Transcript

SPEAKERS

Andy Slavitt, Dr. Ashish Jha

Andy Slavitt  00:41

Welcome to IN THE BUBBLE. This is your host, Andy Slavitt. That voice you just heard was a voice that you hear also often, It’s Ashish Jha. Ashish Jha, who is really, you know, he’s sort of becoming America’s commentator on COVID. And I’ll get to that in a minute. What I want to say is I found very interesting talking to Ashish Jha that he does a lot of Newsmax, Newsmax. I’ve never been on Newsmax. I don’t mean that just that I’ve never been on the channel. I’ve never listened, never watched. So I think it’s kind of interesting. But he is a demeanor Ashish. That I think is it’s really interesting that they would invite him on and invite him on continuously. And as he talks about he has relatives, or relations or people, I don’t know how you say it, like, these are my relations. These are my relatives. These are my people, they’re in laws. They are whatever, they live in a rural Ohio, and they are not vaccinated, and they are not supporters of Joe Biden in the least. I don’t know if he’s a supporter of Joe Biden, I suspect he probably is. Why do I think that?

Andy Slavitt  02:50

I just think he didn’t like Donald Trump very much. But they’re Trump supporters. So he’s on Newsmax. he’s a jolly old fellow. He’s the head of a school of public health at an Ivy League school. I mean, he’s about as elite as you could get. I mean, really, but like he’s on Newsmax, and he is on these conversations with his family in Ohio. Why? Cuz he’s super approachable. And it’s like, boy, you really love to disagree with the person until you kind of go well, this is a pretty good person. And I think the way he does things is interesting because he doesn’t give any ground. Now he doesn’t acknowledge that the people in Newsmax have the right point of view. He does acknowledge that it does boil his blood sometimes to hear some of the […] things they’re saying. But then he goes, and he answers at the very reasonable tone. It’s sort of like that teacher you had in school who like you could piss them off, and they just would never act pissed off.

Andy Slavitt

There’s a skill to that. So we thought it would be great to have back on the show. He was on the air before. He talked a lot about testing. He talked a lot about many things. And then he invited us all over to his house for the Fourth of July last year. So we’re going to talk about that. We’re going to talk about testing. We’re going to talk about the challenges of communicating with people who disagree with you. It’s a good conversation. It gets pretty loose. And I apologize if my teasing of him in any way, offended him. I did talk to him the next day, and he was laughing He had a good time, and help you know that it’s all in fun. But you have to do it for yourself. Let’s go Let’s go listen to Ashish Jha.

Andy Slavitt  04:54

I think there’s a truism in the pandemic that it’s not an official story until there’s a comment from Ashish Jha. How many reporters do you talk to in a day?

Dr. Ashish Jha 

Well, fewer than I used to but I probably still do five to seven a day.

Andy Slavitt 

Is that a mix of print and TV?

Dr. Ashish Jha

Yeah, probably three to four TV and then really cut back on it. I just part of it is, well, part of is I have a day job, but part of it is that, you know, there are a lot of other very good commentators, and there’s a lot of good voices that need to be heard. And I feel like, I do feel like I’m a little overexposed. Like, I do feel like I don’t know that everybody needs to keep hearing from me. And plus, I’m doing in lots of other media so..

Andy Slavitt 

Well, it’s also like, don’t really have to have an opinion on everything. I mean, there’s what do you think of Dr. Walensky saying disagreeing with it’s like, you know, that everything warrants spent, but don’t you feel like sometimes just takes a lot of energy to like, have some authoritative you?

Dr. Ashish Jha 

Absolutely. And what’s, what is funny about this, is that the pandemic has become a little bit of the way I’ve watched elections, right? Like, every day is a cycle and you just like, there’s kind of who’s up who’s down, boosters, in boosters out and everybody commenting, I don’t know that that’s the most useful way to be responding to and managing a pandemic. It almost it. I think it distracts people from the bigger picture of what we’re trying to accomplish. And I find it hard to constantly be in the moment and not really have opportunities in the same way to walk people through the big picture of where we are and where we’re trying to go.

Andy Slavitt  06:33

Right. You make a really great point. I mean, the mood is so influenced like I once was, I said this in the White House, was like, when the number of cases are dropping, people are gonna think we’re just geniuses. And briefcases is going up. People gonna think we’re failing. Because it’s almost like the stock market. It’s such a mood influencer. And we overdo it. […] Cases are dropping now we’re gaining, out of cases, you know, keep going up there, you know, things are disaster. And the truth is that psychology is such a big part of this pandemic.

Dr. Ashish Jha

And the problem with the ups and downs and kind of stock market approach to the pandemic, is, you know, people often say the stock market is not the economy. And daily cases up and down are not quite the pandemic, like there is a broad arc of this pandemic. And it’s very, very hard to have people see that broad arc. If you’re caught up in the up 10% down 5%, Florida’s up, California is down, right. It’s just it’s not it’s important, understand that just as important understand what happened with the stock market today. But to not confuse it for the economy, or in this case, not confused it for the state of public health in America.

Andy Slavitt 

I think you do a good job providing that perspective, it is that you’re overexposed. But there’s a reason why people come to you over and over again. And look, there are other people that the media reaches out to who stock and trade is edginess. coachability playing into the daily narrative, that’s not yours. And like even some, I think, very distinguished heads of public health, schools and epidemiologists, etc. They like have a brand of being, you know, super gloom and doom or super they are super that I would describe you if I were, you know, given a couple words tribe, I would describe you as balanced, thoughtful, cogent. What gives me and that is so anti-society.

Dr. Ashish Jha  08:38

What am I trying to do here? Well, first of all, thank you. Second, obviously, that is high, high praise, particularly coming from you, Andy. But I really try to think about this, as you know, what am I trying to communicate to my mom, who’s really smart and not in healthcare, not a public health person. And you know, like, when I think about that, or other family or friends, like she wants the real deal, she doesn’t want to be frightened unnecessarily. She doesn’t want excessively rosy optimism. But she wants like the real deal, but in a way that helps her understand the bigger picture. Whether it’s my mom, friends, family, that’s what I’m trying to go for. The other part of it I think, is I don’t I try not to overthink how people. Like I don’t try to use it as a way to try to influence behavior in certain way. Like I don’t try to be like, Okay, if I’m a little extra dark, it’ll get people to be a bit more careful. I don’t know that I did, partly because I don’t feel like I’d be all that good at that. I think I’d screw it up. So I think I’ll just give it straight.

Andy Slavitt 

So I think what you’re saying is, you’re running for governor?

Dr. Ashish Jha

Not in this state, not, well, I mean, I live in Massachusetts and no, though is interesting, right? A lot of public health people have run for governor. I mean, we had gone. We did a good job.

Andy Slavitt  10:11

So I was joking. But now I actually think you might be interested in politics.

Dr. Ashish Jha 

I’m not, I’m good. I like my job. I like being an academic.

Andy Slavitt 

There’s the thing about that question. It’s, it’s impossible to deny it. Right? Because you’re like, no, I’m not running for governor. He’s running for governor. That’s exactly what you say what you’re not when you’re running for governor. So I think the news headlines coming out of this, I can feel it already. Reporters are gonna be like, Ashish Jha going on TV all the time. Now we know what his plan was. Of course he’s running for governor. Why would he be so reasonable and likable and thoughtful and cogent? If he wasn’t running for governor? Can I draft you; can we convince you? I mean, first of all, like, the job of Governor over the last year and a half, let’s acknowledge, has been very hard. No, no winning, no winning, but people trying hard. Seeking your advice? Do you find that, you know, you’ve been able to get through to and communicate to people who are looking for answers in these kinds of situations?

Dr. Ashish Jha 

Yeah. And this is a place where I think a lot of people who don’t spend their time talking to political leaders, I think, misunderstand, I think most governors I have interacted with. And I know you’ve spent a lot of time talking to many, many of our nation’s public leaders. They’re trying to get the answer right. Now they have constraints, they have their worldviews, they also have constituencies, you know, but I think they hear me out. The ones that I’ve talked to, they hear me out. They sometimes do what I suggest, they sometimes don’t. Which is fine, by the way, because again, they’re trying to balance many things. And most of them keep calling with some frequency to get input on things. And I’ve always said, You know, I am not accountable to anyone. I’m a public health guy, I guess I’m accountable to my university president who could fire me. But other than that, I am not accountable to the public. But these people are, and so they have a different set of responsibilities. And I think we should be cutting them a lot more slack than we have. It’s very easy on Twitter to be like, you know, Governor, so and so is killing people. There are things to go for some governors do that I find really, really problematic. But mostly I’ve become much more sympathetic to the difficulties of their topic.

Andy Slavitt  12:30

Once again, sounding reasonable. There you go again, well, yeah, no, I tried to do is I tried to distinguish. And I did try to do this in the book I wrote, between what I consider to be honest mistakes with people with the best of intentions acting on the information they have, and people who were not acting in good faith and making good faith decisions. I put Donald Trump in that category, very simply because he knew for a long time that the pandemic was here, and he failed to warn the public to me, lots of things are forgivable. But when identifying the things that forgivable, it also helped me to see the things that actually didn’t think we should ever excuse. Yeah. And that thing is straight with the public. And putting people in danger to me is number one, two and three.

Dr. Ashish Jha

Yeah. And it also actually raises a really important question that I have been struggling with a little bit, which is the scientific leaders who stood next to President Trump. How do we, how do we evaluate them? How do we understand them? How do we judge them in their behavior? And you could ask questions about, you know, Tony Fauci stood next to President Trump for much of the pandemic. I think he handled himself with distinction. And I again, I’m not going to go around slamming others. But I think the point is that those are very difficult positions you are, you can walk away, or you can stay, but it’s not totally straightforward. And we need to have a set of principles for how to evaluate those behaviors. I do like I have a mental model in my mind of how I have thought about the folks who enabled or where they are next or President Trump, but I don’t believe everybody acted with distinction, but a couple of people did.

Andy Slavitt  14:07

You know, look of all the red teaming we did about pandemics and preparedness. The one thing we didn’t count on, in any scenario planning was having a leader who just wanted it to go away and wash his hands of all accountability. And that’s a very difficult factor to try to overcome under any circumstances.

Dr. Ashish Jha 

Yeah. And the other part, you know, and he thought a lot about the fact that so end of last end of January 2020, late January, I wrote a piece I discussed this with the last time we were on together. I wrote a piece in Health Affairs is January 29 2020, in which I talked about the coronavirus pandemic that was coming. And I was pretty optimistic about how America was going to do and not because I thought we had a great presidential leader who was going to lead us on, but I had more faith in the ability of our people. Look, health agencies, CDC and FDA. And I also thought that there’ll be more accountability from Governor said, If even if the federal government failed, that governors would not tolerate 10s of 1000s of people dying in their states. And that there would be this pushback. And I’ve obviously had to do a lot of rethinking about my mental models from two years ago. But one of them is it was there were multiple failures, you know, and many of which you’ve talked about and written about, but there were multiple failures that happened. Donald Trump was the most egregious of them. But the rest of our system didn’t quite function and couldn’t make up for it couldn’t make up for it. That was the part of problem.

Andy Slavitt

Well, you know, what, I think we, what I got wrong, big time was, you know, a virus can be dangerous. But it’s only enabled by a public and the public’s attitude towards the virus, without being able to replicate and go places, the virus is pretty powerless. And I had, I think, naively believed that people would be able to would be willing to take on small inconveniences to save other people’s lives, even if they didn’t know them. Yeah. And that turned out to have to be true for more a large percentage of the population. And, of course, it shouldn’t be surprising, you know, an election, you can win with 51% of the vote, or less than 50%, actually, within the Toro college. And some things you could win with two thirds. But a fast-growing pandemic, you can’t win with even three quarters. You need most people and the fact that we have a sizable minority of people, to whom I think once they felt reasonably personally safe. We’re unwilling to, again, do even modest things, take a test, put on a mask get vaccinated. You could take any, I don’t care the virulence of the virus, you put it against a population like we have. And we made it more dangerous.

Dr. Ashish Jha  17:35

So let me actually, I’m not sure if I’m going to push back, but I’d let me take a bit of a different view on this as well.

Andy Slavitt 

Please do and look, I mean, just in terms of pushing back, demonstrating that we can disagree with one another. And that being a personal thing, is a great thing to model because we sort of equate now, any disagreement without war. It’s just differences in views. Obviously, people know I’m right, and you’re wrong, that’s just gonna be the way it is.

Dr. Ashish Jha  18:06

And yet, you’re willing to have me here and I’m grateful, despite my wrong views. Look, I think about I think about my wife’s family. So my wife is from Ohio, from rural Ohio. And she’s got family who I’ve met multiple times, and this is more extended family, cousins, and just wonderful people like lovely human beings who care deeply about each other care about their community. Almost all of them voted for Donald Trump in 2016, and voted for Donald Trump in 2020. Think that the election was stolen from him in 2020. And believe very strongly that this virus got played up by the media to bring down Donald Trump. And that, yeah, it’s there. But you know, it’s like, marginally worse than the cold. And the people who’ve gotten sick from this, and are all people who haven’t taken good care of themselves, who are all people who are obese people who have other health problems. And, and so they look at me, they see me on TV, and they think he’s such a nice guy. And we know that he doesn’t seem like kind of a dishonest, we’ve known for a long time. And they’re confused by me. And they’re perplexed that I would make it as big a deal as I would. And so they’re not selfish. They are in this information ecosystem that they live in. That is radically different from mine.

Andy Slavitt 

And if they didn’t know you, they would say in his in his self-interest. Because he’s a public health person to play this up.

Dr. Ashish Jha 

Yep. And so they find me a little perplexing, right, because they know me well enough to know that I wouldn’t do this out of some fame or glory and I find them perplexing because They know that they’re really good people. And I can’t believe that they’re not willing to do things that I know would make an enormous difference. And therein lies, at least part of our national challenge is that where I think we could have come together in ways and I don’t know, maybe I’m being naive about 20 years ago would have been different. It just feels like we’re in a time period where neither of us understand each other.

Andy Slavitt  20:25

So you know, it’s interesting, I talked to Hugh Hewitt about this, the conservative commentator and other conservatives when I was in the White House, I spent a lot of time calling conservatives, talking to conservatives to try to just understand exactly what you’re talking about in your in-laws, community. And he said to me, conservatives are getting this understandable rap as people who don’t care about their neighbors, and the community at large. And it’s frustrating, because we all know that these are some of the most tight knit communities there are. And people would bleed for one another. Yeah. But he’s like, what I don’t get. And I’ll put this in your relative’s terms, as you know, I may have an opinion. But you know, Ashish kind of studied this topic for a little longer than I have. So it’s like when I when I go to the doctor, and the doctors, like, I think you may have cancer cells. And we might need a little bit of surgery or a little bit of radiation, you know, no, I don’t think so. I’m just as smart as you are. And I discount all of your experience. It’s kind of like a very broken part, at a time when you really do need to rely on experts. Yeah. And here’s the thing, Ashish is like, a virus is something that defies what we see with the naked eye. If this were a hurricane, we just turn on TV, you see the red sky, you see the winds, you see the downed trees, you see the water line up. But this is something you look outside; it looks the same. Yeah. And in those situations, you have to decide whether if you don’t rely on experts, you’re going to confuse yourself.

Dr. Ashish Jha  22:12

Absolutely, absolutely. And this is one of the challenges of this right is, and actually and part of this virus makes it that much more susceptible, is you know, a friend of mine said early on, it’s bad enough, it’s very bad enough that if you don’t manage it, you’re going to destroy your health system and have millions of people die. But it’s not so virulent, that you can’t deny your way out of it. That the mortality rate is low enough that lots of people say, oh, I had, it was fine. I know for people who had it, that’s fine. And that’s all true, right? So if the mortality rate for this thing was 10%, or 15%, it would be much, much harder to go around denying experience. Yep. And if the mortality rate was 1/10 of what it is, it probably wouldn’t be a big deal. We manage our way through it. It’s in that sweet spot of horrible, and yet not so horrible that you can’t deny it.

Andy Slavitt 

Well. Yeah. So I’ve heard people refer to this as the reverse Goldilocks syndrome. And I believed that and I no longer do. Because I think we’re willing to tolerate pretty much anything. We’re willing to tolerate school shootings, little kids getting shot. Yeah, we’re willing to tolerate. I don’t think there’s any evidence that there’s a point at this reaches other than personal threat. And quite frankly, even in occasions where people are losing personal family members, yeah. where people are willing to admit that they should be seeing things differently. And I think it’s because there’s a lot of reasons. But I can tell you this from talking to world leaders around the world about the differences, what they’re seeing, and we’re seeing in the US is they have the same arguments, as the vaccines effective are they not? Should you wear masks, should they not? The difference is that they those tend to be arguments that are more a little more understandable. They’re on their merits. People are exhausted, etc. Here, the big difference is that it’s a matter of identity. And as you know, she’s when you’re talking to someone about an opinion, or a point of view, that’s not deeply held. It’s one thing but if you’re talking to somebody about something where my identity is, I don’t wear a mask. My identity is this, then that even as facts change, even as now kids are getting hospitalized. apps are changing people’s point of view. I no longer I’m so sure that this reverse called the lacks theory is what holds

Dr. Ashish Jha  24:47

interesting. Look, you make a very compelling case and no part of me wants to hope and believe that you’re wrong, you know, that I can hack into that. It is the identity issue is interesting. So you know, I, you know, do a lot of media. And what I say to my team is, there’s one new station to actually two channels that I will always, always say yes to, and I pretty much do. And those are Newsmax and Fox News. And I’ve been doing Newsmax maybe two to three times a week, almost always my most challenging interviews, just the way that they frame the questions, etc. But one of the things that they keep bringing me back on, it’s very interesting why they do it and what the questions are. But one of things I keep driving home, is that I’ve been trying to disentangle or break the link between being a Trump supporter and not getting a vaccine. Because I feel like that is a very bad place for us to be because the moment you make the claim that it’s the Trump voters, the Trump counties, the Trump states, basically what you’ve said to people, as people like you, people whose beliefs you believe in people who you like and not part of your team, they don’t get vaccinated, right? And then you say, and would you like, what if we gave you like free shots for a free shot? Like No, no, you once you’ve tied it to identity, it is so powerful, that the level of intervention you need to move those people is really very profound.

Andy Slavitt  26:19

I so agree with you. shaming people, first of all, I don’t think it works anyway. Yeah, but trenching this notion that it’s part of people’s identity is really bad. So tell me more about being a Newsmax. Let’s talk about that. What’s that like?

Dr. Ashish Jha 

As you said, it’s hard. And it’s hard for two reason I’m not this is not for sympathy, my god.

Andy Slavitt 

No, no, no, no, I actually really respect this challenge. And it’s a great challenge countries. And I bet people are really tuned in to try to understand how you think about this. And by the way, it’s God’s work. And I’m so grateful that you do.

Dr. Ashish Jha 

So you know, it’s interesting, right? Like you’ve been on TV, lots and lots of times, you’d log in 510 minutes before you usually catch the segment prior and right, and so you get to hear it. And so when I log in, I will get to hear the prior segment. And it always shifts my mood, because it’s often things that are really outside of my worldview of how I think things work. And you know, and it’ll be something about the election and the January 6, and it’s just a reminder that I’m in an information zone where people are thinking about things very, very differently. And, you know, and a lot of the around pandemic stuff is really targeting Dr. Fauci who, Tony Fauci I’ve known since I was a senior medical resident at UCSF, and he came by and he and I spent time together, I’ve known him for 20 plus years, and he’s always been a hero. So I show up to Newsmax at, you know, my 7:35 hit time. And I log in at 7:30. And I’m hearing something about how awful he is and how he did. So that’s sort of the first kind of dissonance right? before I’ve even gotten on.

Andy Slavitt 

How do you get not triggered? Or do you trigger?

Dr. Ashish Jha  28:00

The way I look at it, is, first of all, this is their platform. And if they’re willing to have me on, I gotta show up, and I got to be respectful. And I got to deal with it. I got to deal with my emotions. And if I show up, and the first thing I say is that last segment was a disaster. Yeah, they’re not calling me back. And I understand that maybe that’ll make me feel good. But I don’t think that that’s advances my agenda. Sure. And my agenda is I want to, I want to speak the truth, as I understand it to as broad a group of people as I can reach, that’s my agenda. You know, and then, and then the conversation started. And now I’ve done it enough times, and with the same anchors that we’ve gotten pretty friendly, and they’ll start and so like, a week ago, you know, they were 10 days ago, they showed a clip of Governor DeSantis as the beginning part, they said, you know, now to talk more about the pandemic, we have Dr. Ashish Jha, blah, blah, blah. dr. john, welcome. I want to start with a with a clip from Governor DeSantis.

Dr. Ashish Jha 

And like, Okay, and then they have, you know, Ron DeSantis and he’s there, and he says, you know, we don’t want federal bureaucrats telling parents how to raise kids. We don’t want federal bureaucrats telling parents that they have to mask up their children, sets up the framework. That masking is about Joe Biden telling a mom and a dad in Tallahassee, Florida, how to raise their kids. And then he’ll turn to me and say, don’t you agree that parents should be able to raise their children and not federal bureaucrats? And so usually, when I get asked a question, I try to be very straightforward in answering, framed in that way, that’s a different question to answer. So part of the challenge of being on Newsmax is that I almost always have to flip the framing, right? And so I will often lead an on an answer like that, I’ll say, Look, I’m a dad. I care deeply about having influence about how my kids are raised and how my kids go to school. But there are in fact, constraints on that freedom. I can’t send my kids to school, if they’re not vaccinated. That’s not a federal bureaucrat telling me, that’s Public Health people in my community telling me that that’s how we keep other kids safe. And by the way, I’m glad because then those other kids are also showing up vaccinated, and that protects my children. So we have a community relationship and a community responsibility. I don’t see this bureaucrats versus parents, I see it as all of us taking care of each other. But you have to begin by reframing.

Andy Slavitt  30:20

That’s very skillful. I mean, it’s obviously what you believe. I don’t want to play that it’s not but it’s also a quite an adept way of responding to what’s clearly a loaded question. And what kind of reaction do you get when you do that?

Dr. Ashish Jha 

They’re good, they’re good. And you know, they’re, and they roll with it. And it’s interesting to me, as I said, that they are willing to keep having me on. And I enjoy it. By the way, I mean, as I said, it’s hard, but I don’t think of it as like, painful. Like Rob Finnerty, the person who probably does most of these interviews, you know, I follow him on social media, you know, pretty different views on lots of things. But he’s always respectful. He throws in a couple of questions about the Red Sox. It’s a very kind of lively set of conversations. And I get to make my points and I understand that they don’t necessarily agree with it, but I think it’s helpful for them to hear it and they’re willing to have me back on and I’m delighted to do it.

Dr. Ashish Jha 

Have you ever done Tucker?

Dr. Ashish Jha 

Never done Tucker, I would do Tucker?

Andy Slavitt 

Would you do Tucker?

Dr. Ashish Jha 

I would. I would. And people, there are even people who push back on me on Newsmax with the like, why are you legitimizing? I don’t know what that means. Like Newsmax is a thing. And there are people who listen to it, and those are Americans, and they have views and there are people I care about. And my job is to go and I think it legitimizing something. It would be if I showed up and said things that I didn’t believe in, but were somehow harmful.

Andy Slavitt 

Even acknowledged his points in the interest of being persuasive. That’s where you get challenging. Like, it’s if it’s like, you know, well, I could see your point about why federal bureaucrats you know, that that gets to be a little bit of a danger zone. Yeah. But it’s all of you say what you believe respectfully, people like that. I will tell you, one of the things that you know, he would his headset banned his radio show that he suggested, and I did, and I’ve since done this frequently, is that I appear with a Republican. Yeah. And that we model our agreement. So I will do a lot of things with either Scott Gottlieb or Mark McClellan. Yeah, both frequently. And he said, the feedback he gets from his audience, I don’t know if it’s the same type of audiences, the Newsmax audiences slightly different, because I don’t know the niche Enos of that world, but I think it’s pretty similar. Is he said, when people hear you and Mark agreeing, or even disagreeing, but in a respectful way, he said, it’s really, really calming to people, because they are also getting the message that this doesn’t have to be a fight.

Dr. Ashish Jha 

It’s really important for a couple of reasons. One is obviously we’re a very fractured country, and we need to start repairing those fractures. But one of the things that’s most painful to me, Andy, and I, you know, I’m sure you have seen your fair share of this. But you know, it’s a lot of people email and DM me with questions, most of which I don’t answer. And that’s just because, A, I can’t, B, I don’t want to get into answering people’s kind of individuals situation, because I feel like it’s complex. And I’m not going to get, but a lot of those questions begin with a version of, I’m fully vaccinated, my spouse is fully vaccinated we have young kids, we always get together with my brother and sister-in-law or whatever. None of them are vaccinated, or our summer vacations coming up, we always every year have gotten together. I don’t know that I feel comfortable going and spending a week in a cabin with my unvaccinated members of my family. What would you do? The point of that it’s not a public health question or a medical question.

Dr. Ashish Jha  34:05

It’s like a deeply personal question, right? And the point is that the fracturing is like within families. And that is the most painful and awful part of the fact that we live in these very different information ecosystems, these very different worlds, that people who clearly love each other who clearly care about each other, see the world so incredibly differently, that one is willing to put in the other’s eyes, them and their family at risk. And while the other I’m sure doesn’t feel that way. So part of modeling disagreement is that it gives us a path forward to start having these kinds of conversations and families. I think that’s probably a big part of why you have that effect, is people can calm down and say, Oh, yeah, there is a way forward on this. There’s a way for us to disagree and move forward. I think that’s the hardest part of where we are in this country. It’s all the intra family stuff.

Andy Slavitt 

I noted how you introduced your wife’s family, to talk to you about them. And the first thing you said was how much you care about them and how they’re good people. And I really want to take note of this, and I want to model it myself. And I want other people to think about it, which is, the pandemic stage of this will end when COVID will be here, but the pandemic stage will end, your relationships either will or won’t be intact, we may have some repair work to do. But telling someone hey, guess what, I love you and I respect you. And we, we would maybe disagree with about this. But let’s make this disagreement temporal, not game changing, or relationship changing. I still think you’re a good person. And, you know, because I could hear when you were saying this people in the back of their mind someone going, well, how could they be good people if they’re not willing to vaccinate themselves for others? And it’s really tempting for us to take that next leap. Right? And say, thing I don’t agree with, the important or not important, okay. Important. Important in fact, other people? Yes, if we don’t go to people, they can’t be good people. And so it’s easy to see how you can get into that trap, and are thinking about when I would tell people that I have said this on the show, we’ve talked about this a fair amount is breaking out relationships aren’t worth it. They’re probably extreme cases. And we all get frustrated. But I could tell you ain’t none of us been 100% right

Dr. Ashish Jha  36:31

No, my goodness, no.

Andy Slavitt 

Let’s talk about testing. It’s something that often gets forgotten, not by you. But as a mainstream topic. I mean, once we had vaccines, I like to say, we went from having Swiss cheese, the whole Swiss cheese model to oh, we got a block of cheddar. Yeah. Now, so we don’t have to worry about all this other stuff. Turns out, lo and behold, there’s even some holes in the cheddar. So we’re gonna come back and talk about that in a second. But the role of testing how it evolves, how it should evolve, how it needs to evolve, we’ve got some zealots out there, like Michael Mina has been pushing very, very hard. And want to show you we’ve got a more cautious, conservative approach we’ve always taken, but the reality is our testing needs evolve with the pandemic, the type of testing we need, etc. Help give us a picture, if you can, if you’re willing of where we are now, and what the most important priorities are.

Dr. Ashish Jha 

Yeah. So testing is actually quite complicated at this moment, because we have about half the country vaccinated and the other half the country not vaccinated, a little more than half vaccinated, but you get the notion. So the mental model on testing a year ago, which made a ton of sense to me, was like we needed to have widespread availability of testing was a great way to identify people in their early stages of their infection. And then you isolate them. And that’s a great way of preventing spread. And you do it often enough. And there’s some really nice models, including ones that Dr. Walensky worked on, and I certainly Michael Mina, and that stuff works, and it’s great. The question, one of the big questions is, should we be using that same model for vaccinated? And I guess what I would say is at this moment, let’s take the national conversation on testing and really think about it for the two different groups of people we have. So one of the things that President Biden said in his speech from a couple of weeks ago, was he said, you know, for employers, for instance, vaccinate your people or your people or they do weekly testing. I think testing is a really important part of keeping infection levels low and preventing people from going into dangerous places if they’re unvaccinated.

Dr. Ashish Jha  39:16

I think as a tool for dealing with people who are unvaccinated and may continue to be unvaccinated. We want to have testing around in a relatively ubiquitous way. And I do think that rapid antigen testing is going to be the main strategy because PCR is too slow for many things, and it’s a great confirmatory test, but having antigen tests and I’d be delighted if the workplaces were doing them twice a week for all their unvaccinated workers. If you’re not going to mandate vaccines, which I would prefer that they did, but if they’re not going to do it, twice a week antigen testing for unvaccinated people makes a lot of sense. On the vaccinated side, Andy, it’s really complicated. And I’ll tell you why. So at Brown, where I work we were doing Weekly testing of everybody. And we also have a vaccine mandate. So 98% of folks are vaccinated, and we’re doing twice a week for the unvaccinated. But let’s see unvaccinated out for a second. Our undergrads all show up. And guess what? In the first week, we see this huge spike in cases. A whole lot of young people coming in from around the country hanging out with each other haven’t seen each other all summer. Some of them haven’t really seen each other for a year, socialize. And we had like, I think in one week, like 100 or so cases, 90 some out of which were totally asymptomatic. And there is a question of what do you do with that crap. So now we’re isolating everybody.

Andy Slavitt  40:39

Isolated for 10 days and put them in a special dorm.

Dr. Ashish Jha 

Exactly. And all the people that they hung out with haven’t tested? Are they all quarantining? And do we want to be doing rapid or regular PCR testing for this crowd all the time, we actually bumped it up to twice a week testing. And I can’t help but feel like we’re losing the narrative here on what the role of testing is in these situations. I do think there is a role for testing among vaccinated people. Let’s think about a high-risk event. Let’s say you’re going to go have a dinner with 15 people and a few of them are high risk and older people with chronic diseases it everybody’s fascinated by that nice layer of protection if everybody got an antigen test before that, because breakthrough infections do happen, maybe for that 80-year-old who gets a breakthrough infection can end up being really deadly. So there are moments and instances. But this kind of generalized testing for everybody all the time. I’m pretty game for that for the unvaccinated. I don’t know how to understand it, interpret it or act on it. For the vaccinated.

Andy Slavitt

It’s a really, really important in nuanced conversation. And I think it breaks down to how the science actually works, which is, it’s that like, the vaccine is a sunscreen, which prevents the virus from entering your nose, right? It actually wins the battle at the cellular level. So if you stick a swab of someone’s nose, while the vaccine is winning that battle, you may end up finding some virus. The fact that people could be asymptomatic and contagious. Maybe that complicates things a little bit.

Dr. Ashish Jha  42:23

It does. Sort of one question. I’ve gotten a little bit of pushback on this. But one question. So we know, let’s just be very explicit about this. We know among unvaccinated people, asymptomatic contagious, are real thing, a bad thing, very common. It’s actually one of the major problems of this pandemic, right, was that people were spreading asymptomatic. What about asymptomatic contagious among vaccinated people? Far less clear. Maybe? I’m not saying zero, way, way less frequent. Yeah, far less often. So. And my sense is there’s a very, very narrow window for a vaccinated person to be asymptomatic and contagious, and probably contagious enough that they’re going to give it to another vaccinated person. And most of the times when you find a virus in the nose, and with a very sensitive PCR test in a vaccinated person, most of that is during a period where they’re not spreading attires. Right. And this is a challenge. This is why by the way, antigen tests are a bit better, because they’re far less likely to find that virus, and they’re going to find it in that contagious period.

Andy Slavitt 

Yeah, exactly. It’s what is really interesting. And Michael makes this argument, which is, you actually don’t want highly, highly sensitive tests. You want ideally, you want tests that would say, contagious or not contagious are more likely to be contagious. Not likely be contagious, and therefore a less sensitive test that done more frequently, is actually more what the doctor ordered.

Dr. Ashish Jha 

Yeah, and I know, people have made this point on this podcast before but this is the problem of thinking about this pandemic as a medical problem versus a public health problem. And when you think about it as a medical problem, a clinical problem, and as a physician, you know, I totally understand this when I am like in the hospital wards, I’m doing a test, I want a highly sensitive test, because I want to know is this person have this disease, right? And that’s great. And the FDA is there for that. And that’s the job of the FDA is to make sure that my tests are as sensitive as possible. But in a public health crisis, that’s not the thing you necessarily care about most. and public health tests have just a different set of characteristics that you care about. You want them to be cheap, widely available, easy to use, and you’re totally happy to take a hit on the sensitivity. And that’s a mental model that’s still a struggle for our FDA. And I mean, I’ve spoken to the folks at the FDA and sometimes I get frustrated with them and I beat him up more than I should but they are really, really good people. We’re trying to get it right but I don’t think our agencies are well developed to kind of manage that shift. That’s not why they were created. They were created to make sure that the doctor in the office in the hospital had really high-quality tests. And that’s not what we want in a pandemic.

Andy Slavitt  45:14

I think you make the case quite reasonably. It’s really an important distinction. It’s sort of one of those behind-the-scenes kind of decisions, that turns out to be really, really important. A couple more quick things, and then we’ll let you go with, by the way, great appreciation for not only taking the time and explaining things for being you, but also be willing to put up with my ridiculous humor. We do have a new feature we rolling out on the show, we’ve rolled it out recently. And maybe you play along with us on this feature, this feature is called come on people, can we please just move on? And here’s how it works. We try to give ourselves the break of saying, yes, we’ve said things in the past that we learned more about afterwards, such as how the vaccines work, such as whether or not we need masks or not. And then we spend a lot of time obsessing over that person being wrong. And then oftentimes, that person, instead of saying they’re wrong, says, Oh, it’s the scientific process. I actually knew what I knew at the time, and they just self-justify it. And to people to your in laws in Ohio. That’s like, it’s the people watching Newsmax that’s like, arrogance. It’s arrogance. Like, can’t you just say you were wrong? So I think I’m trying to give people permission to put these arguments aside. And to just say, Okay, fine. We were wrong about that, then, let’s use the word wrong. Yeah, but please, can we just move on? So let me ask you, do you think we should keep litigating all past mistakes? Or should we just say, we know what we know now? And let’s just move on?

Dr. Ashish Jha  47:01

Yeah, so obviously, we cannot keep litigating our past mistakes. And here’s the interesting part, right? Which is differentiating the scientific process. I was right, based on the evidence we had, and the evidence changed. Versus Yeah, I just got that wrong. They are different things. So that’s the point you’re making, they are different things. And I’ve often thought about things that I believe now versus let’s say, that are different, what I used to believe. And I’ve asked myself, is this a scientific process? Sometimes it is, and there are other times I just got stuff wrong. And I will just start by saying, I’ve gotten stuff wrong, because the science has changed and the stuff I’ve gotten wrong, because I just got it wrong. And I would like forgiveness on both. And I’d like to move on. Like, the point is, in this pandemic, no one has gotten it right on using either of those two frameworks. And that’s okay. Because we’re all trying to do the right thing and be as and I totally agree with that. And I think I need that I need to make sure I’m doing that for others. Because that’s how we’re going to get through this. And so I appreciate your point. And it’s a really good one, and one that we don’t spend enough time on, which is even if you just screwed up the analysis, so okay, let’s move on.

Andy Slavitt  48:19

Yeah, let’s move on. And we do more we learn more. I mean, it’s September or October 2021. And if we now know that vax you do, you could be vaccinated, and you still kind of sometimes need to wear a mask. Even though we told you before you didn’t. Okay, fine. We were wrong, then. Now we know differently. And you know, what, if we find out differently in the future, then we’re wrong now. Let’s move on. Let’s just try to move on. We’re trying to heal the country, aren’t Ashish one little segment at a time. Finally, what the heck happened Fourth of July, my friend? Tell me about Fourth of July.

Dr. Ashish Jha 

It was great. It was fabulous. Outdoor barbecue, about 25 family and friends. I posted a picture about it on Twitter. And my only big concern was it rained all weekend. So I was like, Is it going to happen is it going to happen? And then literally about three hours before the barbecue, the sun came out. I thought the gods were smiling on us. And I have to say I was feeling pretty good, the Delta wave was starting to get going. I was getting a little nervous the back of my head, but I was feeling really happy that we got there. That was a reprieve and we’ll have more of those reprieves and actually we’re not even have reprieve we’re just going to get to a much better place. But the July 4th barbecue was a success.

Andy Slavitt 

That’s great. Now what we’re referring to here, for folks who didn’t listen to me she’s last year was he was predicting that we wouldn’t be able to get to be together outdoors without masks by Fourth of July, which was I thought a very bold prediction at the time because this before vaccines rolled out. It was before anything and It was very prescient, he was right. What he didn’t say, of course was like July 7, all hell would break loose.

Dr. Ashish Jha  50:06

That’s why I picked July 4, because that precise.

Andy Slavitt 

Turns out he wasn’t wrong. I mean, he was right. Now, next year, Fourth of July, 2022, I have a proposal for you. Every guest that appeared on IN THE BUBBLE, at your house for a barbecue.

Dr. Ashish Jha 

Oh, deal. I should probably want to be by my wife. But forget that, like, let’s just do it.

Andy Slavitt 

Let’s do it.

Dr. Ashish Jha 

Let’s do it. That would be lovely. I would love that.

Andy Slavitt 

Okay.

Dr. Ashish Jha 

Invite them all, and then maybe invite all the listeners.

Dr. Ashish Jha 

You have to look at my backyard, my friend.

Andy Slavitt

Well, Ashish it’s been a great, a great pleasure. As I say, with all sincerity, I do find that you bring the emphasis to confusion, confusing situation when you do comment on it or connect to it. That gives us a reasonable perspective. Sometimes it’s pessimistic, sometimes it’s optimistic. But it’s, I think you said it earlier. It’s never a managed response. And I think that’s such a tonic. I do think that’s why you get invited back on all these shows continuously. I love the fact that Newsmax invites you back. It gives me a half of a point for them, that they’re willing to have someone on to talk about things in a truthful way in they’re not to just try to embarrass you. I wouldn’t go on Tucker, if I were you. I would go on any other Fox show. My advice would be not to go on Tucker, because I don’t think he aims to give people a fair shot. I think he talks over you makes it takes advantage of the fact that you can’t see his face. And he can see yours. And so he uses that to manipulate many faces. But you know what, if anybody can do it, it probably is you.

Dr. Ashish Jha  52:01

Well, I think it’s a principle of public health. And one of the things I remind people, I was speaking to a group of deans of public health schools, that a fundamental principle of public health is no person left behind. Like we do not walk away from people because they we think they’re don’t agree or that they’re lost causes. And I look at people who have been poisoned by the toxic disinformation, and I do not see them as evil or bad people. And my thing is my job as a public health person, is to engage and do it respectfully as we’ve always done in public health, and it’s actually a really important feature of public health, that we don’t walk away and to me, at least, it includes Tucker, and it includes Tucker’s audience. And if Tucker Carlson, were willing to have me on, I would do my best to try to speak openly, kindly and truthfully.

Andy Slavitt 

That’s great. Well, thank you. You’re gentlemen. great service to the country you

Dr. Ashish Jha 

It’s a pleasure. And it’s so fun to be back on. And next July 4th, all the guests will have to figure out what to do with my backyard. But anyway, well work on that later. We got time.

Andy Slavitt 

Well, maybe we’ll pick a different location.

Dr. Ashish Jha 

We’ll pick a little park.

Andy Slavitt 

But you and I are co-hosting. And then we’ll invite we’ll invite all of the prior guests.

Dr. Ashish Jha 

That’ll be awesome. That’ll be awesome. Thank you. Take good care.

Andy Slavitt 

Alright, so let me tell you what’s coming up on the show. Ask me anything with Lisa Fitzpatrick. That’s otherwise known as Dr. Lisa. Enjoy that show. It’ll be great. I’m gonna call in a disguise voice. Okay. So if don’t let on that. It’s nice when you listen. Also Larry Brilliant. Also, Stéphane Bancel, the CEO of Moderna, very cool. Only here, folks, only here. Do you get that? Both a combination of that quality of guests and that kind of humor? All one place. Take care.

CREDITS

Thanks for listening to IN THE BUBBLE. Hope you rate us highly. We’re a production of Lemonada Media. Kryssy Pease and Alex McOwen produced the show. Our mix is by Ivan Kuraev. Jessica Cordova Kramer and Stephanie Wittels Wachs still rule our lives and executive produced the show. And our theme was composed by Dan Molad and Oliver Hill, and additional music by Ivan Kuraev. You can find out more about our show on social media at @LemonadaMedia. And you can find me at @ASlavitt on Twitter or at @AndySlavitt on Instagram. If you like what you heard today, most importantly, please tell your friends to come listen and please stay safe, share some joy and we will get through this together.