Brian King, Executive Vice President, U.S. Programs, Campaign for Tobacco-Free Kids
“I call them the 5Cs of leading during crisis: communication, clarity, confidence, conflict resolution, and compassion.”
About Brian
Brian King, PhD, MPH, is an American epidemiologist known for his leadership in tobacco control and public health policy. He earned his MPH and PhD in epidemiology from the State University of New York at Buffalo. After over a decade at the U.S. Centers for Disease Control and Prevention, and serving as Director of the U.S. Food and Drug Administration’s Center for Tobacco Products, Brian became Executive Vice President for U.S. Programs at the Campaign for Tobacco-Free Kids in May 2025. In this role, he leads the organization’s work at the federal, state, and local levels to protect youth, influence policy, and reduce the health and economic burden of tobacco. His efforts continue to shape evidence-based strategies to reduce tobacco-related disease, death, and disparities. Here, Brian reflects on lessons from his leadership during the response to the COVID-19 pandemic and the outbreak of E-cigarette or Vaping Use-Associated Lung Injury (EVALI).
Q: Tell us about a time of crisis, when you were called to deliver resilient leadership.
So much of my career has been in tobacco control. But here, I’m reflecting on a non-tobacco context, which brought me outside of my comfort zone. On the heels of a nearly year-long deployment as a leading CDC official responding to cases of E-cigarette or Vaping Use-Associated Lung Injury (EVALI), I was deployed in 2020 to CDC’s COVID-19 emergency response for two years. I served in various leadership roles, including Deputy Lead of the Chief Medical Officer Unit, the Deputy and Lead of the Strategic Science Unit, and finally the Chief Science Officer for CDC’s COVID-19 response unit before it stood down.
There were lots of challenges in those early days. In March 2020, the key challenges were to identify staff, establish protocols, and guide the scientific operations. There was a lot of uncertainty at that time. It was the largest emergency response in our nation’s history. The boots on the ground in the early days were run by many scientists and clinicians and health professionals, who had emergency response training but more typically were working in non-communicable diseases.
Stakeholders were inside and outside the house. Inside the house were key leadership at CDC, the U.S. Department of Health and Human Services, and the White House. We also had a diverse array of other federal partners, including the U.S. Food and Drug Administration and National Institutes of Health. On the outside, we had key individuals looking for scientific information - the general public, clinicians, and non-traditional sectors such as education, workplaces, and others. They needed credible information quickly, succinctly, and in a digestible format that they could use.
Q: What was your vision for resilience, to support yourself and your stakeholders?
“You have to celebrate the short-term wins. That’s what gets you through the hard times.”
It’s important to compartmentalize the wins. It can be easy to lose sight of these wins as you work toward a longer-term mission. Frequently, in public health, we’re looking at the long game… eradication, ending a pandemic, and so on. In that context, it’s important to look at short-, medium-, long-term wins. We need to achieve the results and to galvanize the workforce. Sometimes, the short- and medium-term wins – finalizing a key recommendation, publishing a study – helped us to see that we were making progress towards our long-term outcomes. You have to celebrate the short-term wins. That’s what gets you through the hard times.
Q: What were some behaviors that supported your own resilience?
“Despite the chaos in any workweek, I always had these set periods of stability, normalcy, and time of rest in my own life that would allow me to be grounded, that would optimize my ability to function. If I don’t have my own life together, how do I perform in the work day?”
It’s important to take care of yourself. You have to find some semblance of normalcy. We were working horrendous hours, with 16-18 hour days commonplace. Every minute matters when there’s a life at stake. It’s in the DNA of public health people to care about people’s lives, the diseases we’re preventing and the lives we’re saving… it’s easy to forget about ourselves.
I always had set structure - going to the gym to swim laps, facetime with friends and family during the pandemic, Sunday night was pizza night. Despite the chaos in any workweek, I always had these set periods of stability, normalcy, and time of rest in my own life that would allow me to be grounded, that would optimize my ability to function. If I don’t have my own life together, how do I perform in the work day?
Q: What were some behaviors that supported your stakeholders’ resilience?
“I call them the 5Cs of leading during crisis: communication, clarity, confidence, conflict resolution, and compassion.”
I call them the 5Cs of leading during crisis:
Communication - I’ve prided myself on being an effective communicator to a diverse array of stakeholders. It’s important to know who they are, communicate with them in a way that’s going to reach them, and to do so with information salient to them.
Clarity - You have to be clear in the message: what the risk is to the public, what do you want them to do about it? We’re good, in public health, about saying what the problem is, but we also need to be clear about the solutions. Sometimes, the clarity is specific to different populations, so we have to be targeted and ensure clear communication that best serves those populations.
Confidence - It is important to make sure that you’re confident in the information that you’re providing. Evidence base is key. Confidence in delivery is also essential. It is important to understand the integrity of data and information, and deliver that in a way that’s going to resonate with key audiences.
Conflict resolution - In any emergency response, there’s going to be conflict. It’s human nature that, when anxiety increases, there’s going to be conflict. It helps to make sure that we broach these issues early and head on. We also need to collegially address conflict. If left unaddressed, this impacts the broader productivity of the team and the ability to reach outcomes. Creating an environment to mitigate conflicts in a timely, collegial way is important for success.
Compassion - Kindness goes a long way. You can have respectful disagreements with people. You can have rigorous scientific discussions where there may be disagreements. Compassion is key in making sure that we are treating all people with respect, and being mindful of how we deliver information.
During the EVALI outbreak, we had a lot of people clamoring for information. People were dying, coming to emergency rooms with severe pneumonitis, getting intubated and hospitalized in intensive care units. We needed to collect the science, and communicate credible information to the public that was clearly relayed and with confidence in the information. There was conflict amidst the public in terms of what they thought were the causes. Our job was to follow the data to find the cause and then mitigate it – this is what CDC does.
Following that rigorous scientific process, we did identify the primary cause, which was Vitamin E acetate, a filler used in THC-containing products. We followed scientific steps to document the signs and symptoms among patients and the characteristics of the products that they were using, then testing the products themselves for ingredients of concern, and then linking that ingredient to biospecimens from patients to fully connect all of the available evidence. This took a few months. After following the science and communicating, we saw a plummeting of EVALI cases. That critical communication, clarity, confidence in the data, working to resolve conflict among stakeholders, and to do it in a compassionate way were key.
Q: Are there any behaviors that did not serve you well during the crisis?
“Focusing so much on the work and not cultivating relationships worked against us. This is a continual challenge in emergencies.”
As public health practitioners, we believe that an ounce of prevention is worth a pound of cure. This applies to planning for a sustainable workforce during an emergency response.
One challenge that can arise during public health emergencies is relying too heavily on certain individuals for everything, which can lead to burnout. This is a continual challenge in emergencies. Being mindful of staff burnout - epidemiologists, toxicologists, clinicians, health communication, policy gurus - people can burnout very quickly. Focusing so much on the work and not cultivating relationships can also work against the team. We move at a pace that doesn’t allow camaraderie, with everyone working 24-7. It’s not a knock on the system but it’s important to have an underlying plan to anticipate and mitigate burnout. Having standard operating procedures and other processes to quickly build teams, but also to give people breaks, to allow cycles in staffing.
We need to have plans for how you get the right people, give those people a break, create an environment that allows for full transparency of communication and contingency plans when team members are overworked. This includes setting up infrastructure that helps build relationships so that the team can function as a unit rather than a set of individualized units. Processes that support staff to meet regularly, ensure information sharing, accommodate attrition, and onboard new influxes of staff are all important. Having those relationships and cultivating that collegial environment will, in turn, increase the likelihood of achieving success on your outcomes.
It’s also important to have a big picture view of who makes up a team and how you can strategically backfill roles to avoid team burnout. An epidemiologist is an epidemiologist. Just because you work on non-communicable disease during your day-to-day work doesn’t mean you can’t shift into gear and support an infectious disease response in times of crisis. This is one of the many reasons why I’m concerned about the current decimation of the public health infrastructure that we’re seeing. When there’s a public health crisis, you need to be able to pull from across all sectors, including those whose day job might not be the primary focus of the emergency response.
Q: Can you share a role model for resilient leadership?
“Tom Frieden - The underlying themes he applies are to follow the science, effectively communicate it, and to not be afraid to take a proactive stance.”
I came to CDC during the leadership of Tom Frieden, the Director of CDC for 8 years. He is a public health pillar for multiple reasons. If you look at how he operates, the underlying themes he applies are to follow the science, effectively communicate it, and to not be afraid to take a proactive stance. Operationalizing these themes include working diligently to get out in front of things, following a data-driven approach to aid in communicating as quickly and clearly to stakeholders as possible, and being guided by an overarching goal of preventing as much harm as possible. He can teach a master class on this - it’s a paradigm that can be translated to different public health outcomes, regardless of whether it’s communicable or non-communicable disease.
Q: Do you have an example of a way in which someone in your network has stepped up to demonstrate resilience and leadership during this time?
“Rather than compromise on the science, they exited the agency and communicated their concerns to the public, including about what was preventing their ability to function.”
The civil service leadership at CDC – particularly the recent exits of long-standing leaders after the removal of the CDC Director.
Civil servants ensure continuity across political administrations. It’s therefore no surprise that Deb Houry, Dan Jernigan, and Demetre Daskalakis worked effectively across multiple administrations. But rather than compromise on the science, they exited the agency and communicated their concerns to the public, including what was preventing their ability to function. It takes a lot of guts and grit to do that. I highly respect them all and commend them for standing up for principle, which is hard to do in an environment when there are continued attacks on civil servants, including public health professionals.
Q: What thoughts support you during challenging times? Mine, during this year, has been to remind myself that “there are many good ways to do good in the world”.
“Go without hate, but not without rage - heal the world!” - Paul Monet
One thing that has particularly resonated with me over the past two decades are the words of Paul Monet, who was a poet, an author, and an HIV/AIDS advocate. He said “Go without hate, but not without rage - heal the world!”
The quote really gets to the crux of what our goal is as public health practitioners. We want to heal the world, including to improve the lives of people through reducing disease, death, and disability. In order to accomplish that, we need fire in the belly. That rage is important – and it should come without hate. Ultimately, public health professionals aren’t doing what we do for the glitz, glamor, and cash. We do what we do because we care about saving lives. Even in times of uncertainty and challenge, we can’t lose that rage.