Take As Directed

John-Arne Røttingen, CEO of Wellcome Trust, is a Norwegian leader whose expertise has a remarkable span, encompassing medicine, science, research, clinical trials, negotiations, diplomacy, philanthropy, financing of global health, and governance of international institutions. He shares with us his assessment of what prior factors, during and post-Covid, set the stage for the shocks of 2025; the implications borne by 2025’s sudden crises, and the essential, urgent changes in outlook and strategy unfolding in 2026. Give a listen to this timely and incisive conversation. 

Keith Humphreys, a leading expert on addiction psychiatry, based at Stanford University, unpacks his January article in Science examining the steep reduction in overdoses deaths—between May 2023 and the end of 2024—in the United States and Canada. It likely stemmed from a supply shock, linked to steps taken by China to disrupt the supply of fentanyl and precursor chemicals. Underneath, US-China diplomacy was essential. This story was lost during the 2024 US presidential election cycle. Subsequently, President Trump’s overt threats to China, including the imposition of a 20% tariff tied to fentanyl, changed the negotiating context. Some progress followed on October 30 when Presidents XI and Trump met on the margins of the APEC summit in South Korea.

Amb. (ret) Karl Hofmann is CEO of the recently launched Health X Partners (HXP), a parent company under which Population Services International (PSI) and the Elizabeth Glazer Pediatric AID Foundation (EGPAF) now operate. He explains his personal story—from a successful diplomatic path centered in Africa to a pivot and second career as President and CEO of PSI starting in 2007. And he explains the logic by which PSI and EGPAF agreed in 2024 to form HXP to achieve greater efficiencies and prepare prudently for the end of the 25-year era, begun around 2000, that has generated an “amazing chapter of human progress” in health but which, it had become increasingly obvious, would not last indefinitely. As the unforeseen tsunami of Trump 2.0 hit in early 2025, it was both fortuitous and doubly-risky for HXP, as it stood itself up. The new leadership at FSI and EGPAF suddenly had to come to terms with 50% reductions in staff, budgets, and programs, while consolidating and integrating audit, HR, and IT teams. Change ha

Dr. Chris Murray, IHME, co-chairs the Lancet Commission on 21st Century Global Threats to Health, which will launch its report in February at the Munich Security Conference. It is the “Commission of Commissions,” a novel, highly ambitious three-year effort to forecast what are to be the biggest, most costly problems by taking a broadened non-traditional view. It focuses on 16 factors plus hypertension, each forecast to exact over one billion life years over the next 75 years. These include the familiar big three – pandemics, climate, and conflicts – but includes other factors that rank surprisingly high: education, inequality and low economic growth, obesity, tobacco, and AMR. A wildcard such as malicious use of AI has to be taken into account. “We excluded meteors” and mirror life, the latter too early to include. The Commission calls for a rolling, annualized review, and for higher investment by governments in both promising innovative technological solutions and building better threat-ready health systems.

In the second episode of the Prevention Intention mini-series, Katherine speaks with Wafaa El-Sadr, University Professor in Epidemiology at Columbia University and the director of ICAP. They discuss El-Sadr’s formative experience treating AIDS patients in New York City in the early 1980s, as the global HIV epidemic began to emerge; her decision to found ICAP in order to bring HIV treatments to patients worldwide; and ICAP’s contributions to HIV prevention research. They also cover the evolution of PEPFAR, the challenges and opportunities associated with current efforts to reform U.S. global health assistance, and El-Sadr’s emphasis on ensuring people and their communities are at the heart of all health research and service delivery endeavors.

In the first episode of the Prevention Intention mini-series, a series featuring conversations with leading female HIV clinical researchers, Katherine speaks with Linda-Gail Bekker, a medical doctor and director of the Desmond Tutu HIV Centre at the University of Cape Town.  They discuss Bekker's decision to focus her work on HIV as well as her involvement in the PURPOSE 1 clinical trials, which demonstrated the efficacy of long-acting pre-exposure prophylaxis (PrEP) among adolescent girls and young women in South Africa and Uganda. They also cover why it’s important to approach research as a highly collaborative endeavor that both contributes to scientific understanding and improves people’s lives.

Erika Elvander served her country as a federal career health diplomat for 27 years, including as the U.S. Health Attache in Beijing from the spring 2021 until the end of 2024. Her Asia passion ignited while a student in Hong Kong and traveler to Beijing in the late 1980s. And carried forward for the following decades. As Health Attache in Beijing during COVID, she witnessed China “digging in,” pursuing its 18 months of the fierce controls imposed under “static management.” "Achievements with China are incremental.” She was able to maintain dialogues with Chinese health officials, despite the fraught US-China relationship. Today, the COVID origins quagmire does persist and impede the U.S.-China relationship, six years after the advent of Covid. But “there has to be a path forward,” built on many opportunities in health.

Marian Wentworth, President & CEO, Management Sciences for Health (MSH), at age 13 started working in a local factory. Attended the famous Latin School in Chicago. Studied math at Harvard. Then joined Merck as it was "growing ferociously fast." Stayed 27 years, grew and led the vaccine business to $6 billion. Was the "quant jock." Spearheaded the launch of Gardasil, the HPV vaccine. Then pivoted to MSH. It was important "not having a pharmaceutical company on my business card." Now as she reflects on the stunning year of 2025, a series of radical pivots for MSH, is there space for MSH in the America First Global Health Strategy? Yes. Excited by the Accra Reset? Yes. Where does this leave MSH? "I believe this time is a crucible."

Listen to the recent CSIS Bipartisan Alliance for Health Security discussion with Congressman Adam Smith (WA-09), Ranking Member of the House Armed Services Committee, on his experience leading a Congressional delegation to China in late September 2025. Rep. Smith’s bipartisan delegation—the first House delegation to travel to China since 2019—pressed for high-level military-to-military dialogue between the world’s leading superpowers. What reception did they receive from their Chinese counterparts, what messages did they impart, and how has the dialogue with his colleagues evolved since his return to Washington? What did the trip reveal and how does he expect to see the bilateral relationship evolve—including on key issues such as the debate over fentanyl—into the new year?  Following welcoming remarks from John J. Hamre, CSIS CEO and Langone Chair in American Leadership, J. Stephen Morrison, Senior Vice President and Director of the CSIS Global Health Policy Center, moderates the discussion.

Dr. Rick Brennan, an acclaimed Australian humanitarian leader who led WHO and NGO crisis response in multiple conflicts over several decades, walks us through his personal story. He then unpacks the scale and gravity of what is now unfolding in Darfar—featuring the “F word” (famine), the “G word”( genocide, affirmed by the US Senate), and the “C word” (cholera). The crisis requires political action from the UAE—and President Trump’s attention. “There is an obligation to act.” And yet it occurs as global humanitarian needs have soared while humanitarian funding has dropped by half—the US by over 80%. It is a wake-up call, a rude awakening.

Listen to the recent CSIS Bipartisan Alliance for Global Health Security book launch of Fair Doses: An Insider’s Story of the Pandemic and the Global Fight for Vaccine Equity by Seth Berkley. As the gravity and magnitude of the Covid-19 pandemic became apparent in the first half of 2020, how did the vision for a mechanism to ensure equitable access to new vaccines come together and what role did organizations including Gavi, the Vaccine Alliance; the Center for Epidemic Preparedness Innovations (CEPI); and the World Health Organization (WHO) play in enabling the COVAX Facility to distribute nearly two billion doses of COVID-19 vaccines to people in 146 countries, the majority of which were low-income countries, by the end of  2022? This event featured conversation between Katherine Bliss, Senior Fellow and Director of Immunizations and Health Systems Resilience, CSIS Global Health Policy Center, and Dr. Seth Berkley, author of Fair Doses and CEO of Gavi, the Vaccine Alliance, from 2011 to 2023  regarding the

Keizo Takemi, recent Japan Minister of Health, Labour and Welfare (September 2023-October 2024), shares his personal story that took him to Taiwan, CNN/Japan, the Diet, Harvard, back to the Diet, and recently into the cabinet of then Prime Minister Kishida. Along the way he became a leading force in charting Japan's approach to global health. As Minister he put a spotlight on the thousands of single, isolated elderly who die alone in Japan, unnoticed for days. Though expensive, wearable digital technologies can help connect the elderly better to community health services. Covid-19 exposed the lack of digitalized data and the need for a national mechanism to integrate patient and hospital data. That became a priority for him as Minister, as well as the creation of the Japan Institute of Health Security, a merger that promises far greater capabilities in preparing for and responding to dangerous outbreaks. By 2035, Japan will have 10 million citizens above 85 years of age. "Speedy aging" is raising demands for

Dr. Debra Houry joined the podcast, following her resignation from CDC on August 25, upon the firing of CDC Director Susan Monarez, and shortly after her September 17 testimony before the Senate HELP Committee. What does she make of President Trump’s September 22 press conference on Tylenol, its alleged connection to autism, and the potential use of leucovorin? While serving as CDC’s senior most leader, how did she navigate the period from President Trump’s inauguration on January 20 until the arrival of Susan Monarez as the new CDC Director on July 31? How was the armed attack upon CDC on August 8 experienced? What are the downstream impacts? How did she plan and carry out her resignation in league with other CDC leaders? What did the September 17 Senate HELP Committee meeting accomplish? What is the state now of CDC? “I have grave concerns about what is coming out of that agency.” How to stabilize CDC? It needs permanent scientific leadership, a stable budget, more truth and oversight of advisory committees

The renowned global health leader, Peter Piot, LSHTM, opens this conversation with reflections on what drove the historic global health successes, including “a brilliant coalition” and U.S. bipartisan leadership grounded in statecraft and strategic thinking. That “twenty-five years of historical anomaly” has however now ended. In Europe, that shift has resulted from populism combined with intense migratory pressures, the costs of battling the threat of Russia, and the high costs of providing a social safety net for a rising elderly population. Global Health 2.0 will be built on health sovereignty in Africa, Latin America and Asia. The shock scarcities of the Covid pandemic had already awakened the need for greater self-reliance; the sudden and abrupt decline in donor funding for global health is the latest shock. We will see “sunset clauses” and “mergers and acquisitions” across many familiar international institutions. AI promises innovations in R&D and delivery, aided by philanthropies. Centers of excellenc

Listen to the recent CSIS Bipartisan Alliance for Health Security book launch of The Big One: How We Must Prepare for Future Deadly Pandemics. As bad as Covid-19 was, the next pandemic could be worse. While the world learns to live with Covid-19 and continues to recover from its worst effects, how do we prepare for the next pandemic lurking around the corner?   The event includes a panel moderated by CSIS Senior Vice President and Director J. Stephen Morrison, featuring co-authors Michael T. Osterholm, Director, Center for Infectious Disease Research and Policy (CIDRAP), University of Minnesota, and Mark Olshaker, Emmy Award-winning documentary filmmaker and New York Times #1 bestselling author.

Dr. Celine Gounder, Editor-at-Large, KFF Health News, explains how the U.S. vaccine enterprise could be damaged so swiftly by the Trump administration, with so little apparent resistance: it was a "shock and awe" blitz, while hesitation and fear dominated. "Silence was paralysis." It is too early to estimate the true scope of damage. The middle tier of professionals in government and scientific research has certainly paid a high price. While Secretary Kennedy's firing of CDC Director Monarez was a thunderclap, it remains to be seen if or when President Trump changes his view of the Secretary's performance. What lies ahead? Regional alliances of states setting policy on vaccines will be "the laboratories of public health." The Supreme Court may be called upon to revisit the balance between individual liberty versus public health. If pediatric hospitals are overrun with children suffering from dangerous vaccine-preventable illnesses, public outcry could escalate.  

In the fifteenth episode of the Common Health Live!, Katherine E. Bliss talks with Dr. Jarbas Barbosa, Director of the Pan American Health Organization (PAHO), about challenges related to health security in the Americas, the importance of regional cooperation in building resilient health systems and strengthening preparedness for future health emergencies, and opportunities for advancing efforts to improve the health of the region’s population through the upcoming UN High-Level Meeting on the Prevention and Control of Noncommunicable Diseases and the Promotion of Mental Health and the 10th Summit of the Americas, scheduled to take place in the Dominican Republic in December.  

Dr. Andriy Klepikov, the founder and executive director of the Alliance for Public Health (Ukraine), reflects on the Alliance's remarkable evolution over the past 25 years into a major Ukrainian—and regional—non-governmental force in HIV, TB, and harm reduction programs. Foundational to its early success was the exemplary partnership with the Global Fund and PEPFAR. Ukraine, in the midst of war, cannot at present soon transition to self-reliance. In the past three and a half years of war following the Russian invasion, the Alliance has become a provider of mass emergency humanitarian relief to the most vulnerable in Ukraine. It now serves five times the numbers it served before the war. Recovery will draw on telemedicine and mobile clinics, and prioritize mental health, war veterans who are blinded, have lost limbs, and struggle with long-term trauma. The United States remains indispensable to Ukraine's future—for peace and social justice.  

Dr. Heidi Larson, the acclaimed expert on vaccine confidence at the London School of Hygiene and Tropical Medicine – and CSIS Senior Associate – speaks to how the external world is reacting to the changes in the United States in vaccine policy, the scientific R&D biomedical enterprise, and public health. “What has shocked people is the abruptness of these measures with little consideration of the implications.” An abrupt drop in trust has followed. The United States has for decades been seen as the most stable and trusted collaborator, based in scientific evidence. People are now turning inward and to other countries. For those scientists whose U.S. grants have been disrupted, “You can’t turn your lab off for six months.” We are seeing the outmigration of US-based scientists to Europe and elsewhere. The multilevel siege of American universities is fundamentally a matter of values. It has raised the question of whether it will be possible to sustain transatlantic scientific partnerships. How to break out of a

In this episode of The CommonHealth Live!, Dr. Christopher J.L. Murray, Director of the Institute for Health Metrics and Evaluation (IHME) and Stephanie Psaki, CSIS Global Health Policy Center Senior Adviser, will discuss IHME’s new report on Financing Global Health, also released in a paper in The Lancet, and its implications for the way forward in a constrained financial environment. Who and which countries are those most affected by the sharp drop in development assistance for health between 2024 and 2025? How will recipient governments and other global stakeholders respond to fill the gaps? This event is made possible by the generous support of The Gates Foundation.