The outgoing director, Rochelle Walensky, has submitted a roadmap for reform. His successor has the experience and, more importantly, the political intelligence and connections to make these changes.
Cohen’s most directly relevant experience is leading the North Carolina health agency. for five years. In addition to spearheading the state’s response to the coronavirus, no small feat in a purple state with a Democratic governor and Republican state legislatures, he also helped expand Medicaidcombat the continuum opioid crisis and devise innovative ways insurance to cover social needs such as housing and transportation.
The breadth of these responsibilities prepared her well to lead the CDC. The public associates CDC most closely with epidemic control, but its more than 10,000 employees work on a wide range of issues, including preventing noncommunicable diseases like cancer, heart disease, and diabetes; protect the public from environmental threats to health; thwart injury and violence; and safeguard the health of children. Having overseen many of these programs in North Carolina gives Cohen credibility with her new staff, and her experience on her field resonates with state and local health commissioners who will see her as one of their own.
Cohen has also held high-level positions in the federal government, including as chief of staff and director of operations for the massive Centers for Medicare & Medicaid Services. So he knows how to move the levers of power to advance his agency’s priorities. The CDC is not an island; it relies on other federal agencies and state and local health departments to coordinate and implement strategies. Knowing how to navigate the federal bureaucracy allows you leverage public health assets across government.
Another important attribute that Cohen brings is his close ties to White House officials, especially Biden’s chief of staff Jeffrey Zients. Such connections could catch the eye of observers who believe the CDC should be an independent entity, divorced from the political leadership. But these critics should look to Covid-19 as an example of how public health officials must consider more than just science when making complex policy decisions.
like me discussed before, scientific research must be free from political interference, but public health policy, by definition, requires difficult compromises between individual liberty and the social good. Decisions like implementing mask mandates and closing schools and businesses cannot be made solely based on science; they must consider a variety of factors, including human behavior and the costs to learning and the economy.
Cohen has survived this delicate balancing act in previous roles. She will have to communicate the nuances of policy deliberations, including to her own staff that she might disagree with certain administration decisions, while she is a forceful advocate on behalf of the CDC at the White House.
This, I believe, is the least recognized and fundamental part of his work. His political connections are not a risk; they are his superpower.
Here’s an example: The debt ceiling deal recently reached by Congress and the Biden administration will reduce CDC’s upfront funding by an estimated $1.3 billionwith consequent cuts to public health personnel and programs for routine childhood immunizations. The agency’s head must explain why this will harm the country’s health not only to Congress but also behind the scenes to her own bosses as they determine negotiating priorities. An effective leader is one who is in tune with the White House in public, but achieves victories in private.
No doubt Cohen has a tough road ahead of him. politicians and advocates both sides of the hall they will be rooting for him to fail, as they did for Walensky, who led the agency with dedication and dignity. But if anyone can bring out the best in CDC’s talented workers, transform the agency from within, and restore its reputation with the public, it’s this savvy and experienced leader. Americans who care about the future of public health should support Cohen’s success.
