President Biden has named Dr. Mandy Cohen, former state health secretary in North Carolina, to serve as the next leader of the Centers for Disease Control and Prevention.

In his announcement, Biden praised Cohen's experience and leadership. "Dr. Cohen is one of the nation's top physicians and health leaders," Biden said in the statement, "[She] has been recognized by leaders from both parties" for her ability [to] find common ground and put complex policy into action."

Cohen, 44, is an internal medicine physician who has served in top positions in state and federal government and in the private sector. From 2017-2021, she served as health secretary in North Carolina, where she worked on expanding access to health care for low-income residents and became the face of the state's COVID-19 response during the public health emergency.

She leaves her current position, as an executive at the health care company Aledade, to lead the CDC, a federal agency whose morale and reputation has been deeply tarnished by its pandemic response. She takes the helm from Dr. Rochelle Walensky, the current director, whose last day on the job is June 30.

"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 Xavier Becerra, Secretary of Health and Human Services, in a statement on Friday welcoming Cohen's appointment.

In Cohen, supporters see a seasoned leader in public health — and politics

Those that know Cohen describe her as a strong manager and communicator who approaches tough tasks head on.

"I think she's exactly the right choice," says Andy Slavitt, a former Biden adviser and administrator for the Centers for Medicare and Medicaid Services, who promoted her to the positions of chief of staff and chief operating officer at CMS during his tenure.

The CDC "needs someone who understands how to make health and public health a reality in people's lives, how to implement things operationally, how to lift the morale and culture of an agency that's been badly bruised," says Slavitt, who advised both the Biden administration and Dr. Cohen on the search for the next CDC director.

Cohen may be the last CDC director to be appointed without Senate confirmation (Congressional approval for a CDC director will be required starting January 2025, per requirements in the FY 2023 omnibus bill).

She'll likely face steady criticism from some Republicans in Congress, who have held multiple hearings on what they frame as the CDC's failures to lead in recent years. "Throughout the pandemic, CDC published confusing guidance and made divisive and confusing statements," said Congressman Brad Wenstrup (R-Ohio), chair of the House Select Subcommittee on the Coronavirus Pandemic, at recent a hearing with outgoing CDC director Dr. Rochelle Walensky, "Instead of being a calm and trusted voice of science and reason, the American people felt let down, often deceived and left damaged."

Supporters say Cohen is seasoned at navigating politics, having worked for both the Obama administration and the state government in North Carolina. It's a skill she'll need as she advocates for more money and broader authorities for the agency.

"One of the things she brings, having worked for a Democratic governor [Roy Cooper] in a Republican state, is finding the language that brings people together, as opposed to fomenting the noise of the political discourse," says Marylou Sudders, former health and human services secretary in Massachusetts, who frequently consulted with Cohen during the pandemic.

Those who have worked with Cohen describe her as a good manager and leader.

"She's an expert in managing people and implementing policy," says Natalie Davis, CEO of the nonprofit health care advocacy group United States of Care, who once reported to Cohen as a staffer in the Obama administration. "She is a strategist and operator and knows how to have a vision and see it through, to all the teams and people that [make it] work."

Can Cohen rebuild CDC in the wake of pandemic?

The CDC is an agency of 10,000 employees, tasked with protecting the public from threats to their health and safety. Internally, the agency has been plagued with attrition and low morale, as they faced criticism for politicization and poor communication in their pandemic response.

Outgoing director Dr. Rochelle Walensky had documented some of the agency's "pretty dramatic, pretty public" mistakes, as she described it in an internal video to staff viewed by NPR, before restructuring the senior leadership and parts of the agency in recent months, with the goal of making the CDC more nimble in its response to health threats.

"Having a CDC director who's attentive, spending time with staff, helping the agency get back on its feet and get some confidence back will be important," says Dr. Marcus Plescia, chief medical officer at the Association of State and Territorial Health Officials.

One of the biggest challenges facing Cohen will be restoring trust and credibility with the public.

Trust in the U.S. government is near historic lows, according to a 2022 Pew Research poll – just 20% of Americans say they trust the government to do what is right most of the time. And when it comes to public health specifically, a 2021 poll by the Harvard School of Public Health found that just half of those surveyed in the U.S. have a great deal of trust in the CDC.

It's a topic that Cohen focused on in her commencement address at Guilford College last month.

"Trust in institutions, such as government, or media, or business, has been eroding in recent years. This lack of trust has led to polarization and division, and has made it harder to solve important issues facing our world," she said.

Cohen built trust with North Carolinians during COVID, says Dr. Georges Benjamin, executive director of the American Public Health Association. "She was always right on target communicating to the public – transparent, engaged," he says, "[In public health], you have to be able to effectively articulate the decision-making you did, and she's better than most in doing that."

In addition to steering the CDC and advocating for its budget and authorities in Washington, the new director faces a slew of growing public health concerns.

"We have an obesity epidemic, opioid epidemic, a firearm epidemic," says Benjamin. "We have a rising number of STD's, and a commitment we've made to get a handle around HIV/AIDS," plus potential outbreaks from COVID, Ebola, bird flu, and re-emerging childhood vaccine-preventable diseases such as polio and measles.

"Public health is busy, continuously busy," Benjamin says, "Rebuilding the public health system in the U.S. has got to be a top priority."

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