Periods of disruption have often forced societies to rethink old assumptions, create new institutions, and find novel ways to solve problems. I have been thinking about that idea over the past year after seeing a record number of measles cases in the U.S.; disease outbreaks not seen in our country in decades, such as New World screwworm returning to our states; dismantling of federal health agency programs such as smoking cessation and global health; the chipping away at the childhood vaccine schedule and declining vaccination rates for children; and all of this coupled with less trust in federal agencies and political leaders.
I spent a decade at the U.S. Centers for Disease Control and Prevention (CDC) and believe deeply that our country needs strong, independent federal health institutions. States cannot replace national disease surveillance, reference laboratories, research, or the ability to coordinate a response across 50 states
But since leaving government almost a year ago, I have had a different vantage point. I have worked with state health leaders, universities, entrepreneurs, philanthropists, and organizations across the country. And amid the significant disruption, I see something else happening. Like a phoenix rising from the ashes, new ways of working in public health are emerging
States are finding new ways to work together. The West Coast Health Alliance and the Northeast Public Health Collaborative have aligned states in their regions on evidence-based vaccine recommendations after Health and Human Services Secretary Robert F. Kennedy Jr. fired members of the Advisory Committee on Immunization Practices. And this isn’t simply a red-state or blue-state phenomenon. When Texas needed greater capacity for measles testing, its public health laboratory developed a high-throughput approach that other states could validate and use for measles outbreaks. Further, states are collaborating and sharing information with one another through national organizations in the face of multistate threats such as Cyclospora. Recently, California launched its PHNIX initiative to connect public health with technology to develop scalable solutions in the state that improve health, lower costs, and strengthen emergency response. Rather than simply rebuilding what existed before, PHNIX asks what should be built next.
Medicine is responding, too. The American Academy of Pediatrics has continued issuing evidence-based vaccine recommendations and has challenged federal actions that threaten the integrity of the vaccine advisory process, resulting in courts temporarily pausing these federal policies that might limit access to childhood vaccines. The Vaccine Integrity Project, working with the American Medical Association and other organizations, has created an independent, science-driven process to review evidence on influenza, COVID, and RSV vaccines to counter the political interference impacting CDC’s recent vaccine guidance.
Universities are also rethinking what public health can be. Yale’s new Future of Health Innovation Hub fosters a different model where public health ideas engage commercial partners and move from research into products and solutions. Yale’s PopHIVE combines traditional government data sources with information from electronic health records and other sources to provide a timely picture of population health that is less impacted by government shutdowns or political priorities. With concerns about gaps in federal infectious disease monitoring during the World Cup, Georgetown University created a Health Security Operations Center that brought together universities, health systems, public health, and technology partners to use real-time data to help identify emerging threats.
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And innovators are applying technology to problems that public health and health care have struggled to solve at scale. While it is too early to call them success stories, they are steps in the right direction. This month, the Coalition for Health AI launched PULSE, bringing public health agencies at state, tribal, local, and territorial levels together with technology companies to test responsible use cases of generative AI ranging from biosurveillance to multilingual communication. OpenAI and Anthropic are providing access to their technology, and lessons from participating health departments will be shared so others can build on what works. Akido is using AI to help street medicine teams care for hard-to-reach populations, using technology to increase the number of patients each clinician can see while maintaining strong retention in care and addressing public health concerns such as substance use. Jimini Health is using technology-enabled AI models made for mental health to extend care between visits, engaging patients between sessions while giving clinicians visibility into progress and allowing clinicians to prioritize what the models work on with patients.
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None of this means the challenges facing public health can be solved or even patched up without federal leadership. The U.S. still needs a CDC capable of detecting threats, coordinating across states, conducting rigorous science, and providing trusted guidance. But resilience comes from having multiple sources of strength. Maybe that is a better ambition for American public health now: not simply to restore what has been lost, but to try to rebuild what worked, learn from what didn’t, and establish something stronger in its place.
After a year with plenty of reasons for concern, I find myself increasingly focused on what is being created. For centuries, the phoenix has symbolized renewal and the idea that something new can emerge from destruction. We should not have to lose important institutions and capabilities to spur innovation. But when disruption comes, we can choose what we build from it. Across American public health, I see people making that choice now. And that is what gives me hope
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