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As the U.S. hits the tragic milestone of 1,000,000 deaths, Andy talks with Dr. Deborah Birx to explore how it happened and some of the most pivotal moments of President Donald Trump’s COVID response. Birx says she knew she wouldn’t win any popularity contests when she agreed to serve as the White House Coronavirus Response Coordinator under Trump in 2020. She was right. Andy gives Birx a chance to respond to criticisms that her public praise of Trump undermined the opportunity to save more lives. The conversation gets heated as it goes on.

Keep up with Andy on Twitter @ASlavitt.

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Check out these resources from today’s episode: 

• Check out Dr. Deborah Birx’s new book, “Silent Invasion,” here: https://www.harpercollins.com/products/silent-invasion-deborah-birx
• Find vaccines, masks, testing, treatments, and other resources in your community here: https://www.covid.gov/
• Order Andy’s book, “Preventable: The Inside Story of How Leadership Failures, Politics, and Selfishness Doomed the U.S. Coronavirus Response”: https://us.macmillan.com/books/9781250770165

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For additional resources, information, and a transcript of the episode, visit lemonadamedia.com/show/inthebubble.

Transcript

SPEAKERS

Andy Slavitt, Deborah Birx, Kyle

Andy Slavitt  00:19

Welcome to IN THE BUBBLE`. This is your host, Andy Slavitt. It’s Monday, May 9th. Hey, Kyle.

Kyle 

Hi, Andy.

Andy Slavitt 

Kyle, our executive producer joining us in the studio this morning. So you’ve been on board now a little while with the new show. What do you think?

Kyle 

I had spend, crazy. I’ve been used to the breaking news business. I thought that, you know, I was told by our executive producers Jess and Steph that there were no podcast emergencies. But we’ve been, we keep having to redo the show. So I’m not sure that’s true. But it’s been great. It’s been a lot of fun. And we’re really getting to tackle some important topics. So I’m glad we’re here doing this work.

Andy Slavitt

Yeah. From your perspective and the team’s perspective. Um, you guys turn on a dime. It was midweek that that Supreme Court leak came out. For those of you didn’t hear Friday’s episode. It was our first Friday conversation. We talked about the just suddenness of the post, Roe v. Wade world that seems to be coming upon us. And in the middle is what you guys, you just basically said canceled what we’re doing and do a show on this.

Kyle 

Yeah, you sent that to us at night. And I just I was like, wow, there goes the week. As soon as it was posted we knew that we couldn’t do the show we’d planned we put a lot of effort. Everybody, you missed a great show that unfortunately, you’ll never he’ll never get made. It didn’t come together.

Andy Slavitt 

Yeah, I got to admit, I was nervous about Friday’s show. I mean, leading up to it for sure.

Kyle 

I picked up that you were a little nervous on that. Yeah, I think it’s new to you to go to expand this out. I you know, I was a little, I tried to be calm. I’ve done this a few times. So I know that sometimes, you know, people don’t always pick up on my calmness because they, they’re not used to it. But I knew it would come together eventually. And there were a few moments, especially when we decided to blow up the original plan that certainly got the heart pumping. But we got there. You’ve got the first one under your belt, and it’s all downhill from here.

Andy Slavitt  02:22

You know. So my perspective people, suddenly people have a random spare hour that they want to spend listening to our show. So and you know, they could get news about what happened in the court, anywhere. But so there’s a reason why people listen to our show. And I wanted to live up to it, in this new format and give people something that they could take away that would be useful. And yeah, I just wanted to get right. What do you think of the coming week? We got a big show today.

Kyle  02:51

This is a producer’s dream week, because you couldn’t dream for two guests to come together more perfectly. So today, we’re playing a conversation you had with Dr. Deborah Birx. About her new […] on working in the Trump administration. She was the former head of the White House Coronavirus task force. So that is today’s interview.

Andy Slavitt

If you had to rate that on a spiciness scale of one to 10. How would you rate that interview?

Kyle 

I’d give it a solid eight and a half, especially towards the end, it gets a little spicy.

Andy Slavitt 

Yeah. Well, I mean, I sat here thinking, Okay, this is the one chance that everyone has to ask Deborah Birx. The question that they wanted to ask her like whether she was sitting in the wall, and then one moment or some comments she made about him, and I’m like, I’m not gonna sit there with people around listening to this pounding table. Slavitt asked her, I asked her that question. So but yeah, it got a little spicy. And then Wednesday, it’ll be an interesting contrast, because we’re moving from Trump’s COVID Response Coordinator, to Biden’s COVID Response Coordinator who a lot of people know, Ashish Jha, could they be more different, Kyle?

Kyle  04:03

I mean, you can’t look to the future without looking back. I think that’s why this is a great pairing this week. How did we get here? And where are we going? As we enter another wave of COVID sweeping the country? So yeah, you can’t I mean, it’s great that he’s available and giving us the time to share important information with everybody.

Andy Slavitt  04:23

You know, a lot of people getting COVID?

Kyle  04:25

I have known three different radio hosts in the twin cities who have COVID. And at least one producer right now.

Andy Slavitt  04:33

Yeah, it feels anecdotally you don’t see it in the numbers. But it feels anecdotally like a lot of people I talk to not just where you are in Minnesota, but in San Francisco, in New York, in LA. It just feels like everybody’s talking about the fact that there are lots of people with lots of cases.

Kyle 

Yeah, so we’ll find out from the guy right in the seat, who is at the center of knowing on Wednesday’s show.

Andy Slavitt 

Well, let’s get to Deborah Birx, hang on. Buckle your seatbelt, make sure your airbags working. And seriously enjoy the she’s an interesting, she’s interesting person at all, in all seriousness, I think there’s a lot of sides of her that come out in this episode and she was a serious scientist for a long time before she entered the Trump White House. She’s done an amazing work in Africa on AIDS. And you know, I tried to get a little bit into the Deborah Birx that we know from what we see publicly versus a Deborah Birx who she thinks she has in her interior life and the contrast. So here goes.

Andy Slavitt 

Dr. Birx, welcome to IN THE BUBBLE.

Deborah Birx 

Thank you, Andy, great to be with you.

Andy Slavitt

One thing that that I find so interesting about you have knowing you a little bit having read your book is the difference between the scientist and the inside player, if you will, Deborah Burks and the Deborah Birx that the public knows or thinks they know, from a couple of very famous appearances. And of course, at a time when hundreds of millions of Americans are glued to the TV set. We’re gonna start by telling us a little bit about the other Deborah Burks and the way you normally if operated across your career.

Deborah Birx  06:28

Yeah, so I you know what was really important to me. And frankly, the only reason I came back is I could see that people weren’t applying practical, common-sense solutions that we had developed over the years to combat pandemics and Sub-Saharan Africa. So we had been combating HIV, TB and Malaria for more than two decades later on that Ebola and Zika. And concerns about Avian flu. I think when you do a lot of on the ground work, you understand how important the intersection between governments and their policies and communities and listening, because it doesn’t help to have a lot of policies generated in in the Capitol, or in this case, a capitol or Atlanta, and not have them be implementable.

Andy Slavitt 

And so there you are, you were actually in, in Africa, working in Africa, when you got the call, and came to the White House. Talk a little bit about your impressions of President Trump. I think not everybody knows the difference between a political appointee and a career member of government service. And so, you know, to some people, they might think, oh, well, the President brought her in, she must have been someone on the Trump team from the start. Clarify kind of how you saw, what your sense of both what you thought was potentially positive and what you’re uneasy about in looking at the President and his response.

Deborah Birx 

Yeah, so it’s really important that the American people understand that there’s three branches of government. So there’s the legislative branch, and they’re independent, and of course, the judiciary and they’re independent. Everybody else that’s a civil servant is technically in the executive branch. So you could say that anybody that is working for the federal government, is in the Trump administration. That’s just by definition, but most of us are civil servants. And that what does that mean? Well, I was in the military, and then I worked for HHS, and then the State Department. So always as a civil servant, nonpolitical. Now what does that mean? That means that you aren’t part of that group that is brought in because you served on a campaign that you would come in for four years or eight years, and then leave. And that’s the cycle of people who come in. And if you want to really make government work, and work consistently, on big programs, you have to be non-political. And so I had prided myself, and being nonpolitical, but I also knew how this White House, particularly the President was viewed. And I had spent the last three years with my head down, trying to keep the program intact, and making sure that the critical work we were doing with young women was not compromised in any way. And so I had successfully avoided any engagement with the White House for the first three years of the presidency. And so, but I knew, knowing how the country felt and knowing what I had witnessed myself on TV and looking at the number of people who were senior military, who ended up in the White House and then leaving that if I did this, that would be the end of my federal career. And I knew that before I went in, so it’s not like this was a shock to me. I knew that if I went into that White House with what I knew of its chaos and complexity, that in order to work in that space that I would be perceived as part of the system.

Andy Slavitt  10:14

Do you feel you were clear eyed about who the President was and what you’re getting yourself into?

Deborah Birx 

Yes, because you know, when you work. So I’ve been three decades working globally, I’ve worked with every president and prime minister across the continent of Africa, all pandemics are political, HIV was very political. I knew what it was like to work with presidents who didn’t want to deal with the pandemic that they had, but wanted to deal with a pandemic that they wanted to have. There were many presidents in Sub Saharan Africa that only wanted a mommy baby HIV pandemic that didn’t want to deal with key populations, men who have sex with men or people who inject drugs, or young women that were 15 and 16, and may be having sex, I didn’t want to deal with those issues. But my job was to make sure that I brought the data to them that showed them that we would not be successful unless we dealt with all of those issues, even though they were politically difficult for them to deal with. And so I had gotten a lot of policy changes across Sub Saharan Africa, many of which people said would never happen, including elimination of informal and formal fees in Western Africa. So I believed that data would speak and that even knowing what I had seen on television, from President Trump, I had really a confidence that with as with other presidents and prime ministers, that with the right data presentation, that I could get the president to take this pandemic, seriously.

Andy Slavitt 

Were you right?

Deborah Birx

I was right for six weeks, well, maybe five and a half his disruptive personality made confronting this pandemic, incredibly difficult. Because the number one thing that you have, in a pandemic, as your primary tool before you have anything else is communication, and clarity of communication. And so I make it very clear in the book, that that was a significant problem. But we were actually making progress with the European travel ban, the 15 days to slow the spread the 30 days to slow the spread. So we got to the just eight days after 30 days to slow the spread, which was a very difficult chess game to get us to that place with the data and seriousness of the pandemic. And to find out that another group, took my data, change the assumptions, and went to the President and said, yes, Debbie said 100,000 to 240,000 in this first surge, and that’s what I get clear, I only modelled the first surge.

Andy Slavitt 

You’re talking about fatalities in the US in the first wave?

Deborah Birx 

And so they came to the President with a memo that said she was wrong, she used the wrong assumptions, only 26,000 Americans will die. And I think in that moment, that created the controversy and the ability for all of the leaders in the White House who didn’t want to take COVID seriously to say, Debbie, and the scientists over here are completely wrong. The econ people at CAA who know how to do mathematical modeling, came up with a different answer. And by the way, it matches what we said from the beginning that this wouldn’t be worse than flu.

Andy Slavitt 

So what you describe in the book is, yourself, Tony Fauci and Bob Redfield, who was running the CDC had an estimate that this was going to be quite serious that at a point in time, when there have been only a couple of 1000 deaths, we were about to experience six figures in deaths. And as a result, you had a series of recommendations that were quite serious relative to anything the US had ever done before, a 15 days, 30 days of a really being very careful to slow the spread. It’s well known you didn’t, we didn’t recommend masks, but you recommended social distancing and staying at home and a bunch of serious measures. And you describe how you persuaded the President, that that was the right thing to do. At the same time, you also I think, just talk through that there was another faction in the White House. And there’s were a faction of people that were singularly focused on the economy. And there was a battle that behind the scenes, and we’ll talk a little bit about the public, Deborah Birx moments, but the behind the scenes, it seemed like you were saying you are the principal advocate, to try to stand in the way of the economic team that wanted to say let’s open the country and when they use this, whether there have been completely bad analysis to say, though, Mr. President, there’s not that many people who are going to die, he chose to believe that and that was the end of the argument.

Deborah Birx

Correct. And I think that’s why you heard him, send out those tweets about liberate Michigan. I never really after that moment ever really had access to the President or to the Oval Office. And I just want to make it clear, that’s very much in contrast to I think, who Vice President Pence and Jared Kushner believed. So I do believe that there were people in the White House who believed my data helped me to do what we could behind the scenes. And that helped me alert the governor’s in a weekly report that I wrote, and the daily reports that I wrote to everyone in the White House. So there were people besides myself that were in the west wing that were helping me. There were no one, there was no one else that was working on health in the West Wing. And I think that’s what kept me there.

Andy Slavitt  16:38

So one of the things that you learned, and I’ve worked for two presidents now is to be very careful to not try to tell the President what he wants to hear. But to tell the president, the range of scenarios, the range of potential outcomes as objectively as possible, and in most white houses, at least the ones I’ve been in, and the ones I know about, up until Trump, there’s a pretty good process, where the Chief of Staff’s office really ensures that balanced information comes to the President. So the President doesn’t get the bias of the presenter in the room. And what it feels very much like, I think the public could see this, I don’t think it’s a big surprise was the Trump was shopping for the news he wanted to hear, which was in effect, that this could either be downplayed, minimized, wasn’t that bad, wasn’t his fault. And it wasn’t worth suffering any economic consequences. That feels like one of the people can think about talk about some of the more unusual aspects of him as a president. But behind the scenes, I found that to be one of the most damaging. Now, let’s talk about some of the public moments that the President had and that you had, and the ones that you are better known for, I’d say you know, wouldn’t be exaggerated and say you may be one of them. Or may have been in one of the most meme moments of American society, that probably ever happened. I want to play a quick clip of this moment that many of us remember.

Andy Slavitt  18:06

So I think we all remember that moment, if we didn’t see […], we saw it, you know, and what you can’t tell from playing that clip is the look on your face, which is the one that I think, famously probably represents what a lot of people were probably feeling only you were in the room and had to be in this very awkward position, describe you to prepare for a lot of things coming into the White House. I imagine that’s a moment you could have never prepared for.

Deborah Birx  20:23

Well, you know, I think what’s really important, and thank you for playing the clip, because you can hear that two men are having a discussion. And it is the DHS scientist, Dr. Brian, having a discussion with the president turned 180 degrees away from me in this dialogue. And I think what’s really was the unfortunate is when it was reported, it was never reported, he was not speaking to me. And the implication was that he was speaking to me and I was sitting there letting him go on like this. He was turned away from me, he was talking to this DHS scientists, and you can hear the DHS scientists encouraging him, saying, yes, we will look into that. Yes, we’ll look into that. Now, I had not been party to any of these discussions that have been occurring in the oval office before they walked into the press briefing. And I think this is what you just described, the tragedy of lack of process in this White House resulted in these unforced errors that should have never happened. This DHS scientists was asked to study this because I wanted children to be back on playgrounds. And I knew if mothers heard that sunlight could have as much impact on the virus as the clear disinfectant. They were wiping their groceries down with that they would and mayor’s would reopen the playground, it was incomprehensible to me how a playground experiment, a playground equipment became a dialogue between a basic scientist and the President talking about it potentially being treatment. And I’ve thought about this a lot and thought about how I could have intervened. And if I hadn’t been so shocked by the conversation, I mean, I couldn’t even figure out where this was coming from. I had no idea that the scientists had gone into the Oval Office.

Andy Slavitt  22:25

Because he had some, he told him some potentially positive, interesting thing. The President heard it, and said, hey, I’m gonna bring you to the press conference and kind of that I’ll just, and basically, none of the staff stopped them. They all just were like..

Deborah Birx 

Correct. And I wasn’t there. So I was actually down in the press briefing waiting for the President to come because I had been assigned to go into the briefing that day. And so I’m waiting for him. And what happens is they show up and they launch into this, first the DHS scientist presents to the press the findings on how sunlight can disinfect outdoor play equipment. And then it deteriorates into this dialogue between the DHS scientists and the president.

Andy Slavitt 

Yeah, look, I don’t think there’s a lot of people that think you agreed with the President. I think there are you have gotten criticized for not subsequently coming out and saying, in more clear terms. It’s very hard to tell the president hey, you’re wrong, buddy. In the moment.

Deborah Birx

I did. Soon as I left that press briefing, but I would tell you, within minutes, people had gotten to the President because I asked him to. And that’s why the next day, he said it was joking, and it wasn’t a treatment. And of course, I went out on press and said it wasn’t a treatment. But I was very worried about the country at that time, and people reopening too fast. And I’ve been criticized by saying I really want to talk about what we need to do. I said, it wasn’t a treatment, I want to talk about what we need to do to save lives. And people felt like I should have stayed on that topic longer.

Andy Slavitt  24:03

Well, is it fair to say and I think you talked about this in your book a little bit, that you had this very delicate balancing act, you were trying to win credibility with the president who listen to you, when you said, hey, this is more serious than you think. And you know, he’s a guy who famously likes people who like him and agree with him.

Deborah Birx

Yeah, I want to thank Alyssa Farah because she actually tweeted out a couple of days ago, who was actually telling the President the truth the whole time. And she said, I was the sole doctor who consistently told the president the truth, and that is the truth. And every morning I wrote a report and sent it to every White House staff and Cabinet Secretaries, the truth about the pandemic and the solutions to make it to improve it for every American. When the President stopped listening, the Vice President continued to listen and he facilitated me to translate that work down to every state. And that’s what I did I, I just don’t think you give up. When you’re the only one in the White House, you cannot walk away and say, you know, this is too difficult. I’m going to stop now, or my reputation is at risk. So I’m going to stop. Now, when you’re working on a pandemic, and you know, what needs to be done, you find a way or make one.

Andy Slavitt

Well, actually, it’s the theoretical, Deborah, it’s actual, we actually know what happens in the situation where you fall out of favor, because you do cross, there are consequences that I think I tweeted, this was months later, but I think I tweeted something to the effect later of you didn’t like Deborah Birx question mark, Meet Scott Atlas. But I do I do want to just stay on this question of that, I think, where most people know you and where you get criticism, you put yourself in a position that I think people should be pointed out where people who don’t like Trump, were upset with you. And soon were people who did like Trump were upset with you. So you weren’t I don’t know, if you’re running a popularity contest, or if that’s what you were trying to do that you were running it quite badly. So I would argue that you were in a difficult spot. But I want to play one of those difficult moments, probably the one that that you enjoy hearing the least, which is the moment when I think you people would say you beefed up the President’s credentials in a more significant way, which allowed, I think, him to have a lot more credibility. And some of the things he was saying.

Deborah Birx  26:43

He’s been so attentive to the scientific literature and the details and the data. And I think his ability to analyze and integrate data that comes out of his long history and business is really been a real benefit during these discussions about medical issues.

Andy Slavitt

So after that clip, a US senator called me incredibly disheartened. He and I had had conversations where we both agreed it looked like what you were doing, and there was very much fighting the fight, and trying to make the case, the serious case of the President, and he was very disheartened. And he said she just gave him legitimacy to every stupid thing he’s ever said. When you look back on that, I mean, maybe put brackets back to that moment, do you is that the wrong interpretation?

Deborah Birx

Totally. And this is the problem right now with our country. Bad people that we dislike, can do the right thing in a particular moment. And I stand by the fact that when I got to the White House, and I integrated data, and I put it in front of him, we did the European travel ban based on the data because I said, look, we’re exactly the same place as we were with China when you did the China travel ban. So let’s use data to do data. It was the data that drove him to do the 15 days to slow the spread. And I just want to be very clear, there was an entire group in the White House, who were counseling him that this was not a big deal. And that’s what I came into. This is no worse than the flu, there’s no reason to do anything, we’ve got this under control. And the President’s tone changed with that data. To be honest, I was surprised at how well he was looking at the data and using it for these policy decision making. Because I didn’t expect it, I truly did not expect it. And when we got the 30 days to slow the spread, which I was the sole physician who was going to push for 30 days, others on the Task Force wanted to try to do another 15. I knew it wasn’t going to be enough. I thought we had one shot at this because we were already losing the President’s attention. The fact that he went through all of the you don’t know me, but I’m a big PowerPoint data graphic person. That’s what I’ve used throughout my lifetime.

Andy Slavitt

I’ve seen them.

Deborah Birx

I find out that governors that are aware of business and tracking business do understand the data and graphs quite well. And to be honest, I was surprised that the President listened to me. I mean, I just want to take people back to that moment. He has had everyone around him telling him this wasn’t a big deal. He has had the entire task force telling him that this virus could be contained. And then this woman who he never met before shows up in the White House with a list and says we have to change everything and this is what we have to do. And shockingly to me, he did and then I don’t know what people wanted me to say, I guess they wanted me to go out and say the President doesn’t understand anything, I don’t know, in that moment, he was believing the data.

Andy Slavitt  30:10

I think what they want, well, look, if what you say is true that he was incredibly attentive to scientific data, your statement also had the benefit of participating in the way other people influenced the president, which was object, bold, flattery, publicly. And so that may not have been your intent.

Deborah Birx

It was not my intent. My intent is always to tell the truth.

Andy Slavitt 

it certainly was what everybody else how everybody else influenced him. And you were trying to influence him. So it may have had that may have been a side benefit.

Deborah Birx 

But remember, you know, I think, Andy, what you don’t I think what people don’t realize is, I was not here in the United States. So I am not seeing the president, the way you’re seeing the president, because I’m overseas all of the time. So I’m only coming in for one mission. And that is to get the President of the United States to switch from saying the risk is low. And not we’re not worried about this, do doing aggressive actions, and allowing states to take aggressive actions to change the course of this pandemic? And in that moment, I would say for those four to six weeks, he did believe the data and I think he did act on the data, and then he didn’t. And you can see, I never went out again and said any of those things, I had plenty of opportunity to do press all across the country.

Andy Slavitt 

But would you agree that you’re one of the few people to ever say that he’s data driven. I mean, this is a guy whose gut instinct driven, his friend was in the hospital and dying, we could see him emotionally react to that he’s instinctual, that a lot of people have said the guy’s data driven. I think you’d agree with that.

Deborah Birx

Well, you know, people could say that about presidents and prime ministers across the world. But I’ve been able to use data to convince them to enact policies that are against their intuition against their gut feeling. And so I guess it’s my long history of using data and ensuring that presidents and prime ministers understand it to the point that they can approve the right policies. In the end, it was true in that moment, and then it wasn’t.

Andy Slavitt  32:48

As we sit here today, this week there are a million people that have lost their lives in the US, it’s undoubtedly a lot larger than that. But let’s just focus on the million very rough, very, very rough math. Estimates from places like Kaiser Family Foundation are that about 250,000 of those lives have been lost, after the vaccine by unvaccinated Americans, people whose lives most of which would have very likely been saved about a quarter of those lives. There also, by the way, estimates, that something you point out and take great pains to point out in the book, that the slow start both of the CDC, and Trump in recognizing the virus was very costly. And that’s there’s been estimates that have shown that, that those delays have also cost potentially hundreds of 1000s of lives. Either way, there have been a lot of preventable deaths in this country. And what if we could just reflect I mean, just step back a little bit and reflect on having lived through this experience, when you just call it maybe even just a rough half of the losses didn’t have to happen some of it because people don’t trust science or don’t trust the vaccine, some of it because of a poor government response. How do you reflect on let me take it into pieces that the lack of trust in science and public health, in institutions and in the vaccines and what that tells you about us as a country.

Deborah Birx  34:30

Well, let me be very clear, it is an excuse to say these people die because they are unvaccinated. And let’s just be clear, because most of those people who have died because they were unvaccinated, we’re not necessarily anti vaxxers. In fact, I think a very small percentage of them were most of them were vaccine hesitant and most of them didn’t have access, and most of them were not given the opportunity.

Andy Slavitt

So we say both didn’t have access that I agree with you the most of them. Were vaccine hesitant, not anti vaxxers. I agree with you that most of them have had been either their vaccines, I don’t agree with you that most of them didn’t have access.

Deborah Birx

Okay. So the reason I say most of them didn’t have access is because when you go into these rural communities, they need someone to explain to them about these vaccines and what these vaccines can do and can’t do. And so it’s just not a matter of putting the vaccines in Walmart, you have to have a communication plan at the local level, that actually outreaches to churches and to community centers and to schools, and explains to people how these vaccines work and what the capacity of these vaccines are. So when the vaccines were implied to do more than they could do, which to my mind was evident from the beginning. We never studied prevention from infection, it should have never been out there that these vaccines could deliver herd immunity, that if you were vaccinated, you couldn’t infect your grandparents. They could see then in July of 2021, that vaccinated people were getting infected and were infecting others that were unvaccinated. And so that communication that fractures trust. And so what I keep saying in the book..

Andy Slavitt  36:20

Was that because of Delta, or was that was that true with the wild type virus as well?

Deborah Birx 

Andy, that’s such a, we knew this. We knew this virus would mutate all RNA viruses do so we knew that this virus, we knew that we would never maintain the original strain. All of us knew that have dealt with virology.

Andy Slavitt 

Well, we just tried to go back to the beginning to November of 2020. When the vaccines came out, and you said we knew that it wouldn’t offer..

Deborah Birx 

Because we didn’t study, Andy. We only tested symptomatic patients in those trials.

Andy Slavitt 

I think we didn’t know either way. Right?

Deborah Birx 

Exactly. But we implied it would. That’s my point. That’s my point, you have to be clear to the American people from the beginning of what you know, and what you don’t know. Because when you don’t explain what you don’t know, it comes back to fractured trust. And that’s my whole point is we have to be as public health officials and as political individuals that are running the country much clearer to the American people about what things can do and what can’t be done. Same way with mask every time that we’ve had a problem with misinformation, it’s because we didn’t put out the data that shows that mask worked bi-directionally. And when I got out there in the country, no one could understand how two sides of the same cloth could only work one direction. So when it doesn’t make sense to them, then they become against the information because they believe we’re they’re being lied to. And so telling people what you know, as well as making it clear, what you don’t know, is absolutely critical, and then showing the evidence base and data that allowed you to come to that conclusion. And we’re still not doing that today. We’re getting data the end of April about people who died in January who were vaccinated, that breaks trust, we should have been we had that data in January, we should have told people in January, the reason we’re asking you to get boosted is because people that are vaccinated are infected and dying. So there is a way to do this. You have to be transparent; you have to make data available; you have to make it available in real time. And you have to make everybody have equal access, talk about equity. Equity means that everybody, not just CDC, not just HHS, not just the President of the United States, but everybody can see their data from their community in real time.

Andy Slavitt 

So you’re saying that I certainly agree with you, as we did a poll, we’ve done a poor job communicating, certainly in critical moments about the vaccine, what it does, and that that loss of people, granting that maybe I’ll ask you this way, if you go back to November of 2020. What percentage of Americans did you believe would get vaccinated? Eligible Americans.

Deborah Birx 

You know, in that moment, and the way the vaccine had been studied, and I talked about this in the book, I believe that we should prioritize those people who we knew were going to have severe disease and said to them, we want you to get vaccinated to save your lives. And here’s the data that shows that we believe if you get vaccinated, your life could be saved. And then be very clear that we didn’t know about the durability of protection.. We rolled it in health workers and people in the hospitals who worked in hospice fiddles first and even though there were risk groups within there that should have been vaccinated first, there were also individuals in that original group who wouldn’t have gotten severe disease. And so I think from the beginning.

Andy Slavitt  40:14

So, you wouldn’t have rolled it out to healthcare, you wouldn’t roll it out to healthcare professionals, you would have just done the congregate care settings?

Deborah Birx 

In November, and think about how many of those congregate care center lives would have been saved, if they would have been the first immunize because we knew that that’s where the vaccine would have the biggest impact.

Andy Slavitt 

I guess where I’m going with this is, you know, there were the polls at the time. The US population said that they were about 40% of Americans, who for sure wanted to get vaccinated. This was at the turn of the year. And at the turn of the administration, there were another 30% of fence sitters. There were another 20% of these are rough numbers of very unlikely and another 10% of held those rough bath. And so as we sat there with 40%, and get to the job being convinced the next 30%. You know, I don’t think it was ever in the cards, my view. And I talked to almost everybody who done you did a lot of talk to people who did the modeling around how many people were going to die. And those are things, I talked to everybody who built a model around vaccine acceptance, vaccine hesitancy, probably 30-40% different experts around the world. I never felt that as a country, we had any chance of getting to 80% with a vaccine as new as the one we had.

Deborah Birx 

But Andy, we didn’t even know what the problem was. And this is really the reason I wrote the book, it is not just the fact that we had that survey, it was that we had known that for at least two decades with the flu vaccine. And rather than taking that data and translating that into action, year after year trying to improve those rates. So we knew how to overcome vaccine hesitancy. All we did was measure the fact that people weren’t getting vaccinated and did nothing to use that data to find solutions. You know, a lot of this is on us. And that’s why when we talk about pandemic preparedness, it is not an abstract thing that happens over here. It is a clear call to action about rural healthcare, tribal nations, understanding adult immunizations, doing behavioral research to understand behavioral science around how people communicate and how people accept information. That’s what we had to do to change the course of the pandemic in Africa, yet we’re not doing this in our own country.

Andy Slavitt  42:54

I agree with you. I agree with you completely. I actually think at the end, I actually think there’s another fact or two, on top of all that, which is less to do with the pandemic, and probably harder to solve, which is just how many people feel disconnected and distrustful from society as a whole. And in other words, there are a lot of people they’re gonna hear from that they trust. They don’t they don’t trust the government, they don’t trust pharmaceutical companies, for sure. They don’t trust big institutions. They may trust their own physician, they may trust their church, they may trust people in their lives. But if they’re in a set of like, with a set of like-minded people, it’s not just on the issue of the vaccine, which is why I say it’s not just a vaccine issue, it’s on a number of issues, where people are feeling disconnected.

Deborah Birx 

And let’s stop measuring it and find what works down at the ground level. And that’s really my plea. And that’s the whole..

Andy Slavitt 

I don’t know that that answers the healthcare answer. I think that hitter is a much broader

Deborah Birx 

Oh, it is absolutely a broader answer. If we had approached HIV, HIV pandemic as so as solely a biomedical issue, we would have failed. No, we approached it as a structural issue in young women’s lives and address those issues had nothing to do with health care, but you couldn’t ignore them. We’ve ignored those issues for decades. And now it is coming back and clear reality, how that resulted in many more American deaths than needed to occur. But it doesn’t help today, for people who were immunized to get a superiority complex or for the media to talk about red counties and blue counties implying it’s well how they voted that determined, how they view the America no that’s a consequence, that is an outcome that is not the reason these issues exist. And so we can continue to point fingers and measure it and do nothing about it. Or we can say that this is a crisis in America and do something about it. And so I’m going to do something about it. I’m going to do something about rural healthcare. You’re absolutely right, Andy, I went to places that had less access than Uganda. This is unacceptable on so many levels. So I know you don’t know me that well, I’m a very passionate person. I’m very much committed to our tribal nations. They taught me a lot about community as well as the universities, I think we haven’t tapped into our young people, I think they can be enormously helpful. And I think it’s on us. Now we know what the problem is. Let’s stop talking about it. And let’s do something action oriented about it.

Andy Slavitt

Well, we got we got to a lot of great topics today. And I think that’s a great place to finish. I do think I’d be remiss if I didn’t hit to ask you one other question about the role of public health going forward in this process. And let’s start with that with our mutual friend, Tony Fauci. And in what is a microcosm what has been done in certain communities, for sure to his reputation. But it’s broader than Tony, there are a number of people who believe they need them in the Congress, many of them in the country, that this whole pandemic was an exercise of public health officials having too much power, too much sway over our lives, too much influence, and the evidence of that as all the fact that hey, they’re still alive, because in their backyard, you know, they’re fine. So this was all really a lot of disruption, for nothing. And that, you know, many who would predict that as challenging as things are, we’re gonna see fewer parents give the MMR vaccine to their kids, and more distrust of public health, and even less funding for public health as one potential outcome of this scenario. Now, how do you reflect on that, and the reputation, it’s somewhat related to the CDC, somewhat related to the way things played out so much is related to people are just exhausted from all this and need a place to point their fingers. But it feels like public health is that emerge out of this stronger than it went in.

Deborah Birx

No, that’s on all of us, because I think to be honest, we didn’t approach it with the requirement that we all have learned in executing public health. Nothing was more disruptive than HIV on the continent of Sub-Saharan Africa, where a quarter of the adults were dying from HIV. But also nothing was more magical, and mystical, in people’s thinking about what caused AIDS, how you kept from transmitting AIDS to others, how you could cure yourself from AIDS. And you have to tackle those misperceptions. You don’t give up, you get into the villages, you get into the communities, you find the opinion leaders, you sit down with them. And imagine if we had been doing that for the last decade over many of these other health issues that people have confronted. So we have to be honest with ourselves, our public health institutions have not responded to the needs of Americans. And that has left rural America behind, it’s left tribal nations behind. It has not provided clarity on what people need to do to improve their overall health. And it made us incredibly vulnerable to a virus that preyed on comorbidities. And so I think it’s on all of us to translate this lesson into action to assure that it doesn’t happen in the future. And let’s stop talking about Republicans and Democrats and let’s talk about communities and where our communities live and meeting them where they live and listening to them. And work with them in partnership to change the future of their lives and the lives of their children. I know that is possible. We did it overseas, we can do it here in America, but we have to get out of our ivory towers, we have to get out of Atlanta and Washington and we have to meet the needs of communities where they are.

Andy Slavitt

Well, Deborah Birx that’s a great call to action to end on. So appreciate your time and for you coming IN THE BUBBLE.

Deborah Birx 

Thanks, Andy.

Andy Slavitt

Okay, well, I’m still here. I think that was quite a conversation. Interesting. The visuals of some of those interview questions were also interesting and then maybe you’ll see some of it on social media if they play back some of those moments. A little bit tense but I think you know, she, if you answer try to answer honestly, I mean, And again, I think she’s serious scientist. I guess she does believe truly, that Donald Trump is a data driven, scientific oriented president in her heart. Maybe she’s right and I’m wrong. You feel free to let me know. Let’s see what else is coming up on the show, Wednesday, Ashish Jha, yes, folks. Now he’s been on the show a couple of times. He’s the new White House response coordinator. He’s going to talk about the current wave of cases. We have our Friday conversation coming up, just like last week that we did on Roe. If you haven’t listened to that, please do give us some comments and what we can do better. And then Monday, John King from CNN, he’s the dude who always stands up on election day, and draws circles in the screens and pokes on the screens and so forth. And you get a lot to talk about with him. If you have never heard him in a kind of when he has his guard down. He’s a very interesting guy. And we’re going to talk about a lot of things that will be coming up an interesting, set of very interesting Ohio election. We’ve got the impact of row on the like; you look at the impact of the pandemic on the election. No, that’s the last thing a lot of us want to think about as the election. But I’m gonna force it down your throat with John King coming up next week. It’ll be fun. Okay. Talk to you on Wednesday.

CREDITS

Thanks for listening to IN THE BUBBLE. We’re a production of Lemonada Media. Kathryn Barnes, Jackie Harris and Kyle Shiely produced our show, and they’re great. Our mix is by Noah Smith and James Barber, and they’re great, too. Steve Nelson is the vice president of the weekly content, and he’s okay, too. And of course, the ultimate bosses, Jessica Cordova Kramer and Stephanie Wittels Wachs, they executive produced the show, we love them dearly. Our theme was composed by Dan Molad and Oliver Hill, with additional music by Ivan Kuraev. You can find out more about our show on social media at @LemonadaMedia where you’ll also get the transcript of the show. And you can find me at @ASlavitt on Twitter. If you like what you heard today, why don’t you tell your friends to listen as well, and get them to write a review. Thanks so much, talk to you next time.