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All Podcasts Inside the Biden COVID Task Force (with Task Force Co-Chair Vivek Murthy)

Inside the Biden COVID Task Force (with Task Force Co-Chair Vivek Murthy)

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Description

Andy brings you an inside look at President-elect Biden’s COVID-19 efforts with task force co-chair Vivek Murthy, former US Surgeon General and one of Biden’s senior advisors in the pandemic. Andy and Vivek discuss what the President-elect is thinking about the pandemic, the (lack of) transition, and his priorities come January 20. Plus, how they hope to reverse the damage done by — as Vivek puts it — the way politics has poisoned the pandemic response.

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

Follow Vivek Murthy on Twitter @vivek_murthy.

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Transcript

SPEAKERS

Andy Slavitt, Dr. Vivek Murthy, Kryssy

Andy Slavitt  00:06

Welcome IN THE BUBBLE. This is Andy Slavitt. Vivek Murthy. Joe Biden’s Senior Healthcare Advisor, head of the COVID-19 task force will be on the podcast momentarily, we’re going to be talking to him. Spoiler alert, he does not recommend drinking bleach. He will not recommend inhaling Lysol. Just know that there will be differences between this administration and the last one. He won’t have to hear that anymore. But you will get to hear what Biden’s thinking right now, about the pandemic, what he’s thinking about all this growth in cases, his reaction to the vaccine, what the heck is going on with the transition that is really not happening, but happening on Biden side. And Vivek is a former Surgeon General of the United States under Barack Obama, we serve together, he has a baby in naptime. And let me tell you, he looked a little tired. No offense, Vivek, but you looked a little bit tired. When we find out why. He is Joe’s closest Health Care Advisor. And I think you’ll also get a tone of what’s going to be different about the country. I think it’s a good bet that Vivek will have a prominent role in the Biden Administration. I invite you to judge for yourself. Whether that’s a good thing or a bad thing, or how different that will be. Let’s call Dr. Vivek Murthy.

Dr. Vivek Murthy 

Hi, Andy.

Andy Slavitt  

Hey there, Vivek.

Dr. Vivek Murthy  

How are you?

Andy Slavitt  

Good. How are you?

Dr. Vivek Murthy  

Doing well, thank you.

Andy Slavitt  02:01

How are the kids?

Dr. Vivek Murthy  

They’re Good, thank you. One of them is napping, and the other is doing puzzles. So we’re in a stable moment right now, it probably will last about 30 seconds.

Andy Slavitt  

Start with this, what’s the mood like inside the Biden camp with regard to the pandemic could just give us a sense for some of the routines and some of the conversations that you can share with us?

Dr. Vivek Murthy  02:28

Well, Andy, we’re in a sobering point in this pandemic. And when you look at the numbers, we’re hitting new records in terms of cases, hospitalizations, and deaths are trending upward once again. And inside the transition team, I think there’s a real sense here that we’re at a critical point of greater urgency. And I think a desire, people have to want to act and act fast.  Everyone knows that January 20th is still a ways away. And, but there are still things that the President-Elect and that the rest of the team wants to do. And they fall into two buckets. One is to make sure that everything that we are doing and saying publicly is conveying information to people that’s going to help them stay safe, especially over the holidays, and seldomly slow the spread. But the second thing that we all want to do is to be doing everything possible to take the plans that then Vice President Biden talked about during the campaign, and sharpen them as much as possible, update them with the latest possible science and get them ready to be able to be implemented on day one.

Andy Slavitt  

So how is the President-Elect responding to some of the numbers he’s seeing in some of the stories that are emerging about rural hospitals and some of the hospitals that are at capacity throughout the country?

Dr. Vivek Murthy  

Well, we briefed him on the numbers. He’s been I think appropriately, deeply concerned. He’s been following these numbers at a granular level, from the very beginning of the pandemic, we’ve been briefing him on a very regular basis. And I’ll tell you from being a part of those briefings from the beginning, that he really does delve into the detail that he looks at not just the overall number of cases and deaths, but he wants to know what’s happening in rural areas, what’s happening in particular states, what’s happening with ICU beds versus regular beds, how are we doing in terms of testing capacity and testing wait times? What people are now having to wait long times in some cases to get results? He gets into these details, and he’s been looking at the more recent data in our briefings, and I think he’s, again, appropriately concerned, he knows that some areas in this country are getting harder hit than others. 

04:38

And he would he constantly reminds us up is that rural areas get hit particularly hard because they don’t have the resources, often that urban areas are given, and that communities of color and the poor, get hit particularly hard and in this case, seniors as well, especially those who are in nursing homes and other congregate settings. So part of what is really important to him is that we bring an approach to this. It’s not just driven by science, but that’s grounded in equity, equities of value that tells us that every life matters. Whether you live in a rural or urban area, every life matters, whether you’re young or old, or whether you’re a person of color or not. And we’ve got to make sure that the benefits that his plans are going to bring are accruing to everyone, and that we’re getting through. This is one whole country.

Andy Slavitt  

Yeah, it’s a really great point. It feels like he learned a lot about somebody by the questions they ask. And you kind of know where their heads at. Are there things you’re hearing that you feel like, wow, this is something that we all recognized, including the President-Elect and the Vice President-Elect are really missing. You mentioned health equity. And that’s clearly a great example of something that everyone has seen is a problem. But nobody has been talking about how to solve. Are there other things that he look at it and says, gosh, Vivek, this is really important. We need to make sure we get more focused on this.

Dr. Vivek Murthy  06:05

Yes, and I’ll just say use parenthetically that your earlier point is absolutely right. You do learn a lot by the questions that people ask. It shows you what they care about what they’re focused on, tells us a bit about their value system. And I’ll tell you that there are two themes that consistently emerged, like in the conversations we have with them. And they’re two areas that he tends to focus on a lot. And those are the practical and the personal. The practical in that he always wants to know, how are we going to implement this idea he’s not satisfied with pie in the sky plans or things that sound good on paper. He wants to know, when push comes to shove? How’s this getting done? Who’s doing it? Who are we partnering with? How are we executing? How are we tracking results? But the second is a personal one of the things that impressed me about Joe Biden, when I first met him, was he’s a person who is intensely curious about people. And he spends a lot of time talking to people. No, all politicians spend a lot of time talking to people. But I came to realize that with him, it’s actually part built into his DNA. But even when, after he finished the vice presidency long before he decided to run for president, he was still stopping at restaurants and diners and just talking to people and ask them, so how are things with your health care? How are you doing? 

And the reason that is important is because in these briefings, very often, he’ll ask us, when we bring up an idea, or a proposal, he’ll say, “Tell me how that’s going to impact the mom and pop shop, that I stopped buying, you know, like last week, or tell them tell me how that’s going to affect the teacher who just called me last week and is worried about going back to school, because she’s got people at home or at higher risk per COVID and doesn’t want them to get sick.” So he’s a real focus on those two things. But to your second question, the other area that comes up a lot that we don’t hear as much about in the news is important to strengthening our healthcare and public health system in the midst of this pandemic. So what COVID has done, is really exposed, what’s working and what’s not working about our health and infrastructure overall. And on the healthcare side, what we’ve clearly seen is that we still have a long way to go in covering people as much progress as we made through the Affordable Care Act, we know that we have millions more who need coverage. 

08:22

But we also know that affordability has been a long-standing challenge. And that includes drug pricing, which has been so high for people. But on the public health side, we’ve had an infrastructure there that has been struggling for a long time. In the Great Recession, budgets of public health departments were shredded, like many other budgets, but as the economy recovered, the budgets of those public health departments often didn’t recover along with it. So what you find right now is you’ve got personnel that are lacking in expertise, it’s lacking of outdated technology systems. And so we talked about that a lot with him. And that’s where you see a lot of his plans are, yes, they’re focused on stopping the spread and reopening society safely on equity and rebuilding public trust, but they’re also focused on strengthening and rebuilding our healthcare and public health systems. So they’ll ultimately be stronger than before the pandemic began.

Andy Slavitt 

Just something for the listeners, if you don’t know this. We were supposed to have something like two and a half billion N-95 masks in our stockpile just to pick one thing. And we had 13 million each year that Vivek and I were in the Obama Administration, the President asked for more funding for mass and for the strategic stockpile. Congress turned it down every year. And then as soon as Trump administration came in, that they stopped requesting any money for the stockpile, so it’s great to hear that there’s a focus on some of those lessons. Can you talk to us a little bit Vivek about structure of just as you think about the transition in the task force, you’re chairing a task force with some phenomenal people and I think you probably say coach airing to be more accurate, and in there are other people involved on the COVID transition response. One of them was on our podcast last week, Tom Inglesby. And we’ve had some other folks on this podcast like Mike Osterholm and Zeke Emanuel. 

10:14

So there’s some names that are maybe known to some of these folks. And those are certain types of people, right? Those are people that have really significant public health backgrounds, give a sense of what else we can learn relative to how things are getting structured, we of course have at the Trump administration, we kind of have a task force, which is seems rather loosely organized and doesn’t meet very often. And the membership is kind of variable in it. And it’s a lot of economists do one or two Doc’s including one who is believes in herd immunity, Scott Atlas. So he’s kind of a negative, in my opinion, but help us think through Ron Klain, the new Chief Of Staff is a master of process. Did you guys think about this? How do you think about structuring and organizing?

Dr. Vivek Murthy 

I’m glad you asked, Andy. because there’s a structure and process for transition. And then there will be a different populated structure process for governance for January 20th. And right now, what we are focused on this advisory board of 13 individuals with various medical public health backgrounds is we’re focused on helping the existing transition team, which has been working, keep in mind for not just post-election, but is starting to build and work even pre-election. But we’re helping them to take plans for reopening safely for expanding testing capacity for building a contact tracing workforce, and really develop those into the kind of plans that are ready to be implemented. That is like the crux of our day to day work. And we do it in various forms. Sometimes we do it in large group gatherings, sometimes we have small groups that work closely together, but it’s all with the intent of getting those plans ready. The other thing I should say here is that the 13 individuals that you see on this advisory board, do not constitute the entire range of experts who are being consulted. This is one small part of a much larger apparatus that is drawing each and every day on experts from around the country. 

12:15

And that’s actually good. Because we want a broad range of expertise brought in we need more than the expertise of 13 people to make sure these plans are robust to kick the tires on them to find holes in them so we can fill those holes. So I’m really grateful to all of those folks for helping out then when once we get it becomes time for governance, I think you’ll see a different structure there. And what we’ll probably hear in  over the time that follows between now and January 20th is more details on what that task force equivalent will look like, what are the roles? Who will be on it? Where will it be centered? In a departmental or in the White House. But one thing I can tell you is that this is going to be I think understandably the top priority for the Biden Administration is because not just because it’s the pandemic that’s in front of us, but because it’s touching everything, from our education to the economy, to our way of life.

Andy Slavitt 

And so no question that the number and quality of people, it’s so strong. And the hard part is thinking about how do you prioritize what you get done first, and all those kinds of things. And you guys are asking all those questions, maybe you can enumerate what you think some of the big priorities are, maybe go in a couple categories, if you don’t mind. So let’s start with legislative priorities. There’s some things that were important part of what the President-Elec has been saying and been saying in the campaign, getting support for people so they can have paid leave if they get sick, supporting businesses and the health care system. There’s things like unemployment insurance, feels like one of the great challenges and opportunities is going to be to work with the Senate. However, it’s configured either narrowly Democratic or narrowly Republican. But either way, requiring a lot of buy in from the Senate, and of course, the House. So are you already thinking about legislative package? What’s the outlook for working with Mitch McConnell? What are your thoughts on that?

Dr. Vivek Murthy  14:17

So I think a relief packages is certainly going to be a critical piece of this overall COVID strategy. And President Biden is talked at length about some of the core priorities that have to be included there. You mentioned some of them already, Andy, that we got to support families who are struggling right now, we’ve got to support businesses, because just telling businesses to make a whole bunch of safety changes and telling them they have to shut down without providing them with relief means that we’re contributing to economic pain. So we got to support businesses, but we also have to support schools, and we’ve got to have funding for them. Again, talk about a sector that has really had to make do with very little over the last many years. I think like teachers, so many teachers in our country in public schools or reach into their pockets every day, to find a few dollars to buy school supplies for their kids, they were struggling financially so many public schools before the pandemic. And now to ask them to replace your ventilation systems, and to somehow find more instructors because they need smaller classrooms and to clean more frequently than they normally did. 

These are not simple things, you know, for schools to do. So we need resources for schools. But one last area that we certainly need resources is for state and local government. I mean, this pandemic has really strained the budgets of states and localities. And this is one of those moments when we’re struggling, that we need the federal government to step in and support communities. Because if you don’t do that, when those budgets get strained, that means teachers get laid off, it means cops get laid off, it means first responders get laid off, it means we have to, we’re not as strong,  in our departments of public health as we need to be exactly at the time where we need all of these people working with us. So I think those are some of the areas you’ll see a focus. President Biden has great respect for his colleagues in the House and Senate on both sides. He’s worked closely with many of these individuals for many, many years now. And I think he’s gonna be working closely with them and developing a package as well. And I think they know the reality that there could be a Democratic senate or a Republican Senate, and they have to plan for different sort of eventualities here, but I think the bottom line is, as we see this search getting worse, as we see the pain getting worse in the country, in terms of families, struggling businesses and schools, and let’s see, in local government, I think we’re going to see more pressure from the public to have a relief package delivered. And that’s something I know; the President-Elect Biden really wants to do.

Andy Slavitt  16:47

Do you think he’s optimistic? Is the team optimistic that you’ll be able to get to a meeting of the minds with McConnell? And to remind everybody there was an attempt at a package that the house had a package, which contained all of the things that Vivek just laid out. And Mitch McConnell at one point came out with your very delayed basis, a much smaller package, that wasn’t close enough to getting the priorities that Vivek just laid out in there. So do you think there’s optimism that President-Elect will be able to make progress there?

Dr. Vivek Murthy 

I do think they’re optimistic. I don’t think that means they think it’ll be easy. I think they know, a lot of these were gonna be hard fought, you know, struggles, and it’s gonna have to be compromise and cooperation. But I do think they’re optimistic. And I think that it traces back to the President-Elect himself. He’s fundamentally an optimistic guy.  And he has this refreshing faith in people. That is not all too common these days, but is, I think, especially needed these days. So I think he’s optimistic about his ability to work together with folks on both sides of the island and get a deal done.

Andy Slavitt 

Yeah, I will say, and I think it’s the show before but when I was over at the hill, I would routinely and I was talking to Republican senators or House members, particularly senators, they would routinely say to me, if Joe Biden wants me to do something here, he just needs to ask and I’ll do it. And their different strengths, Obama and Biden, Obama didn’t have that kind of relationship. He didn’t have that those sort of well of built up kind of things that people do for one another when you have relationships over time that Biden had, and you could tell that it was more than just the politics, it was personal.  I remember traveling with Lamar Alexander. And he would make a point every time he saw me, or we were speaking, who did some public events together that he considered Joe Biden to be somebody who trusts as much as anybody. And now there’s new some new senators there and so forth. But that shared history is a starting point. What I tend to try to point out to the audience, when asked the question is, that’s great, so long as you’ve got some motivation, on the other side, in other words, if Mitch Mcconnell doesn’t want anything, there’s nothing that anybody could trade for anything, then it’s awfully hard. But if McConnell wants something, then the President Elect is the kind of person who will be able to get him to share that with him. And those are certainly the basics of getting things done. But as you said, it’s a tough road. But I was always so impressed with that relationship.

Dr. Vivek Murthy  19:26

Yeah, I think it underscores the point that as much as the world has changed, and been dramatically altered by technology in the last several decades, relationships still matter. They matter for getting work done. They matter for our health; they matter for living a fulfilling life. And they’re gonna matter to running a successful administration.

Andy Slavitt 

You have been one of the people that has put that out there for the country when you were the Surgeon General, which was always a really helpful reminder. 

Andy Slavitt 

And now, for something we’d like to call advertising.

Andy Slavitt  20:06

I want to talk about a talk about communications with you. I talked this morning with David Pryor, the chairman of the National Health System in UK. And that’s how things were going in the UK. And he said, terrible, really bad, a lot of COVID fatigue cases are rising. People are really tired of this. And I see people wearing masks, and he said not as much people were slipping, and they’re just really tired of it all. And then I said, has it become a political issue? Is there an issue political identity? And he said, Come again, what do you mean by that? And I feel like if we only had to deal with some of the straightforward issues, like there’s COVID fatigue, there’s vaccine coming, there’s challenges that people have, it’ll be one thing. But I feel like the communication challenge here is wholly different. Because we have some number of people right now, probably 51% of the public who’s not wearing masks, and a large number of them. It’s deeper than simply not knowing that that’s the good public health guidance. Many of them know that it’s good public health guidance. And they’re not complying with it because of some other statement. First of all, do you think that observations basically close to right, and secondly, if so, that feels like one of the biggest challenges that the new administration’s going to have on their hands.

Dr. Vivek Murthy 

So this is a profound challenge, Andy, and I think one of the things that I feel is that if we don’t address the fundamental, like mistrust that has developed in the population, we’re not gonna be able to address this pandemic properly, we’re not going to be able to get people to take vaccines, even if they’re safe and effective, people aren’t going to wear masks, even though we know scientifically that they work to prevent spread, we’re not to be to able to do this stuff. And I think that what we’ve seen unfortunately in our country, is that politics poisons pandemic responses. And we’ve had too much of that, and we have to now do is find a way to de-politicize this response. Now, given that we’re not starting from scratch, but that’s going to require is people from both parties actually speaking up in favor of measures that are guided by science, it’s going to require people from both parties acknowledging the severity of the situation we’re in, but doesn’t require one more thing, which actually does involve politicians at all, which is it’s gonna require people who are trusted on the ground, faith leaders, nurses, and doctors other local leaders actually stepping up to the microphone, and speaking to their communities about what’s going on what matters and what measures we have to take to keep ourselves and our community safe. Because even though trust is eroded for so many people in this big institutions, big companies and national leaders, trust in many ways has filtered downward. And many people still do trust. They’re the leader of their faith congregation, or the teachers and their kids schools or their doctor or the nurse who took care of their family.

Andy Slavitt  

Well, it’s not just that they trust them, though, it isn’t also that they know what’s relevant to them, right? The nurse down the block knows what’s relevant to them, or the person in the Kiwanis Club more than anybody far away well, and I think it’s part and parcel of which you’ve always said, which is, you can’t really expect people to listen to if they don’t think you’re willing to listen to them. And so, okay, my pastor or my chamber of commerce leader, or by for agent, like, they listen to me all the time. So when they come back to me and say something, it’s a different kind of dialogue.

Dr. Vivek Murthy  24:03

That’s right, and we’ll use a word you use if I think it was, they know you. And that is really important. Because when you feel known, you feel understood, when you feel understood, you’re more likely to trust and people who are around you, or in your community, you know, folks, you’re more likely to feel like yeah, they get me they understand what I’m dealing with they as opposed to figer on the television screen or some national person who may not understand their way of life. So this is actually the great challenge though, right now, like when my predecessor C. Everett Koop was Surgeon General in the 1980s. He could go in front of the camera and speak to the entire country through a few major networks, and a few major newspapers. And so it was much simpler to transmit messages, right? But now, given the fact that communication channels have splintered and also trust is very local. If you want to build a campaign to reach America, you’re not building one communications campaign. You’re building a hundred campaigns to reach different people where they are with different messengers. And that is the complexity and challenge of addressing the COVID misinformation situation that we’re dealing with.

Andy Slavitt  

We’ve talked about the Congress, we’ve talked about the messaging, we’ve talked about to some extent priorities, like masks. Are there other areas of real import that we just haven’t touched on yet?

Dr. Vivek Murthy  

Yeah, so there are a whole bunch of areas of focus. But let me mention three really quickly. One is supply chain, because we know that one, we are still struggling in health, some health care settings to get enough masks and gloves and gowns. And that just should not be a question if you’re a nurse or doctor going into work, to worry that, Oh, my gosh, I may not have a mask protecting me that’s, it’s wrong, we shouldn’t be sending people to the frontlines of this pandemic war without the armor so to speak, to protect them. Testing is the other area where we need a lot of focus, because we’ve actually improved the capacity for testing since the spring, we’ve improved considerably. But we still have gaps. And we see those gaps in particular now. When we have a surge and then wait times for your test results extend because we don’t have sufficient capacity. But we don’t just need diagnostic testing, we need sufficient capacity to do surveillance testing. And just explain quickly, the diagnostic testing is what you would do when somebody you suspect might be ill, the surveillance testing is what you’re doing in populations more broadly, even if they don’t have symptoms, just to pick up infection, so you can quickly contain it. 

26:43

And we know from plenty real-world experience that’s surveillance testing, especially in higher risk settings, like nursing homes, that’s really essential we don’t have right now, that is sufficient capacity to do the degree and extent of surveillance testing that we need. So that’s a secondary. And the last one I’ll mention is around guidance. People right now, many people in the country are confused on what to do, particularly for the holidays. But even more broadly. I was just earlier today, talking to a good friend, who is telling me that one of her friends who was immunocompromised and has to be careful that his mother came over at the end of the day to see him and she’s a nurse in the hospital. And it turned out that she had contact that day with somebody who was COVID positive. But she said the rules were so confusing, from the hospital and from the city about what exactly she was supposed to do, that she just came home, and now she was exposed to her son who was also immunocompromised. And you hear that kind of swearing, you think, gosh, shouldn’t it be obvious to a healthcare professional that they shouldn’t come home.

But I’ll tell you, this has gotten so confusing for so many people, that these day to day decisions are challenging. So the guidance that needs to come out of the federal government that needs to be provided to not just state and local governments, but to families has to be clear, it has to be consistent. It has to be evidence based. And as I think of it, we have to frame this guidance, in a way that gets people to Yes, right? Most people when they think about the advice of doctors and public health professionals given, it’s always about no. It’s like don’t eat that doughnut. Like don’t eat that slice of pizza. Don’t drink that beer, don’t smoke that cigarette. We’re always telling people No, no, no, no, no. And I think that the reality is you can keep doing, taking that kind of approach, at this point in a pandemic of just telling people, you just can’t do anything you want to do, just stay home. And I’m not saying that because we just have to conform to what people want to do. I’m saying because practically, that doesn’t get you the end result you want, which is a functioning society where you have low rates of infection. 

28:56

Instead, what we have to do is we have to create guidance that helps people get to yes, so if I want to send my kids to school, and I’m a parent, how do I do that safely? Right? If I want to, I’m an employer, I want to get my workplace up and running. Tell me how I can do that safely. And if I can’t then be honest with me, tell me, but tell me the steps I can go through to reduce risk. Similarly I think about churches and synagogues, you know, in mosques and temples, you know, faith gatherings are such an important part of so many people’s lives, especially during stressful times. And this qualifies is a very stressful time. I don’t think we should be telling people, okay, cancel church, churches off, cancel going to synagogue, etc. I think what we should be doing is having honest conversations with people about what kind of risk it’s entailing and that doesn’t mean everyone can congregate the same way and put each other at risk, but we need to help people find ways to still enjoy community, but to do it safely.

Andy Slavitt  29:50

That’s a great point. I mean, so I find oftentimes, what I’m doing when I’m talking to governors is helping them shop for things that other states put out the work better. So I talked to a governor today who is about to make a major announcement to pull back a bunch of things. And he said, I can’t really pull back on churches. And I said, Oh, I understand that. And I think it was Vermont, I said, Vermont just had some guidance of how many people per thousand square feet, it’s okay to have. So you don’t want to pull back. But I know that the pastor’s, and everyone else would really love to hear that guidance. And the sad thing is, like, you know, someone, it does a slightly better job in Vermont. And then they’re doing it, then that becomes the people who hear about that. And then Minnesota does it their way in New York does it their way. And it would certainly be nice to say, there is a best answer, that best answer may change as we learn more. But at any given point in time, there is a best answer, which is, there shouldn’t be meeting at all in churches, or if you do, it should be X amount per thousand feet, or whatever it is. And here’s the ventilation requirements, it would almost be awfully nice. If there was one answer put forward by the CDC, I presumed that would be the right place to come from, in your opinion.

Dr. Vivek Murthy 

That’s right, that’d be the right place.

Andy Slavitt  

And that they work in partnership with state and local governments and municipalities, as opposed to like, let me go find which of the 50 is doing it in a way that sounds the smartest. And of course, that’s very, very hard to do. I mean, this guidance to make such an important point, if it could be just a place where people would go, a daily press conference from the CDC, the CDC website, things like that, would be enormously helpful.

Dr. Vivek Murthy 

This is a really interesting and important point you’re raising, because I’m on the one hand, I’m so glad that you are doing what you always do, which is to serve as a connector and to bring people together and to share information. I’m also really disturbed, right that states have to rely on you to do that, because they don’t have a central source of information. And that’s what we want. I had a friend who a couple months ago reached out to me and said, I’m really just depressed. I’ve been inside, like, I’m not able to see anyone. And I said to them, we hold on, why haven’t you been able to see any of your friends? They said, Well, you know, where it’s time of COVID, we can’t see any friends. And I said, you could nab a friend meet you in a park. You could both wear masks, you could sit on a bench more than six feet apart. And you could see your friend and have a conversation, would you enjoy that? And she was like, of course, I would love that. It turns out that we’ve learned more about COVID since the spring, that tells us that we can actually come together in safer ways. It’s not the exact same ways that we came together pre pandemic, but it still allows us to recapture some of the life that we love and that we need. And so that’s the thing, the challenge now, and that’s what we’re called to do is to be more precise, to be smarter to be more targeted.

Andy Slavitt  32:47

I see your point about getting to Yes, right? Vivek, how can I see my friends, I really need that. But here’s three ways. 

Andy Slavitt 

Don’t go anywhere, we’ve got to go earn some money to donate to charity.

Andy Slavitt 

Let’s talk about one of the elephants in the room. Or maybe it’s called the donkey in the room is this transition, or the donkey that’s not in the room. Atul, who’s on the task force, Atul Gawande for people who don’t know, made a comment on radio that he was, and I’m gonna paraphrase it. It’s frustrating that to be able to get the information from the Trump administration that the Biden team needs. So I was wondering if you could maybe talk about how that’s going, what the outlook is? How you’re thinking about that?

Dr. Vivek Murthy 

Yeah, that’s a good question, Andy. Well, for any transition to work well, you’ve got to have really good communication between the incoming team and the outgoing team, as well as with the team that’s going to still be there, which is the vast majority of the staff in HHS and other federal departments who are career officials. And those are really that’s not often sort of mentioned piece of it. But in addition to exchanging information, it’s about starting a working relationship between people you’re going to continue working with, are the career staff who are really the repository of your memory and knowledge and extraordinary talent. And so you got to start working with them early. The problem we have now is that we can get into the buildings to work with those individuals, we were not allowed to contact them, technically, at this point, until, until the current administration effectively allows that. And what that’s done is it’s made it harder to start those working relationships and to share information. 

34:46

We can do what we’ve been doing, and we will continue to do which and we have a lot of work to take the plans that we have sharpen them, make them ready, you know, for January 20th. But there’s no doubt that they would be benefited by being able to review the plans that already exist inside the information, look at the data that’s held inside government that the public may not be publicly available so that we can incorporate those into our plans. I’m still hopeful that that day will come soon when we can start that very important collaborative work. But the bottom line is, cooperation is essential right now. And if we don’t work together, right now? We are going to slow down this response at the worst possible moment in this pandemic. And that’s going to mean more lives lost, it’s going to mean more people’s more people who are hurt, and we can’t afford that.

Andy Slavitt 

So this is not a peaceful transfer of power. This is in some respects, a very unpeaceful transfer of power in a different way than I think that phrase is intended. But it’s certainly an important and powerful way. Is there any outlook and they say you’re hopeful? And we’ve talked on this show before about what’s the role of the GSA that they have to play in allowing the transfer of information, including top secret information, and basically the money for the infrastructure for the transition to kick forward to happen? Is there a sense that in the middle of December that there are some key dates that could trigger this such as when the state ballots are certified? Or when electors are put forward? Or does this feel like it’s just going to be entirely up to when the President says it’s okay, because he’s got a political appointee on it?

36:36

Well, Andy, I don’t know enough about the legal piece of this to know like, what those benchmarks might be that would trigger potentially opening the gates and violinists to work together. And I know, there are a lot of people who are working on this, who understand the politics and the legality behind this better than I do, but what I do want to say about it is, look I come at it from the standpoint of a doctor, a scientist, a public health expert, and what I just want to do, is to be able to do my job, and just want to be able to do my job as a medical and public health professional in the middle of this crisis. And that involves talking to my colleagues, colleagues who I’ve actually worked with over the years when I was Surgeon General, who I know are whip smart, and who have been working really hard. And do I want to hear from. You know who I want to talk to so we can put together the best possible plans to serve the country. And this is actually not a partisan issue. There are Republicans and Democrats who have enabled and who have facilitated smooth transitions over the years, because that’s the way our government has worked. That’s important in normal times. It’s extraordinarily important, during a pandemic, that’s cost us 250,000 lives.

Andy Slavitt 

And I think the thing that the public should take comfort in is something you just said, which is, many of the people that will be showing up on noon of January 20th have been gone for only four years, have relationships with the career civil service, Joe Biden, you could blindfold him and put them in the West Wing, he wouldn’t bump into a thing. He knows exactly where everything is. Same thing with the Capitol. Same thing with a number of people in HHS and at the FDA and CDC. If there’s anybody that had to go through a shorter ramp up time, this would be the team. But nevertheless, the things that slipped in the meantime are obviously not optimal. Maybe a couple more, a couple more topics. And before we go, you mentioned the vaccine earlier, just to kind of personal level, like, how did you feel when you first saw the preliminary results released on the Pfizer and Moderna data? Do you recall where you were? Do you recall what your reaction was?

Dr. Vivek Murthy  38:58

Yeah, well, my reaction was just relief and hope. And I was in my parents’ house. This is in Miami. This is where we’ve been quarantining for the last many months. And I just started having all of these visions of being able to see my wife’s parents again, and we haven’t seen them like in almost a year. These visions of my kids actually going to school and making friends with other kids and thriving the way all kids should be able to thrive. I have these like visions of being able to see friends and to travel and to reconnect in person which I miss. And so many of us miss. Clearly there’s more steps before we get there. But I don’t think we could have asked for a better preliminary result than what we heard from Pfizer that day, then later from Moderna and then terms of follow up you From Pfizer, we have two vaccines that according to the company’s view of the early data have approximately 95% efficacy. That is pretty extraordinary. And we’ve got to get the FDA to look at them to make sure they’re safe and effective. 

40:16

We’ve got to then undertake the extraordinarily difficult task of distributing that and getting it to people all over this country quickly and equitably. But we have an opportunity to do that, because we have now these two incredible candidates. And Andy, the reason I’m actually particularly hopeful is not just because these two vaccines, it’s because there are more in the pipeline to, right? That this is just the beginning. And this will stand as one of the more extraordinary scientific achievements of our lifetimes, that we took a process that normally would take many years, and through the benefit of technology and the hard work of scientists around the world, were able to develop and produce a vaccine. In a year’s time, that is an extraordinary testament to the human spirit and what we can do when we put our minds to a task.

Andy Slavitt 

Right, and so for the audience’s benefit, Vivek, who is not smiled much this entire conversation, given the weary topic matter and look, I’ve known him back for a while he’s, he’s a great, he has a great, beautiful smile. And he uses it often. Just the topic of the hope and the vaccine information, brought that smile back to your face. So that’s nice to see.

Dr. Vivek Murthy 

Thanks, Andy.

Andy Slavitt 

do you have any doubt or any concerns whatsoever? About the current FDA in the emergency use authorization process to the extent that it’s likely to happen before the Biden team arrives?

Dr. Vivek Murthy

Well, I actually feel pretty good about where we are with the FDA at the moment. And no question the FDA has had its struggles over the last year. But I think they put out clear guidance on what their standards would be to issue an emergency use authorization. The companies have heard that they waited to get eight weeks of safety data they’re going to be presenting that data to the FDA. And we’ll have an independent review committee also, from the FDA that will be looking at this what’s called an advisory committee. So there’ll be career scientists within the FDA independent scientists outside the FDA.

Andy Slavitt  42:21

And that means December 10th or 11th, or something like that?

Dr. Vivek Murthy

Around that time, early December. So the good news is, I think we will have a number of scientists looking at this. And ultimately, I think that they will follow science in making their decision because they also know that the stakes are extremely high. And at this point, I think because this is all happening post-election also, the political pressure to push an approval or an authorization rather one way or the other is markedly different than what it was pre-election. And neither the public knows that. Also, when they look when they’ve done polls, actually asking people about how confident they are in a vaccine home, how likely would they be to take a vaccine if it was available today, the polls that were done before the election show that there was actually a difference. When you ask people, would you take it today? Would you take it if it was authorized post-election, people’s confidence increased post-election, because I just think that there’s been a lot of worry about, is our response to this pandemic, politicize whether it’s the medicines, we’re approving the vaccines we may be authorizing or the guidance that we’re issuing. But I do have faith and that the FDA is on track to approach this in the right way. And that’s what we need is for science to guide these decisions.

Andy Slavitt 

Good. I mean, just to be clear that we’ve tried to say this as often as we can, vaccines are the greatest invention known to man. And we shouldn’t take for granted how amazing they are, and how important they are to our society. And these little question marks are, I mean, the good news is, it’s all exposed. I mean, it looks messy, because we live in a democracy. And because when somebody tries to color outside lines and tries to use science, and appropriately, we know about it, because we have a free press, and I think that should add to our confidence in this vaccine. This is my commercial. I think this should add all of our confidence in this vaccine and LS 10 questions, but it is very exciting. And I certainly share your enthusiasm.

Andy Slavitt  44:29

Let me close with a couple of other things. One thing I know that’s near and dear to your heart. There’s a lot of other illnesses besides COVID that have probably gotten defer, delayed. We haven’t focused on or things that have been exacerbated, anxiety, addiction, blood pressure screenings, cancer screenings, just to pick a few that you got to imagine Americans have not been able and childhood vaccines of other kinds. I saw some data this morning that we were behind on childhood vaccinations for some of the really standard things like MMR etc. Can you imagine a big push, a big national push on this to create a teachable moment to get Americans back on this and even maybe even leapfrog where we were before?

Dr. Vivek Murthy  

I do think that we can end up better off than we were before the pandemic, I think we can have a stronger healthcare system, a better public health system, I think that we can have greater empathy and understanding of the challenges that each of us are going through in our life. And maybe we can step up more together during these times of crisis, I mean, these are all things that we can come out of this crisis doing and doing better. But I do think that it requires us being aware of what the toll of this pandemic has been. And the two tools we tend to talk about are the death toll, and the economic toll. But what we don’t often I think appreciate as much is the impact on all of the other conditions you talked about, including mental health, you compare according to some data from the CDC and other organizations, depression rates during this pandemic, compared to prior years, we’re looking at fourfold increase in depression symptoms, compared to the prior year, three-fold, increase in anxiety symptoms, two-fold increase in suicide compared this year, compared to 2018. These are not small numbers. And they’re happening because people are in pain. 

Andy Slavitt  46:27

And the base wasn’t low to begin with. 

Dr. Vivek Murthy 

And base was not low, you’re right. And this is the kind of pain that we can’t see. But that impacts people in profound, profound ways. And there are a lot of people suffering in silence right now. So what I want to say, to your listeners, what I want to remind myself of is that if you are in pain, if you are frustrated, if you are angry, if you are scared, if you are just fatigued, that’s not a reason to be ashamed, or to think that there’s something wrong with you. And we’ve all gone through a lot of struggles during this pandemic. And it doesn’t mean if you’re experiencing those feelings that you’re broken, it just means that you’re human. But the other thing it points out to me is that pandemics are best fought together. There’s no shame in going through this pain, because we not only all experience it, but we need each other to get through it. That’s why we are over thousands of years why we have evolved to be social creatures, because our survival was optimized when we were actually together when we were supporting one another helping one another. 

Dr. Vivek Murthy 

And that’s actually what we’re called to do now. We need to do that at all moments in life in moments of crisis like this, remind us of how have that old African proverb that says “If you want to go fast, go alone, if you want to go far, go together.” And that’s the story of this pandemic as well. pandemics tell us that if we just keep ourselves safe, that doesn’t mean the pandemic is over, right? Because this is a disease that goes from person to person to person. And it requires all of us stepping up to do the right thing, recognizing that our destinies interconnected. That’s what helps us get through these pandemics. It also turns out, that’s what helps us get through all great challenges, whether it’s climate change, or health crises. It’s what helps us build a stronger country and a stronger world. So I feel fundamentally optimistic, Andy, as painful as this moment is that we’re in as bad a surge as we’re experiencing. I think we have it in us to not only seek out brighter days, but to help build that brighter future that I know we’re capable of that we deserve. And certainly, that our children need.

Andy Slavitt  48:35

That’s a beautiful thought to end on. So grateful for what you’re doing, and you continue to do for the country. Please do not participate in allowing a President to ask people to drink bleach at any point in time, or spray themselves with Lysol. Because they’ll be hard to forgive. But other than that, man, it’s just so great to hear what you’re doing and see what you’re doing, and see the hope that you can bring to this by all the things you talked about, but really by this sort of honest connection, that this is sort of the heart of every single thing we talked about today.

Dr. Vivek Murthy 

Well, thank you, Andy, it’s so kind of you, it’s been great to talk to you once again, on the podcasts and to see your face and to hear your voice. And I just want to say thank you to you all. So because you do so much. That’s public, but so much more behind the scenes, helping people find resources, helping them find help when they’re trying to figure out how to make decisions for their family or run their state. I just want to thank you for that. Because it’s people like you, like ordinary citizens stepping up, to do big things during moments of crisis. Like, that’s what makes society better. That’s what inspires other people to recognize that it’s when we step up for each other, that we all move forward together. So thanks for the inspiration and for setting such a good example for all of us, Andy, appreciate it.

Andy Slavitt  

Well, thank you. Thanks for saying that and I actually know a lot of the listeners on this show are people are doing that in all those ways. And just seeing multiplies is a great thing.

Dr. Vivek Murthy  

So good to see you, Andy. Take care and stay safe.

Andy Slavitt 

Thank you for listening in to my conversation with Vivek. Let me tell you about some of our upcoming episodes. We have the head of the School of Public Health at Brown University Ashish Jha, otherwise known as a slacker. We have Laurie Garrett, a Pulitzer Prize winning author on pandemics, and she is a real kick, you will enjoy that. We have a TOOLKIT episode on the distribution of vaccines with two great guests that we will be answering your questions about. Who else Kryssy. Who else do we have coming up?

Kryssy  

Well, I’m working on a couple of interesting TOOLKITS, one about how to build a bubble. And then another one on going back to work and how to do that safely.

Andy Slavitt  

Bubbling and working. Okay. And then a couple surprise guests you’re working on that you’re not prepared to talk about?

Kryssy  

A not quite yet. But yeah, there is at least one person that I’m very, very excited about. It is very close to being confirmed. And if it happens, I think all of us will be very happy.

Andy Slavitt 

Okay. Sounds good. Have a great week. I hope you have a good holiday. Thanks so much for listening. 

CREDITS

Thanks for listening IN THE BUBBLE. Hope you rate us highly. We’re production of Lemonada Media. Kryssy Pease and Alex McOwen produced the show. Our mix is by Ivan Kuraev. My son Zach Slavitt is emeritus co-host and onsite producer improved by the much better Lana Slavitt, my wife. Jessica Cordova Kramer and Stephanie 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, but still tell them at a distance or with a mask. And please stay safe, share some joy and we will get through this together. #stayhome

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