Dr. Judy Monroe is the President and CEO of the CDC Foundation. There, she mobilizes philanthropic and private sector resources to support CDCs critical health protection work, managing hundreds of programs across the United States, and in more than 130 countries. The first part of our conversation that you’re about to hear occurred before COVID-19 came to the United States, and we cover the development of the Ebola vaccine, recommendations on building a career in public health and why it takes public private partnerships to eradicate a disease. In the second half of this episode, we continued our conversation remotely covering the foundation’s remarkable response to COVID-19, including how the private sector has stepped up in partnership with the CDC and state public health departments all across the country to fight this virus.
Dr. Judy Monroe: To me, what I felt great about is this is a pandemic, it’s horrendous. We don’t want to see these things, but the public has really embraced supporting public health. I’ve really enjoyed seeing how many people have come forward and how creative they’ve been. I think this pandemic’s brought out a lot of creativity and innovation, and that I think is a bright spot.
Bill Frist: You’re listening to A Second Opinion Podcast. Your trusted source engaging at the intersection of policy, medicine and innovation and rethinking American health. This episode is brought to you by MEDHOST, a trusted EHR for healthcare facilities. To learn more, go to medhost.com, that’s medhost.com.
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Now let’s turn to the episode. Dr. Judy Monroe is the President and CEO of the CDC Foundation. There, she mobilizes philanthropic and private sector resources to support CDCs critical health protection work, managing hundreds of programs across the United States, and in more than 130 countries. The first part of our conversation that you’re about to hear occurred before COVID-19 came to the United States, and we cover the development of the Ebola vaccine, recommendations on building a career in public health and why it takes public private partnerships to eradicate a disease.
In the second half of this episode, we continued our conversation remotely covering the foundation’s remarkable response to COVID-19, including how the private sector has stepped up in partnership with the CDC and state public health departments all across the country to fight this virus. I’m your host Senator Bill Frist, welcome to a Second Opinion.
It was five years ago that Ebola had a huge outbreak. And then just several months ago, the second largest outbreak of Ebola in history. And I remember five years ago there was no vaccine. The terror that it created around the world, the fact that a case could be in Dallas, Texas, just even thinking about it brings back the emotion. But it would take a long time to make a diagnosis. We had no vaccine and then five years later, just a few months ago, we had this other big, big outbreak. But talk a little bit about how different things are today versus five years ago and why.
Dr. Judy Monroe: Yeah, that’s a great question. So Ebola five years ago in West Africa really took those countries by surprise. And that’s why it took so long to make the diagnosis. When you look at capacity like laboratory capacity, surveillance folks that are on the ground that are able to detect, we had delays in diagnosis. Folks didn’t understand the disease. And then one of the big factors in West Africa was the fear of government and of not trusting some of the messages. So that was a problem.
There were some problems in just organization. There were a lot of folks that they came in to help, but we didn’t have the same coordination that I think we have today. We learned a lot from Ebola.
Bill Frist: And that case in Dallas, Texas, which caught the imagination there, the idea you can have a deadly virus for which we had no real treatment, no vaccine for, could be within one flight here in the United States. Is that any different now or it should people be calmer about it?
Dr. Judy Monroe: Well, so that’s the reason we should be concerned about global health. I mean, that’s why everybody here in America should be concerned about what diseases are breaking out around the world. Disease travels pretty fast with air travel these days. And so we have made improvements though. One of the big differences from the Ebola outbreak five years ago, there was no vaccine. And now we have a vaccine. So this outbreak that we’re seeing in the Democratic Republic of Congo, there’ve been thousands of people now that have been vaccinated and the vaccine is not licensed yet, but it’s truly effective.
Bill Frist: Tell me a little bit about the vaccine, and then a little bit later we’re going to talk about the sort of anti-vaccine movement for the vaccines that we have today. But we had no vaccine for Ebola, a deadly sort of mysterious disease at the time. And then how did the vaccine emerge from the corporate world, from the philanthropic world, from the CDC world? Where did the vaccine come?
Dr. Judy Monroe: Yeah, that’s terrific question. So we’ve been seeing outbreaks of Ebola since the 1970s. So there’ve been lots of outbreaks, 20 some odd outbreaks, I think. And so the pharmaceutical industry had been looking at Ebola vaccine. So there was a prototype, there was a vaccine ready to go, but without a large outbreak, how do you test it? And so the things were ramped up and the opportunity to do the trials on the vaccine safety became available five years ago during this West Africa outbreak. In fact, CDC Foundation, where I work played a role that because we were ready to roll out the vaccine trials in Sierra Leone, there was no government funding to do that.
And so we actually came in with some philanthropic funding to begin the trials, and then later a government funding came in and finished out those trials.
Bill Frist: So the CDC Foundation, and I want you to tell me more about that. Because of the nimbleness and the flexibility, because of its ability to partner with corporations. There are a lot of people right now who are in the corporate world, listening to us right now who have no idea that they can play a role. And what you just described, the immediacy of it, the nimbleness of it, the flexibility of a corporation to be able to contribute to the CDC Foundation and accelerate the process is a wonderful story.
Before getting to that though because I want to get to it. Well, right now, we’re sitting at the CDC, the Centers for Disease Control and Prevention in Atlanta, why is the CDC here in Atlanta?
Dr. Judy Monroe: That’s a wonderful story, it dates back to malaria during World War II. There were a number of malaria cases here in Georgia and our troops, there was big national security, our troops were getting malaria. We needed folks to be healthy to be able to defend the country. And so there was a precursor to CDC here in Atlanta that was doing a great job. And when that all settled down, there was some great thought leaders that said, “You know, we need to start a federal agency. Let’s call it the Center for Disease Control, and let’s keep it here in Atlanta.”
Bill Frist: A lot of people don’t realize malaria was really big throughout the South and the Southeast part of the United States. And you have this largest outpost of the federal government right here in Atlanta, Georgia. And also the malaria, because you mentioned it, ties together why the CDC is not just focusing on disease here in the United States, because malaria was a global disease and it’s a global disease.
Dr. Judy Monroe: Yeah. Yeah. And it’s still a big killer. I mean we’re still trying to fight malaria, but we don’t have cases here in the U.S. unless folks have traveled and contracted it elsewhere and then bring it home.
Bill Frist: So the CDC Foundation is not the CDC, is a foundation, and you’re going to have to tell them the story, because I want to… Because I already confused it real quickly. But it is affiliated or has a brotherly sisterly relationship and raises money and supports initiatives that the CDC tells you are important.
Dr. Judy Monroe: Right.
Bill Frist: Now you tell the story.
Dr. Judy Monroe: Yeah. Well, so the story, this one dates back to about four CDC directors that saw a need for the Centers for Disease Control to have access to public private partnerships. Because if we’re trying to do things like eradicate smallpox, only disease we’ve ever eradicated, by the way, it took public private partnerships. A government can do a lot, but it can’t do everything, and it needs some help. And you mentioned it, the flexibility and speed that we have from industry in private sector.
So Congress back in the ’90s authorize the creation of the CDC Foundation. So we’re an independent 501(c)(3), a lot of folks have no idea that we exist and can help CDC. And we forge relationships and partnerships to work with CDC. So what I love about it is you’ve got CDC that has incredible dedicated scientists with deep knowledge. And it’s a way to leverage that scientific knowledge and all of their investments that we’ve already made, right? The federal government has already invested in CDC. This is an opportunity for private sector or a philanthropy to come in and leverage that investment that’s already been made.
Bill Frist: So you have the science, you have a unbelievable organization, the CDC, and I’ve personally been involved in Legionnaires’ outbreak in 1983, 1984 at Stanford. Personally, I’ve been involved with the CDC in a very direct way with Ricin. When I was in United States Senator, Ricin came to my office, and of course with anthrax. So I see it again and again as a position. But that’s sort of the science, it’s there and supportive, but what do you do as a independent sort of 501(c)(3)? You’re the one that can partners with the private sector for the resources. And so these corporations who are listening to us right now, they can talk to you and say, “I want to be a player.” Is it that direct to have that partnership?
Dr. Judy Monroe: Absolutely.
Bill Frist: And how many corporations have invested alongside you?
Dr. Judy Monroe: Oh, hundreds. I mean, we’ve over the years… It’ll be 25 years next year for the CDC Foundation to have been operating. It is unbelievable. And we’ve had corporate partners come in. Sometimes it’s in kind donations. So an example during Zika, we had a number of corporations that came in and gave us product donation.
Bill Frist: Right.
Dr. Judy Monroe: Sometimes it’s financial support. Sometimes it’s their expertise is what’s needed.
Bill Frist: So give me some examples or give me an example. We talked about Ebola, just coming right off the bat, which is a great example of along the vaccine and vaccine development. What would be another example of where you partnered with corporations around a particular entity disease outbreak, that has in some way accelerated the process?
Dr. Judy Monroe: So one I’ll tell you that a lot of folks don’t realize that in the United States, maternal deaths have been on the rise. And so that was a problem, there wasn’t federal funding really to address it in the way it needed to be addressed. And so in this case, a Merck for Mothers came in and helped finance a partnership that we looked at maternal deaths in depth and a few states. They realized from the data and they standardized the data collection. When they did this, they found that 60% of those deaths could be prevented easily.
The beauty of this project is then it caught the attention and got bipartisan support in Congress. And the last appropriations cycle, there were appropriated funding that came to CDC to take this full scale across the U.S. and it’s standardized, and we will decrease maternal deaths, because of that public private partnership. That was kind of the catalyst, if you will.
Bill Frist: You know, it’s a great story. In this particular podcast, we very much focus on this intersection of health and wellbeing and the science. With the policy world, with innovation, and you really described, you said intersection is that nexus that we focus on. And you’ve really given me a sort of a perfect example of that. You started with the partnership itself, with the innovation of being able to move things along in a new way in the organization, and the attention that’s given.
With the health and wellbeing identifying with the CDC that maternal and maternal child health is a huge issue that is growing that a lot of people don’t realize. It feeds back into the policy, that big third circle that we address, in terms of the appropriations on it. And that’s how the world has changed. And it’s this collaboration, it’s this working together. It’s this partnering. My world’s gone back from the public sector, private sector, public sector, private sector.
And it’s really working together, it’s not one of the other, which I clearly see you focus on. Again, we’re now in Atlanta, Georgia at the CDC. But you’ve spent some time in Tennessee and a wonderful part of Tennessee, a gorgeous part of Tennessee, spent four years there. Let’s start there. And then walk me through a little bit. Your career is fascinating. For the last four or five years you’ve been at the foundation, is that right?
Dr. Judy Monroe: Uh-huh (affirmative), uh-huh (affirmative).
Bill Frist: But let’s jump back. So what about Tennessee?
Dr. Judy Monroe: Yes.
Bill Frist: Tell me about it.
Dr. Judy Monroe: Yes, yes. So when I was in medical school, I learned about the National Health Service Corps and that’s a federal program. And so I took the scholarship and then-
Bill Frist: Tell me about the program. Just so people will know again. Just the sort of program is… I mean, it has an unbelievable history to it, but what is that program?
Dr. Judy Monroe: Yeah, the National Health Service Corps, tremendous. So it was started to help get physicians into underserved communities, whether that be inner city or rural communities.
Bill Frist: Native-American reservations, yeah.
Dr. Judy Monroe: Yeah, and it’s through HERSA, federal agency… And so students will have opportunity for either loan repayment or scholarship. And they have dentists as well. They’ve expanded beyond physicians. So I think a lot of the program it’s tremendous. And many times once you get the scholarship, you’ll be placed in a community health center, which is another great story across the United States. So in my case, I was placed in a rural community health center in Wartburg, Tennessee back in 1986. I was there in 1986 to 1990 and practice rural medicine.
Bill Frist: And this was after you had assistance going to medical school?
Dr. Judy Monroe: Correct.
Bill Frist: And you spent how many years there?
Dr. Judy Monroe: Yeah, so they gave me assistance for the four years of medical school, and then my payback was four years.
Bill Frist: Yeah. And that experience of going to a beautiful, but not poorest of the poor, but from a socioeconomic status point, a very poor area. Serving, you had children.
Dr. Judy Monroe: I did.
Bill Frist: Maybe had some more children then. How did that affect what you did subsequently? And I ask that because a lot of people listening are in training or out in training or thinking about going into medicine. And how important is that experience of deep immersion in an underserved area?
Dr. Judy Monroe: It shaped my career. I mean, very simply. When I started there the individuals in the community, they embraced me as their physician and in turn, I learned so much from them. I saw a lot of pathology. I did see poverty. It was a community that had everything. So being a family physician in a rural community, there was nothing I didn’t see whether that was… There was child abuse and those kinds of things that came to my office.
Trauma, I had like a little emergency room. So I had farmers.
Bill Frist: You did it all.
Dr. Judy Monroe: Yeah, coal miners. I mean, everybody was coming into the office no matter what the issue was. And I took care of folks all through the whole stage of life, from newborns to the elderly and death and dying.
Bill Frist: And then you say it changed, altered, defined your trajectory.
Dr. Judy Monroe: It did.
Bill Frist: What was the next step? How did it?
Dr. Judy Monroe: It did. So from there, I became a residency program director, I ended up teaching. One of the interesting things when I was teaching is that the residents then would try to stump me with cases. And every time they try to stump me, I’d say, “You know, I saw this when I was in Tennessee.” And sometimes it was really rare cases because I took care of the entire community. So I learned in that experience, because I had limited resources. I learned how to take a good history, really to listen to the patient, understand the family dynamics, community dynamics. And that served me really well, when I got into medical education and running a residency program.
Bill Frist: And that sort of experience you had it through the scholarship program of our government. I got it in many ways by going to parts of Africa and Haiti, and other parts of the world year after year spending a few weeks there. But going through that eye of the needle and you can do it obviously in your own city, urban areas as well.
Dr. Judy Monroe: Right, right.
Bill Frist: But it’s interesting that it really does affect your empathy, your ability to communicate and listen forever. And in the residency program from there, where did you go?
Dr. Judy Monroe: Yeah, so I was with the residency program and then Mitch Daniels became the governor of Indiana. And kind of out of the blue, I got a call that the governor wanted to speak to me, and he was looking for a new state health officer. And so I became state health officer in Indiana, had a fantastic time working with Governor Daniels. And then from there I was asked to take a look at a position here at CDC and became a deputy director of the agency and stood up an office that supports all the health departments across the nation. So that was a great ride as well.
Bill Frist: Yeah. How do you describe public health generally today?
Dr. Judy Monroe: Yeah, it’s interesting because both in my experience at the state, CDC and now what I’m doing, public health, everybody needs to be involved and everybody can play a role. So employers can play a role. And when we look at the issues affecting populations whether its chronic disease, infectious disease, or folks getting their flu shots, the prevention side of it, everybody can play a role. And I think that part’s really important. Public health is not always supported to the degree that it needs to be.
We’ve got a lot of smart and dedicated people in governmental public health, that don’t always have the support. And I will tell you, we don’t have to look very far that if programs are supported, we’ll see impact, we’ll see improvement. As soon as that support is withdrawn, the disease starts to rise again. So we can’t neglect public health.
Bill Frist: Yeah. There’s so many great examples of that and the eradication of smallpox, which you said. People think Polio was eradicated, and again, just a little bit ago, looking around the city, see if you see an iron lung in the museum here. And I remember as a young boy in the ’50s when I was six years old going on rounds with dad and the whole floor of St. Thomas hospital in Nashville, there was 30 iron lungs laid out and today people don’t even know what iron lungs are, unless you come to a museum to see.
But then people say, “Well, Polio…” And I think in 1952, there were probably 60,000 children who had polio. I’d say, ’52 because I was born. But then people think polio was eradicated, but it hasn’t been eradicated. It’s a great success story, but it has not yet been eradicated coming to it today. Which again, we have to stay on it and on it and on it. And the whole story of HIV AIDS again, there’s a fascinating story here in terms of the importance of staying on it and staying focused as you come through.
Let’s go back a little bit just to the foundation itself. Day in day out, do you take specific projects, in terms of what you… You are looking for partners and do you go to a corporation? Do you go to a big entity and basically say, “Okay, we’re on that project now, and would you contribute to us?” Or how does the mechanics work?
Dr. Judy Monroe: Yeah, so usually the way it works is CDC will come to us and say, this is a project we want to work on. We don’t have all the resources we need or there might be an innovation piece to it that we want to have a proof of concept. They’ll come to us. And then we start saying, who cares about this issue? Who might want to partner? And then we’ll do our outreach to corporations that or to philanthropies.
Bill Frist: For people who are listening to us now, who might be considering a career. What advice do you give young people coming through? Your career has been such a tremendous trajectory in terms of practicing in underserved areas, going to teaching and not just the fishing, but teaching people to fish. And now working with the foundation. What advice do you give to young people who have that same motivation that you had, before he went to medical school or during medical?
Dr. Judy Monroe: Yeah. I actually usually give pretty simple advice. I tell them to follow their interests, do the best job that they can do wherever they are, whether they’re in school, residency, do the best you possibly can do and stay focused on what you’re doing that day. And then when that opportunity comes knocking, say, “Yes.”
Bill Frist: Yeah, jump.
Dr. Judy Monroe: Jump, say yes and take a leap and continue to learn. I don’t stop learning. That’s the best part.
Bill Frist: Yeah. I think that continually learning is exactly right. Exactly.
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You just finished listening to the conversation Dr. Monroe and I had shortly before the COVID-19 pandemic hit the United States. Now she is joining us remotely to give us an update on how the CDC Foundation is so remarkably responding to today’s pandemic.
Dr. Monroe COVID has changed all of our lives in radical ways. And since our last conversation, I know that the COVID-19 has changed the CDC Foundation as well. Why don’t you describe a little bit about the changes that have been underway there?
Dr. Judy Monroe: Yeah, so COVID has transformed the CDC Foundation. It’s remarkable what’s happened in the last three months. For starters, we are a remote workforce now, and we’ve got almost a 100% folks working from home. One or two still try to go to the office just because they like the technology. But we’ve been on the steep learning curve, in terms of how to work remotely. And we’ve been highly, highly productive. COVID has brought to us new ways to do fundraising on our fundraising side of the house. And it has expanded the way we’ve been thinking about helping CDC in the field during an emergency response.
Bill Frist: Earlier in our conversation, we talked about very specifically how the CDC Foundation stepped up with regard to Ebola, which was the last major pandemic in the country, we’ve had other in the world. But we’ve had other epidemics and outbreaks. But describe a little bit how the CDC Foundation is responding specifically to COVID-19.
Dr. Judy Monroe: Yeah. So the outbreak of COVID late January, we activated our emergency response fund. And so our first order of business was to bring the story to the donors and to try to bring in funding, which we’ve been really successful with. And we’re really happy with the support we’ve had. And then we went immediately into helping CDC do what they ask us to do. The early part of the response was actually helping those in quarantine.
If you remember folks coming over on planes from Wuhan China, they didn’t expect to be 14 days in quarantine. And some of them had medical needs and medical equipment that we purchased to help them. And then we really went into full scale response. So we’ve done everything from helping the local response at the local health department level, some of the gaps and needs that they have. We’ve been helping the healthcare delivery system, personal protective equipment procuring that has been part of our job.
We’ve gotten very heavily involved with the technology. There’s a lot of new technology that’s being deployed now, especially with the contact tracing that’s coming. And we’ve been involved with that. Capacity building in laboratories is another big area that we’ve done in vulnerable populations. So our health departments have said, like homeless populations. And of course our long-term care facilities and so forth.
Big area of need has been communications because there’s been… There are a lot of mixed messages, a lot of beliefs out there, it’s a big area. And then we’ve had quite a portfolio of research that we’ve supported. We don’t know a lot about this. We know more about the virus now than we did, but there’s so much more to learn.
Bill Frist: Part of the attractiveness of the CDC Foundation, and it’s not typical for foundations, but it’s the nimbleness, the flexibility, the responsiveness. And I’m sure you get a lot of requests, especially early on when there was this fog of uncertainty. Describe a little the decision-making process or how you decide where to allocate those funds that are coming in, to where they’re needed most and will have the greatest impact.
Dr. Judy Monroe: Yeah, no, that’s a terrific question. We kind of have a two-part decision making at the foundation, one has been when CDC comes to us and says, “Here’s a gap. We have an immediate need that we’ve identified.” Then we’ll deploy resources to that request that CDC has made. And in this response, we’ve relied a lot on the health departments. I really think the tip of the spear is the local health department, because they know the epidemiology in their communities.
They know how the outbreak of COVID is impacting their special communities, their institutions. So we’ve gone directly to local health departments, or they’ve come to us saying, “This is an immediate need on the ground,” and then we’ve responded in that way. And we make our decisions very quickly. As the funding has come in, we’ve been getting it out the door in very strategic ways, I believe. The other thing that has been satisfying to me because of our view of public health at large, we’ve been able to invest early in some new technologies as an example, to help them get to the next level of development that then had gone to scale.
So there was one technology we invested in that now is being used in multiple health departments across the country. And other funding has come in to help support them. So we try to make strategic investments with our funds as well.
Bill Frist: It really is an example of almost a pitch, perfect public private partnership. I use that term all the time and people use it to say there’s synergies and it gives ways to accelerate and take scale to… Or take things to scale. But the CDC Foundation working with the CDC and the larger public health community is I think a beautiful example of public private partnerships. How in particular has the private sector stepped up here, and is there any effort made to match the funds coming in by particular donors to the particular needs that are expressed to you, or that they may vision or envision?
Dr. Judy Monroe: Yes. Another great question. A large portion of the funding that has come in has been unrestricted. Many of our donors have said, we just want to contribute to the response, and they rely on us to help figure out the best strategy for the use of those funds, and to use where the greatest need is. But we have other partners that may have specific areas that they would like to either put their resources. And then sometimes it’s in kind donations or it’s pro bono donations as well.
And in that case, we work with them. Because first of all, of course, we’re dealing with a pandemic, so it’s everywhere and the need is great. But we’ve had some donors that will come in and say, they’d like to fund a particular geographic area, a particular city or state. Sometimes it’s particular… As an example, we’ve got one donor that wanted us to hire staff. They wanted their funding to go for staffing.
And let me tell you the health departments and our partners on the ground love that, because they needed more staff and they needed them hired very quickly. Other times they might want us to put it toward research or mental health. There’s a whole variety of requests and we meet those needs without any problem.
Bill Frist: I found it interesting in one of your recent newsletters, and I think it will be interesting to our viewers and our listeners of the sorts of people who are stepping forward in these challenging times. And I know many of which, and most of which you probably had relationship in the past. And the newsletter, I remember they’re interesting people. You might not expect the NFL, the NHL, T-Mobile TikTok, Facebook as a donor. And again, people don’t think of them as your typical public health supporters, where do they come from?
Dr. Judy Monroe: So this a pandemic has brought donors from all sectors to us, and we have… To be honest, that part has actually been a lot of fun and very gratifying to work with all these different groups. So example, just this past weekend, United Health Group sponsored a golf tournament with four of the world’s best players to compete in a skins’ competition, where the support raised went to the CDC Foundation and the American Nurses Foundation.
We’ve been able to work with… So with the NFL, we became one of the nonprofits that was supported during the NFL Draft. And first time they’ve ever had to do a virtual draft is my understanding. Facebook came in with a donation and then they doubled the match. They did a match for other individuals on Facebook to contribute. One of my favorites was we contacted by folks on Broadway and Jason Alexander and a team put together a Saturday Night Seder. It was online and it raised millions of dollars for the CDC Foundation.
So we’ve just really been delighted with the response and the creativity that folks have done. A couple of weeks ago, we had one that came out of Nashville with country music. And I had a chance to go online and talk to folks live and thank them for their donations. And then we were entertained by a lot of country musician. So, really exciting.
Bill Frist: Do they ask you to sing a song or write a song or?
Dr. Judy Monroe: So I told them up front, they did not want me singing.
Bill Frist: I love it. I love it. Well, I think it really is important, because it reflects the generosity of the American people. Because all those corporations that are doing it on behalf of their constituents, their employees and their clients. And it’s one of the silver linings in this pandemic to see how the country comes together. The corporations come together in support of our public health infrastructure, and that is the foundation, the CDC Foundation, and of course the CDC itself, that is the most trusted entity in the world when it comes to protecting our global health, our public health, our own individual health.
Again, we’ve talked about it earlier, but in addition to being head of the CDC Foundation, served as deputy director of the CDC. So you intrinsically know that foundation well, both instinctively and from all the years that you spent there and working on a daily basis. If there was one thing out there that you would like for people to know about the CDC itself, not the foundation, but the CDC and its work in the current response. What would it be?
Let me preface that while you’re thinking of that. It’s interesting times, because the CDC, I just you said is the most trusted organization in the world. And that’s been built on 70 years or 80 years now of experience and scientific expertise in being in the field, not just the United States but around the world. But with the recent testing and the difficulty getting started there, there has been a tendency of some people to say, “Well, the CDC right now has made mistakes.”
And obviously there were stumbles made, as were stumbles that were made throughout. And there was good reasons for some and good reasons for not. But the CDC stands today as the best, with the most experience and the most expertise. So with that as a background, just pick one thing that would be interesting to our listeners about the CDC and its work.
Dr. Judy Monroe: One of the things that, when a first response takes place like, this folks working at CDC get deployed to the response from across the entire agency. So there are over a thousand people from CDC that are working not only in the agency, and they’re working around the clock, but they’re out in the field. So CDC immediately sends staff into the field to the local, state health departments to help them on the ground.
So when you saw whether it was in Seattle epicenter, or New York City or wherever you’ve read about these huge caseloads, CDC was there and working side by side with those state and local health department staff, and they bring so much expertise. So my hats off to CDC and the team over there.
Bill Frist: And what about the support? A lot of people will say in the aggregate that the public health… And again, the definition of public health is unclear in a lot of people’s minds. But as it goes through the government, there are lots of different places that the money goes to. And some people will say that in the aggregate, if you look at that large bucket, put it all into one bucket, there have been pretty dramatic increases. And clearly, I don’t know what goes up 5, 10, 15% a year. But then the amount that seems to get to the basic fundamental core missions of the CDC in terms of public infrastructure seems not to have gone up that much.
And we don’t need to get into the figures specifically about that, but from your perch where you are now, looking back to your former position of deputy director, give us a little bit of feel about, do they have enough support today to carry out their mission?
Dr. Judy Monroe: Yeah, I would say no. I think for a number of years, the public health infrastructure has not been supported to the level it needs to be, and it’s multifactorial. We need to increase the workforce and better train the workforce in public health. And we need data systems. We’ve got to modernize, and I say revolutionize how we use data in public health, and all of that requires resources and a real commitment. And so that’s been lacking. And I think we’re seeing that with some of the results of this pandemic.
I mean, our health departments are pretty stretched. What folks may not realize that 70% of CDC funding goes out to the health departments. So whatever community you’re living in there are CDC dollars that are helping support your public health infrastructure in your local community, and that’s not strong…
Bill Frist: Yeah, I think that is an important figure because people, they say, “I know the headquarters in Atlanta, and just all this money going there.” So I think that 70% figure is really important. And you mentioned it earlier but build on it a little bit now that you’ve mentioned that 70% of the funds going out to the state health department. And the state of health departments end up distributing that to the local communities as well. How does the CDC Foundation specifically compliment that or supplement that? And you can use COVID as an example.
Dr. Judy Monroe: Yeah. So as an example in COVID, so if a local health department, they are receiving some funding from the state or local authorities and then CDC funding coming in. But there are always gaps. And what we try to do with foundation is we come in and try to fill really important gaps, or things that need to move faster than government funding can move to advance whatever’s happening on the ground. I’ll give you an example, Seattle King County. So you had an epicenter right in Seattle King County.
And we got a request they needed to do some retooling and improvements in their emergency operations center at that local health department, they didn’t have the funding for it. So we said, “Absolutely. We’ll fund that. You’re in the middle of a crisis. You need to have a functional emergency operation center.” So sometimes it’s really fundamental needs that we will try to fill, but what we try not to do, we don’t ever want to fund anything that government funding is going to fund. We don’t supplant any funding. We want to advance public health and improve health in creative and strategic ways that complement the government funding.
Bill Frist: And I think that is one of the attractive things to donors. They know that you have that close coordination where you’re complimenting and you’re supplementing and you’re filling gaps. And that you can do it in such a fast way, a nimble way, a quick way that they can get dollars to you. And they know they’re going to be used well and efficiently and in targeted ways. And that’s just not true with many other foundations. They do good and they do great things, but it takes a long time and you are very fast. They sometimes duplicate, or maybe even aggravate some of the inefficiencies that are out there. And you have that advantage of being able to coordinate.
We talked a little bit about it in our earlier conversation, but the CDC Foundation is a global in the sense of who you support, describe some of the activities that you’re currently doing with COVID on the global stage. We know these viruses don’t need visas, and we know the pandemic means that you don’t have to have a passport, these viruses are everywhere. What sort of things are you doing globally?
Dr. Judy Monroe: Yeah, so the CDC Foundation just routinely we’re in anywhere from 130 to 140 countries with programmatic work. So we’ve got relationships all around the world. And so with COVID, we have had requests from CDC to help on the international response, particularly in Africa. So we have put funding into a number of countries in Africa to help build their infrastructure specifically with COVID. You need laboratory capacity, workforce, emergency operation centers, and then surveillance having those systems to be able to find the disease and contact people that are positive. So we are supporting all of those efforts in multiple countries, actually,
Bill Frist: There’s a lot of promise of a vaccine, and it’s sort of being held out as once we have a vaccine our worries will end. And vaccines we know are lifesaving and hugely important where there’s a lot of controversy or disagreement over, how quickly we can both discover or create an appropriate vaccine. And then the whole issues of manufacturing it, another huge challenge that we really haven’t been prepared for, and we haven’t fully addressed now. And then the equities around distribution, again, a whole ‘nother issue.
But something you and I have talked about previously is the rise of the anti-vaxxer movement, the anti-vaccination movement and the spread of misleading and false on social media. How does this impact our ability to fight COVID and other diseases in the future?
Dr. Judy Monroe: My real hope is especially how this pandemic, how COVID has impacted our economy, and folks have lost jobs. That’s really real to people, what the impact of this has been. So my hope is that we do get a successful vaccine and that this helps counter some of that anti-vaxxer movement. Because quite frankly, this will be the savior, if we will, right? That’s the game changer. If we get a vaccine to fight COVID that’s safe and effective. So that’s my hope.
One of the things on vaccinations, we need to look at the consequence of this is, that we’re seeing a decrease in children getting their immunizations over the last three months or so. Because people have been sheltering at home and unable to go for in office visits. So even those that want to be vaccinated have had some challenges with COVID. And we need to overcome that on the backend.
Bill Frist: Yeah. I think that getting that vaccine, and they’ll probably be a series of vaccines or three or four vaccines, and we’ll have to figure out and we’ll have to demonstrate the efficacy. I don’t worry too much about it. Because I think we can do that. There are already coronavirus vaccines out there for pigs and for dogs and for animals that are already been made. So I think we will get a vaccine, but then this whole issue of manufacturing, it is a huge, huge issue.
And then this whole anti-vaxxer movement, which we’ve got to be able to address in a mature sort of educated, trusted way coming forward. And we’ll continue our conversation on that, because it is such a big issue. Well, there are a lot of people listing to us on this podcast, as we address this intersection of policy and health and innovation. For individuals and business owners who are listening, who want to make a difference, but don’t know how, what do you recommend?
Dr. Judy Monroe: That’s a question that’s coming up quite often actually. I think folks are very interested in helping to make a difference. And I will tell you, I mean we do… At the CDC Foundation, we are at this intersection of public private partnerships. We have conversations every day with businesses that would like to make a difference, and they’d like to have a more granular discussion. We’re happy to have conversations with businesses and talk with them about especially where this response is going.
I mean, we’ve had the early response, we’re moving into a new phase of this particularly with reopening businesses and trying to do that safely. We’re very involved with the CDC Foundation with contact tracing and would be more than happy to have conversations with folks. We have a lot on our website that they can come to. And then of course, CDCs website, they just released more guidelines for different sectors for reopening safely. And we need to really pay attention to that.
What I will say is that it’s not just donations of funds, though I’d come back to some of the pro bono work that companies… We’ve had a number of companies that have said they’ve got a workforce, they have a lot of skills that they love to help. And we’re working on a project now at the foundation to try to do a better matching between what health departments or the public health response needs, and what companies would like to offer in pro bono services. So I’m quite excited about that. I think that’s a sweet spot for public private partnerships, for sure.
Bill Frist: When you talk to these potential donors who come in, who basically say, “We want to help. We want to help now. We wanted to make a difference now.” What is their biggest misconception about the CDC? I know they wouldn’t come to you if they didn’t have a sort of positive feelings to start off with. But when you’re educating and when you’re talking, is there any one thing that you say that surprises the donors the most?
Dr. Judy Monroe: Sometimes they’re surprised at… Because CDC is a federal agency there are some firewalls, and sometimes they don’t always understand the firewall between what a federal agency can do with private sector. So we end up actually being the intermediary to help navigate those questions and those issues. That’s probably the number one surprise I see.
Bill Frist: Yeah. Yeah. And then for funding getting money out the door today, I brag upon you because I compare it to so many other foundations that I work with, that struggle in their decision making process and don’t know exactly the best place to spend it and take time. So I really admire the responsiveness with which you can both direct those funds, but then ensure transparency and accountability, which you do so, so well on your website, and the like.
Is there anything directionally that will change in terms of the amount of money that you put out the door. Natural catastrophes typically like a hurricane or a tornado. They happen assess, you rebuild, and you move forward in that rebuilding. This pandemic, and we talked about the vaccines and we know antiviral agents are going to come. It’s totally different in that it hits and it’s out there. And then it stays out there for a long period of time.
How do you decide how much money that has come in to get out the door, and how quickly? When you know that the battle, we’re sort of maybe midway through it. Probably still in the first three innings of it. How do you determine how much money to get out the door and how much to reserve for the ongoing possible surge that may come, or if it takes longer to get a vaccine or the antiviral agents don’t work? How do you juggle that?
Dr. Judy Monroe: Well, that’s been one of the key questions that we’ve had, and I just had a discussion with some of my board members about that very question. Our approach has been we’re moving a substantial amount of what’s come in out quickly in the early parts of this, like I said, the first three innings. But we have some funding that we are holding back a little bit, because we don’t fully know what we’re going to need as this progresses. We know there’s going to be longer range.
But we also are encouraged because we know that there are some donors that are holding back as well. They want to help, but they know that there are going to be longer term. So we’re anticipating more funding coming in. So we have been trying to do a bit of a bouncing act to that point. Our goal at the very end of this is that every penny has gone to COVID, you know what I mean? That’s what we do in every emergency. We assure that all the funding coming in for the emergency goes to the needs of that emergency. And sometimes it is a tail. I mean their aftermath… Effects in the aftermath that need to be funded. So we’ll many times wrap up our funding with those types of things.
Bill Frist: I was talking to your board chair the other day, Leah Devlin, who obviously you work with very closely. And I worked with at the Robert Wood Johnson Foundation as well. And she was describing a lot of the ongoing fundraising efforts that you’re doing. And for people who are listing now, if they do want to contribute in some way, either through their corporation or through their own nonprofits, or through family foundations or individuals, where do they find you? How should they do that? Who should they call?
Dr. Judy Monroe: Yeah. So I’m happy to take calls myself. They can come to our website, www.cdcfoundation.org. I mean you can find us pretty easily and we’ve got front and center is COVID, about the COVID response. But we’ve got a whole staff that would be happy to talk to folks individually about what their interests are, and then where we’re seeing the needs and doing a nice match.
Bill Frist: Well, let’s say you’ve been so generous and really appreciate both of the discussions that we’ve had, that really set up what the CDC Foundation is, the history and a little bit about you. And then to be able to come in with this case study on COVID, which really brings it home, in terms of the great strengths of the foundation of its leadership and how it works so synergistically. Let us go to close with one final. What is your biggest worry about where we are today, in terms of the COVID pandemic, biggest challenge and biggest worry? And then also then we’ll finally close, we want to be on an upbeat, is sort of what are you most optimistic about, as we look forward? So what’s the biggest worry first?
Dr. Judy Monroe: Yeah, I do worry about the fact that this is not going to be an immediate return to normal for our society. And so I do worry about folks that are trying to rush it maybe a little bit too fast and we’re going to have outbreaks. So I think a lot of this has to do with communications and understanding. Obviously, I’m concerned about a resurgence in the fall if we do get a second wave in the fall that’s a concern as well.
Bill Frist: And what about sort of, what do you feel good about? If there are any silver linings here or directionally, what’s a positive sort of underscoring event or entity you’d like to close with?
Dr. Judy Monroe: I will tell you, I’ve been given actually a lot of hope and a lot of joy in this, despite how bad this has been. And I go back to what we’ve seen with the outpouring of generosity and we have had children, and this is the first time for the CDC Foundation. We have had children fundraising for the CDC Foundation. We have one little girl that sold artwork. We’ve had other children that have written songs and post them on YouTube to raise money for the CDC Foundation. And our donations have ranged from $1, all the way up to millions of dollars.
So to me, what I felt great about is this is a pandemic, it’s horrendous. We don’t want to see these things, but the public has really embraced supporting public health in these demonstrations of these range of donations. And I’ve really enjoyed seeing how many people have come forward and how creative they’ve been. I think this pandemic’s brought out a lot of creativity and innovation, and that I think is a bright spot.
Bill Frist: Yeah, I agree wholeheartedly. I think all of us as individuals, as communities, in all our sheltering and sort of self-isolation have come back to these basic principles of creativity, of innovation in addition to the compassion and the self-reflection that it’s provided, and we can come out of this a lot stronger. I think that appreciation for the public health infrastructure, for public health and the broader sense to which you committed your whole life.
Both within the CDC and now in the CDC Foundation, supporting it is a tremendous reflection of the commitment, and the discipline, and the sort of goodness that we all rely upon, as we have this public health infrastructure protecting us on the frontline very quietly every day. But thank you for being with us again. Thank you, Dr. Judy Monroe, CDC Foundation President and CEO. Look forward to having you on again, appreciate it.
Dr. Judy Monroe: Thanks so much. Great being with you.
Bill Frist: This episode of A Second Opinion was produced by Todd Schlosser, the Motus Creative Group and Snapshot Interactive. You can subscribe to A Second Opinion on Apple podcast or wherever you’re listening right now. And be sure to rate and review A Second Opinion so we can continue to bring you great content. You can get more information about the show and our guests and sponsors at ASecondOpinionPodcast.com.
A Second Opinion broadcast from Nashville, Tennessee, the nation Silicon Valley of health services, where we engage at the intersection of policy medicine and innovation.
