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Description

Andy calls up Ashish Jha, Dean of Brown University’s School of Public Health, to discuss what to expect during the next three stages of the pandemic. Ashish also describes going through what he calls “among the most surreal experiences of my life” – testifying in front of the Senate Homeland Security and Governmental Affairs Committee about hydroxychloroquine. Plus, Ashish’s projections for 2021 including which holiday we will be able to celebrate with friends and family — and an invitation too!

 

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

 

Follow Ashish Jha on Twitter @ashishkjha.

 

In the Bubble is supported in part by listeners like you. Become a member, get exclusive bonus content, ask Andy questions, and get discounted merch at https://lemonadamedia.com/inthebubble/

 

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Check out these resources from today’s episode: 

• Read Ashish’s op-ed in The New York Times about the recent Senate hearing on hydroxychloroquine: https://www.nytimes.com/2020/11/24/opinion/hydroxychloroquine-covid.html
• Listen to Ashish’s podcast, COVID: What comes next – With Dr. Ashish Jha: https://podcasts.apple.com/us/podcast/covid-what-comes-next-with-dr-ashish-jha/id1537623373
• Keep up with all of Ashish’s work with the Brown School of Public Health: https://www.brown.edu/academics/public-health/about/people/dean/ashish-jha
• Pre-order Andy’s book, Preventable: The Inside Story of How Leadership Failures, Politics, and Selfishness Doomed the U.S. Coronavirus Response, here: https://us.macmillan.com/books/9781250770165

 

To follow along with a transcript and/or take notes for friends and family, go to www.lemonadamedia.com/show/in-the-bubble shortly after the air date.

 

Stay up to date with us on Twitter, Facebook, and Instagram at @LemonadaMedia. For additional resources, information, and a transcript of the episode, visit lemonadamedia.com.

Transcription

SPEAKERS

Andy Slavitt, Dr. Ashish Jha

Andy Slavitt 

Welcome IN THE BUBBLE with Andy Slavitt. Did you have a nice Thanksgiving? It was a few days ago now. Maybe you watch some football on TV, maybe you Zoom giving people you had a little baby Turkey. I Hope you’re doing well. I hope that if you are part of the healthcare profession, that things are going okay, and you’re getting a breather, and know that we’re grateful for your work, I hope that if you have someone in your family who is suffering a little bit sick or anything, anxiety, depression, anything else, that things get better, and they get better soon. We have a show today with Ashish Jha. She a doc. He’s the Dean of the School of Public Health at Brown, is a professor of health services policy and practice. And we’re going to talk about what we’re going to experience next, the three stages that are coming with COVID-19. 

Andy Slavitt 

That’s what we’re going to talk about the three next stages with someone who is not only smart enough to have some ideas about that, but also, to his credit, he’s willing to stick himself out there and you’ll see there’s a great invitation in this show that he sends to you. I think you should take him up on. I know I will. It has to do with something over the summer. Okay. Let’s turn it on. Get to Ashish. Oh, before I do, by the way, if you’re listening on Stitcher premium, or you’re interested in listening at Stitcher premium, I am taping some extra shows. I didn’t know that, for that platform, where I answer your questions. Oh, I didn’t know that. So check it out. Those are fun shows. I play music out of my phone and the show. If you want to listen, if that doesn’t entice you, I don’t know what will. Alright, here’s Ashish

Dr. Ashish Jha  02:14

Hello.

Andy Slavitt 

How are you?

Dr. Ashish Jha  

Very good. How are you? 

Andy Slavitt

Good. 

Dr. Ashish Jha 

I’m looking forward to this conversation. And who knows? We might end up having a good time.

Andy Slavitt 

I bet we will. I bet we will. I bet we’ll have a better time than you had last last week. you’re like, I like I’m thinking of you up there. And I have this image of you is like the defender of like all truth and freedom. Like you should have been wearing a cape.

Dr. Ashish Jha 

Oh, my God. It was it was among the most surreal experiences of my life. I mean, we’ve all testified in front of Congress, like there are plenty of witnesses I disagree with. But you generally tend to like respect people. And you say, Okay, I see it differently. We have different tradeoffs; we have different values. That’s not what was happening here. And I think in some ways, I didn’t really appreciate what was happening. Until well, after the event was over. I walked into a super spreader event; it was a misinformation super spreader event. And I didn’t see it coming, I have to tell you. And it certainly made me smarter. I won’t do that again. But it was a very interesting thing.

Andy Slavitt 

Well, let’s back up and tell people we’re talking about a case they didn’t see it. And by the way, that so the Senate, which committee? 

Dr. Ashish Jha 

Homeland Security and Government Affairs. 

Andy Slavitt  

And for those who don’t know, the majority has the right to structure, whatever hearings they want. And they structured a hearing on the most important topic of our times, considering the global pandemic crisis, right, which would be making sure we have enough hydroxychloroquine. So of all of the things that our Department of Homeland Security Committee thinks is important right now, at this very second, it’s access to hydroxychloroquine. Which scares me more than everything else, by the way. So describe the setup. Describe the structure, what you walked into?

Dr. Ashish Jha  04:08

Yeah. So you know, I got a call from the minority staff saying the Homeland Security Committee is having this hearing. It’s about early therapies, early outpatient therapies, which I think are important. And they said to be perfectly asked them to focusing on hydroxychloroquine. I said, that’s not how I would do it. But I understand that I’m not going to set the agenda and they said, We were wondering if you’d be willing to be a witness. And you know, any my general feeling in life has been when Congress calls you say, Yes, like, you have to have a very compelling reason to say no. So I said, Yes. And,  unexpected a conversation about evidence and data around early therapies, and maybe hydroxychloroquine is an important part of that. And what happened was when I found out who the other three witnesses were there, all three who had been pushing hydroxy since April, and they’re part of a network of individuals who still very much believe that basically we could make this pandemic go away, and everybody could be cured if everybody just got hydroxychloroquine. 

Dr. Ashish Jha 

And it’s a very, very nice narrative, it just turns out to be wrong, but it’s a very attractive one. And somehow, they have managed to get Ron Johnson, the Senator from Wisconsin to hold a hearing. And it was those three individuals, all of them were physicians, and me. And they laid out a case for hydroxychloroquine. That was much more about personal anecdote and the intermittent sprinkling of bad data. And then I stood up and try to explain why, like, we really do need to let evidence and got the science guide us. And it felt like we were having totally separate conversations.

Andy Slavitt 

So you made a really interesting observation about how we live in these news bubbles. Which, of course, it’s sort of an it’s kind of a tangential theme to our podcast IN THE BUBBLE, right? Which is that we all have these. But this is quite a large. I mean, these guys absolutely believe this. This is not something that they’re doing for profit, or, I mean, these are people who absolutely 100% believe that this one drug is the thing that would arrest this entire pandemic, which by the way, some of them don’t even believe the pandemic exists. But that’s another story.

Dr. Ashish Jha  06:38

Yeah. And they believe that to the extent that pandemic is real at all, it’s so easily defeatable. And no, they absolutely believe it. And people ask, well, what’s their motive? Is it a profit motive, it’s not a profit motive. I mean, it’s a pretty cheap drug. It’s a worldview that gets reinforced over and over again, and you have to find yourself in that information bubble to understand their worldview. And it’s all self-reinforcing. It’s a small group that reinforce it for each other. And they believe very deeply in this stuff. So anything that doesn’t comply with that is wrong and problematic, and they have explanations for why every randomized trial has failed. And they have explanations for why every observational study that’s been successful is the right answer. This is a trap any of us can fall into these guys have really nailed down.

Andy Slavitt

Oh, you know, I think that’s a very fair point you make about all of us checking to make sure we don’t, you know, because we all occasionally do sort of believe something first, and then get it confirmed. I would like to think not to this extent. But you know, there are people out there who would refute that masks work and, and other things. And so for the record, you do agree that hydroxychloroquine would, in fact, cure this pandemic? Correct?

Dr. Ashish Jha  

Oh, my God, we should like start it now. And I think by the end of the week, before that, everybody can celebrate Christmas. I think the other part of this, that’s important. So first of all, I do agree that while we all are susceptible, there are ways of checking yourself. And it’s important to do that. But I also think it’s important to understand that we have to find ways of engaging people outside of our own information bubble, if we’re going to have a, in some ways a functioning democracy. And this was really riffing on a comment that President Obama made, where he said, if we don’t have the same kind of set of facts, then it’s very hard to have a marketplace of ideas. And it’s very hard to have a functioning democracy. And that, by the way, means all of us have an obligation to engage with people who live in different information bubbles. And that’s a fundamentally hard thing to do.

Andy Slavitt 

Yep. Well, look, I just have to say just before we should go on to other more fun topics. But look, I think that the example you set by showing and engaging and being polite, considerate of the views, it’s a really another important reminder that I just wanted to call you out for which is that just because we disagree with people, doesn’t make them bad people, doesn’t make them our enemies. It doesn’t make them the reason why we’re in this pandemic. And I think people, all of us have a little bit of pent up hostility. Right, and we don’t know where to put it. Do we blame the other side? Do we blame the President? Do we blame our Governor? Do we blame the Chinese? Do we blame Governor Cuomo? Depending on who you are and where you sit? We’re used to finding someone to blame. And it’s very hard to blame this little pathogen and say, You know what, there are bad things out there. And sometimes, that’s were there. And the test we failed, is probably that we turned out ourselves and the pathogen just ate that up.

Dr. Ashish Jha  10:08

Absolutely. That’s the challenge in front of us is to not do that. And it’s interesting. One last thing about this before we move on is in that hearing. So there’s all this sort of personal attack on me. And then Ron Johnson essentially invited me to attack the other three witnesses. He basically said, you know, you’re sitting there in your ivory tower, do you just not find these people credible? Do you think these people are lying? And I didn’t, I was not going to take that bait. I said these folks are smart. I’m sure they care about the right things. I just think they’re wrong. But that doesn’t make them bad people. But it is hard when you’re right when we find ourselves in that position. And I think all of us, and I’m not trying to be a hero here. I’m sure I’ve done this badly many times. But it is important to try to keep focusing on the topics and issues and engage people as humans and respect them, even if you disagree with them.

Andy Slavitt 

It’s good, you keep asking yourself these questions because you have this sort of responsibility, and only in the sense that if you choose to, you know, a lot of people are looking for guidance, and not just on what to believe, but on how to understand these issues and how to think about the various points of view and the humility and I don’t just mean like a false humility, with rich, you know, we sometimes talk about humility, but humility with what you really don’t understand so many, many things, and can show that I think is, is really important. I found over time, and I by no means have perfected this either. But I think people like people listen to this show. They want a couple things. They want to be told the straight story like plain English straight story no pull punches. No. Look at the glass half full, though. I mean, they’re tired. They’re tired of that there’s one of the truth. 

They want some guidance on what to do about it. What does this mean? What’s actionable about this? What should I do? They want to know what we know when we don’t know. They don’t need it breathlessly, panicky. People, I think, one understand that life does go on, and we can deal with these problems. And then to the extent that there is a legitimate light at the end of the tunnel to think that there’s legitimate hope that people want that explained. And that’s it. I mean, to me, if you can go out and hit that mark, and you’re on cable, and you do such a good job at it, just explaining it thoughtfully, etc. That way, people crave it because they haven’t been getting it.

Dr. Ashish Jha 

Yeah, and it’s ultimately just about treating people with respect, being honest with them, and then giving it to them straight.

Andy Slavitt  

And now, for something we like to call advertising.

Andy Slavitt  

Let’s talk about where we are and where we go. We’re having this conversation, and we’re pushing up to December. We’re about to enter the heart of winter. And I want to talk about the three phases of what comes next, or however we’re going to talk about that. But maybe start just ground us in context. Where do we stand in the life of this pandemic? Right now?

Dr. Ashish Jha 

Yeah, you know, they always say that it gets darkest before dawn, this is the darkest. I’ve been an optimist throughout this pandemic, that optimism is definitely at times gotten me into trouble. But it’s hard to be optimistic about the very short run, the very short run, what do I mean? Next six to eight weeks, just gonna be really hard, um, number of infections in the country are very high, my best guess is 5 to 600,000 Americans are getting infected every day, we’re identifying hundred and fifty, hundred and 80,000 of them. But half a million people are getting infected every day, everybody we’re missing is out spreading it to others. As you know, hospitals are in a lot of trouble in a lot of places. And one of the things that I think is a is an issue and you know, Scott Atlas, who’s also quite impressive at spreading misinformation, you know, and other people often point to number of hospital beds and say, Oh, so 20% of hospital beds are free. It’s not the beds, it’s the people, the nurses, the doctors, respiratory therapists, were running out of our ability to add a lot more and they and you there’s no, there’s no ability to make more in the short run.

Andy Slavitt  14:41

Let’s also talk about the difference between a hospital near capacity in Boston versus a rural hospital, three hours West, in Western Massachusetts, getting filled up.

Dr. Ashish Jha 

Yeah, they are very different situations, right. And in Boston, you have all of this kind of built up search capacity in your community. There are a lot of doctors like me, who are  20% docs, but who could become 80 or 100% docs or researchers who you pull out of the lab. But who can do this, you’ve got a ton of resources for planning. And so I don’t worry so much that Boston hospitals will ultimately become incapable of taking care of people. In Western Massachusetts, you’re the only hospital, you don’t have a large base of providers you can turn to surge, everybody who you can’t take care of, it’s got to get on an ambulance or a flight and go several hours, which raises the bar of who you can set. And if somebody is too critically, Ill you can’t send up, it becomes a very different set of problems. 

15:56

And you get one outbreak in your community. And let’s say seven of your nurses get infected, and 10 or more are quarantined. And you’re supposed like your whole hospital can’t function. So you’re much more on a kind of a razor’s edge in terms of your ability to withstand shocks. And that’s what we’re seeing, right? That’s what we’re seeing in so much of the Midwest, is these rural hospitals, these rural areas, just in big trouble, the next six to eight weeks are going to be very hard.

Andy Slavitt  16:26

So I promised this audience that we would talk about what the next stages are going to look like coming out of this. So we’ve got six to eight weeks, as you’ve said, where it’s gonna be winter, people are gonna be indoors, gonna be a lot of spread, vaccines will not be quite rolled out, but we’ll have some UAS, I assume. Okay, so take us through, if you can this sort of glimpse into the future, because I think people are wondering as they get to 2021 is, what’s it all gonna feel like? And what are the things that we’re going to go through as a country to get back to wherever we’re going to get back to?

Dr. Ashish Jha 

Yeah, so there are different ways you could mark time, but let me maybe start to say, okay, so we pretty tough December, January, by the end of January into February, I am hopeful that things start turning around. And I’m hopeful that things start turning around in for two reasons. One is, I do think that we will have more and more testing available. And I think, like, I believe we’re gonna have a lot more testing available. And what that does, is it creates a space to be able to do schools more comfortably to feel more comfortable about what’s happening in nursing home. So these pockets of places that are very, very special for our society that are really important, start being able to protect them in a much more aggressive way. So I think that across sort of the end, again, I think the amount of testing we’ll have available by the end of January. And a lot of it would depend on how much the Biden team can do during transition, what Congress can do in terms of legislation. So if those things go well, and I’m hopeful they will, we could have three or four x the number of tests we have now. And that really is and that means might have six, 8 million tested it.

Andy Slavitt  18:17

It is the number of tests, or also the type of tests that’s important to you in that thought process?

Dr. Ashish Jha

I mean, at this point, I’ll take a number of tests. And even if majority of those are antigen tests, that’s fine antigen tests are perfectly good for surveillance. But I suspect we’ll have PCR we’ll have an antigen and we’ll have a next generation genomic sequencing. There’s a bunch of testing kind of modalities, CRISPR based test will be amazing. If we could have them by then. And really what we’re going to have is kind of an almost a menu. And then there’ll be some really interesting complicated questions like how to deploy them and what tests do you deploy where, again, things that I wished we had guidance from the White House or the CDC. But I think that guidance is going to certainly come under a Biden team. But if not, I think a bunch of us have developed some ideas of how you deploy these things. But that alone, I think, will start making a difference. But the second thing that will start making a difference as we finished January and get into February is vaccinations. 

And I know it’ll still be early. And I don’t want to overstate how much vaccines will help by the end of January. But, you know, Moncef Slaoui the head of Operation Warp Speed, yesterday, said he thought that 50 million Americans could be vaccinated by the end of January. And I don’t think that’s a crazy number. I think that’s again, a lot has to go right. But that is within the realm of reasonable if possible, and you get 50 million vaccines, and that’s about 16%-17% we’ll have probably 20% of Americans will have gotten infected and recovered by then, those two numbers can overlap a little bit. But even if we’re at 30% immunity, again, let’s be very clear, we’re not talking about herd immunity at 30%. But it starts helping it starts slowing down the spread, it starts making a difference. And so I see February is like the month where things you can see the trajectory of this of this pandemic change. 

20:24

And it starts heading in the right direction, still lots of problems. But February, March better, and April and May, I’m hoping we get to high levels of vaccinations, there’s so much work to be done to make that happen. And not just distribution and logistics, all the confidence building the engagement with communities, the finding the right voices to talk about vaccines, I mean, just the campaign that needs to be led and executed by a Biden administration is daunting. But everything I’ve seen out of them, they’ve got really terrific people, they’re willing to put those people in the right spots. So I’m feeling a little bit bullish on execution abilities.

Andy Slavitt

And so look, even if you’re off by a couple of months, right? You said February, March, a couple things go wrong, you know, you’re talking first half of the year, with a little bit of play, you could see us being in a place by then where you know, 30% plus of the population could be vaccinated. And of course, the weather will be on our side a little bit, except in maybe the southern parts of the country.

Dr. Ashish Jha

I expect in July, to be able to have a barbecue outside of my house and have 15-20 people over not be freaking out. Try to get people to make a little distance maybe a little. Masks, we can talk about that. If they come into inside the house, definitely mask but maybe outside. That’s a pretty optimistic July 4th. I think it’s doable. It’s all execution at this point. And it’s all also communication information trust building.

Andy Slavitt  22:04

How much are you worried about people getting ahead of themselves on the timing? In other words, you know, if this were synchronized swimming, you’d get people to be following clear directives from the CDC and local and state health commissioners. There’s also a world under which, you know, people are very tired as it is they start to see some progress, they see cases start to dip the jump back in governors who are basically barely able to hold the ship together at this point. So could that create setbacks?

Dr. Ashish Jha 

Yeah, absolutely. One of the thing overtimes, as I’ve talked, for instance, to the Biden team, I have said to them, that they should expect actually some level of like outbreaks for years and two, three years, I mean, it’s not we’re not, the pandemic is gonna be gone, the virus doesn’t just magically go away. But let’s talk about February, March, April, where I’m describing life is starting to get better. The pressure on governors to like open up restaurants, bars is going to be immense. And so this is where I think, like why I started with testing on top of vaccines, because I think with really widespread testing availability, it will allow us to do certain things open up certain things more readily. I mean, I’d love to get to a point by March where you can get a 10-minute 15-minute antigen test before you go to the restaurant. So you just show up 15 minutes early. And it’s five bucks.

Andy Slavitt 

Do you have any hope for these newfangled things that are getting tested like the breathalyzers and the dogs and all those things?

Dr. Ashish Jha  

I love the dog idea only because we got a dog about a year ago, and I think I have come to believe. We didn’t have one before then I’ve come to believe dogs aren’t magical. So I love that idea. There’s a lot of technology stuff that passes through my you know, my inbox of cool things. I haven’t seen anything that really is convincing. I think this stuff Michael Minis has been talking about around these kinds of Rapid Strep Test. That makes much more sense to me. 

Andy Slavitt  24:10

He’s been on the show. So people might want to go back and listen.

Dr. Ashish Jha 

He’s really been impressive about this. And has been a great voice for how to use rapid tests, to drive down things. So my hope is that as that pressure builds on Governor’s two things will happen. First of all, I really do hope that Congress gets more money out to states, part of what’s really driving the governor’s crazies have no money, and they’re getting a lot of pressure. And we’ve got to preserve these places. I don’t want every restaurant and bar to shut down forever. I don’t want those workers to be struggling. So if we can find resources to help folks get through the next three to six months, we’ll be in a much, much better spot. But no doubt about it. There will be places that’ll open too fast. That’ll do too much. They’ll see outbreaks, and they’re going to have to manage that.

Andy Slavitt 

So it’ll be a little about bouncy. Okay, so then we’ll get to the to the second half of the year, we’ll have Fourth of July, you have your barbecue. Thank you for the invitation. Where does it go from there? What does it feel like from there?

Dr. Ashish Jha 

So, I think there will be certain things that will still feel pretty tough, right? So I’ve been thinking about is like, what in the fall of 2021, what will not feel like the fall of 2019. And your large indoor gatherings will continue to be a real challenge. I feel like I can think of concerts, nightclubs, things where you pack him, you know, a couple thousand people into or if a couple of hundred people into a tight spot, those will be hard. And we will have to think about how to manage them. And again, My take is the thing that buys us out of those allows us to do them is testing and then the question will be like, you know, if you go to a concert, does everybody have to wear a mask? And I don’t know the answer to that yet. But it won’t be totally normal.

Andy Slavitt  26:00

Sure. So a couple thoughts. Tell me tell me what you think about these. One is that, you know, we’re used to seeing numbers of quite literally hundreds of thousands of cases in a day. and managing a couple hundred thousand cases a day is like a raging forest fire on every side that by the way, is invisible. So you don’t know where to even point the hose. You can imagine being down to a place where Oh my God, we have a community that has an outbreak of six people. And we’re you just the state is seeing numbers like that. And all of a sudden, you actually have tools. You have testing, you have contact tracing, you can isolate people, God willing, you can give people some paid medical leave in this country. So that if they’re sick, they don’t have to go, in fact, to other people. So for one, what you’re not talking about is a world where we’re at zero. But we’re talking about a world where the major outbreaks scare you, but small, like, you know, infections here and there. A handful of people here and there. Well, of course, we want to prevent them just like we want to prevent any illness. That’s a very different ballgame.

Dr. Ashish Jha 

Totally. And what it does, is it allows you, for instance, to be able to use your therapeutics in a very different way like monoclonal antibodies, I can imagine we’ll have plenty of doses at that point, that you get an outbreak, you swamp that whole area with testing of everybody South Korea style, and everybody who’s positive gets their doses of monoclonal antibodies, and you prevent almost every hospitalization and one or two people get hospitalized get treatment.

Andy Slavitt 

So you can do that prophylactically?

Dr. Ashish Jha 

you could do it prophylactically, anybody who’s been exposed. Interesting. We’ll have to see where the data on that come out. But I’m optimistic. And it’s a different ballgame. Because as you said, we’ve been building a bunch of tools, but the tools are not for a raging forest fire. The tools are really effective, when you have like these little controlled outbreaks where you just can go in and you swap it out.

Andy Slavitt  28:01

kay, so let me see this next question. So I actually used this term when I was talking to Tom Inglesby. So you can tell me if this makes sense to you or not. It’s a question of when can I presume innocence versus presuming guilt? And this is a fundamental question. And what I mean by that I’ll explain is, I run into you on the street, you’re not wearing a mask. Today, I have no choice but to presume guilt. I backup six feet. As you put on a mask, I avoid you, whatever, anybody I meet, because there’s so much community spread, you’re safer to assume that, to me, there’s a like a crossover point. Where at some point, you’re like, you know what, I can now assume innocence. I run in to Ashish in the street. And my assumption is, it would be so unlikely that he would be infected that yes, maybe he and I won’t shake hands, the way we used to, maybe we’ll take a couple of the precautions just because you know what, shaking hands, we never really sure why we did it anyway. But you see where I’m going is that feels like a way of describing normalcy, and I avoid saying normalcy. Because, like, I think the world is gonna evolve and, you know, will things change things adapt, etc. And believe it or not, viruses are part of the normal world. We just had been blasted. We’ve not seen a lot of it. When do you see that happening?

Dr. Ashish Jha  

It’s a good question. It will depend a lot, Andy, on levels of vaccinations in your community because this is going to be very spotty, right? So I can imagine communities where you get 90%-95% vaccination and you start assuming a bit of normalcy, whatever your said like innocence versus guilt idea, right? So could I imagine And Eastern Massachusetts that 90% of people are vaccinated by the end of the summer. I could. So next fall, I run into somebody from, you know, who lives in Boston and I run into them in the street. And we’re outside I can imagine. I mean, right, as you said may not hug them may not shake their hands, but may assume that with low, low levels of transmission of the community, and they’re vaccinated and unvaccinated, and we both gotten 95% effective vaccines. I think it’s probably reasonable in early fall next year to say, we’re okay. What did Tom Inglesby say? What do you think?

Andy Slavitt  30:43

I didn’t ask him the question. I didn’t ask him the question. But I did ask him whether or not that was the way or the appropriate way of describing the kind of flip we were looking for. And he said he thought it was unlike you, and Tom, I’m not a science guy. And I’m not a good science student. So like, I feel like part of my job on this show is okay, I want to talk to really smart scientists, and then use really dumb analogies to make sure that I understand it. And then if I do that, then people on the show who have various degrees of interested background in science can hopefully go look I got it way before Slavitt did. I was right there with Ashish. But I’m glad he broke it down for you know the rest of the people who didn’t.

Dr. Ashish Jha 

Yeah, I hope it’s in the summer, early fall. But look, they’re going to be communities in America, where vaccination rates are gonna be 30%-40%. And in those communities, if I get on an airplane and go to one of those places, I’m not going to assume that.

Andy Slavitt 

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

Andy Slavitt 

Let’s go through it. Like let’s label these stages. We’ve got this basically, hello winter stage. Then we have kind of the rising spring, that we have fireworks for the Fourth of July. Those are milestone pointers that we’re gonna remember, you promised the American public that they could have a barbecue on the Fourth of July. No ifs, ands, or buts. You’re guaranteeing it?

Dr. Ashish Jha 

I’m you know, this is totally prudent, it is a bad idea. But yes, I promise. And I’ll tell you why I am as confident as I am. And I have no business being so but I’ll say it, I think we’re going to have by January, four or five vaccines, lots and lots of doses. And it is as I said, it’s all execution at that point. And they’re really complicated execution issues. I do not mean to minimize them. But you know, there are many reasons to be critical of the Trump team’s response. But to me this, beyond the misinformation and the underplaying was this, I’m going to be a little harsh, like the sheer incompetence of a lot of the people running the response. 

And that is one place where, again, reasonable people can disagree about the role of government. But we all agree, everybody agrees you need an effective government on things where you want the government engaged, everything I’ve seen out of the Biden team, gives me confidence that they’re going to put in competent people who are gonna be able to execute effectively. And if they do, and so um, part of it is betting on that. Then I see By May, that anybody who wants a vaccine can get one. And I see by July 4, communities where vaccine acceptance is high, 90 plus percent, I shouldn’t say 90%, but 80%-90% vaccination rates, and boy that’ll make a massive difference. So barbecue at my house.

Andy Slavitt  34:03

We may not even need that high of acceptance rates, given the effectiveness of the vaccines proved to be as effective as they start.

Dr. Ashish Jha  

60%-70% would be great.

Andy Slavitt  

But if in January, you can get it anybody can get a test. And by March or April, I think you said anybody can get a do you say Oh, May and you said May people can get a vaccine, if they want one. You know, that would that would be incredible progress. By the way, I just would agree with you were to win. One thing you said about the Biden folks is, you know, first of all the values you look for are compassion, competence, and honesty. And I will tell you that like you know this because you were around the during different administrations, there’s a cultural tone about what’s acceptable. That that is really set at the top. And it’s set by the President. It’s set by the Chief of Staff, Ron Klain. It’ll be set by the various other members of the administration, but you wouldn’t dream of doing something dishonest as part of the Obama administration, you would make a mistake and honest mistake, you’d ask for help. You’d get support, you wouldn’t feel great to screw up. But you would never worry. 

No one would that I ever met at least, would do anything in the least bit dishonest or untrustworthy. I think, Biden, you know, those three characteristics, people who are competent, people have compassion, people who are honest, are there and then I think it then becomes about, believe it or not, because they have such a high-quality set of people. It’s entirely about organization. It’s entirely about discipline and decision making and reps with one another. And the message I keep delivering to them is just work together a lot in teams, so you get comfortable with each other, you know, who’s doing what, and this is where I think the choice of Klain as Chief of Staff is such a good choice, because he just brings that in a very, very good way from what everything I’ve observed, during his time doing the Ebola crisis.

Dr. Ashish Jha  36:11

Yeah, I got to know Ron, through the Ebola stuff, and over the years have turned to him for advice about a bunch of stuff we were doing on pandemics and pandemic response at Harvard, just before I left there, and you know, he’s freaking brilliant. But beyond that. And as you said, he cares deeply about the right stuff. But a guy who believes deeply that government can do good, and that it is important to use the levers of government effectively to do good in the world. It just sort of and you sense that when you talk to them. And this is why when President Obama got a lot of crap for picking Ron Klain with Ebola could go like he’s not an infectious disease guy. Yeah, at this, the sense I had from President Obama back then was, he’s like, I’ve got an infectious disease guy, his name is Tony Fauci. And he’s really good. And I don’t need a somebody to top Tony on infectious disease. But I need somebody who can make the government pull in the same direction, all the different agencies, all the different parts, so that we’re effective and getting what we need to get done. And that’s Ron, and Ron, is probably the single biggest reason, I think I can have a barbecue at my house in July. And I mean that, because he will make sure that the team that’s doing this because it’s going to be priority one, the team that’s doing this is good. That’s compassionate and honest, but really good. And that is what gives me faith.

Andy Slavitt 

This is a really interesting feeling Ashish, because you said it, I think very well, when you said that the times are darkest before the dawn. But what’s interesting is that expression, at least as I’ve come to use it is usually when you don’t know when dawn’s coming. And you just have to remind yourself, and this is how it felt two months ago, that it’s going to get darker and darker, but eventually it will break. This is actually a really interesting occasion case where we actually have quite a bit of confidence people like yourself, and Eric Topol and many of the other people we’ve had scientists, David Agus, and others on the show, that we are, in fact, going to see dawn pretty quickly. But we are also very confident of how dark it will be until then. And it’s a really unusual feeling to see both of those things at the same time. 

Andy Slavitt  38:36

But I hope that people really use the fact that we are going to get through this now. It’s not that much longer. That next Thanksgiving will be the best Thanksgiving people hopefully ever have had in their lives because they’ll be reunited with family and so forth. That your 750% barbecue on the Fourth of July is just going to be gangbusters. But yes, you better tell you better tell your wife because I think about 60-70,000 people will listen to the podcast. And so you’ll get you get probably like maybe you get a 1% yield. You get 700, we’ll put your address in the show notes. Don’t worry about it. Getting the road now and start driving earlier in middle of June and I assume we can spend the night if we get there a little early. We’ll figure it out.

Dr. Ashish Jha 

People bringing sleeping bags, people will bunk everywhere. It’ll be great.

Andy Slavitt 

Bring tents, bring sleeping bags. Bring marshmallows.

Dr. Ashish Jha 

Thank you so much for having me on. 

Andy Slavitt  

Thank you. I’m so glad you came on. 

Dr. Ashish Jha  

Be well stay well.

Andy Slavitt 

Okay, let’s all pack our stuff and get ready to go to Ashish’s house for Fourth of July. I know that’ll be fun. Maybe we’ll do a live broadcast IN THE BUBBLE from Ashish’s barbecue. I’m going to be really fixated on that now. Because you could tell when you’re talking to him that he was hinting that he wanted me to come over, right? I mean, that seemed like what he was getting at. So I just jumped. I just jumped into that. I don’t like to be rude. And of course, I don’t know where he lives. And I’m sure he’s definitely telling me but that’s okay. 

Andy Slavitt  40:20

Anyway, let me tell you what’s coming up. Wednesday, we have a show about what’s going on in US hospitals right now. With a fabulous emergency room doctor from her Island. She’s at Brown. Name is Megan Ranney. And this is just where the center of action is, right now. It’s Ground Zero. The following Monday will be I’m gonna go out on  and say your favorite. Not IN THE BUBBLE episode ever, not podcast episode ever. Maybe one of your favorite moments on the planet. Maybe if you had birth of a child or something that could rival it. Vaccine distribution episode, where we are going to tell you everything you need to know about when the vaccines are coming, how to get them, etc. And then I went today, Laurie Garrett, who is one of the world’s leading experts, on pandemics, and we’re gonna get a good picture of where we are. Until then. I will talk to you Wednesday. Thanks for sticking with me. 

CREDITS

Thanks for listening IN THE BUBBLE. Hope you rate us highly. We’re a production of Lemonada Media. Kryssy Pease and Alex Owen 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 Wittels Wachs still rule our lives and executive produced the show. And our theme was composed by Dan Molad and Oliver Hill and additional music by Ivan Kuraev. You can find out more about our show on social media at @lemonadamedia. And you can find me at @aslavitt on Twitter or at @andyslavitt on Instagram. If you like what you heard today, most importantly, please tell your friends to come listen, 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