Getting Kids Vaccinated (with Richard Besser)

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Andy begins with the big news: a vaccine for kids seems imminent. He breaks down the FDA vaccine advisory committee’s vote recommending authorization of the Pfizer vaccine, and outlines the next steps to get shots for 5-11 year-olds as soon as possible. Then, he calls up Dr. Richard Besser, President and CEO of the Robert Wood Johnson Foundation. They discuss what our response to COVID could mean for future public health crises and how we come back from the entrenched, tribalistic camps we find ourselves in today. Plus, the lessons we should be taking away from the death of General Colin Powell.

Keep up with Andy on Twitter @ASlavitt and Instagram @andyslavitt.

Follow Rich @DrRichBesser on Twitter.

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Andy Slavitt, Richard Besser

Andy Slavitt  00:10

Welcome to IN THE BUBBLE. This is your host, Andy Slavitt. With the message you just heard, we are now rolling towards giving vaccines to our young people, 5-to-11-year old’s are now poised to get vaccines almost a year from Joe Biden’s election, almost a year from election day, we will now be in that vaccines available for Pfizer, all the way down to age 5, all the way up to age 113. That’s for my friend, Ruth. Now, that’s an amazing amount of progress in a year. But I want to talk a little bit about what’s different about the vaccination program for kids. First of all, we all know that kids can get sick from COVID. We all know that on rare occasions, kids can die from COVID, somewhat less rare, but not very common. We’ve seen kids hospitalized with COVID, some at the peak of things this summer, it was up to about 3000 kids a week, were hospitalized. And look, that’s no fun. I mean, for people who point to the fact that it’s much safer for kids. That’s true. But I don’t think any of us want to see kids hospitalized and the fact that they have a vaccine for that as a good thing.

Andy Slavitt 

Yet, I think for a number of parents, it’s a different equation. When it comes to thinking about whether or not to vaccinate their kids than it is for themselves. Many people will be readily and happily getting in line and getting their kids vaccinated. And these vaccines, like the vaccines for adults are extraordinarily safe. There’s about a third of the dose and a great safety record. Still, there are rare occasions, when there have been side effects myocarditis, I think we all know about. Now, what the FDA committees been doing, and the FDA staff has been weighing, how likely is it that you’re gonna have adverse side effects, versus all the bad things can happen from COVID. And by the way, we didn’t mention Miss C, which is the long term COVID condition that affects kids. And we didn’t mention the fact that kids can unknowingly, in fact, adults in their life, who can have bigger problems with COVID. But even on a pure comparison, here’s what the FDA found.

Andy Slavitt  02:57

It found that in most cases, in cases where there’s even modest amounts of COVID, the benefit of getting vaccinated outweighs the risk. Now, if there is very little to no COVID in the community, then there obviously is almost no benefit to getting vaccinated, and still the same level of risk. So there is a bit of a qualification in the data, a bit of nuance, which says that this makes sense. But in the case where we’re out of the pandemic, which we’re not to be clear right now, that it doesn’t make a lot of sense in those cases for kids that get vaccinated. Now, complex message, we don’t do great with complex messages. But I hope we put the full message out there. I hope that everybody who talks about this doesn’t take the expedient route of saying just get your kids vaccinated, because I understand that we all may choose to get vaccinated both because it helps us and because of societal benefit. But when it comes to our kids, I think people process it a bit differently. I think the safety of our kids is top of mind. And I think we should be respecting that and parents who want to know that trade off. And ultimately, some of them may decide not to vaccinate their kids.

Andy Slavitt  04:11

I hope we don’t end up in a situation where we do the same thing we’re doing with adults, which is that we stigmatize people who choose not to get vaccinated. This is something that has a more complex story to it. It’s complex, and I think it still leads you a reasonable person to say it’s make sense to get vaccinated, make sense get your kids vaccinated. I certainly would get my kids vaccinated if they were young enough if they weren’t big, strapping, you know, dudes, they’re no longer little kids, but if they were, we’d be first in line. But for some people, quite reasonably, they’re going to want to consider it differently. And hence, some of the controversy that’s followed this question of whether or not kids should be getting vaccinated a lot. A lot of social media and public anti-vaccine noise. Not all of it irresponsible, some of it, asking reasonable questions. A lot of it, unfortunately, sort of misusing the facts. I have Richard Besser today on the show. Speaking of kids whose pediatrician is a former head of the CDC, he runs something called the Robert Wood Johnson Foundation, which is the largest non for profit, Health Care Foundation. And we’ll talk about kids and other stuff. So let’s bring on Richard.

Andy Slavitt 

So, I’ve never started an interview like this before. But what would you like to talk about? Wow.

Richard Besser

Wow. You know, I’d love to talk about where we are in America when it comes to COVID. And what it what it may say about the future of where we are with public health crises. I mean, that’s kind of where my head is what we’ve seen over the past year and a half, and the concerns it gives me for the future when it comes to the nation coming together around it around a public health crisis.

Andy Slavitt  06:17

So we have 100 laws that have been passed in states around the country restricting people’s ability to respond to a public health crisis, for example, making it illegal to require people to wear masks, and we could name some of the others. We also have a situation where some of the public are reacting pretty badly to the notion that they should be required to be vaccinated. So imagine, a few years down the road, Rich, you got a measles outbreak, is highly contagious. And you have it in a place that is set up all these very unhelpful regulations. I don’t know if this is what you’re referring to, but that this sort of this spillover effect of understanding both public attitudes and kind of some of the reactionary response to dealing with COVID is an interesting brew, isn’t it?

Richard Besser 

Yeah, you know, I’m a general pediatrician. And I’ve been a general pediatrician for over  30 years. And one of the things that I love about being a pediatrician is that, you know, I can see a child, I can give them a shot, I give them a vaccine, and I know that I’m doing something incredibly powerful, that will impact the rest of their lives. And I have the ability to do that. Because we have agreed as a society as a community that we do things to protect ourselves, but also, we do things to be part of society, protect those around us. And we have laws and regulations that allow us to do that. Requiring kids to be vaccinated to go to school is a key piece of that. And when I’m seeing and hearing states right now saying, well, not only do I have concerns about requiring COVID vaccination, why do we have to require vaccines for school? And if that is something that that becomes open for debate, then your question about measles in the future isn’t theoretical at all, because the only thing that keeps measles at bay is very high levels of vaccination coverage. It’s one of the most contagious diseases that’s out there. The only reason we’re not seeing children in America today, who are in wheelchairs, because of polio, is because of the success of that. And we could lose all of that if we lose the contract that we have, as members of society, that we do things for each other, and that the government has actually the right and the responsibility to require us to do things for the general good.

Andy Slavitt  09:03

So, you know, to a certain extent, what you say, should make us all shudder a little bit. Most of us aren’t old enough to remember that in 1963, before the measles vaccine, 8 million kids died that year of the measles. So when we have these debates that we have the luxury of having about how honored is my individual freedom, what liberties do I have, and we don’t have it in the context of what we do for one another. It’s really stark. I was thinking about it the other day when we lost General Powell, because this is a guy who vaccines were just not going to be very effective. Because, you know, he had multiple myeloma at he’s 84 years old. And it probably describes a lot of people’s parents and grandparents, a lot of people who are dying. So if you’ve got a high case count, eventually Colin Powell is going to get COVID-19 If you have a low case counter to community, people like Colin Powell can survive with some protections for quite a long time. Right?

Richard Besser  10:10

Right. And if everyone around Colin Powell is vaccinated, the fact that he because of his medical condition didn’t get a good immune response isn’t going to matter very much. I was hearing so many wrong takeaways from the loss of General Powell with, I mean, it’s so sad to lose someone who contributed so much from a disease that is largely preventable. But he believed in vaccines and he was fully vaccinated and to hear people say, see, it doesn’t matter why get vaccinated, you can still die from COVID. It’s the exact wrong message. What it says is that no vaccine is 100%. And one of the reasons we require vaccination in many settings, is because you can’t tell who that person is who may be fully vaccinated, but didn’t get that immune response. Someone who has a condition, they’re not even aware of that meant that they were not going to get that response. We don’t know who that person is, who may have a rare allergic condition where they can’t get a vaccine. And it’s one of the things I talked to parents about why it’s really important that all the kids in the classroom are vaccinated. You don’t know which kid in that classroom may have leukemia,

Andy Slavitt 

Or who’s grandparent may have multiple myeloma.

Richard Besser 

Exactly, and that for one child to bring it home to their family, may be a life changing event.

Andy Slavitt 

Yeah, it’d be interesting if any of us who’ve been in the chain of transmission could see the end result, then it wouldn’t be as simple as oh, I had COVID. But I got over it. You know, there are people who are undoubtedly in this in the chain of transmission for Colin Powell, who will never know it, quite likely. And because it’s invisible, and it’s faceless, we don’t see it. We don’t believe it, it happened to be someone famous. But 1900 people also died that day, from this thing going around. And it’s become something we can live with. But let me take a couple of steps back, because you’re one of the people I respect a lot in terms of how you think about these things. And these are very difficult, integrated problems. And there’s sort of two things that I think you’re getting at; we’re scratching your head. One is that we have a lot of people in the country called 20% who just don’t trust in science or an experts or in institutions, government, the medical establishment, and in fact that really don’t they trust in it, but they may, in fact, see darker motives there. Feels like something that we have to solve. And then secondly, and it’s perhaps related, is this notion that none of us are more important than all of us. This notion that the reason we have laws is because I can’t make you care about General Powell. And you can’t make me care about some kid I’ve never met. But because we can’t rely on that. That’s why we have laws for those things. But it feels like at a fundamental level as those two things fall apart. How do we put the genie back in the bottle, as you say, as we look about what happens next in this pandemic, and the next pandemic?

Richard Besser  13:25

It’s a major challenge. Yeah, I’m a pediatrician. But my perspective is public health. And I know that the actions that we take as individuals have a profound effect on population health and the health of an entire community. And so I believe strongly in the government’s right to compel people to take an action that is for the greater good. And that’s totally in line with our American conceptions of freedom and what it truly means to be free. And to hear people say, well, Freedom means you can’t tell me to do something, you know, freedom ends where what I do has impact on the person next to me. Here when it comes to COVID. It’s even worse than what I’m describing. Because it’s not just that we see a difference in well, the government should be allowed to do this or the government should not, we’re seeing intentional efforts to confuse and mislead and cloud people’s decision making where disinformation, not just something that happens to be wrong, but disinformation, deliberate attempts to spread falsehood are leading to 1000s of people and measurable number of people dying from COVID. People who are believing conspiracy theories, people who are believing that corners were cut and that these aren’t, you know, some of the safest vaccines that we’ve ever seen, some of the most effective vaccines that we’ve ever seen, but because of misinformation and, and this kind of tribalism and team sport that seems to be around everything in society today, you are having people saying no to this vaccine simply because of who is saying yes to the vaccine.

Andy Slavitt  15:46

So I want to be looking to have this conversation with somebody for quite a while, which is how do we work our way back, I can imagine, you know, a public survey that comes out, you know, sometime in 2022, which says, public health is considered to be one of the least trusted things by a sub segment of society. And yet you and I, and many others could rattle off the things that in the last 100 years alone in public health, that have doubled our life expectancy, clean air, clean water, kids who could be healthy at school, I mean, so many, many things, get public health hasn’t laid claim to those things. And it’s hard to lay, it’s harder to lay claim to prevention than it is to curing a disease. But it feels like we’ve got this problem at two levels. One of them is how do we over the next call it five years, reengage folks on what public health is what it means for them what it can do for their lives, in a very tangible ways. And then secondly, I think we can’t pretend that this can be solved in the sphere of health alone, and in an area where I think you’ve pioneered and it’s this notion that the health care is only a segment of the overall picture on health, that we rely on so many other things, where we live, what we eat, what we drink, how much money we make the color of our skin, but here, also the social fabric and social forces, it feels like that the conversation needs to be had not just at the level of health, but at the level of our society. I’ve been looking for somebody to have this conversation with about how do we build that back?

Richard Besser  17:29

Well, I think some of it comes by having conversations and listening, having conversations with people who we fundamentally disagree with, and starting to see the humanity in any other way. Because I think we are in in a state where people are getting so much information through their own channels, and those channels are running in parallel, there’s very little intersection in terms of where people get information, that it becomes very easy to demonize, and other eyes, people who, who you don’t agree with, I do a lot of media. And I love when I can get on conservative media, because I’m able then to engage with people who are coming at this from a different perspective from me.

Andy Slavitt  18:23

But I’m gonna say something, I’m gonna say something that’s gonna sound insulting, but it’s really not. When you do media, and I do media, we are not effective. And here’s why. Because we play by the rules. You tell people the truth. The people you talked about earlier, the people who prevented misinformation, there are no rules. So you can show a four-foot-long needle to a needle phobe on social media. And you win your case. You are fighting when you go on whether it’s conservative media or not conservative media. You’re fighting against people who are willing to say and do anything for the spread of misinformation. And so it’s not a fair fight. And it’s only getting worse.

Richard Besser 

Yeah, it’s I mean, that’s not a fair fight. But I do think that refusing to engage, refusing to have those conversations is part of part of the challenge. And I and I also do think that there are people on the right side of the aisle who believe fundamentally in the power of public health fundamentally in the value of vaccines and enlisting trusted voices, voices trusted by different communities.

Andy Slavitt 

And there are many on the left who don’t

Richard Besser 

Exactly, yeah. It doesn’t break down that evenly. I remember when I was with ABC News doing reports on measles outbreaks in In California, and you what you were seeing was clustering of low vaccine rates in very wealthy California communities, highly educated communities, and denial of science by people who, who viewed themselves as progressive and viewed themselves as highly educated on the left. And to me, it struck me as the left’s parallel to what we were seeing with climate change on the right, where the information could line up, and it didn’t matter. It’s where, in so many situations, people make their decision with their heart, and they line up the facts in their head to go along with, and this is just this is, this is in an example of it. But I think that there are trusted voices on the right, who need to do more who need to stand up and say, no, this is not acceptable. This is putting every community at risk. And, you know, as a pediatrician, you know, the one-on-one interaction, it’s so important to meet people where they are, to listen to respect people’s questions, to answer them, honestly, and to give people room to make to change their mind. Because once you’ve demonized someone, there’s no room to change. You know, when I think was it Asa Hutchinson changed his mind about masks mandates. It was like, celebrate that and say, wow, you know, this is this is great. Someone took that information and changed their mind, that’s wonderful. But as soon as you make someone feel ridiculous from where they are in their position, it’s really hard to, for them to change their mind.

Andy Slavitt 

Yeah, I mean, I ask people all the time, tell me a time when you were deeply, deeply believed in something and then change your mind, you got on record on it. I mean, it’s true for all of us. And certainly, demonizing people doesn’t leave that room. It’s a very, very good point. At a very micro level, you know, you’ve done this as a physician, you’ve had to listen to people who are skeptical of things, or who are concerned or scared and talk people through this. You know, I’ve been talking to a lot of CEOs of companies, who’ve asked a simple question, how do I talk to people who don’t want to get the vaccine? And I will tell you, it’s been an incredibly productive exercise, incredibly productive, because you started exactly where you started by saying, first of all, you don’t talk, you listen. And then you help people through their questions and their concerns and their problems. But you tell them that their point of view has validity to it.

Andy Slavitt  22:30

Because they certainly got it somewhere. And they’re certainly considering this decision. More likely, they’re a victim of misinformation than the creator of the misinformation. Look, in the White House. I was the person who did the most Fox. I spent a lot of time with Hugh Hewitt and evangelical leaders, I find exactly what you found, that the demonization of those communities was actually more harmful than where they started. But I came to the point of view that the Gulf far preceded the pandemic, that it wasn’t, quote unquote, bad messaging, or that Dr. Fauci changed his mind about masks or any of that. It wasn’t Donald Trump. It proceeded Donald Trump, Donald Trump, I think rode that wave of recognizing that they were people who were so antiestablishment, and so skeptical, and indeed, conspiracy theories, which are apparently attractive in large segments of the population. But all those things exist for a reason that’s beyond my ability to understand entirely why they exist?

Richard Besser 

Well, it’s one of those things that we have to solve, or we’re all at risk in so many different in so many different ways. Our democracy is at risk, our health is at risk. You know, I ran emergency preparedness and response at CDC for four years. And it was preceding the flu pandemic of 2009. And we would be exercising off of the national flu influenza response plan. And nowhere in those plans, did we have any scenario where government would reject the guidance of public health. It was, you know, how do you get the best science? How do you get it out quickly? How do you share it with people so that people could do the right thing? Nowhere would did we have in there and we’re going to put the information forward? And the government is going to say, no, we don’t believe you. We’re going to do something exactly the opposite of that. And because you’re saying this, that’s part of the reason why we’re not going to say it because you’re experts. That was never and these exercises, this was during the Bush administration that all this work was going on. There was a summit held in every single state with a leader from government so Republican leader from government in every single state, helping states please plan for flu pandemic, what would need to take place how you would distribute vaccines, how you’d make those tough decisions about allocating scarce resources, when you might need to close schools, all of the things that we’re playing out here, there was a lot of terrific work being done across government by a Republican administration, and then it continued into the Obama administration. And then we have this scenario where there’s a total rejection of all of that. And it was mind blowing.

Andy Slavitt 

Well, people may not be aware or may have forgotten, but what you point out is exactly right. There’s no president who took pandemics more seriously and was more deeply interested in them than George W. Bush. And it was not a Republican versus Democratic question. It was a competency question. It was, and hard to argue is the most competent president we’ve had, but it would also this was, but this was an area that he had gotten informed on and gotten religion on. I actually think I’m very loath to talk about people’s reactions in political party identity terms, in some part, because I’ve seen whether it’s Asa Hutchinson or Mike DeWine, or Charlie Baker, I don’t see this breaking down as partisan. I actually think there may be some correlation, but I don’t think it’s causation. I think if Mitt Romney had been president, you’d have a very similar response in the one you had with Joe Biden, or Barack Obama, or George W. Bush. What I think is at fault is populism. There’s a particular brand of kind of rejecting establishment, rejecting science, sort of taking the pulse and temperature of your particular base, and saying things to please them, trying to look good in their eyes. That is such a horrible mismatch for the management of a pandemic. And I think we see it in certain states as well, right now, probably two or three states, South Dakota, Florida, Texas, where I think you get a similar style of leadership, but I don’t think it’s because the Republicans, they happen to be Republicans, but I think it’s a type of Republican perhaps.

Richard Besser 

One of the things that, you know, at the foundation we’ve called attention to a lot during this pandemic is that, you know, a result of that, as well as long, long history of policy failures is that this pandemic disproportionately hit Black, Latino, indigenous people, lower income people, people in rural communities. And that’s part of what’s at play here. The sense of othering? And who is getting hit the hardest? And who is not sure, and what’s acceptable? And, you know, we’ve seen a change in that. And thankfully, one of the one of the things that gives me a lot of hope right now is that we’ve seen dramatic closure in the vaccine gap between black and white adults, Black, Latino, White adults, all at about the same level of vaccine coverage. And that took an intentional effort to address that. But what it says is don’t give up on people, you know, because six months ago, the gap there was enormous, and it’s not anymore. And as vaccines are rolled out for children, we need to be extremely intentional to make sure that those challenges and things where there may be gaps, where information has to be brought from trusted sources that that’s there from the beginning. And I see that in the planning that’s taking place right now, in terms of Vaccines for Children, being given at their place where the kids normally get vaccines, so their pediatricians or family doctors, trusted sources of information, that’s going to be really important here, if we don’t want to see a gap in children like we saw in adults.

Andy Slavitt  28:53

Well, and you’re also being a little bit modest. You were, undoubtedly one of the voices pointed out, keeping us honest, all along the way about the importance of equity, very publicly, very responsibly. And it didn’t just come to you recently, you know, Robert Wood Johnson, under your leadership, under the great work of the people at Robert Wood Johnson, have been talking about public health equity for a number of years. And those points are sadly proven during the pandemic, but your leadership was really important there.

Andy Slavitt 

Let me ask you a sensitive question. And I hope I asked it sensitively enough, because it’s a sensitive type of question. We talk about race, we talked about age, we talk about illness. What we don’t talk about a lot is propensity for people to get COVID, because of their weight, for people who are obese. And it’s a sensitive topic. But it’s an important topic. And I don’t know that we as a society have figured out how to talk about it, or whether to talk about it, how we want to talk about it. But there’s a correlation between people who are overweight to have resulting medical conditions from being overweight, and the seriousness with which COVID hits them if they get COVID. Yet, we also have a society that for too long, carelessly, body shamed people, and didn’t understand the underlying causes of obesity didn’t understand that poverty, food deserts, and all these things were at work, there was a lot of blaming. And so we’re better at that as society, I think we are more responsible about that, there are efforts and initiatives not to shame people for the way they look, and to understand that there are a lot of root causes. But as a public health matter, it’s beyond a doubt that it’s important in talking about this, in managing the severity of COVID. How do you think about that? How are you talking about that? Should we talk about that?

Richard Besser  31:28

Yeah, you know, our foundation has had a big commitment for a long time in terms of addressing childhood obesity in America and our thinking as an institution, as has shifted a lot when it comes to this question. And it’s, it ties into the conversation we’re having, we’ve been having about who is at greatest risk during COVID and why? An early way of thinking about obesity was wow, if people would just eat right and exercise, get a good night’s sleep, they wouldn’t be overweight, we wouldn’t see. So tissues of obesity, is very individualistic approach to this.

Andy Slavitt  32:10

Personal responsibility.

Richard Besser

Just do the right thing. And I reflect back on conversations that I’ve had with parents in, I’ve been a volunteer pediatrician, my entire career and working in community clinics, federally qualified health centers. So the patients we see are lower income, many below the poverty line. And I would have these conversations about nutrition and the food pyramid. And then eventually the food plate, what should be on your plate, it should be low fat protein, and, you know, some carbohydrates and a lot of fats and greens and lots of veggies and those kinds of things. And I would have these conversations and parents would look at me like I was nuts. They’re like, I know what goes on the food plate. But if you’re in a minimum wage job in America, the only way you’re going to be able to feed your family is going to a fast-food restaurant. So to say that, you know, wow, if we would just educate people to eat, right. And so much of the effort around obesity was around, you know, let’s just give some more food classes, take people to the supermarket and teach them how to shop.

Richard Besser 

Well, I say let’s give people enough money in their pockets so that they can buy healthy food. And will have enough food in their bellies. And the I would have these conversations. I remember this conversation in New York. I was seeing this grandmother; my clinic was up in Harlem. And we saw a lot of kids in foster care. And this grandma, who had a 9-year-old, 11-year-old grandchildren who are in foster care, and I’m talking to her about exercise, say, well, the CDC recommends, you know, an hour of exercise at least five days a week for children. You know, your grandchildren’s ages. Tell me what do they do after school? And she said, well, they do their homework. And then they’ll play video games. And I said, well, you know, CDC says, she says, I know what the CDC says. It’s not safe to play outside in my neighborhood. And so you know, we focus so much on the individual behavior. But if you look at the kinds of things that we need to see in America, you know, America and America that was intentionally segregated.

Richard Besser  34:17

If we create communities of opportunity for everybody, we would do a lot to profoundly address the issue of obesity in America. And so, you know, as an institution, we’re focusing much more on the structural things. How do you give people more SNAP benefits, so Supplemental Nutrition Assistance Program, so they have more money to be able to buy more nutritious food, or something like the Child Tax Credit, which is being discussed now and in reconciliation, child hatch guide puts more money in people’s pockets. It’s estimated that we’ll reduce hunger in America by about 25%. Not only will it reduce hunger, but it will allow people to buy healthier food. So I say let’s stop blaming the individual, let’s focus on the structures and systems that are in a sense obesogenic causing obesity because they don’t create the opportunity for health.

Richard Besser

And stop focusing on this is just a matter of doing an ad campaign, teaching people what to do, yes, there’s personal responsibility. But if you don’t have those dollars in your pocket, and you’re bouncing between paying the rent, or we’re buying healthier food, you’re going to cut corners and make sure your kids aren’t hungry. And, you know, the universal school lunch which has been in place, which is now at risk. That’s, you know, for many children in America, that is their only healthy meal every single day, if we ensure that we have the systems and structures in place, so that parents and other caregivers can do the right thing. They will and then we can see where’s education need to fit in. But so often, we are demonizing the victims of a system that is so inequitable, it doesn’t provide any opportunity, except for poor health.

Andy Slavitt  36:05

It’s really well said. And it’s a reminder what an insult it is to tell people that vegetables are good for you and ships or not. If that was all that was required, we’d be there. We’d be there by now. And I guess I’m wondering whether you think, taking your point that the biggest things we could do, and I’ve said it on the show, I said instead of at a public forum, what’s the number one thing we could do for to help with the next pandemic? I said, bring the child tax credit permanent? That’s the number one thing I would do. But watching where you’re going a little bit is, do we avoid talking about the tie between obesity and severity of COVID? Are we avoiding that too much. Should that be part of the discourse as well? It feels like it’s being very studiously avoided even by public health people.

Richard Besser 

You know, I, personally, I don’t see the value in talking about that, you know, what I see the value in talking about is what’s modifiable right now, that could improve the situation. And someone who’s obese right now, saying, wow, you’re at greater risk of COVID time to lose some weight is not going to accomplish anything in this situation.

Andy Slavitt 

But even the first half of what you said, you’re at greater risk of COVID. And until such time as that’s not the case, then you know, you ought to be careful, the same way we talk about people who are older, and are immunocompromised. But we don’t do that when it comes to people who are overweight. Again, I’m wondering whether or not that’s because we’re being appropriately thoughtful and careful. But to some detriment.

Richard Besser 

Yeah. You know, I think early on, when vaccines were being made differentially available based on risk, it was a higher risk people get lined first. There’s more relevance there, then then now, I don’t think we are saying to people, and I would need to look to see how much is the elevation in risk. We’re not saying to people, change your behavior. We’re saying everyone should get vaccinated. And we’re saying to people, everyone if you’re in a community with high transmission, everyone should be wearing masks indoors. And you know, you should require vaccination for anyone who’s coming into restaurants and attending different things. There, it doesn’t need to be disease specific conditions specific in order to because you want everyone to do those things. So in situations where we’re, we’re, we’re saying, wow, people who have high blood pressure and diabetes, you need to do something differently. And if obesity is equally, at the same level of risk factor, we should be doing that. But I don’t think we’re there right now. Except in the situation of therapeutics of treatments, where some people who are at higher risk of bad disease, you’re saying, hey, if someone with this condition gets COVID, they should get monoclonal antibodies or some other form of early treatment.

Andy Slavitt  39:09

Let me just say that, I think this may be a place where we lose a lot of credibility with conservatives, as I reflect on it, because it feels to some people it feels very conspicuous by its absence, in terms of what comes out of the public health people’s mouths, and it feels like they’re being less than scientific by this very difficult thing to talk about. And I think made more difficult by the fact that you’re exactly right. That societal causes are at root of so many of these things. But I think when you listen to people who are on the right, they would say that it is more evidence that we’re making up the rules and how we talk to people and what we say to people and ultimately causes us to lose a little bit of trust.

Richard Besser 

Yeah, I take the point that it’s critically important that those of us who work in data and science and evidence are true to the data and science and, and evidence. And, you know, I think that’s going to be really important as vaccines come forward for children, that we are clear in terms of what the risks are to children, and we don’t over inflate the risks of children. So we give people the information they need to make an informed decision. And that’s really, really important. And this is a situation where I think that rational people may disagree in terms of what they decide to do with their kids and COVID vaccination. And especially early on, you know, I’m extremely excited that we, I think, will very soon have a licensed safe vaccine for kids 5 to 11. But I also recognize that the approval of those vaccines is not done with the 10s of 1000s of people where it was done for adults. And we don’t have as long as history. And so I think that, you know, the survey suggests that about a third of parents are going to be lining up right away and give their kids a shot. And you know, about 40% are going to say, I want to wait and see how it goes as this rolls forward. And then there’s another group there of about 30% that are saying absolutely no way, I think the absolutely no way group will eventually start to move. But we need to give people the room to make a choice that’s right for them and their family, given that the risk to children is much less than it is safer for elderly people. And I think that’s really important that we do that, we don’t RAM vaccines down into families and communities where they’re not ready based on over overstated risk.

Andy Slavitt  42:02

Yeah, no, I think that’s exactly what conservatives are fearful of is that there’s a paternalistic message, that because we want to reduce the spread, we will tell the story that says you have to vaccinate your kids, because it’s good for society, as opposed to the more nuanced rendition, which is to say, there are very mild cases of side effects. They’re very mild, but they exist. And they’re manageable. There are also less severe outcomes from getting COVID. So there’s a net benefit. And that benefits made larger by the fact that you will reduce the spread. And you’ll be able to go back to school and be less concerned and so forth. But you start by saying it’s apparent we know that the most important decision you make every day is how you care for your kids. And giving people some sense of the truth. I do think that if I were gonna find fault with the thinking of people like me, and I feel my head go there on occasion, it’s like, well, let’s just tell them the simple thing, which is get vaccinated. And let’s not worry about the nuance. And I think you may put your finger on a really, really important thing that may be exactly the kind of thing that is at work in eroding credibility of public health.

Richard Besser 

Yeah, it’s a challenge because there is nuance and it is so much easier to paint things with a broad brush. And in a pandemic, in any public health crisis situation, the information you have early on is very, very limited. And you have to be really upfront about that. Otherwise, as you get new information as we’ve had throughout this pandemic, and you change instead of it being viewed as learning in real time. And then the beauty and awesome power of science. It’s viewed as they didn’t know what they were talking about. They’re flip flopping. And a lot of that comes because there’s too much certainty given with the initial recommendation or declaration. And there’s just so many examples of that during this pandemic, where we felt like it was ending, we felt we’d rounded the corner. It was, wow, we’re finally done with this. And the virus is like, well, not so much not ready to be done yet. And I think we’re in one of those moments right now where I am really cautiously optimistic. But I have the caution in there because we don’t know for sure that the virus is done with us.

Andy Slavitt  44:25

Yeah. Look, one thing I feel like what’s one of my lessons in the White House is if you talk to people, like adults, if you talk to people, like you’re talking to your friends, or your mother or your sister, and you give people the nuance, you’ll be okay. It’ll be okay. You may feel risky at times. But if you feel like I need to impart the information that is most helpful to you, then you end up doing better and I think plain English, don’t talk down to people don’t use acronyms. All those things turn people off, as long as you, I think, talk in a common-sense way and say, look, here’s what we know. And I wish I was in position to be more definitive. But here’s where we are. I think we end up doing better. Look, it’s the pandemic, people aren’t going to be happy, no matter what, right? I’ve been having conversation with many, many elected politicians, it’s like you ran to be popular, you’re gonna do a lot of things here that are gonna make you feel popular at all times. Yet, that’s what the situation calls for. And I think at the end of the day, the body of evidence is starting to come in, that the people who are being viewed as having managed things more successfully, between, say, take to extremes like Ron DeSantis and Gavin Newsom. All the political evidence shows all the polling evidence shows that the people who have made tough decisions for people’s benefits are recognized for that.

Richard Besser 

Yeah. I think that’s spot on.

Andy Slavitt 

Well, Rich, you know, I’ve always felt like you were a bright light in the world. I now I am reminded why I feel that way.

Richard Besser  46:09

Thank you, Andy, real pleasure talking with you. There’s so few conversations that get into the nuance and the challenge and the complexity. And that’s what this situation is it’s not so cut and dry. And if we can see that and make room for movement in our own extreme positionality in this. I think that’s the path to moving forward out of this, which is where we started. I believe it’s possible, and it’s absolutely crucial.

Andy Slavitt 

Great. Well, thank you.

Andy Slavitt 

Thanks to Rich, and thanks to you for listening in. I want to tell you about our next three shows, because I think they’re all spectacular. All very newsy. First one is coming up on Monday, Kara Swisher. We’re going to be talking about the Facebook papers about Facebook about the role of social media in our lives, not just in the pandemic. But beyond that, Kara if you don’t know her is fascinating. She’s brilliant. She’s wonderful. It’s a great episode. We just did the interview. Then we have the mayor of Chicago, Lori Lightfoot. Lori Lightfoot is in the midst of probably the Ground Zero battle over vaccine requirements with the Chicago Police Department. She is having a battle, as many people have seen with the union boss from the Chicago Police Department. It is an epic battle. And we’re delighted that she’s come to talk about it on our show. And then following week, will have our episode for all of you parents about the new vaccine for kids and answering your questions and telling you about how to get your kids vaccinated. Great episodes. Alright, then. Have a great rest of the week.

Richard Besser 

Thanks so much.


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.

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