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Brian: Brian Lehrer on WNYC and here we are on the final day of our 30 issues in 30 days election series, we did it. In total, we will have had 10 on pandemic related issues, 10 on racial justice-related issues, and 10 on other things that really aren't getting enough coverage in this year when people are so obsessed with both racial justice and pandemic issues for obvious reasons, but we're happy to have done 10 other issues in this series as well.

Now we arrive at issue number 30, politics and the CDC, or how to de-politicize the centers for Disease Control and other federal health agencies and make them as effective as possible with the next wave of the pandemic rising. What is the proper role of the CDC? It is a science agency in a political environment, the government. What's the role of the CDC and other federal health offices, and what will the Trump administration or a possible Biden administration do differently if they win the election?

Joining me now is Andy Slavitt former Administrator of the Centers for Medicare and Medicaid Services under President Obama. He has hosted the podcast In The Bubble and author of the forthcoming book Preventable, The Inside Story Of How Leadership, Failures, Politics, and Selfishness Doomed The US Coronavirus Response. Andy, thank you so much for coming on with us at this busy time. Welcome back to WNYC.

Andy: Great to be here.

Brian: Where do you start your book?

Andy: I actually think that for many Americans, the experience of January, February, and March was a bit surreal. There were various steps and time when people realized that things were going to be very, very different. Obviously, the President knew much sooner than he let on, but I try to take people back to the point where they experienced this discovery and the various events that cause us to see what was going on.

Then I go back into the White House and show what was going on based on a lot of the conversations that I've been having and currently having with the team in there and governors and others around the country as everybody reacted differently at different speeds and in different ways.

Brian: Let me play a clip from March. If we go back two years to 2018, there's been a lot of confusion about what happened to something called the Global Health Security and Biodefense Unit within the National Security Council, but for people who are asking, "What does have to do with coronavirus?" Back in 2018, that unit ceased operations.

When people talk about a pandemic response team, that's who they're referring to when they say Trump disbanded a pandemic response team. Back in March, Yamiche Léone Alcindor White House correspondent for the PBS NewsHour asked

the President about it at a press conference.

Yamiche: You said that you don't take responsibility, but you did disband the White House pandemic office and the officials that were working in that office left this administration abruptly. What responsibility do you take to that? The officials that worked in that office said that the White House lost valuable time because that office was disbanded. What do you make of that?

Trump: Well, I just think it's a nasty question because what we've done, and Tony had said numerous times that we saved thousands of lives because of the quick closing. When you say me, I didn't do it.

Brian: What did he do? What didn't he do, Andy?

Andy: Well, look, if you go back to the last number of presidents going as far back as we can even think, certainly Barack Obama, George W. Bush, Bill Clinton, these were people who were all very much briefed on what was going on with the threat of a pandemic in coronavirus and knew that it was one of our existential threats.

Trump, I think just in his contrarian nature dismissed that. He also doesn't pay a lot of attention to things that aren't serving him closely. I wouldn't be surprised when Bolton got rid of that pandemic response unit, he barely noticed or it's quite possible he said, "What are all these people doing?" As he said at one point, "I don't like people sitting around doing nothing."

It's clear that whether it was negligence or whether it was more active, he disbanded one of our core abilities, both there and within the CDC to get the intelligence to allow us to respond.

Brian: We talk about the Centers for Disease Control. Is it fair to say that it's always been influenced by various corporate and political interests and it's never been completely independent? If you agree with that statement, to what degree was it true in the past, and how has it changed under Trump?

Andy: Well, I think the CDC has historically been one of the least influenced bodies in our government. In some respects, the wide birth given to the CDC and allowing them to-- They're headquartered in Atlanta. It's quite a distance from things that most presidents actually care about or think about. White Houses tend not to interfere other than picking one person to run the CDC, which is often typically an expert in public health.

What happened here almost from the start was different. Robert Redfield, who is, I think, a nice person and means well was a person who was- and the AIDS epidemic was believed that abstinence was the solution. Is a favorite of the religious right not known for its public health chops. Then Trump put in five other political appointees, which has never happened in the history of the CDC around, I should say, four other ones. Five total political appointees in the CDC and in no time before then there've been more than one.

From the start, he was viewing this that way. I think in particular because Trump likes  

to control the message and CDC, one of their main roles is communication.

Brian: Yes, and we've had communication at cross purposes between Redfield, even with the shortcomings that you just identified with respect to him and the President. The President says the vaccine will be available very soon. Redfield says the vaccine would not likely be available until sometime in 2021.

The CDC put out the recent advisory that coronavirus is more aerosolized than officially had been said before. That is, it will linger in a room where people had been for longer than maybe first thought. The Trump administration said, "No, it doesn't," and they withdrew that advisory, and then they put it back. Talk about that, talk about that communication role, and to what degree has the CDC been politicized and is now an unreliable source of information for the public in your opinion?

Andy: Well, it's interesting, Brian, this context is when you have a novel pandemic until you have a vaccine or very reliable antivirals, communication is your medicine. That's the way we should think about this because it is the ability to control the virus is entirely controlled by getting a consistent message out to the public. As I go into the book, the scientists he has, whether it's in CDC or FDA or other places, they only lasted because they're either weak or loyal.

What is interesting is that by the- and Anthony Fauci is an exception and Deborah Birx becomes an exception, but by the end, he crushes descent. He crushes descent as you said, in the case of the CDC, he does it in the case of the FDA, he does it with [unintelligible 00:08:45], Rick Bright, that eventually even Robert Redfield and Stephen Han who are not political figures, are not paid to be brave. They certainly don't want to take on the President. Even they finally just say, my scientific credentials don't allow me to not at least find some way to say what I think is going on.

About a few weeks ago, Trump really lost all control when the FDA went ahead and put out guidelines on the vaccine that were against what his wishes were. The CDC essentially said, there are too many of us scientists. We might as well just keep talking.

I think the thing I want to remind people of is, if you take away the one or two political people at top of the FDA or the CDC, the agencies are the same and they're not perfect but they're the best we have and they are protectors of democracy. They're the protectors of our health, they are the institutions that we need. We should take whatever concerns or frustrations we have about the politicization of them and reform them but not throw them out.

Yes, they made mistakes. We can point to CDC, several big mistakes the CDC and the FDA made even irrespective of the politics. That's going to happen when you have a novel virus, it's not cause to lose competency in institutions, it's cause to see how we can make them better.

Brian: Maybe the biggest problem that the CDC had came at the beginning of the coronavirus. Let me say that- I mean by that the biggest problem not related to

politicization by the White House, they bungled the early testing rollout. They distributed this test that was supposed to be used around the country to help contain the virus before it really got out in the land and the test didn't work. Did that have anything to do with politics?

Andy: Only loosely. You can argue that one of the things that President Trump did was he shut down a bunch of our intelligence offices overseas, including dramatic reductions in China and other places. He also-- A number of people left the CDC, a number of good people left. You could say indirectly that that happened because of Trump, but that's, I don't think that gets them fully off the hook.

They made a number of mistakes. One of which you described was a really critical mistake, but almost bigger mistake was that we had early on and we'll go into this in the book, in Preventable. We had people around the country, labs around the country who were volunteering to roll out their own tests and we would've gotten tests out much more rapidly. This is what they did in South Korea and the CDC decided no, it was only going to use its own test and the FDA decided only the CDC tests would be approved.

Yes, there was a mistake in that test, but the other problem was that they put all their eggs in one basket, instead of saying every lab in the country, go ahead and create a test, which they eventually ended up doing. If they had done that from the start, they would have had a shot to contain this. They didn't know how to operate in a time of crisis. They were operating as if things were just going on normally. That's bad leadership. That's a mistake.

Brian: If you're just joining us, listeners, this is issue 30 in our 30 issues in 30 days election series, we did it, or we will have done it at the end of the segment. Issue 30, politics and the CDC, how to de-politicize the Centers for Disease Control and other federal health agencies, and also make them as effective as possible with the next wave of the pandemic rising.

My guest is Andy Slavitt, who was the administrator of the Centers for Medicare and Medicaid Services under President Obama. He has hosted the podcast In The Bubble and author of the forthcoming book Preventable, the inside story of how leadership, failures, politics, and selfishness doomed the US coronavirus response.

If you have any questions for Andy Slavitt based on his experience or yours, (646) 435-7280, (646) 435-7280. Let me play a couple of clips. Here is Joe Biden on the matter of vaccines in an exchange with ABC News congressional correspondent, Mary Bruce, last month.

Joe Biden: Trust trust the scientists. It's one thing for Donald Trump to say the vaccine is safe. Okay. Then give it to the board of scientists. Have total transparency so independent operators and scientists and companies go out and take a look at it. What did you base that decision on? What did you do? Did you pressure the head of the FDA? Did you pressure whomever?

I'm not saying he would or will, but that's what has to happen. You know yourself you  

all know the polls better than I do. The American people right now don't trust what the President says about things relating to science.

Mary Bruce: If the scientists say a vaccine under the President's watch is safe and effective you will take it?

Biden: Absolutely. Do it. Yes. Those three questions I laid out can be answered, yes. Absolutely.

Brian: Joe Biden with Mary Bruce from ABC in September, and I guess we should say that here we sit four days before election day, Andy, and no vaccine. The President really wanted to be able to have a big October surprise, or maybe we'll still get it as an extremely early November surprise but at this point I doubt it. Is this a result of independence from the CDC and the FDA standing up and saying, no, this is not ready so you can't say it's ready and he was trying to or is there any political dynamic or assertion of independence by the science agencies that you can attribute this to?

Andy: Well, number one, they didn't receive an application and the reason they didn't receive an application is because the vaccine data wasn't ready. The reason that Trump's statement was absurd is not because we don't want a vaccine as early as possible, it's because you can't set a time and say, we're going to do it on this date. What has to happen is there's 30,000 people that have been given the vaccine or a placebo, and they have to be exposed. There has to be enough exposure to COVID-19 for you to have enough data.

That doesn't happen on a magical date, that happens based upon when those 30,000 people get their exposure. Then by the way, if they get their exposure and there is some sort of event and a safety event, or some other thing, they have to stop and look at it.

What was offensive to people was that a politician who is not evaluating all of those ins and outs was saying we'll have it by a certain date. I think Joe Biden's right. If it happens October 25th or November 1st, November 2nd, if that was the right decision, if the data's ready, that's far more important than politics. I think Joe Biden would have said, "Great, let's do that."

The fact is, we're probably towards the end of November before we have the first application best case, I think we'll probably have one, maybe two applications in by then. Then the FDA did, to their credit, resist Trump's efforts to politicize the decision by saying we are going to be very, very stringent about our decision-making and the reason is, Brian, if I can say this, there is a huge asset that we have that we can't squander, and that's called trust in vaccines. If you have a vaccine that works a hundred percent, well, but nobody takes it, it doesn't matter. The process is as important as anything else.

Brian: Let's take a phone call from a caller who I think is a Trump supporter with a question from a Trump perspective that I was going to ask you anyway, let's let the caller do it if he does it. Andy Anastoria, you're on WNYC with Andy Slavitt. Andy,

meet Andy, thank you for calling in.

Anastoria: Hi, Brian. I love your show, a long time listener, first-time caller. It's not that I'm a Trump supporter, but what I got to say is that this is the biggest lie the left has ever pushed to us, because my job makes me talk to a lot of doctors. I've talked to a lot of pulmonologists and infectious disease specialists. This virus cannot be controlled, stop lying and telling people you can control this virus.

The only thing you can do is minimize the spread, but you cannot control. You cannot eradicate this virus. Europe is the biggest example. They took the drastic measures out there and see what happened. You cannot control this virus. Stop telling people we can control this virus.

Brian: What's the difference as you use the words, Andy, between control and minimize the spread? When you're trying to control the virus, isn't that what you're trying to do? Minimize the spread? [crosstalk] Let me ask the caller. Andy, the caller, go ahead.

Anastoria: Sorry. Well, you got to put that in perspective because the government is not only the department of health. The government is department of agriculture, of the economy, so we've got to put that into perspective. Yes. We got to take some drastic measures, but are those measures worse than the cure? Are we going to kill the economy or are we going to kill whatever we've worked for so far just to minimize the spread of a disease that is going to end up spreading anyhow in my view?

Brian: I got you. Please call us again. Thank you very much for this call. Really that question, Andy Slavitt goes, he took it to the second level at the end. It's not that you can't control the virus, it's that the economic pain and other kinds of ill effects from controlling the virus with hard lockdowns might be worse than the disease.

We've been debating that on the show day after day for months, but he cites Europe as an example. Here we are with, as you know, Europe rising ahead of the United States now. We're probably a few weeks behind them like we were in the spring and hard lockdowns coming in France, more of a lockdown than Germany had previously, I believe, and other countries in Europe and they don't have Donald Trump.

Andy: It's a very fair question. It's very fair debate and good for the caller, Andy, and good for you for having a forum for that. Let's look at the facts. Where he's right is COVID-19 cannot be eradicated. Can't be eradicated with the tools we have today, but it can be controlled.

Let me point-- He points to Europe, let me point to Africa. Africa has no stranger to infectious diseases, loses hundreds of thousands of people to infectious diseases all the time. This particular infectious disease- there's 1.3 billion people in Africa, 35,000 deaths. Look at Hong Kong, which is the closest neighbor to China, has the most cross border traffic with China. There's been about a hundred deaths.

The question is why? The answer has a lot to do with people's experience controlling diseases like this. This is not a particularly complex disease with all respect to the

pulmonologists that Andy talked to. This is not a hard disease to control the spread of. It requires behavior change and that's not easy, but it's all about not breathing near one another. It's a respiratory disease.

When we thought it spread a lot through things people touched, it was much more complex. It's not. You wear a mask like people slept on in Hong Kong right away. You don't breathe near one another and you don't spread it. I don't think there's very much question left about the science of reducing the spread. There's a lot of questions about the sociology, about people in the US having supposedly COVID fatigue, about people who just want to live their lives, creating alternate theories.

The truth is that the deaths are being concentrated among the working-class population. They're happening rapidly and more rapidly and they're not happening with people who have the privilege of being able to seclude themselves. They're only spreading the virus. A little bit of empathy and understanding into those communities would help people say, "Wait a minute, I can change my behavior a little bit." It can make an enormous difference. You absolutely can control the spread and reduce the spread, it's being done all over the world.

Brian: Last question, real quick, we just have a minute left then we're going to have the news and our weekly Ask the Mayor segment, folks, Mayor Bill de Blasio, there's news on schools and the virus and other things. A five-second clip of Jared Kushner back in April, talking about a federal stockpile that people were pushing for masks, for healthcare workers and other PPE, five seconds of Jared Kushner.

Jared Kushner: The notion of the federal stockpile was it's supposed to be our stockpile. It's not supposed to be states' stockpiles that they then use.

Brian: It's supposed to be state stockpiles and that's been a centerpiece of Trump administration policy trying to say, this is the state's responsibility, not the federal government. In 30 seconds, Biden comes in and changes that, how much can it become a federal response in a way that it isn't now, how much of that is even realistic to expect?

Andy: It needs to be a partnership. What the Trump administration did is they did something called the state authority handoff is what they called it, where they believe they could wash their hands and the task force. Which won is a President who says, I'm not going to sleep at night as long as people are dying from this. As long as people don't have PPE, as long as we don't have the things we need in the country, and then works hand in hand in accountability with the states and local officials, because you want a federal government that sets the guideline, procures the materials, makes things easier so states aren't bidding against one another and then let states apply stuff locally. I think that's the right model. I think that's what Joe Biden would do if he were to become President.

Brian: That is our 30 issues in 30 days election series for this year, issue 30, politics and the CDC. We thank Andy Slavitt, former Administrator of the Centers for Medicare and Medicaid Services, author of the forthcoming book Preventable, the

inside story of how leadership, failures, politics, and selfishness doom the US coronavirus response. He hosts a podcast called In The Bubble. Andy, thank you so much. I hope you'll keep coming on with us.

Andy: Of course. Thank you.

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