At CDC, Mandy Cohen seeks to foster trust in a battered agency

DALLAS — Dr. Mandy K. Cohen dropped by the Fox affiliate in Dallas in November, just days after the governor of Texas signed a law barring private employers from requiring COVID-19 shots. If she thought promoting vaccination would be a tough sell in a ruby-red state, Cohen, the new director of the Centers for Disease Control and Prevention, did not give any indication.

“I’m not just the CDC director, I’m also a mom,” she said cheerily, noting on live television that her daughters, 9 and 11, had already received the latest COVID and flu shots. She added, “So I wouldn’t recommend something for the American people I wouldn’t recommend for my own family.”

It was the kind of stock phrase that Cohen has repeatedly invoked as she pursues a task that some public health experts fear is impossible: restoring Americans’ faith in public health, and in her battered agency. Five months into her tenure, with the COVID public health emergency officially over, the CDC’s new leader is relentlessly on message.

Americans’ trust in the agency, and in science more broadly, was badly damaged by the coronavirus pandemic, and the loss of faith is particularly pronounced among Republicans. In a recent survey by the Pew Research Center, 38% of Republicans said they had little or no confidence in scientists to act in the public’s best interests, up from 14% in April 2020.

At the same time, the CDC’s winter vaccination campaign appears to be falling on deaf ears. On Thursday, the agency issued an alert warning that low vaccination rates for the flu, COVID and respiratory syncytial virus, known as RSV, could lead to “severe disease and increased health care capacity strain in the coming weeks.” And partisan divisions over vaccination persist: A KFF poll in September found that 7 in 10 Democrats but just a quarter of Republicans planned to get the updated COVID shot.

Cohen, whom President Joe Biden selected to succeed Dr. Rochelle P. Walensky, is responding with a nationwide media blitz. Since taking the helm of the CDC in July, she has traveled the country, promoting vaccination in 19 cities in 13 states. She has visited 22 vaccination sites and has participated in dozens of interviews, including an appearance on NBC’s “Today” just before Thanksgiving.

She has left a trail of social media posts in her wake, including a series of short videos, called “Check-In With Dr. Cohen,” that typically begin with some variation of the same greeting: “Hi everyone, it’s Mandy Cohen!”

In one video recorded on Long Island, New York, Cohen and a county health official, wearing hard hats and vests, reported on how wastewater can help scientists track viruses and disease. In Dallas, she appeared with another county health official to talk about the importance of data, and with a nurse at a church health fair. And in Chicago, she stood by the president of the American Medical Association as he promoted vaccination.

When she speaks to reporters, she frequently brings up her children.

“Science is important and yes, the data is important,” Cohen said in an interview with The New York Times. “But at the end of the day, we’re also all humans. And if we can have a human-to-human conversation about what I would do for my own kids, who I love and I want to be healthy, maybe that can connect us in a different way.”

Cohen is taking over an agency that is in transition. Her predecessor, Walensky, who began serving at the start of the Biden administration and stepped down in June, commissioned a review of the CDC that identified serious weaknesses in areas ranging from testing to data collection to communications. Walensky then initiated an overhaul of the agency.

Cohen has said she is committed to carrying out that plan, which included setting up a new forecasting and analytics center, as well as structural changes intended to enable the agency to quickly translate its science into coherent policy recommendations. But even her staunchest allies say her top priority must be to change the way the public views her agency.

“Restoring trust probably is the No. 1 challenge right now,” said Dr. Judith Monroe, president and chief executive of the CDC Foundation, an independent nonprofit established by Congress to mobilize private-sector support for the agency’s work. “Because where’s your platform if folks don’t trust what you say?”

Experts agree that CDC officials and other public health leaders made serious messaging missteps during the pandemic. Officials bred mistrust by speaking “with certainty when there wasn’t any” and later changing their recommendations, said Brian C. Castrucci, president and chief executive of the de Beaumont Foundation, a public health nonprofit that is partnering with Frank Luntz, a pollster and political strategist, to study attitudes toward public health.

Luntz, who rose to prominence working for Republicans, said his research had found that a significant portion of the public — as much as 20% or 25% — was now unreachable, because public health officials used language that “sounded like it was lecturing, and almost abusive toward people who had legitimate doubts.”

Based on Luntz’s surveys and focus groups, the foundation has developed messaging guidance, including a “communications cheat sheet,” to help public health officials reach Americans of all political stripes. Dr. Tom Frieden, who served as CDC director under President Barack Obama and has participated in the project, said Cohen’s communications style was in keeping with its findings.

“You’re there to empower people with information, not berate people to change their behavior,” he said. “I think Dr. Cohen gets that.”

The morning before she was to leave for a two-day, three-city swing through Texas, Cohen huddled with her top aides and her infectious disease team at CDC headquarters in Atlanta for an update on the flu, COVID and RSV — which circulate during what the agency now calls the “winter respiratory virus season.” One benefit of that moniker: Winter viruses are less politically toxic than COVID.

The news was mixed. Hospitalizations from the flu were up slightly from last year. The rate of COVID vaccination was much lower than that of flu vaccination among health care workers — not a good sign. A new monoclonal antibody shot to prevent RSV in infants was in short supply, but 77,000 more doses had just been released. Texas was seeing an uptick in RSV.

But there was something else on Cohen’s mind. During her travels, she had been hearing from people who worried about side effects from vaccination and wanted more information about what federal health officials were doing to monitor vaccine safety. The CDC, she told her colleagues, needed to be able to “tell a clear and concise story.”

To that end, Cohen is changing the language that the CDC uses to describe itself. Testifying last month before a House subcommittee in what was her first appearance before Congress in her new post, she described the agency as a “critical national security asset” — a phrase that might have particular appeal to House Republicans, who have proposed cutting the CDC’s funding by $1.6 billion, or roughly one-sixth of its budget.

But M. Anthony Mills, a senior fellow at the conservative American Enterprise Institute who studies public trust in science, said the national security frame might not appeal to ordinary Americans who distrust the CDC and other agencies including the National Institutes of Health and the Food and Drug Administration.

“For Americans who believe NIH lied about funding research that caused the pandemic, suspect the pharmaceutical industry is in bed with the FDA and see public health efforts as an infringement on their freedom, that constellation of concerns doesn’t have much to do with national security,” he said.

Unlike Walensky, who had no prior government experience and made headlines for seeking out media training, Cohen is not a stranger to Washington or the spotlight.

She was a top official at the Centers for Medicare & Medicaid Services during the Obama administration. Later, as secretary of health and human services in North Carolina, she laid the groundwork for the Republican-controlled legislature to accept an expansion of Medicaid, and she helped steer the state through the pandemic.

After news reports that Biden was planning to pick Cohen for the director’s post, more than two dozen congressional Republicans signed a letter accusing her of politicizing science. They cited her tenure in North Carolina, where she called for students and staff members in K-8 schools to wear masks and threatened legal action against a school district over its COVID policies.

But while her relationships with Republicans in North Carolina may have been tense, they never veered into vitriol, said state Rep. Donny Lambeth, a Republican and a chair of the Health Committee in the North Carolina House of Representatives.

“She was cool, calm and collected almost every time we had her in front of us,” Lambeth said. “She did not get rattled.”

There were few fireworks during her congressional testimony last month. When Rep. Daniel Crenshaw, R-Texas, pushed her to admit that the CDC had been wrong during the pandemic, she politely ignored the request.

Rep. Jeff Duncan, R-S.C., wanted to know if she had regrets about COVID restrictions from her time in North Carolina. Cohen did not admit to any. When he asked her pointedly if she would impose such restrictions today, she ducked the question, telling him instead that she was looking forward to a new chapter at the CDC.

“The good news,” she said, “is we’re in a new place.”

This article originally appeared in The New York Times.