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Biden picks Mandy Cohen, the architect of NC’s COVID-19 response, as CDC director

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Mandy Cohen, who led North Carolina’s response to the COVID-19 pandemic, is President Joe Biden’s choice to lead the Centers for Disease Control and Prevention.

In this role, Cohen, who served for five years as the secretary of the state’s department of health and human services, will now lead federal efforts to track and manage health problems and diseases.

Biden made the announcement Friday, saying he chose Cohen because she is “one of the nation’s top physicians and health leaders with experience leading large and complex organizations, and a proven track-record protecting Americans’ health and safety.”

Cohen is replacing Rochelle Walensky, who announced in May that she would leave office at the end of June.

As CDC director, Cohen will be tasked with leading a major branch of the Department of Health and Human Services, one that “identifies and defines preventable health problems and maintains active surveillance of diseases” through research and investigation.

It is also responsible for “controlling the introduction and spread of infectious diseases, and providing consultation and assistance to other nations and international agencies to assist in improving their disease prevention and control, environmental health, and health promotion activities,” according to the CDC website .

The CDC is well known and looked to internationally for health guidance but has faced scrutiny in recent years following the coronavirus pandemic, which hit the world in 2020 and led to millions of deaths.

This is the second former secretary of a major North Carolina agency. Biden has selected to lead a high-profile federal agency. Michael Regan, this state’s former environment secretary, now runs the US EPA. Gov. Roy Cooper, a Democrat, appointed both to their North Carolina positions.

Cooper and Cohen were the faces of North Carolina’s pandemic response, tag-teaming questions from reporters at weekly COVID-19 briefings throughout 2020 and 2021.

Cohen became known for what she called the “Three W’s,” which meant to wear a mask, wait 6 feet apart from others and wash your hands, as they tried to control the spread of coronavirus. She and Cooper also repeatedly referred to their approach to pandemic restrictions as using a “dimmer switch.”

Dr.  Mandy Cohen, secretary of the NC Department of Health and Human Services, answers a question during a briefing at the Emergency Operations Center in Raleigh, NC, Wednesday, Oct.  28, 2020. Gov.  Roy Cooper stands to the left.

Dr. Mandy Cohen, secretary of the NC Department of Health and Human Services, answers a question during a briefing at the Emergency Operations Center in Raleigh, NC, Wednesday, Oct. 28, 2020. Gov. Roy Cooper stands to the left.

Mandy Cohen’s experience at NC DHHS

Cohen has years of experience at the federal and state levels.

During her time as head of the North Carolina Department of Health and Human Services, Cohen led the state’s response to the pandemic.

She was a fixture at Gov. Roy Cooper’s constant briefings on the latest infection numbers and restrictions. She urged people to use masks and social distance, and she provided information on vaccine eligibility and availability.

Cooper, during the pandemic, enacted various executive decrees shutting down bars, restaurants, gyms and other public locations for months. Many other states enacted similar restrictions, some more lenient and some more strict. These shutdowns and measures were met with varying reactions, with some people in favor of loosening restrictions and others against them.

Science and strategy

In an interview with The News & Observer in 2020 during the pandemic, Cohen talked about how they planned their day-to-day responses.

She had two deputies who filtered the workflow, but the “science and data” she and Cooper mentioned so often in news conferences came from hundreds of people, sometimes thousands. Morning meetings included the latest numbers, trends and outbreaks overnight. Cohen described the meetings as the “ready, set, go” for the day.

“Science means me and my team bring him the science to lead these decisions. That has been our north star. Now, we learn new things as we go,” Cohen said then. She said she repeated the “three W’s” so many times that people would hear it in their sleep, as repetition changes behavior.

Asked in 2020 if she would have done anything differently for the state’s response, Cohen said they were making decisions with the evidence and data they have at that moment. “I don’t think it’s fair to Monday morning quarterback a pandemic,” she said.

“I feel very proud of the work we’ve done. Are we perfect? No. We’re in a pandemic, we’re in a crisis,” Cohen said in September 2020.

Apart from focusing on COVID-19, Cohen called for Medicaid expansion to close a health-insurance coverage gap in the state. On her watch, the state launched Medicaid managed care.

Adrian Hernandez, vice dean and executive director of the Duke Clinical Research Institute, said Cohen has a combination of experience suitable for the CDC role, with a background as an internal medicine physician and having held leadership roles at the federal and state level.

Dr.  Mandy Cohen, Secretary of the North Carolina Department of Health and Human Services, reacts as she receives the Johnson &  Johnson COVID-19 vaccination on Friday, March 5, 2021 at PNC Arena in Raleigh, NC

Dr. Mandy Cohen, Secretary of the North Carolina Department of Health and Human Services, reacts as she receives the Johnson & Johnson COVID-19 vaccination on Friday, March 5, 2021 at PNC Arena in Raleigh, NC

What’s ahead for the CDC

Hernandez said he thinks Cohen, as CDC director, will need to focus on public trust, with the agency having “been through a lot because of the pandemic, some of it is unfairly.”

She will also need to prioritize the implementation of a less fragmented and “better system for the nation that leverages data from every corner to meet the public’s health needs,” he said.

mark McClellan, founding director of the Duke-Margolis Center for Health Policy, worked with Cohen while she led DHHS during the pandemic. He said she emphasized “better disease prevention and supporting home-based care” and “taking some new steps to address the social factors that can” get in the way of health, such as lacking access to healthy food.

“I think she’s going to take the same kind of approach to her work at the CDC and it’s a challenging agency to lead right now,” with trust in it low and resources limited, he said.

“I see a real opportunity to take advantage of progress in medicine to make it easier to diagnose and treat problems like diabetes and many advanced diseases, and better data that can help us take steps to improve public health without restrictions on what people do, just better targeted interventions,” he said.

Still, in a divided Congress and with low public trust in health institutions, “major new legislation to give the CDC a lot more money or a lot of new authorities” is unlikely.

Instead, Cohen will need to focus on using resources more effectively, communicating effectively with the public and working with health care providers and others, McClellan said.

Dr.  Mandy Cohen, secretary of the state Department of Health and Human Services, talks during a briefing on the coronavirus pandemic at the Joint Force Headquarters in Raleigh, NC, Wednesday, May 20, 2020.

Dr. Mandy Cohen, secretary of the state Department of Health and Human Services, talks during a briefing on the coronavirus pandemic at the Joint Force Headquarters in Raleigh, NC, Wednesday, May 20, 2020.

Cohen’s critics

Some Republicans say Cohen’s COVID-19 strategy was not ideal. On Tuesday, North Carolina Sen. Ted Budd, Rep. Dan Bishop and 26 other GOP members of Congress — many from the ultra-conservative House Freedom Caucus — sent a letter to Biden opposing Cohen’s possible selection.

In the letter, authors wrote that Cohen is “unfit for the position” and that throughout her career she “has politicized science, disregarded civil liberties, and spread misinformation about the efficacy and necessity of COVID vaccinations and the necessity of masks, during her time as the secretary of the North Carolina Department of Health and Human Services,” as previously reported by The News & Observer.

Republican State Treasurer and gubernatorial candidate Dale Folwell last week tweeted, “Pray for our country. As a member of the NC Council of State, my observation is that the actions of Dr. Mandy Cohen during COVID resulted in more disease, death, poverty and illiteracy. As NC governor, I would be hard pressed to ever follow her lead at CDC if chosen by the POTUS.”

Folwell, as treasurer, oversees the State Health Plan. When COVID-19 hit he was among the first Republican leaders to criticize restrictions enacted by Cooper, urging him to loosen them and open up businesses.

Cohen’s move to the private sector

Cohen stepped down from her role with DHHS and in January 2022 announced she would work for Aledade, a private health care company, where she is serving as the chief executive officer of its health services unit, Aledade Care Solutions, and executive vice president of Aledade , as previously reported by The News & Observer.

Prior to these jobs, she worked for over a decade in women’s health services with the Department of Veterans Affairs.

She was also chief operating officer and chief of staff at the federal Centers for Medicare and Medicaid Services under the Obama administration.

Cohen has received accolades for her work with DHHS. In September of 2020, she was awarded the Leadership in Public Health Practice Award from Harvard University’s TH Chan School of Public Health for her leadership during the COVID-19 pandemic.

A policy, analysis and management graduate of Cornell University, Cohen received her medical degree from Yale School of Medicine and a master’s in public health from the Harvard School of Public Health.