Biden picks Mandy Cohen, former North Carolina health secretary, to lead the CDC

President Biden has named Dr. Mandy Cohen, former state health secretary in North Carolina, as the next leader of the Centers for Disease Control and Prevention.

In his announcement, Biden praised Cohen’s experience and leadership. “Dr. Cohen is one of the best doctors and health care leaders in the nation,” Biden said in the statement, “[She] she was recognized by leaders on both sides” for her skill [to] find common ground and implement complex policies”.

Cohen, 44, is an internal medicine physician who has held senior positions in state and federal government and in the private sector. From 2017 to 2021, she served as secretary of health in North Carolina, where she worked to expand access to health care for low-income residents and became the face of the state’s COVID-19 response during the emergency public health.

He is leaving his current position as an executive at Aledade Healthcare to lead the CDC, a federal agency whose morale and reputation have been deeply tarnished by its response to the pandemic. He takes the helm from Dr. Rochelle Walensky, the current director, whose last day on the job is June 30th.

“Her experience at both the federal and state levels prepares her for the challenges we face today, tomorrow and in the years to come,” Xavier Becerra, secretary of health and human services, said on Friday in a statement welcoming the appointment of Cohen.

In Cohen, supporters see a leader well versed in public health and politics

Those who know Cohen describe her as a strong manager and communicator who tackles difficult tasks head on.

“I think she’s exactly the right call,” says Andy Slavitt, Biden’s former adviser and administrator for the Centers for Medicare and Medicaid Services, who promoted her to chief of staff and chief operating officer positions at CMS during her tenure.

The CDC “needs someone who understands how to make health and public health a reality in people’s lives, how to get things done operationally, how to lift the morale and culture of an agency that has been badly hurt,” says Slavitt, who has advised both the Biden administration and Dr. Cohen on finding the next director of the CDC.

Cohen may be the last CDC director to be nominated without Senate confirmation (Congressional approval for a CDC director will be required starting January 2025, per the requirements of the FY 2023 omnibus bill).

He will likely face continued criticism from some Republicans in Congress, who have held multiple hearings on what they frame as the CDC’s failures in recent years. “During the pandemic, the CDC has issued confusing guidelines and made controversial and confusing statements,” Congressman Brad Wenstrup (R-Ohio), chairman of the House Select subcommittee on the coronavirus pandemic, said in a recent hearing with outgoing CDC director Dr. Rochelle Walensky, “Instead of being a calm and trusted voice of science and reason, the American people have felt let down, often deceived and harmed.”

Supporters say Cohen is adept at political navigation, having worked for both the Obama administration and the North Carolina state government. It’s a skill he’ll need as he advocates for more money and broader authority for the agency.

“One of the things he brings, having worked for a Democratic governor [Roy Cooper] in a Republican state, it’s finding language that brings people together, instead of stirring up the noise of political discourse,” says Marylou Sudders, a former Massachusetts health and human services secretary who has frequently consulted with Cohen during the pandemic.

Those who have worked with Cohen describe her as a good manager and leader.

“She’s an expert in people management and policy implementation,” says Natalie Davis, CEO of the nonprofit health care advocacy group United States of Care, who once reported to Cohen as a staffer of the Obama administration. “She IS a strategist and an operator and she knows how to have a vision and see it through, to all the teams and people who [make it] Work.”

Can Cohen rebuild the CDC in the wake of the pandemic?

The CDC is a 10,000-person agency charged with protecting the public from threats to their health and safety. Internally, the agency has been plagued by attrition and low morale, as it has faced criticism for politicization and poor communication in their response to the pandemic.

The outgoing director, Dr. Rochelle Walensky, had documented some of the agency’s “fairly dramatic and rather public” mistakes, as she described them in an internal staff video viewed by NPR, before restructuring senior management and parts of the agency in recent months, with the goal of making the CDC more agile in its response to health threats.

“Having an attentive CDC director, spending time with the staff, helping the agency get back on its feet, and regaining some confidence will be important,” says Dr. Marcus Plescia, chief physician at the Association of State and Territory Health Officials.

One of the biggest challenges Cohen will face will be restoring trust and credibility with the public.

Trust in the US government is near an all-time low, with only 20% of Americans saying they trust the government to do what’s right most of the time, according to a 2022 Pew Research survey. And when it comes to public health specifically, a 2021 survey by the Harvard School of Public Health found that only half of US respondents have much faith in the CDC.

It’s a topic Cohen focused on in her Guilford College commencement address last month.

“Trust in institutions, such as government, media or business, has eroded in recent years. This lack of trust has led to polarization and division and made it more difficult to solve important issues facing our world.” he has declared.

Cohen has built trust with North Carolinas during COVID, says Dr. Georges Benjamin, executive director of the American Public Health Association. “He has always hit the target by communicating to the public in a transparent, committed way,” he says, “[In public health]you have to be able to effectively articulate the decision-making process that you’ve made, and she’s better than most at it.”

In addition to leading the CDC and defending its budget and authorities in Washington, the new director faces a number of growing public health concerns.

“We have an obesity epidemic, an opioid epidemic, a gun epidemic,” Benjamin says. “We have a growing number of STDs and a commitment we’ve made to managing HIV/AIDS,” as well as potential outbreaks of COVID, Ebola, bird flu, and re-emerging childhood vaccine-preventable diseases like polio and measles.

“Public health is busy, continuously busy,” says Benjamin, “rebuilding the public health system in the United States must be a top priority.”