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tv   Scott Gottlieb Uncontrolled Spread - Why COVID-19 Crushed Us and How We...  CSPAN  November 9, 2021 6:19am-7:10am EST

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introduction because
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everybody is in what he is a scholar and served in the bush administration as sba before the trump administration and was sba commissioner and after he left he spent the last several years hoping our country get through this crisis we face with solid empirical direct, honest straightforward guidance and advice and on top of all that he's nominated for an any because of his performance on cbs face the nation. he set a record for most consecutive appearances on sunday morning and margaret brennan because of his outstanding guidance in those interviews and i also think the cause of a nice chemistry between him and margaret, a
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chemistry that reminded some of us of spencer tracy and katharine hepburn although a lot of people don't know who i'm referring to he's been nominated for anemmy and i got worried about all this . i didn't see the announcement and i thought i'd thought he didn't win but then i was informed the daytime emmys or news emmys are not until next week and i want you to know i have serious bats that scott and martha will win fortheir performance . >> cbs it has dominated for the enemy, i'm just happy to be part of the package. >> will give the credit tocbs which i guess deserves some . content matters. i've spent a lot of time reading the book. you shared with me early drafts. one way of reading it is to say that you been long in the
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city and i want to ask you not so much to take us through what they did wrong or what was wrong about them but what do we have to do to fix it and what is it about the cdc that made them particularly ineffective and in directing the responseto this crisis ? >> the cdc was thrust into a position they were nevergoing to be able to fulfill . there was a suggestion there were going to be able to deploy testing, to collect information in a real-time fashion and do dll analytics that would inform real-time policy. there an agency that's a high science organization. they're very retrospective. there accompanied to do doing deep data andputting out weekly reports . >> are not operational. >> they're not an operational agency and they're not jsoc putting out regular
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assessments. i think policymakers early on and a misguided perception of what their capabilities were. he thought they would be in the coordinated response across the whole nation and be able to deploy diagnostic tests and put out guidance would inform all manner of life. in criticism of the cdc they didn't raise their hand to say we don't have this. at some point there should have been self-awareness organized around this mission . eventually the trump organization was no one agency capable of diving a response that was operation warp speed, a marriage between the regulators and logistical capability of the department of defense to scale the manufacturing and development of a vaccine. we didn't do that early on. we had this mixed misguided expectation that the cdc was going to lead a national
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response but they didn't have the authority or culture to be able to do it. >> you make that case strongly and effectively in the book and it's clear . but people knew the cdc has been around for years. was it so hard tosee that they work up to that challenge, that they were set up to be this operational agency ? >> part of it was people involved in policymaking didn't recognize what the limitations work and also i think there was a failure of vision early on to recognize how this was going to unfold that if this became a global pandemic there should have been an awareness that this could be a global pandemic that could engulf the united states . there were people who had an awareness of the severity that they were running up that once the chinese shut down the ube province that should have been an indication of how this is serious. if that was the case then you needed to the red button early.
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you needed and all of the above approach and they were following a playbook that had the cdc engaging a highly sequential process or the steps that needed to be taken so the best example of this is diagnostic tests. old playbook have been developing a test and they got wind that there was a new pathogen. they designed a test, manufactured in small quantities. there's hundred public health labs you can do about 100 tests a day. so it's 10,000 tests today. if that's not enough and the cdc would work with the clinical labs and get them stood up and if that still wasn't enough and have, you turn the commercial manufacturers and manufacture testing. i got a copy of the planet that it laid out how this was going to unfold and they had months . we didn't have six months. we didn't have six days so they were following thismodel . you can argue two things. number one, we didn't have
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the right agency in charge, didn't have the right approach to try to get the tools we needed in place to deal with what could be a fast-moving pandemic we also didn't foresee what this would become. there was still keep people who that this could be controlled even as late as february we were looking back at the quotes of officials in late february and in february there were still emphasis on whether or not we could tame this. >> let's look forward to today. you said in an interview or maybe in a book that the cdc still has not stepped up to this new operational chart. you say you think the entity that you do this in washington were all conscious of the organizational chart. should we create a new agency, combine agencies? you say you recommend this operational entity that could respond if it happens again should be within the cdc. what is the status now of the biden administration's
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efforts to address this issue ? >> the conversation hasn't been done. the book was an effort to look at the more systemic shortcomings that plague our response, that left us vulnerable and try to get beyond the political dialogue that it is all a failure of politics. there you're going to ask me about i want to be up front. >> going to get to lessons. >> the conversation hasn't begun and i'm trying to, i've been having conversations about why. the only thing i could come to is maybe it's tooearly to have this discussionbecause were still in the throes of the pandemic . after 9/11 , the conversation began immediately on how to reform government to make sure it doesn't happen again butthere was a pervasive sense that the threat was pervasive , omnipresent, persistent. i don't think that there's a feeling right now that the threat of the next pandemic is pervasive and it's right around the corner.
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there's a little bit more complacency for right or wrong but before we get to that discussion about how we create different infrastructure to guard against the next pandemic and i believe it should reside with the cdc but a different reconstituted cdc. we have to have a more fundamental question about what the role of public health officials in the setting of the crisis is . i think international crisis of this magnitude, a public health crisis you need public health officials who are properly resourced and empowered that notion i think has come under assault and it's not just a right left debate. it's not just conservative liberal. there's a broader swap for americans who are skeptical of public health officials and feel the guidance was ill-informed and shifting, unreliable. and are skeptical of empowering public health officials to put out dictates that are going to impede their decision-making and their ability to sort of take matters into their own hands
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in terms of how they reduce individual risk and are going to have to have a fundamental debate about what the role is of public health and international crisis because if we don't not going to get anywhere. we won't get a consensus about how toreform the cdc and how to empower it . if we don't have enough of the public saying if public health does right in the setting of a crisis. it is the right vehicle to respond and we need public health officials empowered to make these decisions . >> i wonder if you're going farther because it would be uncomfortable giving that much public power to help official but they won't be uncomfortable with making an agency of government more effective operationally which the cdc was clearly not. >> you can't do one without the other. it's the cdc to be properly, for it to be sort of reformed and effective is also going to need to be empowered. >> that whole obsession with protecting intellectual property. they wouldn't turn over commercial manufacturers. >> we've got to fix those messages but that's doesn't
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get us the deeper reforms of what needs to behappen . >>. >> i was going to ask you about fda but i wanted to talk about the who. a lot of discussion in the book is getting so much attention about treating this as a national security risk. and having i think you're for two clandestine operations in foreign countries that catch this in advance. tell us about that . >> we have a long history now of situations where countries have not been forthcoming about the emergence of dangerous pathogens and have not shared samples. i think it was the country of tanzania. where the leader denied that there was an outbreak of it in his country up untilthe point where he was hospitalized for it . and in the sars one, china wasn't forthcoming about the information. it wasn't until you have an outbreak in toronto in the
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canadians once the virus and discovered there was a novel coronavirus that the chinese government admitted there was a double coronavirus certainly in china and it wasn't a fungal infection. the cdc maintained it and we can go back multiple examples with company's. >> and china wasn't forthcoming. >> china wasn't forthcoming about covid. particularly after sars one international health organizations were strengthened and companies would die voltage information and every time these episodes have happened countries haven't been forthcoming. the idea that we're going to come together under the world health assembly again, were going to hold hands and say we really mean it this time and is going to work i think is a littlepollyanna . it's great, we need to engage in bilateral agreements. we need to engage in capacity building and hot zones but we can't rely on that as our only defense.
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so what we're going to need is the capacity to actually elect the information, to monitor for these kind of events. if you look back at the history in china, we now know this is in the public record that there were dozens of samples set off by chinese physicians for sequencing in mid-december so those are the ones we know about . we know that there were healthcare workers who were becoming infected. that's clear evidence of humantransmission . we know chinese physicians were saying there was a symptomatic transmission going on in mid-december. those were, we know that they knew it was a novel coronavirus as far as that. those were critical facts that weren't fully revealed until certainly by the end of december but close to january. we sort of didn't ascertain those facts until early january. all that information could have been had . the information was shared
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electronically, could have been intercepted . we could have had human intelligence and i'm not saying that was going on. >> it's interesting you mention because one of the big characters in the book matt pottinger at the national security council at the time, you depict him as being someone who was kind of this oddball at the white house. wearing a mask, telling everybody this is serious. and no one else waswearing a mask and people thought it was silly to wear a mask . was that an example of someone who was in touch through other sources and world health organization about what was really goingon in china ? >> the mast history, part of his history is he had worked for the wall street journal in china and have broken the story about the initial sars-1 outbreak. max also moved his office out of thewest wing . his own active social distancing because he was so
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worried about the precautions being taken in the white house he extricated himself from the white house and made a decision on the national security council on the two top officials that they wouldn't meet in the same room together so theywere taking precautions early . >> they were taking precautions on the official position of the white house . >> it's only 5:46. >> you have some strong language in the book about the importance of messaging, being honest with the public, telling the truth, not saying when you don't know and being willing to step up to that and then you tell about 2 lost weeks when the white house panicked over a remark made by a low level agency official. come on now. the book if you read very carefully is very critical of president trump, am i right about that? >> the book is critical of
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the political leadership including the president . we can look back at the early history when the president was reluctant to take progressive steps early and there was lost time and we were at a point in time where every week matters but ultimately and i met with the president right before the announced the mitigation . ultimately the administration did a decision to slow the spread and an unprecedented shutdown and they followed it with 30 days after that so clearly theywere taking decisive steps . >> i'm sorry, to slow the spread was nationwide and i just want to make sure i'm right about this . he said if we did have the testing in place, to the slow the spread could have been targeted at the places. >> that was my next point. the point about the diagnostic testing is important because we didn't
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have a diagnostic test available we didn't know where the virus was spreading. we couldn't do sentinel surveillance which is testing of people presenting with flulike symptoms, to turn over the kobe cases and in 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
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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. >>.
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>> 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
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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
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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
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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
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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
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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.
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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 .
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>> 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
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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
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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
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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
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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.
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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
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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
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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
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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
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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.
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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
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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
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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
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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
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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
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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
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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
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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.
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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
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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
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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.
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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
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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
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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. thank you. hope you all enjoyed it. i hope our listeners listening enjoyed it. thank you very much for all you have done, thank you.
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♪♪ c-span: presidential historian craig fairman calls the a autobiography of calvin coolidge the to have gotten classic of presidential writing. the new authorized, expanded and annotated edition has just been published by isi books. editors amity the shlaes and matt denhart quote coolidge this their introduction as saying this is a great advantage to a president ask is a major source of safety to the country for him to know that he is not a great man. we asked amity shlaes to give us some background about the re-released coolidge autobiography which was originally published in may of 1929, 92 years ago. >> chair of the caln

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