tv Scott Gottlieb Uncontrolled Spread - Why COVID-19 Crushed Us and How We... CSPAN November 8, 2021 11:45am-12:38pm EST
>> weekend this on c-span are an intellectual feast, every saturday american history tv documents america story and on sundays, book tv brings you the nonfiction books and authors funding for "c-span2" comes from these television companies and more including charter communications. broadband, empowerment, that's why charter has invested billions for infrastructure, upgrading technology and empowering opportunity in communities big, and small. charter is connecting us charter communications along with these television company support "c-span2", is a public service. >> good evening everyone and thank you for being here for this really exciting book event. it's a series of book of having
important books coming out in america and this is a really important book by a really outstanding ai scholar and american it, hero someone's we are very proud of, scott gottieb and thank you for being here and we are his new book "uncontrolled spread - why covid-19 crushed us and how we can defeat the next pandemic". and how we can defeat the next pandemic which is out now and it will be available at bookstores all over america. i do not want to get too much into this because i think everybody knows god but i think this an important reminder that he is an ai scholar they serve in the bush administration as fda before the trump administration, then he was the fda commmissioner and then after he left the trump administration, he spent really the last couple of years helping our country get through this crisis we face with solid direct honest straightforward guidance and advice and on top of all of
that, is nominated for an emmy because for his performance on cbs face the nation. i think he set the record for the most executive appearances on sunday morning. and because of his outstanding guidance in those interviews and i also think that because of a really nice chemistry between them, it reminded some of us of the spencer tracy and katharine hepburn although i know a lot of people don't know, i'm referrinp to, a lot of the younger people he's been nominated for an emmy i got worried about all of this because the emmys were last night that i did not see the announcement i thought oh my god, then i was informed that the daytime emmys are news emmys are not until next week nodule to know that it is serious thought that they will win for their outstanding performance and were looking forward it to sing this pretty. >> i'm just having to be part of this redo.
>> all right, will this good braided and of course that some of it. this the content of the talent the matters and so, a lot of times reading the book and he shared it with me an earlier draft and of course we watch him for this altogether and when way of reading itwa is to say is a pretty long indictment of this. and i wanted to ask you, no semester to go through but they did wrong or what was wrong about them, but what we have to do to fix it and what is it about the cdc that made them particularly ineffective and directing the response of theto crisis pretty. >> i think the cdc was thrust into a position they would never be able to fill there was exultation that they were going to beev able to have a physical response across the country to scale the development of the testing to collect information in a real-time fashion with the analytics and service
information that would inform real-time policymaking and decision-making and their agency that very retrospective, accustomed to getting the seeds of analytics and putting out the mortality weekly report rated they're not an operational agency and they are not day stock, not in intelligence agencies. though the harvard school of public health i think the policymakers early on, and misguided perception of what their capabilities were they thought they would be able to lead and coordinate a response of the information and be able to develop and deploy diagnostic test to be able to put out guidance that would be all matter of life and now in criticism and criticism of the cdc, they didn't raise her head to sayd that we don't have an t some point should been self-awareness that they could not self organize around the mission and they're going to be able to kimball during an event for the trump administration and recognition app that there was no one agency of capable of
guiding a response there was operation warp speed is between nih and scientists and fda and the regulators and the logistical capabilities of the department of defense to try to scale the manufacturing and developing of deployment a vaccine we did not do that early on, we had a misguided expectation to be able to lead initial response and they could not come they did not have the capabilities of the didn't have the authorities the culture of the resources to get it done. >> i get that you make that case probably and effectively in the book that is clear, but people through the cdc, is been around for years. was it so hard to see that they were not up to that challenge that they were not set up to be this operational agency pretty. >> i think part of it that the people involved, will they didn't recognize with those limitations work and also think there was a failure of vision early on to recognize how this was going to enfold that this became a global pandemic there
should've been an awareness in january that this could be a global pandemic that could involve the united states a lot of people that that point who had an awareness of the severity and we were writing it up in the wall street journal and was attorney shut down the province and basically crushed their entire economy to get control of this that should been a pretty good indication on how this would be an f that was the case, then you needed to hit the red button early in all of the approaching they were following the playbook that had them engaging a highly sequential process for rolling out the mitigation so the best example of this is diagnostic test so the old playbook at cdc developing a diagnostic test in the get access that there was a new passage circulating the design a test in the manufacture to small quantities of deploying to the public health labs and there's hundred public health labs these can be to about 100 test today, and is 10000 test today and if that is not enough, then the cdcwo would work with e
clinical labs in the academic medical centers to get them set up and that was the loving nephew would have the commercial manufactures stepping in and actually got a copy of the plan the cdc laid out and how this would enfold they had six months. we did not have six mostly didn't even have six days of the workrk following this model so u can argue two things, number one we did not have the right agency in charge we did not have the right approach to try to get the tools we needed in place to deal with whatst could be moving a pandemic but we also did not foresee with this would become and i i think there were stills ispeople who thought this coulde controlled even as late as february we were looking at this and in february they were wondering whether or not we could contain this rated. >> celeste move forward to today and whether in the book are, i read that the cdc still has not moved up to this new operational
chart you say that you think the entity that should doch this, would they were all conscious of the organizational charts and should we create a new agency or combine them and i think that you say that you recommend that this operational entity, that could respond and if it happens it should be within the cdc. what is the status now of the biden administration's efforts to address this issue. >> the conversation really has begun in the book was an effort to try to look at the more stomach shortcomings that plague our response and left us vulnerable and try to get beyond just the political dialogue that this is all failure politics and clearly i know you can ask me and i don't want to get . >> the conversation has not begun and i am trying and i been having conversations with myself about why and the only thing that i can come to his maybe is too early to have this discussion.
after 911, the conversation began immediately and how to reform the government to make sure it is not happen again but there was a pervasive in a sense of a threat was pervasive and the press and the president persisting we need to protect yourselves right away and i don't think there's a feeling right now that the threat of the next pandemic is purse and impersonate intoou pervasive. by thinking and before we get to that discussion about how do we create the infrastructure to guard against the next connecticut if you're right, believe it should reside been a much different in a reconstituted cdc and i think we have to have more fundamental question about what the role of public health officials and setting ofd a crisis of the crisis of the scalp. and i think in this unique public health officials who are public resource empowered, i think it has come under assault not just the right left debate, not just conservative and liberal under liberal i think
now they're skeptical they feel the guidance of god was so informed and shifting and unreliable and are skeptical of empowering public health official to put out dictate things it will impede their decision-making and their ability to sort ofab take mattes into their own hands and were going to have to have a very fundamental debate about whether role is h of public health is because if weam don't, were not going to get anywhere with congress. but how to reform the cdc how to properly resource and empower us. and if we don't have enough publican, if the public health is done right in a setting of the crisis, it is the right vehicle to respondent in the officials to make these decisions printed. >> i'm wondering if you're going toocl far because it could be in comfortable that they won't meet and comfortable with it an agency of government more effective operationally in the cdc wasct clearly not pretty. >> but nothing you can do one without the other.
and for them to be properly sort of reform, it will also need to be empowered. >> and also being protected from the property and they would not turn it over to commercial manufacturers braided. >> we got mixed messages but that does not get us into a deep reform into what needs to be happening. >> i want to skip right to the who because you have a lot of discussions inu the book that's getting attention about treating this is a nationall security rik and having i think you referred to operations in foreign countries that catches in advance and tell us about that. >> we have a long history now situations where countries have not been forthcoming about the emergence of dangerous pathogens
in mature samples i think it was a countries of the intensity with the latest denied that there was this outbreak of covid-19 in the country right until the point he was hospitalized for it. and is ours one, china at what's coming about this information, that was not until you had an outbreak in toronto thehe canadn sequence the virus discover there is a novel coronavirus circulated that the chinese government finally admitted that it was circling this in china and it was not an infection they had previously maintained it we can go backk multiple examples werepa country have not been forthcoming about new outbreaks and china was not forthcoming about covid-19 so every time you have these episodes, vertically of the stars one and health relations were strengthened they were funny committed mets and it wouldrm - and every time these episodes happen countries
have not been forthcoming so the idea that we will come together into the world health organization and we are going to hold hands and say that we really be atha this time, is gog to work, i thank you so little pollyanna and we need to in vision multilateral and engage in capacity building in places and in hot zones but we can't rely on that is really defense. so what were going to need a capacity to actually collect the information and monitor for these kinds of events and so if look back at the history of this in china, we now know this and the public record it that there were dozens of samples of it set up by chinese physicians in the sequencing and mid december and those who was we know about to we know that there were healthcare workers who were becoming infected and has clear evidencema. we know the chinese physicians were saying that there were a symptomatic transmissions going
on intr mid-december those, i think we know that they knew that it was novel coronavirus. those were critical facts that were really not fully revealed until certainly by the end of december early into january. we do not get the specs until early january and all the information could've been had. and if the information was shared electronically orul intercepted, we could've had sources, human intelligence is not saying that was not going on. >> what is interesting you mention that because one of the big characters in the book is matt pottinger at the national security advisor at the time and you depict him as being someone who is kind of this oddball at the white house wearing a mask, telling everybody that thisri is serious. and when nobody else was wearing a mask and people thought it was silly braided and so was that an example of someone who was in touch through other sources in the world health of what was
really going on in china. >> part of his history was any work for the in china as a journalism but he was going information through alternative sources and he also moved his office out of the left wing and so is on active social distancing because he was so worried about this being taken the white house that he left the white house and he made a decision to the national scary counsel that the top officials on this and if they would not meet in the same room together so they were taking precautions early. ... ... being honest with the public, telling the truth, saying what
you don't know and being willing to step up to that and then you tell about two lost weeks when the white house panic over a remark made by low-level agent justice official. come on now. the book if you read very carefully it's very critical of president trump's. am i right? >> the book is critical of the political leadership including the president. i think we can look back at the early history when the president was reluctant to take aggressive steps early and of lost time and were at a point where every week mattered. but ultimately and i met with the president right before the announced the mitigation, ultimately the administration made a decision to do 15 days t show the spread, an unprecedented shutout and the folder with 30 days of slow the spread. clearly they were takingfo decisive steps. >> stop one second. >> let me finish. >> i'm sorry but i want to slow the spread thing was a nationwide, and one of the important points of the book on
election right about this is that if we did have the testing in place -- >> your right. t >> the slow the spread could've been targeted at the places where it was speedy that was my next point. the point about the diagnostic testing is important because because we can have a diagnostic test available we did know where the virus was spreading. we couldn't do surveillance which was testing a represented sample number of people who presented with flulike symptoms testing negative to fluted turnover to covid cases. kobe ca seattle they were doing surveillance and by the end of february they were turning over one percent positive cases. this wasn't made public at the time, someone let me know this was going on so we could have known that the virus was spreading much earlier and that community transmission was underway and this was a time we were being told there is no community transmission of the other piece of that, the reason the diagnostic test was a critical missing element was not only did we not know where the virus was
spreading, we didn't know where it wasn't spreading when we reach for the population wide mitigation to help people stay at home very clearly we have to dothat in new york . the health system was breached. we have to do it in new orleans and had to do it in chicago, had to do it in boston . did we have to doit in wyoming ? austin, jacksonville west and mark those workplaces the virus had spread. this was a regionalized epidemic so we could have saved the mitigation not implemented in those places, use testing and tracing to keep up with the local spread and saved the political capital to do it down the road and the pandemic got to this part of the country but by the time we had shut down the country in the spring and in the virus moved to those parts of the country inthe summer people there said look , we already shut down, he lost the opportunity to use mitigation and the final point is if you look back at the 2005 pandemic plan on which a lot of this was predicated it was the first time mitigation was contemplated at any scale. the idea of closing congregants settings and it
was controversial at the time. i told a story about how it got into that plan but nowhere in that plan did they ever consider a simultaneous national shutdown. it was always premised you have diagnostic testing and you would deployment mitigation when the virus got to those parts of the country and we got into this because we didn't have the tests. >>. >> i want to ask you about hydroxy. you do tell the story of that . what was going on there. >> early on in the crisis, we were desperate. we didn't know, we didn't have anything. so doctors were trying things that showed activity in the meeting they showed activity in the test tube against the virus because we didn't have evidence of activity of drugs and actual patients sohydroxy chlorine when showed in vitro activity .
it showed against a lot of viruses and it's one of those things that's always fooled us. it showed activity against evil up. we're using testing early on and officials were optimistic that testing might be effective in the treatment so we didn't have therapeutics and we were tryingeverything. the whole story of hydroxychloroquine isn't that we tried it . it's that the story is that in my view that we didn't firmly establish quickly enough that it wasn't working in a definitive way that actually puts to rest the speculation that was having a treatment effect so because they sort of the lord around the drum was persistent for so long to get swept up in a political narrative and persists to this day. there is a study that was a poorly done study out of a hospital in northernnew jersey . i grew up in new jersey. and it got picked up by a lot of the resident trumps supporters to say look we were right all along. after multiple studies, definitive studies that said
it does not have a treatment effect so the point of that chapter is that you need to have the infrastructure in place to do research in the setting of a crisis. you can't do randomized placebo-controlled trials and test 300 variables and expect doctors to do the trial. the british did this right because the andes practical studies. we didn't participate in the british studies. we have thesestudies and we couldn't rollthem because doctors were trying to keep patients alive . they couldn't enroll patients in complicated studies . >> i want to turnto the vaccine development . first of all you have there's news today from and by the way one of the great things about doc is he's very upfront and direct and open about his other relationships . you're on the pfizer board. pfizer announced today something concerning children. can you just describe what happened today and i want to go back to the development of the vaccine and i want you to
also some people in the crowd want to know why motor appears to be better than pfizer. >> so pfizer put data today from a phase 2 trial on the vaccine in development for children ages 5 to 11 and the data was positive. it should be immune response measured by the anti-money production of the vaccine induces is comparable to the anti-body response in children ages 16 to 25 who receive the 30 microgram dose so it goes in adults and children over the age of 12 is the micrograms. the dose being developed for children between ages of five and 11 is a 10 milligrams dose and the reason pfizer chose that does is there were multiple doses tested and what you want to try to achieve is the lowest dose possible that's going to achieve anti-body response for an immune response is going tobe effective . this does looks like it achieve a comparable immune response to the adult dose without a much lower dose so
you're going to get much less presumably less vaccine -related side effects . less arm hair. so it's going to be in a young child a vaccine that's safe and tolerable and that was the effort to arrive at this 10 microgram dose. pfizer as the data from a trial conducted in 90 clinical trial sites that will be submitted to the fda when i'm within a matterof days . fda has said the review is going to be a matter of weeks not months. having been at the agency i typically makes 4 to 6 weeks because if i said if i meant two months i would say months. i don't know what the current to con is that i would surmise this is going to be a 4 to 6 week review so you can have a vaccine available as early as halloween, maybe my mid-november. and then there's another vaccine in developing for children ages x months to
four years. that's a three microgram vaccine so one 30th the dose of the adult formulation. this is the one for 5 to 11 is 1/10. >> the development of vaccines is purely a huge success and it's been proven to be effective . i think you agree with that. i know you agree with that. what you think should be done about vaccine resistance that still exists among americans and what did we do wrong to allow it to grow to the size of that? >> first of all i think we ought to decide what is success in terms of getting the adult population vaccinated. we have 76 percent of adults over the age of 18 that have received at least one dose. most of them will complete this, 90 percent will become fully vaccinated. if you look at childhood immunizations, the rate of vaccination among children is anywhere from 90 to 94 percent this is a mandated vaccine. measles, mumps and rubella. it's required vaccine.
again, 94 percent to 94 percent in recent years higher. it's highly variable, connecticut is 90 percent other states it's less. this year it's going to be a lot less vaccination rates among kids are down but the ten-year average is somewhere in the low 90 percent. other vaccines much less. compliance with the entire childhood immunization schedule is about 90 percent. so ask yourself what you think you're going to achieve with an adult vaccination and what are you willing to do to try to vaccination rates increments higher. i think on our current trajectory and i think the biden administration has done a good job rolling this out. on our current trajectory before the recent announcement about the mandates to small to medium-size large businesses we would have gotten 80 percent based onwhere we were going . but. >> stopped for just a second. that 80 percent nationally takes connecticut's 95. what about the state that are
well below 70? >> that's true of every vaccine. >> the rate of vaccination for mmr because i looked in connecticut is 90 percent. i'm telling you the national averagesbetween 90 and 94 percent . >> they're not at 50. you're right that there are pockets, there are greater pockets of vulnerability around the country but the rates have gone up. >> that's a good thing, we want rates to go up. what is the rate we wantto get to ? >> we ought to decide what is success here and what are we willing to do to achieve it. my view is we would have gotten 80 percent. maybe we can get 85 percent if we impose a lot of the mandates have been announced. there's a price to be here because we can something that was vertically political and made it more objective political now that we're
managing it on small businesses. my personal view around us and i'm kind of going far a field but this will be the next question on the suspects is that you're going to pay a price for imposing these mandates on small businesses. this is not an individual choice and that getting a vaccine only affects me. your choice about getting vaccinated affects your community. it's a collective choice but it's a collective choice that affects your community the preferable approach would be to allow these decisionsto be made at a community level . allow school boards to manage and allow local communities to mandate at a local community level and businesses to make a decision. that's the only way i can protect my employers. so i don't think governors should be telling small business they can't mandate the vaccine if that's the only way youfeel like you can protect your community but the federal government shouldn't be saying they have to . >> once we cross that bridge
this becomes political. >>what about the bully pulpit, a prominent leader . >> with a strong following among people that are vaccine resistance stepping up and saying i got it, you should get it . we need everybody to get it . is that an effective way to get morevaccines ? >> aprons following on twitter? >> a major leader in america stepping up. >> i think that's the role of public officials is to try to provide consistent messaging and galvanize action among the republicans.this is where you went to the political question early on the president and what i was going to say is i was going was the president and the administration they did this 45 days to slow the spread. i think where the administration wasn't effective and failed was the lack of consistency. you had an administration at one point at some point got to a place and i have met
with the president right before the announcement mitigation where they felt this was a serious enough concern and were going to take a dramatic step of flowing and basically stopping selectivity and by the end the president was harmoniously taking his mask off while he was still in texas with the virus. a very big spread. you come along way and i think the last lack of consistency all the way through around an agreed-upon set of things we can all do to try to reduce the spread, we were never going to be able to prevent a pandemic but what we needed to do is reduce the spread long enough to get our protections in place and in order to do that we needed toagree on a common set of actions we could take on a routine basis . individually if everyone goes shopping one last time a week , your relatives a little bit more and wears a high-quality mass when they're in a private setting. takes certain activities they might have done indoors and does it outdoors. collectively back and have a tremendous impact on the
concourse of an epidemic. we never galvanized public opinion and national level around a consistent set of actions . that's where there was a failure of leadership. >> i want to turn to another sub topic which you talked a lot about about a lot and it's worth facing up to. i think you believe it is and that is the difference in the impact of this virus on people who are the rich versus the poor, minorities. why is that. first of all is it true the virus has affected in a harmful way lower income americans, minority americans much worse than it has others and what can be done to turn that around? >> i think i talk a lot about this in the conclusion of the other parts of the book. i think that infectious diseases historically have had a disproportionate impact
on certain segments of society. people who are lower income, who work in jobs where they are more in contact with the virus or where their in-service jobs where they come into contact with a lot of people who live in crowded housing situations where one member of the household gets infected, thewhole house is exposed . you can't socially distance. people who face bias who don't have access to the healthcare system. don't get adequate response from providers when they enter the healthcare system because of inherited bias in healthcare delivery. and it exposed that in a dramatic fashion because it was sopervasive . it was it spread so rapidly over society and it was so deadly. it exposed all those weaknesses in the healthcare system. >> ..
don't get good follow-up from product disease to have access to good nutrition. so a lot of it is driven by the same social inequities that make infectious disease something that disproportionate impacts certain segments of society. what can be done? i think over the last year we've had, we've gone through a timer with can find some of these harsh realities. whether or not will galvanize action to confront them in a meaningful way i don't know, i hope so. there's more of an awareness of this. we used to say in medicine and infectious diseases eventually become diseases of poverty. you think disproportionally the impact certain communities. this was no different. edges happen over a a very sht period of time. >> i just want, and when it's
faxing resistance fall in the causes of this? >> i don't think that vaccine hesitancy, look, there's faxing hesitancy in different communities and some vaccine hesitancy in black and brown america because of concerns around past practices about medical have been deployed in that community and distrust thai don't think that is so disproportionate in one community or another if that's what's driving some of these disparities. if you look at the data uptake of that among moderate groups has been pretty good especially relative to other vaccines as well. i don't think that explains the differences we see in outcomes. when you talk about faxing hesitancy i try to avoid that word because it means different things to different people. the reason why people are reluctant to get vaccinated is so heterogeneous that you can't
say there's a monolithic school of thought around reluctant to vaccinate. different people have different concerns, and were at the point now, getting back to my point about 76% of adults been vaccinated at least one dose and getting close to levels where top off, notwithstanding her point about even across the country but we getting close to levels where getting that next 1% is going to be a lot harder to getting the first 10%. we're fighting that will be hard to achieve because the holdouts are more reluctant. there are people with longer considerations period. there are people of been in mexico and know that some residual immunity and while i believe there are those people eventually have to get vaccinated they are not wrong to have immunity that will afford them a level of protection at least for the time being. at some point they will have to get vaccinated but phil have a time of protection. >> you said this decision should
be made at the local level. >> the mandates. >> i got that but now let's say you are an employer having entity at 190 employees, what do you do? do you mandate it or allow an exception for health and religious objection in attempting requirement? what is the optimal answer on that? >> the optimal answer depends on what the setting of business is. businesses that have a high rate of vaccination already among their workforce are going be less at risk than if a handful of people unvaccinated in that environment. businesses that have the ability to create some social distancing on jobs job site, people an top of each other, you have to look at your own situation. are you asking for personal advise? >> no. the first one you made is interesting. if you are at 90% already forcing the remaining 10% doesn't get you much. >> from a public health standpoint you're probably not achieve a big increment of protection for the overall
office try to get the last couple of percent. if you're running a facility where people are closer together, can't socially distance, there any work environment where it's conducive to spread come vaccination becomes are important. the meatpacking plants, why with so many outbreaks in meatpacking plants? first of all because people are close together. second of all it was a cold facility and probably that facilitate the spread of respiratory pathogen. you have to judge the environment in which are working. working. if you had environment where there's older people as well who could be vulnerable that might instigate how you think about opening a a mandate. >> okay. have a bunch of questions that it didn't pre-submitted which i will select a few of them but i wasn't kidding about the differences in the vaccines. is there something we should know about the difference between moderna and j&j and pfizer? >> i've been fairly consistent.
there's been studies that suggest pfizer may be slightly more efficacious than moderna and vice versa. these are comparable vaccines or delivering comparable level of vaccine any small differences probably don't of clinical relevance. the rally as if there's any small difference in the clinical performance it's going to come out in the wash once you start administering boosters because the effect from boosters is so robust it's going to wash over any perceived differences. the vaccines were administered on different schedules. we now presume i believe a longer interval is better than a shorter interval because you primed the immune system if you wait longer here. >> interval between shots? >> interval between shots. moderna was delivered on four week interval. the challenge you noted on top i'm on the board of pfizer but the other issue around the data coming out of and pfizer is number one a lot of -- pfizer
administered the vaccines very early and is collecting data very rigorously. you are saying the effects of the vaccine over a long period of time. at least in the united states the fisa vaccine was authorized earlier and it was preferentially distribute through hospitals because of the admission requirements and had to be kept very cold. you ended up putting the fisa vaccine into both healthcare workers and nursing homes because it was the first out in the first people we inoculated were healthcare workers and nursing home patients and your internet distribute more around hospitals where you attend to find a population that has more pre-existing health conditions. it's hard to make apples to apples comparisons between these. >> you were the commissioner and fda and one of the questions has concerns about fta. we talked about cdc, talked about w.h.o. what about fta?
what needs to change to make them more effective response to the next? >> i don't know the fda is fundamental reform as articulated around cdc in the book but i think there are things we can think about and what is the use of emergency use authorization. that authorization was conceived and project bio shield i believe in 2004 as part of our response to 9/11 and the anthrax attack. we needed a way to get medical countermeasures quickly on the market using different complements of data in the setting of a global emergency or national emergency. it was eventually evolved to also address pandemic preparedness under the pandemic preparedness act but the way it's been used to date is sort of as an fda approval process light. what a mean by that is the emergency use authorization is
still being used in a binder since. the vaccine was authorized for everyone under emergency use authorization. you could use that process to make something there were any much more interactive way. let's talk about vaccine because i talk about this in the book. back in december it was a lot of debate on whether or not the vaccines would be authorized before the election on the basis of the interim data from the clinical trial. ultimately the fda and a lot of outside critics put pressure on the advisory process to sort of demand that the vaccines be authorized on the basis of the full complement of clinical data from the clinical trial, and that delayed the authorization probably by about a month maybe a little less come three weeks. you can argue how much the delay was. but what if we had gotten the interim data from a a clinical trial that showed the vaccine was 90% effective at some point
in late october and initially authorized the vaccines just for patients, older patients above the age of 65 bulletin congregant settings and nursing homes? that was where we were losing 7000 people we can nursing homes. when cms said to me we cannot keep covid out of nursing homes. the only way to resolve this is to get a vaccine into the nursing homes. they had blocked visitors. they had required testing of the staff and i couldn't keep covid out. 7000 nursing patients a week week would die. could you have made an early authorization just that population, allowed the rest of the data to mature, collected the data from the experience of the nursing homes and approval for a broader population? sort of an iterative fashion staged approval. you could do that. it allows flexibility but it wasn't imagined. when congress comes back and thinks that how do we get fd the right tools and authorities and the right instruction how to use these things in setting of
emergency that id of states market entry of products will be important because it's very clear there was some groups more at risk of covid than others and making these things available earlier you could've had had a bigger impact earlier. >> to be clear on this, are the current vaccines that many of us have taken, where they approved on emergency basis and does not remain in effect or is there another -- will they announce they find have given it full approval not on emergency basis? >> the fisa vaccine has been fully licensed. it's now, it's got application. the moderna vaccine is pending full approval. they gather application later than pfizer. you would expect they will get some point soon. >> okay. last couple questions about what's ahead of us. is another one coming? and how likely is that? and also is this particular virus going to mutate again?
and to give something else after delta? >> multiparty question, i can't member. >> i apologize. >> the conventional wisdom among some, if you talk to the genetic epidemiologist who i spent a lot of time talking to and i value their opinion because they look at the fibers but they also look at how the virus is behaving in nature. they think that this virus has mutated very quickly over a short time basically a new fitness level and its rate of mutation will slow down. it's mutating at the rate of influenza b right now but they think it will slow down and new mutations occur that's partially escaped immunity we've acquired from the natural. there's 20 different variants of delta. that delta is going to mutate in ways that going to partially not dramatically but partially invade our community and will need to update the vaccines. one consideration is do we leave
all the vaccine in the future towards a delta variant backbone vaccine? is dealt with the new backbone for the next faxing? that's a discussion actively going on among public health officials and probably something we'll have to make a decision round sort of in the fall of 2022 delta season. you'll see continued evolution of this virus. when you see something that is, the changes in a dramatic way where it could when they would wake up and it completely evades our immunity? it's unlikely. there's a tail risk but it's unlikely because this virus it hasn't been able to perform this yet. what it needs to do is change the confirmation of the tip of this that sits on the surface enough so our immune system no longer recognize it. that's the dominant immuno dominant epitopes on a virus surface. that's the part our immune system develop antibodies against. somehow he asked to change up but that's also the part of the virus uses to attach to our
receptors in her lungs. the virus has to samco to change this so much that the human body no longer will recognize this tip anymore, but the tip still has to be good enough to attach to the human receptors and it just so happens biology is clever and the aspects of -- >> we need an illustration of this. >> the aspect, the very aspects he used to attach to our lungs, so it's hard, it's along with saying it's our piece to pull off, not impossible but hard and it somewhat reassuring we seen so much buyers around the world and has been able to really do that yet. >> so what about the potential something else? >> look, we will see another virus that threatens the global pandemic. my thesis in the book is when you to come up with an infrastructure that prevents the next pandemic. we can't go to the american people and say we will allocate tens of billions of dollars and reform government so the next a mishap but it's not quite so bad. i don't think that's a good sales pitch.
our focus needs to be how do we prevent the next pandemic. the category of viruses we need to be worried about our, rna viruses that are respiratory viruses. what a mean by that is viruses the replicate through rna and the reason we worry about viruses the replicate through rna is because they undergo rapid mutation or the capacity to. if you think about the category of viruses it includes coronavirus and influenza but includes a lot more. viruses that have the capacity to spread the respiratory droplets of aerosol have the capacity to spread very quickly. i virus that spreads to the blood can spread quickly but not it can race around the world is quickly something that spreads through respiratory pathogens. the of the piece of that is we proved uniquely challenge at the opera mini respiratory precautions. this virus hurt us a lot more than other parts of the world. this is an asymmetric risk to the united states because of respiratory pathogen. >> why? why did it hurt us more? y respiratory pathogen causes
bigger problems? because we talk with each other more closely? >> because we couldn't galvanize, good government effect respiratory precautions and a consistent way. we couldn't agree to wear masks, and respiratory pathogens pose in certain aspects a greater risk to industrialized nations that we have dense cities. with people working in conditions where there closely packed, office buildings, shop floors. >> we have a lot of freedom. >> and agriculture vibrant people are spaced apart it ie post less of risk than in downtown new york. >> right. last question for me that's also in the list. we've been watching the current president, president biden and his team. what are your views on how they're doing on all this and let's leave out the mandate. you discussed the mandate, the president's reasons statement. what about the things you really care about, the structural, the changes to the agencies that do this work, the leadership to
putting in place, what is your take? >> look, i don't think they have engaged a fundamental reform of government. i think the biden administration came in with an ethos that they're going to allow the agencies to do their scientific work and they're not going to interfere with the scientific work for the agencies, and i suspect on some level i have low bit of bias of remorse -- buyer's remorse. the trump administration, very clearly interfered with certain agency functions. so their solution might have been wrong in terms of some what they did. it wasn't right to tweet at fda. that wasn't a good way to reform the fda but a diagnosis wasn't completely wrong. there was recently frustrated with the performs of the agency. when the biden administration -- >> with the experts and the scientists. >> and the function of the agency and information the white house was getting.
>> they didn't trust the experts. that's not going help. >> now they have a harder time exerting control over the agencies, like they did with these boosters which they had a good rationale to do with it did but it looked like they were now anything with the scientific and agencies. i don't think either approach is optimal. you've got to be able to politically appointed officials have to be able to reform government. i think there any harder position. >> they are learning. don't just something in an interview on the book a couple people are in cbcf now let because they're being pushed by the politicals? is that what you think is happening? >> i don't know why the exact reason, they were senior officials but it know the exact reason why those officials left. there were multiple reasons why they left but the cdc director is attending preform the agency but it's hard to do. it's very hard to self organize and setting of a crisis, she's got to come in and tried to boost morale and support the
agency and it's hard for her to come in and sort point all the criticisms of laws and try to reform that the special in the setting of crisis remediating to to perform as best it can. >> okay. this is been a great conversation. this is been a great conversation. thank you and hope you all enjoyed it. i hope our listeners listening and enjoyed it. thank you very much, scott. thank you. [applause] >> with the senate out of session join us all this week for booktv. >> that all starts at 8 p.m. eastern on c-span2. you can also access our programs
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