Biden Picks Next CDC Director

On Friday, President Biden announced his intent to choose former top North Carolina health official Mandy Cohen, MD, MPH, to lead the CDC.

"Dr. Cohen 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," Biden said in a statement.

"As Secretary of North Carolina's Department of Health and Human Services [DHHS], Dr. Cohen developed innovative and nationally recognized programs that improved the health and lives of families across the state," Biden continued. "Her leadership through the COVID-19 crisis drew bipartisan praise, as did her successful transformation of North Carolina's Medicaid program and pivotal role in the bipartisan passage of Medicaid expansion."

CDC Director Rochelle Walensky, MD, MPH, announced last month that she will be stepping down from the agency at the end of June. While the $1.7 trillion spending package passed in December included a provision mandating that the Senate confirm the CDC director, that requirement won't take effect until 2025.

Cohen, an internal medicine physician, served as North Carolina DHHS Secretary from 2017 to 2022. Prior to her post there she worked as the chief operating officer and chief of staff at the Centers for Medicare & Medicaid Services (CMS) where she helped to launch the Affordable Care Act health insurance exchanges and a series of new payment models.

She has also worked in the private sector, most recently as executive vice president of Aledade and as CEO of Aledade Care Solutions.

Cohen has been recognized for her work leading North Carolina's pandemic response. She has been elected to the National Academy of Medicine and is an adjunct professor at the UNC Gillings School of Global Public Health in Chapel Hill, North Carolina.

As head of the CDC, Cohen is expected to call on Congress to increase funding for the agency in legislation on the Hill, through both the reauthorization of a pandemic preparedness law slated to expire at the end of September and through a fiscal 2024 appropriations bill.

"Her experience at both the federal and state level equips her to meet the challenges we face today, tomorrow, and in the years ahead," said HHS Secretary Xavier Becerra, in a statement following Friday's announcement. "I am confident that her leadership will help us build on the work of Dr. Walensky and the Biden-Harris Administration to transform essential elements of our public health infrastructure."

Walensky also praised Cohen's selection. "Her unique experience and accomplished tenure in North Carolina -- along with her other career contributions -- make her perfectly suited to lead CDC as it moves forward by building on the lessons learned from COVID-19 to create an organization poised to meet public health challenges of the future," she said in a statement. "I can think of no better hands in which to leave this agency during a critical time in its history. I wish Dr. Cohen and the dedicated people of CDC strength and the brightest successes in the next chapter."

The response to her expected appointment -- leaked a couple of weeks ago -- had been largely positive.

"The trains will run less erratically and slowly with new leadership. Where they head will be determined by larger political forces and calculations," said Thomas Miller, JD, resident fellow at the American Enterprise Institute, in an email.

Regardless of one's political leanings Cohen is "well-trained and experienced," he said.

"Running CDC in a less polarizing and more competent management style would be a good first step. And the list of candidates who could do that is relatively short," Miller added.

J. Stephen Morrison, PhD, Senior Vice President and director of the Global Health Policy Center at the Center for Strategic and International Studies, in Washington, noted that by choosing Cohen, the administration took a different tack than previous choices because of her broad credentials.

"She has a direct personal relationship with the president's chief of staff, and big-time chops on managing big programs and systems that matter enormously at a national level," Morrison said.

But at the same time she led the health department in a purple state through a crisis and "managed that very ably."

"She's an innovator, she's a skilled communicator, she knows how to speak to people who aren't Democrats ... and she can, I think, do well on the Hill. She's got the personality, she's got political acumen, [and] she has built up trust across party lines," Morrison said. "All those things really matter."

Jeffrey Levi, PhD, professor of health policy and management at the George Washington University Milken Institute School of Public Health, said he knows Cohen through the Commonwealth Fund's Commission to Envision a National Public Health System in the U.S. -- a project he helps support and for which she is a commissioner.

"For the CDC [job], what's particularly important is her experience at HHS and her experience at CMS," said Levi. "That will help to put the work of the CDC and public health into the larger frame of the health system. If nothing else, CDC needs someone who really understands the broader federal policymaking structure so it can be advocated for."

However, not everyone is on team Cohen.

In a letter to President Biden, Sen. Ted Budd (R-N.C) and Rep. Dan Bishop (R-N.C.) along with more than 20 other Republican colleagues took issue with her handling of the COVID-19 pandemic, according to Fox8.

"Dr. Cohen is unfit for the position," the letter stated. "Throughout her career, Dr. Cohen 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. She also has a history of engaging in partisan left-wing politics."

Cohen earned her bachelor's degree at Cornell University in Ithaca, New York, her medical degree from the Yale School of Medicine in New Haven, Connecticut, and her master's in public health from the Harvard Public School of Health in Boston. She completed her residency at Massachusetts General Hospital.

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