Below is a lightly edited, AI-generated transcript of the “First Opinion Podcast” interview with Richard Besser. Be sure to sign up for the weekly “First Opinion Podcast” on Apple Podcasts, Spotify, or wherever you get your podcasts. Get alerts about each new episode by signing up for the “First Opinion Podcast” newsletter. And don’t forget to sign up for the First Opinion newsletter, delivered every Sunday.
Torie Bosch: Former acting CDC director Rich Besser is worried. When public health is working, no one notices. When it’s not working, people die. And Besser doesn’t think the current CDC is working.
Welcome to the “First Opinion Podcast.” I’m Torie Bosch, editor of First Opinion. First Opinion is STAT’s home for big, bold ideas from health care providers, researchers, patients, and others who have something to say about medicine’s most important and interesting topics.
Today I’m speaking with Rich Besser. He’s president and CEO of the Robert Wood Johnson Foundation. He also served as acting CDC director and practiced as a pediatrician for more than 30 years.
After a quick break, I’ll bring you our conversation about a new era for the CDC, vaccines, and communicating about health to a skeptical public.
Dr. Rich Besser, welcome to the “First Opinion Podcast.”
Besser: Oh, it’s great to be here, Torie.
Bosch: We’re recording this on Tuesday, Oct. 7. Yesterday, the current acting director of the CDC called for the measles, mumps, and rubella vaccine to be split into three vaccines. Since you were a pediatrician for so long, I wanted to start by asking you about that. What’s your immediate response to the idea of breaking up the MMR?
Besser: You know, Torie, I used to think that I couldn’t be surprised, but it seems like just about every day something comes out of the Department of Health and Human Services that to me is absolutely against the best interests of people’s health, makes no sense, and yet it keeps on coming. You know, the measles, mumps, rubella vaccine, it’s called the MMR, is one of the mainstays of vaccination for children and for people around the world. And initially these were developed as single vaccines and you gave them separately. And as a pediatrician and as a parent, it’s really nice when you don’t have to give quite so many shots to kids. And so these were developed as a single shot, the MMR, and it was found to be just as good, just as effective, and no more side effects if you gave it as the MMR.
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And so why [acting CDC Director and HHS Associate Director] Jim O’Neill, who has absolutely no public health experience, is basically parroting something that the president said, that these are going to be separated, it makes no sense and it supports my belief that we can no longer look to the CDC for vaccine advice.
Bosch: How does that feel to you as someone who previously led the CDC?
Besser: It’s absolutely heartbreaking. You know, I remember when I first was kind of like dreaming of working at the CDC. I was working in Bangladesh. I had just finished my pediatric residency. I got a job in Bangladesh doing some vaccine research. And I met a guy who was a disease detective from the CDC. And he was there to investigate a measles outbreak or cluster in a refugee camp in in Bangladesh. And he told me about this program where you go to the CDC and you learn to become a disease detective. And I was like, I want to do that. And so a couple years later I did. And you know, the CDC has been the gold standard for the world in terms of what federal public health agency should look like.
So to see it first being gutted, you know, to have a secretary of Health and Human Services who doesn’t believe it should do basically anything but infectious diseases, to see thousands of people lose their jobs, and then to see him move forward with a strong ideological anti-vaccine agenda. It’s just, it just breaks my heart. And I feel for all of the people who are still working at the CDC trying to do their best, and I feel for the public in the United States that can no longer look there for the information they trust. And I feel for people around the world. The CDC and its relationship with the World Health Organization and its relationship with different governments has been such a stalwart in in global health. And that’s just being destroyed.
Bosch: Are you in in close touch with folks who are still at the CDC, and if so, what are you hearing from them?
Besser: You know, some. I left the CDC in 2009. I was the acting director at the start of the Obama administration and was supposed to be in the job just for about six weeks, and it ended up six months, and I led the agency at the start of the swine flu pandemic, which is another reason why I’m really concerned about Jim O’Neill. You want someone in the acting job who knows how to respond to a public health crisis. And that’s not something he’s had experience with.
But I’ve tried to stay in touch. A lot of the people who were there with me have since retired. I had set up a meeting with the director, Susan Monarez, and it just happened to be on the day that she lost her job. And we were talking, and she’s … I reach out to all the CDC directors to offer my support and to see if there are things at RWJF that we can work on with them. We’ve done a lot of work with the CDC, and she was very appreciative for the for the call. She said, “But I don’t know how long I’m gonna be in the job. They could come for me at any moment.” And she explained that she was asked to do something illegal, which is to fire federal employees without cause, and she was asked to do something she felt was unethical, which was to approve vaccine recommendations that go that went against the science.
And you know, I’ve talked to some of the leaders who’ve left, and they explained why they left. And it’s just heartbreaking. They try, they tried to do the right thing. I worked under Republican and Democratic administrations. I ran emergency preparedness for four years during the Bush administration. You know, I started on the day Katrina hit New Orleans. And yeah, and it didn’t matter what party was in power. It was all about the health of the public. The policies might change, the emphasis might change, but we never doubted a commitment to the health of people here and around the world. And now that is in doubt.
Bosch: We’ve seen leaders from the CDC resign in protest having been asked to do things they don’t agree with or out of concern. What is your thinking about whether people working for the CDC should stay and try to sort of defend the organization as they see it versus leaving so as not to take part in something they object to?
Besser: It’s a great question. I think that anyone in a leadership position has to have a line that they won’t cross. It’s so important that that you know for yourself what that line is. And you know, in every job I’ve had, I’ve had that line, and it’s actually a privilege to be able to do that, to not feel that, “Oh, if I leave this job, I don’t have a job and I can’t do that.” If you have that privilege and you’re asked to do something that is unethical, I think you gotta go. If you’re someone who’s in a technical position, someone running a laboratory or doing some studies and you’re allowed to do those studies, I would say keep on doing it. Keep on getting the information. It may not come out right away, but keep on doing that.
Rebuilding the CDC is going to be a real challenge. There’s been a lot of talent that was lost. A lot was lost during Covid because of the demonization and the politicization of public health. But a lot of people stayed. And you know, I hope that that people find a way to continue to do important work during this time.
Bosch: Obviously we’re less than a year in, right? There’s at least three more years of this and, you know, we’re already thinking or you’re already thinking about rebuilding the CDC. How are you thinking about what will have to happen after this administration to rebuild it, in your words?
Besser: Yeah, I mean there’s no guarantee that this is a three-year deal either. And so you know, as a foundation, we have defined what we call generational goals. And one of those generational goals is around equitable and accountable public health and health care institutions. And the reason for that as a goal is that the institutions we had were not meeting the needs of all people.
And so it’s not about going back to what was. It’s about imagining what could be and lifting that up as a vision that can inspire people that we can that we can work towards. The CDC did a lot of things great, but there were a lot of things it needed to do better. It needed to connect with people at the community level better. It needed as a federal agency to figure out how to understand what people’s biggest health concerns and public health concerns were and and how to address that. You know, I think as an agency, it needed to do a better job communicating. That’s been kind of my mantra for quite a while.
Early in my career, I was based in San Diego. I was at the University of California, San Diego, and I had the opportunity to have a segment on the local news every week. And it was basically answering questions that viewers had about health. They’d send them over to me, I’d come in and I’d give answers. And it was really, you know, being a pediatrician on the air, even though they weren’t all pediatric, it was trying to understand what people’s concerns were and speaking to people in nonjargon, plain speak that was respectful. And CDC and a lot of physicians in general have a hard time getting away from the jargon. And some have a hard time treating people with respect who don’t agree on all issues. And so that’s an area where I think public health needs to do a much better job. Communication has to be seen as a core function of public health and something that that you know, more and more public health schools are training in that in that area. But how you communicate and the means of communication are really, really important.
Bosch: You mentioned respect, which I think is a really important idea here. I think that we see a lot of people who’ve become anti-public-health, saying that they felt that during Covid, and perhaps before, that their opinions or ideas weren’t respected. Can you talk a little bit about what it means for medicine to treat patients with respect while not sort of encouraging beliefs that aren’t based in fact?
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Besser: Yeah, you know, that’s a multi-layered question. Coming from a from a couple directions. Right now we’re hearing a lot from the Make America Healthy again, the MAHA movement, which tends to be a fairly well-educated, higher income white group of folks who have felt disrespected, their concerns not being addressed. And it’s important those concerns are addressed.
There are also really big issues when it comes to health care and issues of health equity and racial equity and gender equity. Over time we’ve sponsored a number of surveys with the Harvard School of Public Health and NPR looking at the this issue of respect and disrespect. And every racial group, every gender, every sexual orientation feels that they’ve been disrespected. Black patients more than other groups. And it has real consequences for health. You know, there’s great data to show that Black patients are are given much better care when they’re treated by Black physicians. And yet the pipeline for Black physicians remains extremely dry. There is great data to show the ways in which interpersonal racism and structural racism are seen throughout our health care system. And so those things fundamentally have to be addressed.
What concerns me is that the issue of respect right now is being framed is pretty much through a MAHA lens, which I don’t hear addressing these issues of disrespect, lack of access, needs not being met by individuals who have been marginalized over time, people with marginalized identities.
Bosch: In a pretty challenging time for public health, how is RWJF changing the way it’s approaching public health in this moment?
Besser: So we took a pretty hard pivot back in 2020, 2021, 2022 during Covid and during the movement for racial reckoning. And for a couple of reasons. One, with Covid, it was clear that Black patients, brown patients were having much worse outcomes during that that pandemic. Lower-income individuals were faring much, much worse than others. So our focus as a foundation has been around issues of health equity and in particular racial equity. And the movement for racial justice led us to center dismantling structural racism, the biggest barrier to health in America, as central to the work that we do. And we are all in.
And so when this administration, when the president, one of his first things was an executive order basically that said that diversity, equity, inclusion were illegal. We had a statement out the next day saying not only are these not illegal, these are fundamentally American values. The idea that everyone in our country should have the opportunity to lead their healthiest life, that is a fundamentally American value. And we’re not backing down from that. And you know, our grantees are working towards a better day. We believe in America that health should not be a privilege, it should be a right. And we are all in on that. And I think that if we can help lift up a vision for what that looks like, it’s inspiring. It’s what everyone wants. Everyone wants to be able to work a good job that has self-respect, that where you earn enough money to take care of your family and enjoy life, and you have health, and that’s not available to so many people in our in in our country. And I think that that a lot of what we’re seeing right now is a reflection on the economic situation in our nation that’s left so many people behind. And so we are about a future where everyone can thrive.
Bosch: So how has your work changed at the foundation because of the Trump administration and the cuts to HHS?
Besser: I mean, it’s changed in a number of ways. I’ve gotten louder than ever before. You know, philanthropy is in a pretty privileged position. This is the first philanthropy I’ve ever worked in, and it is the least accountable sector I’ve ever seen. We are a private foundation, and we must use our resources for the public good, and we define what the public good is. And so, from our perspective, if we’re not able to lean in to what is right and into our values in this time, how can we expect others to do the same? Others who are being threatened with losing federal dollars, others who are being threatened in so many different ways.
So we are leaning in. We are our spending in terms of grants more than ever before. We are doing more work around the defense of democracy. And I love when people ask, you know, “Why is a health philanthropy investing in democracy?” Well, there can be no health if we don’t have a functioning democracy. People don’t have the agency to change the conditions in in which they live. And so we’re very invested in that. We have more than 30 grantees who are involved in lawsuits against the administration and illegal actions that they’re that they’re taking. We’re supporting grassroots organizing. These are things that are really, really critical in this in this time. And we’re trying to encourage other sectors to say no, that this is not the new normal, this is not acceptable.
Bosch: You said you’ve been louder than ever before. You know, certainly I’ve edited opinion pieces that you’ve written for STAT. We’ll put links to some of those in the show notes for this episode for sure. How do you decide when it’s time to be loud? As an opinion editor right now, I’m struggling a bit with, you know, when do we write the op-ed from a former official who’s prominent and well respected that just says “all of this is troubling” when sometimes readers might think, “Well, I’ve read this before,” right? So how are you thinking about the way to use your expertise and when you’re trying to rally people who agree with you versus when you might be trying to persuade somebody who doesn’t agree with you?
Besser: We don’t want to speak out constantly because then you just become kind of noise. And at the same time, you don’t want kind of the daily assault on health to be viewed as normal. So we haven’t put anything out about dividing up the MMR vaccine. At this point it’s just a statement. I don’t even think that there’s licensed products in this country for each all three of those. We did put something out a week ago when the administration attacked Open Society Foundation, you know, one of our peer philanthropies that’s focused on supporting democracy. We put something out because that kind of assault shouldn’t be allowed to just stand. An assault on free speech is an assault on basic fundamental values in the in our nation.
And so we we ask the question a lot: Are you gonna speak out on that? Are you gonna speak out on this? I’m fortunate that I have a lot of access to media, so even when we’re not putting out statements, I’m often going on different outlets to kind of explain, you know, I can explain why dividing MMR is probably gonna lead some kids to be unvaccinated and at risk. And I can talk about investigating and a mumps outbreak when I was in in Bangladesh and what it was like to see kids on a polio ward in in Bangladesh and in India. There are things I can do that hopefully won’t be noise, but hopefully also won’t allow this daily assault to be viewed as oh yeah, that’s just another thing. Is that one a big deal? Any of these things, if it was the only thing that took place, it would be huge. And so it is a real challenge.
Bosch: So you’ve coordinated with other former CDC directors recently writing an op-ed, for instance. Just today, former surgeons general wrote an op-ed in the Washington Post about their concerns about the Trump administration’s health policy. Is there a group chat among the former directors? Or are you all sort of in regular communication discussing what’s happening and coordinating responses in some way?
Besser: During Covid, there was a lot more of that. And you know, we have resources at the foundation, so we’re able to play a coordinating role. For this, no, I mean, when you look at the former CDC directors and acting directors who signed on, you know, some are not very accessible when it comes to modern media connecting. What we were trying to do there was to say across the political spectrum, you know, this is a group of people who’ve worked in every administration from Carter to Trump, including Trump. And all saying this is fundamentally different. We were all public servants, and this shouldn’t be allowed to stand. Similarly with the piece today from the surgeons general, it’s the same. This is a group of folks worked in Republican and Democratic administrations who are saying that that Secretary Kennedy is dangerous, and this is not good for our nation. It’s not good for the world, but it clearly is not good for America.
At the foundation, we’re looking to try and position me and others with more conservative media for the purpose of persuading. Early in my career as a pediatrician, my first job, I was on the faculty at UC-San Diego, and I was working the faculty practice, and I had just come from my fellowship as a disease detective, and some expectant parents came to see me and they said, “You know, we really want to join the practice. But we need to let you know that that we’re not so sure we want to vaccinate our baby.” And I said, “I don’t think I’m your pediatrician. Nothing that I do as a pediatrician has more value in terms of protecting health than vaccinating fully and on time.” And so they went somewhere else.
Within a year or two, I changed my approach. You know, it’s fine to stake out that perspective, but for me it was like, well, maybe if I develop a trusted relationship with these parents, they’ll think about things differently. And so that’s the approach that I took. And it’s the approach that I’ve tried to take since then. You know, I love being on call-in shows because there you get people who may not agree with you and you have to try and listen and understand and sometimes you can persuade and sometimes they’ll persuade me. So it’s you know, that kind of openness to movement.
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Bosch: Can you think of a time when someone persuaded you?
Besser: You know, I’ve been listening lately to a podcast that we provide some funding for. It’s called [“Why Should I Trust You?“] I don’t know, can we talk about other podcasts?
Bosch: Please do. Yes. We love a recommendation here.
Besser: What it brings together are people from the MAHA community with people from like governmental public health. And listening to it, I’ve been persuaded that I have more common ground with some of the MAHA community than I thought. And I think that there could be opportunities to come together on some issues. Maybe not around vaccines, but you know, around food and food supply and the importance of access to real food. You know, if it can be about more than just, “Oh, we need to ban dyes in food” and expand beyond that to, well, what would it take for everyone in America to be able to afford real food? You know, real food, when I was when I talk about real food, I’ve heard it described as shopping the perimeter of the supermarket.
Bosch: Right, yes. Yeah.
Besser: So all the packaged stuff is in the middle. Around the outside, that’s your fresh stuff. That’s your fruits, your vegetables, your meats, your real food. What would it take for everyone to be able to afford that? What would it take for the school lunch program in America to be providing real food? And every school to have a kitchen with people who could actually cook and prepare real food? Why can’t that be something that we all work together on? You know, if we invested in that, what would it do to the farming community in America? That would be a great bump for rural America. It would be a great bump for health, and maybe that’s a topic where there can be some coming together.
Bosch: We only have a couple minutes left, but I wanted to talk a little bit about the media. In addition to having a segment on the local news, you then ended up becoming, I believe it was the chief health and medical editor at ABC News, is that right?
Besser: Yeah, I was there for eight years.
Bosch: Oh wow. What grade would you give the media on covering what’s been happening at HHS and CDC this year?
Besser: I mean, it’s that’s a bit challenging in that the media has gotten so fragmented. When I was at ABC News, you still saw the vast majority of people who are watching broadcast were watching the big networks. That’s not the case so much anymore. And I don’t consume that personally. So it’s hard to say.
I’ve been really concerned about how many media companies have rolled over and capitulated to the administration, settling lawsuits in huge ways. And that concerns me in terms of, are they gonna pull their punches, or are they pulling their punches so they don’t get sued again? And our democracy falls if there aren’t independent voices that are calling out when things are illegal and unjust, that allows autocracy to solidify.
Bosch: So, you know, you mentioned that you’ve been trying to do more work with conservative media. Are you advising others, other physicians, other public health experts to try to reach out more? Are people open to doing that kind of thing more?
Besser: I try and model the behavior that I that I’d like others to follow. You know, part of it is the pediatrician in me, and that’s the advice I always gave to parents. You know, catch your child doing good and reward that, you know, and try and model the behavior you’d like to see. And so one of the reasons that we speak out so much at the foundation is to try and encourage others to do the same. That the sky doesn’t fall when you do that and allows your grantees, who are really the ones at risk, to do their work more effectively. I would encourage others to try and reach out. Don’t demonize people you haven’t gotten to know. And that’s really important. You know, there’s there is a large movable middle in America that we have to figure out how to reach. And you don’t reach them with the same messages and the same approach that you do to those folks who are fully aligned with your thinking. And I also think that we have to find ways to find common ground with people where we don’t have common ground on everything. And that’s been a little bit challenging among more progressive institutions.
Bosch: Are there other outlets that you recommend people think about, in terms of places where people are genuinely seeking common ground, or are genuinely open to good faith discussion?
Besser: We have a lot of grants to try and diversify the media landscape. So a lot of media outlets that for demographic groups that that haven’t had as much of a voice within media. We’re also have joined with others in philanthropy to try and protect public media, which as you know under such a devastating assault from the administration.
But I think a lot of it isn’t so much the media as talking to your neighbors. You know, talk to someone on your street who may have been having a political sign that you don’t agree with, and get to know them and see where there could be common ground and why they voted the way they did or thought the way they did. It’s a challenge I’m trying to give myself is to find ways to have more conversations with people who I don’t agree with politically.
Bosch: All right, well, last question, and it’s a big one, I’m afraid. What do you think public health needs to do to prepare for whatever comes after the next three years?
Besser: I’m really concerned about what could happen during these three years. You know, public health is practically invisible until the system is stressed. We know there’s going to be another pandemic, we don’t know when. We know there will be new infectious diseases that arrive that may not cause a pandemic. Will we be able to detect them quickly? Will we be able to respond? You know, with global warming, the odds of another Katrina go up and up. Will the public health community be able to respond? I don’t think so. The cuts to CDC’s budget mean drastic cuts to the states and local health departments and tribal and territorial because that’s where most of the CDC’s money goes.
So we need to find a better way in public health to make the invisible visible so that people can value it and say to their representatives, “We need this, and it’s going away, and I’m worried about that, and you need to fix it.”
At the same time, we need to think about what public health look like that meets the needs of everyone in every community. You know, there were things during Covid that public health did really, really well that should be part of public health. The vaccination gap between Blacks and whites went away. And it went away because public health was in a position where it reached out to people in communities and identified trusted leaders to be the messengers, and they met people where they were and vaccinated in churches and community centers and didn’t have this system where it was just those who can get to it are getting protected. That should be public part of our public health system.
And what gives me hope is young people are really excited about the profession of public health. People want to go into it. Right now they don’t see there’s a lot of jobs, and I’m with you on that. But there will be, because it is something that society needs, and it will be seen when the next stressors come. It’s more and more challenging because the government is not collecting all the data that they used to. One of the things we’re doing as a foundation is trying to support some alternative data collection approaches. But it will come back. You know, public health is one of the most optimistic professions there is. It is about a world in which everyone can lead their healthiest life. And that’s a good thing, right?
Bosch: Rich Besser, thank you so much for coming on the “First Opinion Podcast.”
Besser: Thank you so much, Torie. I’ve really enjoyed it.
Bosch: And thank you for listening to the “First Opinion Podcast.” It’s produced by Hyacinth Empinado. Alissa Ambrose is senior producer, and Rick Berke is executive producer. You can always share your opinion about the show by emailing me at [email protected]. And please leave a review or rating on whatever platform you use to get your podcasts. Until next time, I’m Torie Bosch, and please don’t keep your opinions to yourself.
Be sure to sign up for the weekly “First Opinion Podcast” on Apple Podcasts, Spotify, or wherever you get your podcasts. Get alerts about each new episode by signing up for the “First Opinion Podcast” newsletter. And don’t forget to sign up for the First Opinion newsletter, delivered every Sunday.