The Next 12 Months of COVID-19, with Dr. Zeke Emanuel

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We all want to know what’s next so Andy calls up Zeke Emanuel, someone who spends a lot of time thinking about just that. Zeke was a special advisor to President Obama and now advises Vice President Joe Biden’s coronavirus task force. Andy and Zeke look ahead at what might happen with COVID-19 in the late fall and winter, at what we hope to learn about what COVID-19 does to the human body in the next few years, at how effective a vaccine might be, and at what may change with a Biden victory in November.

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

Follow Zeke Emanuel on Twitter @ZekeEmanuel.

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Andy Slavitt: [01:07] Welcome to In the Bubble. This is Andy Slavitt. We have an episode for you today with my friend Zeke Emanuel. Zeke is doc, he’s a health policy guru from the Obama administration. He’s currently a vice provost at Penn. And he sits on Vice President Biden’s coronavirus task force. The question we’re going to zero in on with Zeke today is what’s going to happen in the next 12 months? We’re gonna go backwards a little bit, but then really hone in on what he sees at a much kind of lower level of detail. How will the vaccine work? How will it be distributed? Very specifically, if there is a Biden administration, how he sees these things playing out and panning out. So I think it’s really very much the promise of In the Bubble in the center of the bullseye, trying to give you the information you need from the people who are very much in the middle of this and have a lot of thought. Zeke and I go back quite a ways, and I hope you’ll enjoy it. I think you will. He’s a fun person to talk to. Very interesting. So let’s call up Zeke. 

Zeke Emanuel: [02:25] How are you, Andy?

Andy Slavitt: [02:27] I’m pretty good. What are you spending most of your time on these days? 

Zeke Emanuel: [02:34] I’m thinking about COVID and thinking about — right up your old alley — thinking about reforms that we, the Democrats should make when we take over the reins of government in terms of fixing the healthcare system itself. So the public health part and COVID and distributing vaccines and getting people, you know, worrying about the fall, late fall and winter when we go inside. And I’m worried about, you know, if we take over, how do we actually fix the healthcare? What can we do to fix our healthcare system? Because I think COVID has preempted probably major healthcare legislation that we might have gotten otherwise. 

Andy Slavitt: [03:18] So let’s start with COVID. What do most people not understand about and how it works, what it means, how to deal with it. What are some of the biggest misconceptions you see? 

Zeke Emanuel: [03:31] I think actually probably the most important thing to understand is that we’ve had a catastrophe. 211,000-plus people dead, more than seven million people infected and probably, you know, many, many more who’ve gotten it, who just haven’t been tested. And it didn’t have to be this way. And that, I think, is the important thing for people to understand. And the most important comparison, in my humble opinion, is with Italy. So Italy is another country about a week ahead of the United States was hit hard by COVID. We saw all the disasters in Italy. Hospitals overrun, lots of deaths. But in Italy, March 11th and 12th, they locked down the country. First the north and the whole country. You really couldn’t go out except for food. There were a lot of severe restrictions. And by the mid to end of May, their new cases were down very, very low. And they’ve been low all the way through the end of August to when summer vacation kicked in and people sort of began ignoring all the public health measures that had been put into place. They were able, because of getting very low prevalence of the disease, they were able to open up cinemas, open up lots more of their country than we’ve been able to safely open up. And they’ve had since May, one-quarter, maybe even less, of the mortality compared to us. So we could have had a very different outcome. And that represents tens, if not 100,000 fewer deaths. That is a lot of deaths that we could have avoided had we taken the serious public health measures. You know, there’s no country in the world that has a vaccine. We’re all in the same boat. And the real difference is how effectively did you introduce the public health measures? 

Andy Slavitt: [05:26] Well, you know, the numbers you’re talking about are being a little bit generous to the US because your starting point is May, you’re not starting at first reaction where a lot of people start and say, if we’d been better prepared, if the CDC had performed better, so there’s a number of points. 

Zeke Emanuel: [05:43] I’m trying to give us that 10 weeks before the middle of May. So, you know, call it March 1st. Obviously, the president knew even in January that, you know, this was going to be serious. We could have prepared much better. We didn’t prepare before March 1st. But even considering our starting date of March 1st, as you point out, we’re being generous, you know, after we had 10 weeks, which we did not do all the work that other countries did in implementing the public health measures, getting our arms around testing, getting our arms around contact tracing, getting our arms around the isolation techniques we needed, and literally people have died because of it.

Andy Slavitt: [06:22] It seems to me that this is sort of a giant puzzle we’re reconstructing from the inside. So maybe you’ll help me construct it a little bit. Because we’re learning facts along the way. We learn how the disease moves from person to person. We learn about what the disease does when it’s in the human body. We learn some things that we think we know and then we find out later that there’s better explanations. And then, of course, everybody on the Internet is a perfect understanding of cause and effect. Oh, we’re here in Florida. We didn’t have any problems. Therefore, you know, the beaches are fine and oh, we closed the beaches, therefore this and the other. And I would say that we all fall into the trap of lacking the humility to kind of understand that there’s a lot of randomness to how this thing spreads, that there are gaps in our knowledge still about why some communities are doing better than others, why the mortality rates have gone down. There’s explanations, but it’s hard to know what’s right and what’s wrong. So where are we in putting together this puzzle? How much of it do you think we can be confident in? What are some of the things that you would say we really don’t still understand that yet, or that perhaps there’s an alternate explanation of what people think? 

Zeke Emanuel: [07:30] Well, I think the most important gap we have is why do some people who look for all the world like someone right next to them, why do they actually do worse or do better? And I think that, you know, who has a bad time with the disease, who has a slow recovery, who actually is asymptomatic through the whole course, we have no idea about that.

Andy Slavitt: [07:54] And we don’t even know if it connects to viral load, do we? 

Zeke Emanuel: [07:56] Well, I’ve heard a recent explanation from the head of worldwide research and development at Johnson & Johnson. It’s a scatter diagram. It’s not viral load, was his claim. You were at that same presentation. So the question is, well, then what’s it in the immune system or what’s it in other factors that might influence? Are there really differences in the virus that you get? We just don’t know. And I think being humble about that, so we can’t give people advice other than we know that age is a bad prognostic indicator. Sex, men do worse than women, we know is a bad prognostic indicator. And we have this group of comorbidities that are bad prognostic indicators. And we’re sure about those. I would say separate from the health care system interventions, I think when it comes to race, you know, it’s very confusing. Do blacks and Hispanics do worse because they’re minorities in some way? They’ve got different genetics? Or do they do worse because they have more comorbidities? Or do they do worse because the healthcare system has not been not been good at treating them or because of environmental factors, because they’re more exposed. I think we have no good explanation or understanding. But it’s pretty clear that age, sex and comorbidities are prognostic indicators that are reliable for severity of the disease and mortality. 

Andy Slavitt: [09:28] But not necessarily for transmission, is that right? 

Zeke Emanuel: [09:30] Yeah. Or acquiring it, correct. 

Andy Slavitt: [09:33] OK. And it’s fair to say that we couldn’t possibly have much of a long view in terms of what this does to the human body. This is very relevant in the Affordable Care Act case, of course, because COVID could be this preexisting condition that begets every preexisting condition at any organ system at any time, decades later. So you think about these kids in college who are, you know, symptom free, get COVID, and 20 years later, they would discover they got a heart arrhythmia or, you know, shortness of breath or they’re getting blood clots in their legs and they’ve had COVID. We just don’t understand that either, obviously.

Zeke Emanuel: [10:10] Yeah. So that’s part of the problem of, you know, a new infection. And so you have no long term follow up, nor long prediction. But you’ve got to be suspicious that there are, for a group of people, going to be some serious long-term complications. I mean, we have these long-haulers, people that are now, you know, months out, still have physical problems, they’re constantly fatigued. Months out, they report some mental confusion, fog, whatever you want to call it, that they’re just not as clear as beforehand. And that has to make you worry that this virus does trigger something, at least for some segment of people. How big that is, we simply don’t know. And it’ll take years before we’re going to know.

Andy Slavitt: [10:55] Right. If you step back and give us a little bit of perspective of time and comparison. I’ll relate to you a conversation I had with Mark Smith. In 1981, he was the chief intern at UCSF University of San Francisco Hospital, and I called him because I said, when you saw the first AIDS and HIV patients in 1981, ’82, did you know what you were seeing? How much was mysterious, how much was unknown? And he said, oh, we knew very quickly. And I said, well, how quickly? He said within a year or two. So it struck me that here we are six months out, and, you know, in the context of looking back in 1981, understanding so. But I got sent textbooks that are still in existence which say that it could be passed genetically, HIV and AIDS. So this guesswork is a natural — you can be the smartest person in the world, but there’s just not enough data and not enough experience. So when you think about, like, our understanding of what we’re looking at, how quickly do you think we’re gonna be able to answer questions here? 

Zeke Emanuel: [11:58] Well, some of it, as we’ve just been describing, some of it just a matter of time. You can’t say if there’s long-term complications until you’ve had years go by and follow up with people. So that’s just a natural product of time. We’ve learned a remarkably huge amount about this virus and how the body reacts in a short amount of time. We’ve had more brains working on this problem than probably any — you know, the only other two problems I can think of, or maybe three problems I can think of that have so much brain power, the Human Genome Project, going to the moon and the Manhattan Project. That’s it. And we’ve had so much attention to this and so much great, super smart people focusing on it that we know a lot more about it than anything else in such a short period of time. 

Andy Slavitt: [12:52] How well is science collaborating, how well are people across different countries, different biopharmaceutical organizations, academics, researchers, government, BARDA, etc.? How efficient are people and sharing the knowledge in this puzzle? In other words, somebody could have solved one corner of the puzzle but be missing a piece. Someone else, you know, in Belgium could have that other piece. How well are we doing that, at sharing the data and information and just having scientists talk to each other and publish and learn from each other? 

Zeke Emanuel: [13:26] I think we’re doing very well, but there’s still huge gaps. So I think, you know, if you look at the United States, we pride ourselves on our research. You know, the big justification for high drug prices is we get a lot of research out of it. But the fact of the matter is that in terms of so far clinical research, we actually haven’t been that great at it. We’ve had one big breakthrough. That big breakthrough is the remdesivir study, and even that wasn’t so great, you know, didn’t have enough patients in it to determine whether there was a significant reduction in mortality. What we got was evidence that it actually decreased hospital length of stay, which is, you know, not the hardest of end points, not necessarily the thing you really care about. Conversely, the British have been much better. They have a much better organized system for doing large, simple randomized trials than we do. I’ve written about this and I think that’s a lesson we have to learn. I’m not sure we’re going to learn it, but I think it’s a lesson that we need to push. And, you know, frankly, the NIH took a long time to get going with its trials and coordinating trials. You know, it took probably five months as opposed to the British, who got it up very, you know, within weeks. So I think we are sharing a lot of data. There’s a lot of preprints. The journals have done a great job of getting peer-reviewed stuff out there. Nonetheless, I think the researchers could be better. And I frankly think that the government also, in terms of epidemiology, could have done a much better job in terms of creating data on every single patient who got this and putting it out. And I think that’s been a very severe failure, pointing to problems of the electronic health record, problems of our public health data acquisition system, etc. 

Andy Slavitt: [15:21] Well, I called one very big electronic medical record company because I had learned that they had not heard any other data with CDC. And of course, what they’re waiting for is to monetize it. And so they’re sitting on some 100,000 hospitalized patients records and they claim to be using it for — hospitals are using it one on one. They’re not even studying it within their whole electronic medical record system. I tried to get Congress to have a bill to force them to turn the data over. But with so much going on, you know, it just sort of hasn’t happened. 

Zeke Emanuel: [15:55] Well, I’ve also been surprised by how little the tech companies have done. You know, you can’t point to a single thing the tech companies have done that have made any difference in terms of fighting this situation. You know, all the hullabaloo over Apple and Google. No difference. Zero. They have a lot of data. They also don’t want to share it. And, you know, they’re afraid that people will understand now how much they actually collect on us. I think that’s their major fear. 

Andy Slavitt: [20:31] You put a line in the sand pretty early, which was quite helpful and said people should be thinking of this as more of a marathon, not a sprint. I think if I recall correctly, you put out November 2021 as a date when — I think people are looking for kind of a magic ‘normal’ date, which is in itself a flawed question, probably just given the way things work. But given that you’ve done that and you may have learned things since then that you may want to revise how you position it. Help us think through the next 12 months. And I know that it feels like it’s pretty dependent on who wins the election, at least it does to me. It probably does to you as well. So I don’t know how to solve for that in this question. So maybe you just have to answer twice. But what do you think it looks like over the next 12 months from a standpoint of all the things that people in society care about? 

Zeke Emanuel: [21:22] Well, I think it’s pretty inevitable that we’re going to have a bump up in the fall, late fall. But I think in the late fall when we really do have to go inside because it is cold and it’s hovering around zero in large parts of the country. And I think that will have a predictable influence. We do know that going inside, large crowds, exchanging air by sneezes and others, you know, those are key modes of transmission. And I think we’re going to see that increase. I’ve described it as a roller coaster, you can describe it as waves, but that seems inevitable that we’re going to have this wave coming probably in a month or two and then subsiding. I think the issue is we’re probably going to have a vaccine, how effective it is and how long it lasts, durability, which age groups it’s going to be best in. Lots of questions to be raised. But I think we’re going to have a major challenge about distributing it and administering it. That’s going to occupy the new administration for most six, eight, nine months of 2021. 

Andy Slavitt: [22:37] So what’s a good kind of center point for people to think about? 50 percent effectiveness, 60 percent distribution, eventually, you know, over the course of the middle to the end of 2021. What would you say the center points are?

Zeke Emanuel: [22:52] Well, I think you need to look at, you know, if we have 75 percent effectiveness, you need to get I forget 220 million Americans, like two-thirds of Americans, immunized. And that’s the challenge. And, you know, you first have to produce enough. So say we’re approved in early 2021, we’ll have 30 million, 50 million doses, something like that. Especially if we have these vaccines that require two doses, that’s a big challenge. You’ve got to give it to one person, you’ve got to track them and give it again. 

Andy Slavitt: [23:25] What about the cold storage? 

Zeke Emanuel: [23:27] All of these are challenges, the cold storage. It’s not clear we have enough glass vials of the right type to ship it around. It’s not clear we have enough needles and syringes ready. A lot of investment in alternative technologies, maybe that’s a good thing, but, you know, when you’re up against the wall and you’re really got to do things, you probably don’t want to be experimenting with the new technology and find out it doesn’t really work and we’ve relied on it. And then we’ll probably have more than one. I don’t think it’s just going to be one. You’re going to then have several of them coming along that, you know, Novavax and J&J are coming along and then further behind them are going to be Merck, Sanofi, GSK. So I do think we’re going to have multiple. 

Andy Slavitt: [24:12] Do you have enough data on and knowing some of the differences in the Pfizer, the Moderna, the Merck, the J&J, to kind of have a sense of what’s likely to be first, what’s likely to be where the data looks the strongest. Obviously, the AstraZeneca, I should have mentioned as well. 

Zeke Emanuel: [24:29] Well, I think the AstraZeneca one, you know, in the US is still on hold. I think, you know, Pfizer, I’ve heard positive things. But again, all of this is rumor, speculation because we don’t have the data, as we shouldn’t. But I think, you know, there’s the Pfizer one does have this minus-70 degrees centigrade cold chain, which presents huge problems for administering. It can’t be done in doctor’s offices as a result. The advantage of the J&J one is it’s one shot if it works. And I think, you know, the advantage of the Merck one is they’re trying to go oral and one shot, you know, one oral dose. And again, we don’t know which ones are going to do better in which patient populations. And some of these may not work in the elderly, may be better for younger people. And the other thing that, you know, you began with is, look, we don’t know if we immunize teenagers, is that going to be good for reducing transmission? They may not be people at high mortality. But they may be critical people in the transmission process. And that’s something we really do need to understand, where if we administered the vaccine, it’s gonna be most effective in terms of reducing the mortality from the disease. 

Zeke Emanuel: [25:45] And the assumption of these people are at high risk from dying, older people, therefore, we should vaccinate them, may turn out not to be right. It may be well, you know, if we reduce the transmission of the chance that they get infected. And so I think some of these complications and difficulties need to be modeled out to really understand. The last thing I would say is, look, we’ve got a situation of governments now developing a priority list. Are we going to adhere to that? Are we going to actually be able to implement it? That’s going to be another challenge for a new administration. I still think, given all these challenges, we are likely to be able to get out enough vaccine for many people to return to some normalcy. Normalcy doesn’t mean everything goes away. I think I still think we’re going to need to wear masks because a lot of us aren’t going to know who’s infected, whether we’re infected or not. I think we’re going to have to probably still have some limitations on how many people can gather. But I do think that, again, November 2021, plus or minus, is probably the time we’re looking at. 

Andy Slavitt: [26:51] I think a lot of people, when they think about a vaccine like we all do, they think about themselves. They think about, OK, am I going to be safe or my mother or my relative or whatever. And what isn’t I don’t think well explained to people is the herd effect from the vaccine. And the fact that, you know, we have to have a vaccine that’s really widely trusted because the vaccine gives us 50 to 60 to 70 percent effectiveness, in a sense, it’s just enough uncertainty that it doesn’t really improve your life. But if we give the virus fewer places to travel and we start to get to this magical spot where, you know, R-naught or R-effective is under, let’s say, .7, then the math pretty quickly takes you to places like Italy and New York City and other places where, you know, there’s just not much of it around and you can kind of test for it what it shows up. 

Zeke Emanuel: [27:43] Yeah, I think you’re 100 percent right on that. And I think the important aspect is we are going to have to convince the public that this thing is relatively safe and effective and allows you to resume your life normally if enough people get it. And I think, you know, one of the problems of rushing in — I think we’re too close to the election for any vaccine to be approved. But I would say that it’s critical that independent experts validate it. People talk about Tony Fauci, I think critical is going to be the vaccine and other biological products advisory committee at the FDA. They meet October 22nd and then they’re going to meet again later. Critical for them to weigh in on the data and give their blessing for it so that we have independent experts, not government officials, who are subject to political pressures evaluating this. And that, I think, is going to be a tipping point for most Americans in terms of can I trust this vaccine? And I do think, again, you know, assuming Joe Biden and Kamala Harris win, that change in tone, we’re going to trust the experts, the scientists on this is going to be critical to reassuring the public. There is a huge swath of uncertain people, right? I mean, the country boils down into three. 

Zeke Emanuel: [29:07] Those of us who will definitely take it, assuming, you know, the data work out. Those people who are definitely against all vaccines, which is a smaller group. And then there are some people in the middle who are like, I don’t know what to think about this, and I need a lot of reassurance. Some of that reassurance is other people have gone first. You know, the president and vice president take it and the cabinet takes it. Some of that reassurance is independent expertise approve it. Some of that reassurance is my doctor endorses that. Some of that reassurance is my neighbor’s taken it. I think it’s a layered effect to build trust. And I think we’re going to need that layered effect. But in my view, once we get past the initial skepticism, we are going to get most Americans wanting this thing. I hope we can avoid, you know, having to need use mandate, which I think would be a bad mistake.

Andy Slavitt: [30:00] Yeah, I mean, the culture of this country has shown this is a giant sociological experiment. It’s the one against the many, the freedom against the responsibility. All of these things. 

Zeke Emanuel: [30:09] But, Andy, I hate that freedom versus, you know, imposing on me, because if you look at Taiwan now or you look at New Zealand now, they have way more freedom than you and I do. And, you know, they endured that eight to 10 weeks of severe lockdown to get the number of cases low. 

Andy Slavitt: [30:26] I’m talking about the public arena debate. Your grandparents and parents are probably similar situation to mine. If I had said to my grandmother, hey, I have the freedom not to do something, not wear piece of cloth across my face or take something that’s going help people for six weeks or three months. You know, she came here on Ellis Island. You know, she lived there a 10-year depression. She would smack me across the face. She lived through a six-year world war that, you know, could have gone on forever. They had two years without drinking coffee. I mean, if Starbucks is out of the dark roast, I’m upset, you know. You know what I mean? So do we have it in us still to sacrifice, number one? And number two, do we still have it in us to have compassion for one another? Number three, do you understand that freedom always comes with a price? That price was paid by prior generations in our country, the price was paid by people who are protesting today in the street for greater justice. And so to sit back and say, you know, I’ve been handed this freedom and there’s no cost, to me, I think some of this is we haven’t called on people’s better nature. People are naturally fearful, so you already have to figure out what to do with that. And if you allow people — we have a president who’s clearly playing to people’s fears and playing in division as opposed to saying, what can we do to call out the better side of people to contribute? And I think when that happens — you know, we went through a period of time when we were making masks for hospital workers. And that was a really good feeling. We have to figure out how to get back there. 

Zeke Emanuel: [32:00] Well, look, you know, I think President Kennedy’s inaugural embodied that notion. Ask not what your country can do for you, but what you can do for your country. And I think that is a spirit. And I think you’re 100 percent right. People do respond to that. If we know we’re all in it together, people will respond to that. And what we haven’t had is a call, this is what we need everyone to do. You have certain skills, this is what we need you to do. And I don’t think that vision has been the one that’s been animating the government thus far. 

Zeke Emanuel: [32:35] We had Andy Beshear on the show, governor of Kentucky. He’s done a remarkable job in a very hard state. And he said two things which were interesting. One was —

Andy Beshear: [32:44] I do think that we’ve learned here that when you really need people to do something, but that something is sometimes to do nothing, is more emotionally challenging than if we’d asked people to head into the factories, like we did during World War II. What we’re asking of people really here is so little compared to what we’ve had to in the past. But emotionally, and in terms of anxiety, it may be even more difficult. I think as opposed to being the greatest generation, that title is taken. To defeat COVID, we almost have to be the kindest generation. 

Andy Slavitt: [33:22] It’s really interesting. I wrote a piece that’s coming out in JAMA about how it’s thought the hard sciences that are failing us in COVID, it’s the soft sciences. It’s our lack of understanding of psychology, sociology, political science. That’s the stuff that’s killing us now, the stuff we all didn’t pay attention to at Penn. 

Zeke Emanuel: [33:38] Right. Angela Duckworth and I wrote an article exactly on this point about how we need to use behavioral economics and psychology. And there are reasons people resist the masks. So how do we use our understanding of human psychology to get people to wear masks? And, you know, a large part of it is you’ve got to make it easy. You’ve got to norm on it. All of us would be wearing masks, were we in Taiwan where 95, 99 percent of the population — you’re going to feel weird if you’re not wearing a mask. And I think that social norming is critical. Making it easy. So distributing, you know, the U.S. Postal Service had an idea we’re going to send every household five masks. Why didn’t we do that? That tells you government agrees that you should be wearing masks, and by the way, we’re going to make it easy. Here they are. Your starter pack. 

Andy Slavitt: [34:29] Would have been smart. What do you know, what do you think of kind of how Vice President Biden and the team of people around him are thinking about and talking about what they would be inheriting in a transition were they to win? What’s some of the immediate, most important things for them to do are. Can you give us a sense of the conversations going on and your general sense of things and your sense of him? 

Zeke Emanuel: [35:13] So I think they understand they’re going to have to get the public health messages out and re-convince people to adopt them. There are clearly going to be major challenges around testing, contact tracing and isolation. I think that the testing issue may solve itself because of some of these relatively cheap point of care, point of service instantaneous tests that are now going through. 

Andy Slavitt: [35:38] So you have confidence in the antigen tests? 

Zeke Emanuel: [35:40] Yeah, I think that maybe will change the ball game. And then there’s got to be a big focus on getting these vaccines produced, distributed and administered. That’s a huge coordination problem with companies as well as the states and local public health departments. So I think those are the three buckets. I was privileged to do a briefing for the vice president on vaccines and on access. I have to say, I was incredibly impressed by his attention. And I would say he’s a guy who wants to know attention to detail. So at various points, he kept asking whatever the next thing is that we were going to talk about. You know, so we were giving him a rundown of which vaccines are being developed. And he says, well, I’ve heard about this cold chain problem. Are we really going to be able to get these vaccines out because of the demands of the cold chain? You know, that was literally the next thing we were going to brief on. And then at some point he said, well, you know, I understand we’re not testing this on children yet. How are we going to know whether we can administer this to children safely? And, you know, again, that was the very next thing we were going to talk about, the different age groups. 

Andy Slavitt: [36:51] He’s as detailed as Trump, you’re saying? 

Zeke Emanuel: [36:54] He was very, very focused on being practical. What do we got to do? And then the I would say the biggest difference by far is, you know, his orientation internationally. You know, this is a guy who’s been on the Foreign Relations Committee, chaired it. Very much keen about having the United States lead the world. And so the idea of, you know, how do we work with the WHO? What do we have to do about — I mean, he didn’t name the COVAX facility, but about making sure that other countries get a vaccine. Also, he was very, very focused on that, our position post-PEPFAR and what the United States did for getting antiretrovirals and malaria treatments and TB treatments to sub-Saharan Africa. You know, we were and still are to some large degree leaders in global health. Well, obviously, Trump has, you know, I would say screwed that up by withdrawing from the WHO and other things. It’s quite clear just Joe Biden’s approach is going to be literally 180 degrees difference. We have to be the world’s leaders. We have to contribute what we have, both skills and money and knowhow. And we have to reengage. And we cannot be disengaged from this. And our engagement has to be very reliable. And so those are the three things that really impressed me about the briefing with him. 

Andy Slavitt: [38:20] Now, I know you’ve got to run. I’ll close this way. If Biden is to win, do you feel optimistic about the ability of our country, with all the complexities, including the social issues, including the scientific issues, including the inevitable bumps, including all the distribution issues and all the surprises, do you feel optimistic or pessimistic about our ability to get our arms around this thing and beat it? And by beat it, I don’t mean eradicate it 100 percent. I mean, get back to where this isn’t running our life. We’re running our life. We’ve got very, very modest issues here. 

Zeke Emanuel: [39:00] Assuming Biden wins and the Democrats take back the Senate so that you can pass a lot of this legislation without endless negotiations and watering things down, the answer is yes. I do think the larger question, once we get our arms around COVID, the next large question is can we actually begin to do the structural reform of the American system so that we can return to our ideal of, you know, equal opportunity, social mobility and creating social policies that allow Americans to live their richest lives? I think that’s the bigger question. And that that I think, you know, we’re gonna have to rebuild the safety net. You know, you can’t have gig workers who have no benefits and just are left out. We can’t have this sort of Swiss cheese. So people don’t have childcare. People don’t have maternity leave. People don’t have sick leave. We have to rebuild that. We also have to get to, you know, frankly, universal coverage, something that you and I have both worked on. And Americans, you know, they widely accept that. And we need to create a platform that allows that to happen and build on what we have for that. So I think that’s the bigger question for me. I’m pretty confident that we’re gonna get to November 2021 where we do switch this. We go to a situation where COVID isn’t running our lives. But I think the bigger question is, can we rebuild the American dream for, you know, 330 million Americans. That’s the bigger question, because that’s more structural changes than the system has had certainly since the 1960s and 1930s. And that I think, you know, is a huge, huge challenge. 

Andy Slavitt: [40:47] Yes. And we didn’t get to that very much on this. But I tell you what, let’s get through the next month. And I would love to have you back on and have that conversation with you. Look, God willing, we can have that conversation with a sense of hope that we have the opportunity to reshape those things as policy priorities as a country because of the work of people like you and others that are making it possible. I want to thank you again. You know, you’ve been a both a remarkable friend and influence on me, a loud voice that the country has needed. So I’ve been fortunate, and we’re all fortunate to have you. So I’m so glad you were on today. 

Zeke Emanuel: [41:26] Great. Thanks, Andy. It’s been a pleasure to do this interview with you. Thank you very much. 

Andy Slavitt: [41:38] All right. Thank you, Zeke. We have another show coming up on Wednesday, and this is going to be a bit of an experiment and hopefully a fun one. We’re going to call Senate Minority Leader Chuck Schumer basically on the floor of the Senate as they are beginning the hearing for Judge Amy Barrett. And that’s a bit strange because we don’t really know what’s gonna happen there yet. There’s a lot of inner fighting, inner conversation going on. I will admit I was part of this top-secret call on the Barrett nomination, that I just got off with a bunch of people and Schumer’s staff and its all interesting stuff. And so hopefully we will learn, we’ll hone in on the state of affairs. And I think I’ll be a good contrast for the existing podcast. If we can’t make that work for some reason, we have another great episode in the bag we will surprise you with on Wednesday. 

Andy Slavitt: [42:31] Next week, as I’ve talked about before, I think it’s really important and probably remiss of me that we haven’t talked more about mental health in an explicit way. We’ve had some conversations, but not enough. And I think we need to take the toll here very seriously around what’s going on with mental health and how hard this is on people. And so we’re going to talk to Gary Mendell, who created an organization called Shatterproof after he lost his young adult son, who was fighting addiction. And Steph Wittels Wachs, who is kind of one of both my favorite people in the world, but also somebody who has chronicled an incredible experience with loss and addiction and so forth. And, you know, it won’t be that dark in episode. I know it’s dark topics, but we’re going to really intend to be helpful in and exploring that. And then we’ve got more good shows coming up, including one with the Oscar winning director, Alex Gibney, who is making a movie called Totally Under Control about the government’s response to the pandemic. And we will be one of the first people to talk to him. So I’m excited about that. Anyway, thank you so much. You guys are amazing. I really appreciate you listening. 

Andy Slavitt: [43:51] Thanks for listening to In the Bubble. Hope you rate us highly. We’re a production of Lemonada Media. Kryssy Pease and Alex McOwen, produce 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 Wittels Wachs still rule our lives and executive produce 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 @LemonadaMedia. And you can find me @ASlavitt on Twitter or @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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