly.
( 24:35 ):
We're trying to help folks understand how all those pieces fit together. I think there's more work we
have to do on the CDC side to communicate more timely, accurate, simple common sense solutions so
that folks understand complexity, but we can make it as clear and simple for folks as we possibly can. So
we have some work to do on our side to both prioritize to communicate better, but then we need folks
to understand the importance of having a strong CDC and what that means in their own backyard, in
their congressional district or in their state and how it's working for them. So I'm going to keep talking to
folks about this and I appreciate your assistance in getting that word out as well for folks who are
listening, because a well - funded CDC means communities are protected.

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Margaret Flinter ( 25:26 ):
Well, it's good you're in Washington today and you're talking to some of the right people that you need
to win over to that way of thinking, and we wish you the best with that. I want to just tackle on other
subject briefly. And that is in order to accomplish all that you seek to do, there's the issue of workforce
and across the entire country in healthcare writ large, public health, private health, primary care,
specialty, you name it, there's a workforce shortage and real challenges in terms of the pipeline. We see
this with behavioral health even when there's funding trying to meet the demand for it. How are things
at CDC relative to workforce and maybe more importantly in the public health departments around the
country that you hear from as you provide these resources and they then need to execute on getting it
out into the field?

Dr. Mandy Cohen ( 26:14 ):
Yeah, so I think workforce is a challenge across a lot of industries, as you were mentioning right now and
public health is not immune to that. I have been traveling all around the country, California, Florida,
Wisconsin, Massachusetts. They all say the same thing about workforce is tough to recruit and retain
good talent. CDC for years has had incredible training programs to make sure we're bringing in talented
folks, but there's more we can do. And that's one of the things I'm talking with Congress about, about
how once we train fellows, how can we make sure we're retaining them and keeping them in public
service for their career? So there's just a bunch of administrative hurdles that don't need to be there if
we want to make sure that we have the workforce that is needed. I'll say for the states and localities, we
at CDC are actually trying to help with that and actually help them with the recruiting of particularly data
scientists, which are really hard to recruit, but so necessary for us to be successful.
( 27:19 ):
So we're partnering with states through a few different vehicles to help them hire the talent that they
need. So we're trying to be the best partners we possibly can. And you mentioned morale, I think that
we all have to acknowledge that public health has been through a lot in the last number of years. Folks
are tired and have been through a traumatic experience of leading through this pandemic. And so we
have to recognize that some folks need to be one, I am doing a lot of just thanking them for that hard
work and also to reconnect with the mission again. And to make sure that they're rededicating
themselves to that core mission. That's what we're focused on. One of our core values at CDC is joy and
to have joy at work because I truly believe if you're not bringing joy and having joy in your work, you
can't bring the best of yourself to that work. And frankly, this work is too hard for us not to do that. So
we are trying to really focus on our morale of our team and then help our localities as well.

Mark Masselli ( 28:27 ):
Well, that's so important. Public health workers, but public heroes as well. So Director Cohen, thank you
for joining us today. Please thank all of the workers at CDC on our behalf for the great work you do. And
to our audience, be sure to go online to CHCradio.com to sign up for email updates. You can also share
your thoughts and comments about this program. Dr. Cohen, thank you again.

Dr. Mandy Cohen ( 28:55 ):
Thanks for having me.

Margaret Flinter ( 29:00 ):

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