Chapter 1: What background shaped Dr. Susan Monarez's career in public health?
So this is a first live podcast for who I consider a hero, Dr. Susan Monero. A hero, I say, because she stood up for the integrity of science. at a time when we don't see much of that anymore because of a culture of fear and all sorts of other reasons. And so this is going back to Dr. Menier's background.
We're going to go through some of the events that she went through in her tenure at CDC, however brief that it was. It wasn't at any time short of happenings. And then we're going to head into the future now that she's a free agent. So, Susan, welcome.
Thank you so much. This is truly an honor. I mean, I think I've followed you for so long and you know, you've been such an inspiration to me and your Ground Truth sub stack is required reading. I know I read it. I hope everyone does. It's absolutely such a delight to be on with you. And yes, this is the first time that I've had a live conversation to, you know, to a large group.
And primarily I waited because I wanted to have a conversation with someone like you who really understands the technical depth and the breadth and the complexity of everything that we do in science. And so it's truly a pleasure to be on with you.
Well, thanks.
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Chapter 2: How did Dr. Monarez respond to the CDC shooting incident?
And I want to announce, too, that you just started a Substack. It's called, tell me again, your Substack?
It's called The Road Best Traveled, and it is a passion piece, and it's a place where I hope that people can amplify those individuals, the ideas, the inspiration in the health space. Really inspired by the journey that I've taken facing headwinds and really having to make
some critical decisions about how do you choose the best path when, when you are in a place where, of course, there's many different ways that, that one can, can go forward. And I'm, you know, I found a lot of inspiration from people like you and others that when I was going through everything, you know, I just, I just, you know, I,
found a place of optimism and found a place to be inspired and i want to put a forum forward where people who are similarly you know who have who have been through different challenges and and what inspired them and how do they keep moving and some of the biggest challenges that we have in health and and what are we who are the who are the change makers that are helping overcome them and what do we do so it's really just it's going to be a passionate place for me well and i want to
give the prelude that you exude optimism and you had to be to do what you've done, I have to say. And as I think has become clear, that's an important quality for healthy aging. And, you know, so it's great that you have that view now. I thought we'd start off with background. that you grew up in rural Wisconsin on a dairy farm, which your father had to sell to then he became a policeman.
Is that kind of the skinny on that?
That's the skinny. I mean, you know, I don't know that I saw it as a privilege at the time, but yeah, when we, when I was a child, you know, my father was idealistic and he, he wanted to become a dairy farmer and an organic dairy farmer back in the seventies before that was really a thing. And there was no economic path for him.
Uh, you know, at some point, you know, his dairy cows, um, because he, he tried to keep everything as natural as possible. They got, quite sick and he had to sell off.
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Chapter 3: What innovative vision did Dr. Monarez have for the CDC?
And, you know, we faced some really challenging financial times and he became a police officer to make ends meet. And I, you know, my mom was a librarian and worked in other factory jobs or whatnot. But what that does is it grounds you in a way where, you know, you learn to appreciate things besides material expectations. And
And I, you know, like I said, at the time, you know, it was difficult, but now it grounds me. It keeps me humble in a place where I don't need to have materialism or financial gain. What I need to have is a positive contribution to others. And that is my core principle.
And so there you were in Wisconsin. Then you went to the top institution at UW-Madison University. You got your baccalaureate and PhD degree there, and you're a full-fledged microbiologist, immunologist. You went to Stanford for postdocs. I mean, you had some incredible training. And then you decided you're going to be doing work in the government, various government agencies.
I didn't even know the depth of all these agencies that you've been working at. What, for 18 years or so? Maybe you can tell us a little bit about that run because you've been with BARDA, Homeland Security, ARPA-H. I mean, wow. Yeah.
It has been such a privilege to serve the American people at all of those institutions.
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Chapter 4: What challenges did Dr. Monarez face during her tenure at the CDC?
So I... was at Stanford, and I was working on something that was, it was on the NIH pay line. It was deemed interesting but too innovative because there was no other, no one else working in phosphoproteomics or differential diagnostics at the time.
So I had this idea that if you could look at the differential phosphorylation patterns between, you know, four categories of pathogens, bacteria, virus, fungus, and parasitic pathogens, you could actually have the right intervention. which helps in low and middle income countries when you're trying to make sure, do you give them an antibiotic or do something else?
And I had seen the path, I'd seen all of this happen in the scientific, you know, sort of at the lab bench, but there was no way to take that, you know, basic evidence and get it into you know, an R01 or anything like that.
So I sort of had to make, this is one of my, this is probably the biggest first choice that I had to take is do I change essentially my approach to science and immunology and this, you know, sort of moonshot approach that I was, was trying to, to, you know, go down or do I do something different? Different entirely.
And the AAAS, the American Association for the Advancement of Science Fellowship, sort of came to my attention. And it was such a unique opportunity to be part of a group of scientists that joined the federal government. And they bring that technical depth and complexity, and then they go and help to support policy and science in the federal government.
And I was very, very fortunate to be placed in BARDA when BARDA was just standing up.
Mm-hmm.
Development Authority. Just, it was a brand new agency. I think there were seven people on the floor. I mean, it was tiny at the time. And I had the opportunity to apply really deep technical science to the portfolio. We had just been given $5.6 billion through the Project Bioshield Act.
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Chapter 5: How did Dr. Monarez's leadership style impact her team?
And to be able to make a determination of how do you actually allocate those resources to have the greatest impact to prevent disease and illness from whether it was intentional use of CBRN or whether it was emerging infectious diseases. And so, you know, that was such an amazing experience. And so I worked there for a while. And then, you know, I went to another ARPA.
I went to the Homeland Security Advanced Research Projects Agency. And that's really where I started to get deeply involved in anticipatory data analytics, AI, ML. And that was back in 2009. And at that time, we were working in the
space, you had to use supercomputers because it was so complex to do those, those, that level of, you know, data integration and sort of algorithm development and computer modeling and everything like that. But we were, we, you know, I had the mantra at the time, model, model anything, anywhere at any time. And so we were modeling, you know, public health response to different disease outbreaks.
And we had, you know, global research labs all over the world looking at, you know, various biological pathogens and the potential impact. And So I did that for about three, four years. And then I went up to the White House National Security Council during the Ebola outbreak in West Africa.
And it was such a unique experience trying to figure out how to both address an evolving crisis in a number of countries that did not have public health infrastructure and
commensurate with the need so how do you actually get the resource to them in the timely manner especially when you know misinformation was very prevalent at that time and distrust and you know the the support that we were trying to bring and that actually uh led to an extension of that outbreak i was working on the domestic side as well which is if we should have you know some individuals come back who were exposed what do we do about it and then of course we did we had oh yeah
come into the country. And that really also shaped a lot of my thinking in terms of not just pandemic preparedness and response, but interestingly, wearables and telehealth, knowing that remote patient monitoring and access to clinical care capacity when
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Chapter 6: What is the significance of the 90/90/2035 initiative?
People are cut off from brick and mortar institutions because we saw a lot of that happening with just some of the fear that was, you know, when individuals were coming back and they were either exposed to Ebola or we thought that they may be. And just, you know, the fear factor promulgating and also the need to monitor individuals who had actually been exposed.
And wearables were just at the earliest stages. But, you know, having that level of exposure that early to something of that magnitude really helped shape my innovative thinking.
You know, so I was at the White House, was at Nestero Council, then Office of Science and Technology Policy, and then was a Deputy Assistant Secretary of Strategy and Data Analytics for DHS, which was also, you know, fantastically interesting running a $70 billion strategic portfolio and looking at data analytics systems for
you know, you know, 23 different individual law enforcement components are trying to have integration across all of them. And I mean, that was, that was also, you know, absolutely fascinating.
And then I went back to my roots in health and I was at the Health Resources and Services Administration, which is a $15 billion organization providing healthcare services to rural individuals living in rural environments or other small populations. And I
Actually, I stood up a Center for Innovation there first because what I saw is that there was an opportunity to bring much greater science and technology and data innovation to the populations that had been untouched yet with this level of innovation. And so that was my first real opportunity to try to innovate in sort of a historic and working in
under-resourced and rural populations and trying to advance health innovation was probably one of the greatest challenges that I've, that I, that I had because it's, it's, there's just such a tension between traditional, you know, how do you provide care and actually innovating that.
That's saying a lot considering the challenges you had subsequently.
Yeah.
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Chapter 7: How does Dr. Monarez view the future of public health in the U.S.?
That's what it was conceived as with initially a $6 billion support or something like that. Anyway, so here you are. You're at ARPA-H. You're providing this important directing function. And then you get the call to be the acting director of the CDC for two months, I guess, January to March. And that's, of course, in the middle of, what, five outbreaks?
Yep, there were five ongoing outbreaks. Yeah, we had Ebola in Marburg in Africa. We had TB in Kansas. We had H5N1 where we really didn't know what the arc was going to look like. And then we had the emerging measles outbreak that was starting in Texas. And yeah, it was, I mean, it was everything that CDC, you know, is expected to be able to handle.
And I was, I jumped right in and, you know, really incredible team. amazing team down there as such professionals. You know, I would, I would ask, um, you know, daily, hourly, what are we doing here? What are we doing here? What are we doing here? And what I would hear under Dr. Monroe is we have this, this is what we do. And it was just steady at the helm and, and decision-making and,
based on the evidence that we were seeing in the field.
Chapter 8: What lessons did Dr. Monarez learn from her experience at the CDC?
And so it was hectic and frenetic, but it was disciplined. And I really can't say enough about the staff that were leading all of those outbreaks and all of them to a place of resolution.
Oh, so that takes us towards the end of March after two months as acting director of CDC. And then you were, of course, in suspension about being made the real director. And this was the first time in history that this required Senate confirmation. So you are the first Senate-confirmed CDC director. Now, this finally led to your, at the end of July, you became the CDC director.
And of course, this led to, with our background, within a week or so, maybe eight or nine days, there was a shooting at the CDC, which as far as I know, might be the first shooting in the CDC in history. Hundreds of rounds of shots were taken. that must've been quite a thing to work through, right?
Oh my God. It was, it was gut wrenching and traumatic. I mean, it was day five on the job. I mean, I got, yeah, I was sworn in on Thursday, did the background paperwork and I got down there on Monday morning and a morning. I, my goal for that week had just been meet everyone. So go to both campuses in Atlanta and, meet as many staff from all the centers from every part of the organization.
I must have met a thousand or more different staff. I was in the hallways and in the cafeterias. And I walked around and just lines and lines of people that I had the opportunity to meet. And I would ask them, who are you? Where do you work? And then I would ask them the two most interesting questions that I always want to know, which is, what inspires you? And how do
And every single person that I talked to, every person, they, you know, they would offer these really inspirational stories about why they were there. You know, they had a calling to do global health or, you know, they had a loved one who had, you know, preventable illness or they, you know, they wanted to make a contribution for communicable disease control and
All of them were, this is one of the most inspired organizations. Every single person wants to contribute. But what I also found so interesting is they all saw opportunities for innovation, which you know is what I love.
They would all say, you know, if we could do things differently, if we could do this, if we had better data, if we had different tools, if we had, you know, this different approach or that different approach. We could do things faster. We could do things less expensive so we could put resources in other places. We could make greater contributions geographically or demographically.
And those first four days were so amazing. And I was so elated. And even that morning on August 8th, I met with all the new EIS officers. And this is a group of, I don't know, maybe 200 young people who they joined the CDC and the EAS group, the Epidemiological Intelligence Service group. And they deploy all over the world, across the country and around the world.
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