Subscribe to Lemonada Premium for Bonus Content

The White House is ending the public health emergency and disbanding its COVID response team. Andy calls up outgoing coordinator Dr. Ashish Jha to find out what this means for the American people. Jha explains why the band is breaking up, predicts what might happen if a dangerous new variant wreaks havoc again, and promises free vaccines for the uninsured moving forward.

Keep up with Andy on Twitter and Post @ASlavitt.

Follow Ashish Jha on Twitter @AshishKJha46.

Joining Lemonada Premium is a great way to support our show and get bonus content. Subscribe today at bit.ly/lemonadapremium.

Support the show by checking out our sponsors!

• Click this link for a list of current sponsors and discount codes for this show and all Lemonada shows: https://lemonadamedia.com/sponsors/

Check out these resources from today’s episode: 

• Find vaccines, masks, testing, treatments, and other resources in your community: 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

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/show/inthebubble.

Transcript

SPEAKERS

Andy Slavitt, Ashish Jha

Andy Slavitt  00:18

It’s IN THE BUBBLE with Andy Slavitt. Please email me at andy@lemonadamedia.com. Tell your friends about the show. Ashish Jha is on the program today. Very important conversation. They are closing up shop in the next couple of months in the White House, the COVID response team, we are ending the public health emergency, symbolically, it feels like a set of steps being taken, which sends a message to the country, whether intentional or not, that we are moving our attention on from COVID I think different people are going to be responding differently to this. I think some people feel like they’ve been done with this thing for a long time. I think there are many others who believe that we have taken our eye off the ball. And that that will come back to haunt us. And I think there are other people who believe that for them, this pandemic is still as real as it was from the start. And to acknowledge that all of us have some validity to them, depending on where people sit, depending on their lives or priorities, etc. But when the White House does this, it does send a message. So we’re going to talk to Ashish today about that decision about these decisions. And get a sense for where the country goes from here. We’re pleased to have him on I think this is a great conversation. Here’s Ashish.

Andy Slavitt  01:50

How you doing Dr. Jha?

Ashish Jha  01:52

I’m good.

Andy Slavitt  01:54

I think you’re here like at our official third year anniversary of in the bubble. There’ll be cake and gifts. Coming my way, not your way.

Ashish Jha  02:03

I’m in the wrong spot.

Andy Slavitt  02:07

We have a couple of things to cover that are topical, you know, come May we’re going to have an official and to the public health emergency. Yep. What does that all about? What does that mean?

Ashish Jha  02:19

So as you know Andy, each of the last two winters before this current, this before this winter that just passed, we saw a really horrendous number of people getting sick, dying from COVID. We saw that in the winter of 2021. And then a year, a little over a year ago with the Omicron wave. And it was I think one key thing we were paying attention to was the importance of being able to get through a winter without our healthcare system getting overwhelmed without 1000s of people dying every day from COVID. And we did a lot of work to prepare for that. Obviously, we had new bi-vaillant vaccines, we put a got a lot of treatments out to a lot of work with the healthcare system. And got through the winter,  we saw a spike of cases we saw people getting sick. But it was meaningfully better. And the combination of that, and the fact that we’ve now gone about a year with the lowest death rates and hospitalization rates that we’ve seen throughout the entire pandemic, I think gave us confidence that it was time to move to the next phase. So it was time to end the public health emergency. And I should take a minute, because I think there’s a lot of confusion about this, I’m gonna just take a minute to explain what the ending of a public health emergency is, doesn’t mean that there isn’t a public health problem doesn’t mean that COVID is gone. What it means is there are a set of tools that government had put in to help us manage the worst of the COVID days, right. And I always sort of give examples like, you know, in April 2020, if you’re running a hospital and you want to set up beds in a parking lot, you can do that. That’s a flexibility offered by a public health emergency. Under normal circumstances, we don’t allow hospitals to set up beds and parking lots. But in April of 2020, that’s how hospitals got through this. Those flexibilities wind down basically those kinds of unusual rules that we put in, those go away. vaccines don’t go away, treatments don’t go away. Most of the stuff that most people care about doesn’t those things don’t go away. But these flexibilities that they’re just no longer needed. And that was essentially the calculus that the Secretary of HHS made, that we can now manage COVID without those extra tools.

Andy Slavitt  04:33

So when I look at the kind of preponderance of things that are going to change when the public health emergency ends, they seem to disproportionately affect poor people. They affect people without insurance, because it becomes uncertain as to whether or not they can get vaccines or get medications at a cost they can afford. Or there’s going to be people kicked off of Medicaid. Some of which don’t qualify, but many of which do qualify, and a series of other things that I think, you know, disproportionately will affect poor people. And I can imagine that someone who is, you know, well off and well insured and so forth, may feel very little change. But it feels like the brunt of this is going to be borne by people of lower incomes.

Ashish Jha  05:23

Yeah. Let me actually clarify to the two examples you gave there. So on the issue of Medicaid, no question about it, that during the public health emergency, the government is able to have a far more expansive view of who was eligible and could be covered under Medicaid. Congress decided in December in the omnibus bill, that, that was going to go away irrespective of the public health emergency, I think. So they decoupled public health emergency ending from the Medicaid eligibility issues. I mean, you and I both know, expanding Medicaid, making sure that people have health insurance is critically important. And whether we ended the public health emergency or not, that change in Medicaid rules was going in good was going to go into effect. That was a decision Congress made, as I said, in December of 2022, on the issue of free vaccines and treatments, it really is not tied to the public health emergency. So let me be absolutely clear about this. The reason vaccines and treatments have been free is because the US government has been buying them. And Congress stopped funding that. And we have a stockpile, and at some point, that stockpile goes away, the counter example I use is imagine we kept the public health emergency going for another year, you know, we’d still run out of that stockpile sometime this summer into fall, we would still have to transition. So it’s not tied to the public health emergency, it is tied to the fact that we had a limited amount of money, certain amount, number of vaccine doses and treatments. And we just can’t buy more without more money. And so we have to make this transition. But one last point on this, Andy, because this administration obviously cares a lot about poor people who are uninsured. People who have been previously on Medicaid, we’ve been pushing hard to make sure that people can get enrolled in health insurance. And we have developing a plan. And I can be very confident about this, we are going to have a plan to make sure that uninsured Americans continue to get access to vaccines and treatments for free. Like that is a really important goal. And we have set aside money to make sure that we can meet that goal.

Andy Slavitt  07:29

Can you talk about that at all?

Ashish Jha  07:32

Yeah, look, there’s some parts of it, I can talk about some parts, I can only because we don’t know the details. And we may not know for a while. So for instance, let’s talk about vaccines. The good news is if you have health insurance in America, you’re gonna get vaccines for free. That’s not because of the large s of any drug company or any insurance company is because of the Affordable Care Act, the ACA makes sure that people who have who are insured, which is 92% of Americans will get preventive services for free. But what about that other 8%? So we are working through there a couple of different mechanisms. You know, obviously, it’ll depend on when there’s new vaccines, the current vaccines, we have plenty. So if an uninsured person walks into a CVS on June 1st of this year, they’re going to get a free vaccine. At some point down the road, we may get an updated vaccine. And we are setting aside dollars to make sure that we have a plan to buy some for the uninsured. We’re working through what the distribution channels would be where can uninsured people get it? That is just being worked out. And obviously, it’s hard to work out all those details that when that vaccine doesn’t even exist yet. Similarly, for treatments, we have plenty of treatments right now. And down the road, we are going to make sure that there are treatment options available for the uninsured that they can go get their excellent if they’re eligible, and not have to pay substantial money.

Andy Slavitt 08:53

Well, that would certainly be great news.

Ashish Jha  08:55

I can tell you, Andy, this is not an aspiration, this is something we are going to get done.

Andy Slavitt  09:00

Let’s take a quick break. And I want to come back and talk about what happens if something bad happens with COVID or other infectious disease right after the public health emergency end, will we’ll be prepared to respond. We’ve talked about this before in the past Ashish, how it was super-efficient for the government to buy vaccines. And you’ve made a number of good points is these weren’t points you made on the show. These are points that we’ve made. Just you and I were talking including the fact that it gets the US higher up in line should a new vaccine or new therapeutic come to market because you can combine your purchasing in one place. You also can negotiate a bulk rate so to speak. One of the things that you’ve talked about as we run out of the vaccines and therapeutics that the government purchased for Americans, is that the Pfizer and Moderna, there’s no ways that they’re going to raise their prices to quote unquote, commercial rates. And there’s a bit of thought of controversy around there. Can you explain that and kind of where that currently sits?

Ashish Jha  10:24

So first of all, I do believe it was incredibly efficient, good for the American taxpayer, when the US government was buying these vaccines and treatments, but and if we just stick with vaccines for a bit, we got very good prices, then if this was all done through the commercial market, but that was only possible because Congress continued to fund that. And the congressional decision not to do it means that we’re out of money, and we can’t do that anymore. Now, what is going to happen in the private market Moderna, and Pfizer will set their prices again, we’ve heard different numbers Moderna, talking about $130 A dose, I think most people know, we paid about $30, a dose for Moderna and Pfizer, a little different, there’s some minor technical issues, but that there’s a ballpark is about 30 bucks. So that’s a pretty substantial increase to go from 30 to maybe 130. Again, for the consumer, it should remain free. But someone’s gonna have to pay for it. Insurance companies, PBMs, that money is going to have to get paid for. And we have again, we don’t get into contract negotiation. That’s something that’s going to be done between HHS and these will actually end with private, between private payers and, and these companies. But we have been very clear, we think that those price right increases and you look at Moderna’s price increase. It’s pretty hard to justify, and it’s hard to understand.

Andy Slavitt  11:47

Well, they’re hurting, they’re obviously hurting financially. Yeah, I mean, look, I think it’s a really stark, stark reminder of a truism that that’s something that Rob Califf once said to me, he said, he’s the commissioner of the FDA. When we were talking one night over dinner, I asked him, How do drug companies set their prices? He said, well, it’s pretty simple. There’s a simple formula, it works like this. It’s the maximum they could get away with minus shame. And so depends on what shame they feel. And in this case, it doesn’t seem to be a lot of shame here. I’m just wondering if there’s anything that the government can do to assist in either perhaps helping the purchasers the insurance companies, etc, to aggregate the power? Or it’s something else we could do? I mean, certainly, in the case of Madonna, you know, a lot of a lot of this vaccine was developed with us paid for taxpayer paid for technology, taxpayer paid for in operation warp speed, not so much in the case of Pfizer, but that feels like it’s gotta count for something.

Ashish Jha  13:01

Yeah. And you saw Senator Sanders take that up this past week, in his hearings, really asking about the prices and the price increases. And I think, asking hard questions about how do we make sure that that these things remain affordable to the American people, and that affordability isn’t just the dollars that people pay out of pocket, but the dollars, they will pay in their insurance premiums, if the insurance companies are having to pay a lot for these products.

Andy Slavitt  13:30

So the end of the public health emergency, in many ways, as you said, for many people won’t have a very direct impact. It does feel like there is some symbolic thing going on. And I think it’s fair for people to read into not just the Public Health Agency heading, but recent news that the White House is going to wind down your office, the office that I was in as well, for a time, which was the COVID response team. Dr. Fauci retiring, which is unrelated, of course, but I think, again, adds to the symbolism. And, you know, I think it’s safe to say that Americans are at various stages of where they are with regard to COVID. Very much depending upon their circumstances, their belief system, their health. So I suspect that the reaction to this symbolism ranges from you should have done it long ago to I can’t believe were ending the government’s effort here. What do you say to people at these stages as we continue to move forward in this world where COVID still certainly exists?

Ashish Jha  14:45

What people care about in my mind is making sure that the government is still engaged in surveillance, can see new variants coming, that they will have access to vaccines and treatments because that has been central well And then we’re going to continue to get good communication about what the problem is how people can protect themselves. All of that remains, all of that remains post public health, emergency ending, all of that remains after the COVID response team at the White House winds down. As you know, the COVID response team at the White House was a very unusual thing. Usually the White House doesn’t have teams like this. But of course, this was a very unusual disease and very unusual. And a really historic pandemic. And so it made a lot of sense. And my assurance to people is that the things people care about, we will have now and continue to have a whole set of mechanisms to make sure they continue. And so I want people to read less into the symbolism and look more at the substance. And the substance here is we’re in a better place. And we’re going to continue having new vaccines and treatments that will make a big difference in people’s lives.

Andy Slavitt  15:56

And the reports that have been out in the last week or so around the office, ending right around the time that the […] ends. What are some of your thoughts on primarily, I think people wonder, okay, well, what’s being left behind? If there’s something to occur, a new variant, something troubling. Is there something being left behind? Because you’re certainly right that we have plenty of people fighting infectious disease, all over the government outside of the White House, and who carried the water for disease prevention, drug approval, science, many, many things. But the White House played a really important role. And you played a very, you have played and still play a very important role in coordinating policy and getting things done quickly. And being able to speak with one mind and one voice and so to be accountable to the President, when something important happens. So can you speak to what kind of her will remain if should we face a situation like that?

Ashish Jha  17:00

Yeah, absolutely. So the way I think about the answer to your question is it comes in two buckets. There is what have we done as a government to strengthen the agency’s abilities to fight this pandemic? That is a really important part of this to fight COVID, defied future things. And I think you’ve seen a lot of this get announced publicly by Dr. Walensky. But CDC is in a different place than it was two years ago, there have been a lot of reforms, there’s a lot of effort, CDC is ability to do wastewater surveillance across the country, you know, we will have less data coming in from states, but we have phenomenal wastewater surveillance, that will help us identify new variants very, very quickly. So my take is like we have done a lot to strengthen the agencies that work continues, it’s not done. But that means that the government is going to be better prepared to manage future waves of COVID and better prepared for other outbreaks. Now, more specifically, to your question around the White House, that second part of it. You may know this, I think you do, actually, I know you do. In the omnibus that was passed in December, Congress put in for the creation of a new office inside the White House. Inside the ELP, the Executive Office of the President called the Office of pandemic preparedness and response OPR. They laid out a series of things that they thought the office should do. We think it’s a good idea to get this office together. And so obviously, Congress has legislated it. We are working on developing that office. And there’s a lot of questions to be sorted out where exactly in the EOP does it said, How’s it going to get staffed, who’s going to run it? All of those issues are being worked out right now. But that office will have a very important role in continue to coordinate around COVID, coordinate around NParks, other diseases, other disease outbreaks that happen, and that is going to be an office dedicated to these issues inside the Executive Office of the President. And that’s going to be really, really important part of the federal government’s response.

Andy Slavitt  19:03

And that’s a permanent office, right? That’s not a temporary office.

Ashish Jha  19:06

It’s a permanent office, which is really important.

Andy Slavitt  19:08

Yeah. And that I could say, from my own experience, it is important because the government is just so big and so vast, and there’s so many priorities that you want the ability for someone with some proximity to the West Wing, to be able to raise the flag and make it so that, you know, it gets attention more quickly than it might have someone in the far flung reaches of CDC somewhere sees something from a surveillance standpoint that troubles them. You want them be able to pick up the phone, have someone in the White House, answer the phone and say, Okay, we got to act on this information. And we got to at least learn more. That’s great. Let’s take one final break. And I want to come back and talk about the CDC. Americans confidence in the CDC has waned, and let’s try to understand whether or not they will be up for the job and we’ve seen improvements We’ll be right back. You mentioned CDC and this is probably a bit of a touchy subject. But you mentioned some of the reforms going into place. And what’s touchy about it, I think is over the course of the pandemic, people probably have had reason to question the confidence that they should have in the CDC, going all the way back to 2020, when there were botch tests, when there was suppressed communication from the administration prior to this, oh, way through, you know, frankly, and I think, you know, Rochelle has certainly owned up to this, some of the things that some of the communication efforts that people didn’t feel targeted them, well, and Tony Fauci was on the show Monday, you know, he’s, he’s talked about them some of the things that could have been done better, but the confidence levels, you know, we great to have high confidence in our ability to have great surveillance, wastewater surveillance, which of course we’ve invested in, it would be great to feel like we’ve got an airtight system where we’re leaving behind. How do you feel about that? Because we’re going to find out soon enough, I mean, whatever state it’s in, we’re going to be dealing with it soon enough.

Ashish Jha  21:25

Two thoughts on this, Andy. First is, I think, you know, I’ve watched CDC very, very closely as an outsider in 2020. And watch the ways in which it’s struggled. A lot of it, I think, driven by unnecessary interference from people who weren’t scientists who did not understand the science and data. It is a different CDC, I do not mean to suggest that every issue is fixed, every eyes dotted and there’s still a lot of work to do. But you know, the second part, I will say, what gives me confidence as I interact with CDC scientists all the time. I just had a, just under an hour long call. I was in an agency call, where there were three people from the CDC, and listening to them. You remember? Oh, yeah. CDC has some pretty amazing people, like some of the smartest best people in this area in these areas, work at the CDC. And what we need to do, and I think Rochelle has done a great job on this is to make sure their voices are heard that their voices influence and shape policy. And she’s continuing that reform, that is not an overnight fix. She’s done a lot. But I feel like this is a much better agency than it was three years ago. And, yeah, we’ve got more work to do. To keep plugging away at that.

Andy Slavitt  22:48

Have you enjoyed your time in the White House?

Ashish Jha  22:51

It’s been extraordinary. I mean, to say that it’s a privilege feels like an understatement in some ways, right? Like every issue that you work on ends up having real impact. Things that are complicated things that have different stakeholders with different perspectives. Those are the ones that come to you and you get to work through them with a lot of input A lot of it’s just an it’s just an extraordinary space, I’ve learned a ton. I have loved serving as President, I have loved serving the country, you know, and these days, I just continue focusing on that privilege.

Andy Slavitt  23:21

Yeah, we talked about it when you were going in, and I think you certainly had the right attitude and philosophy, and humility. I think it feels like it calls on every ounce of talent, you have every ounce of energy, you have every amount of critical thinking that you could possibly bear every element of scenario planning, communication skills, people skills, patience, and you almost can’t let if there’s a moment when you let any of that rests, right, your guards down, then it can be costly. And so it’s an attempt a really intense kind of experience.

Ashish Jha  23:57

It’s very intense. And rightly so. I mean, if when I think about every issue that people work on in the White House are these are all important issues across all of our society. For me, obviously, most of what I have spent the last year working on has been COVID. And the complexity of the impact of COVID on our country is hard to overstate. And working through the policy issues, making sure we’re getting the science right making sure that science is shaping and influencing policy. And doing it in a way that really makes a difference for people’s lives is just it’s hard work, but it’s extraordinary work. And yeah, it requires it’s certainly let me just say that I can’t think of a single day where I did not feel really challenged. And at times you’re stretched to the limit of what I can do.

Andy Slavitt  24:51

So what lessons I guess it to learn just from managing, communicating, reaching out to people making decisions, any lessons that are fresh for you?

Ashish Jha  25:03

There’s a bunch and this continues to this day. I mean, I just think about the things that I’ve been working on the last 24 hours, reminder. So first and foremost, there is no substitute for having a great team. Because the sheer volume of things that come through, you need to rely on your team to make most of those decisions. So because you so having a talented team is everything. Second, you don’t just need them to make the decisions on most of those things. Having a great team means that you they question your assumptions, there have been a bunch of times I have gone into things thinking, I know what the answer here is, it’s got to be x. And I’ve had and because I have the team that I have, they will tell me why I’m wrong, and have made us all much, much better. So there is nothing more important than I think having a very strong team. And that strong team, by the way, has meant for us having a super diversity to team with variety of different skills, variety of different backgrounds, variety of different lived experiences, because we’re trying to serve a very diverse American population. And none no one of us can bring that entire set of perspectives to complex policy issues. So that has been, I would say, very important. In terms of advice that I would give, I will say to people, and it’s funny, because you and I have talked about this before I came in. I think there are a lot of people out there who wonder about government service. And yes, there are challenges, and government has certain safeguards and difficulties of like, you know, it’s got a whole bunch of rules you got to live by, first of all, when you do it from the inside, you begin to appreciate the importance of those rules. But second, there is nothing more impactful that you can do in your life, then, when you get to work on really important issues inside the government. I mean, the US government’s ability to do big things is unmatched. And so what my advice would not have been giving out to people over the last year is if you get an opportunity to work in government service, go do it. You will not regret it.

Andy Slavitt  27:09

Any closing thoughts? Anything we didn’t talk about that you think people should do?

Ashish Jha  27:13

Yes, let me say I think in this moment of transition, there is a sense I have I talked to friends and colleagues and family. For some people, as I said, COVID is in the rearview mirror, and they don’t want to think about it. For a lot of people this transition feels like a loss feels like we had a way of doing things for the last three years. It got us to a good place. Why are we giving up on that. And the point I have been trying to make is, we have made incredible progress because of the leadership of this President, the work of this team, obviously, the work across all of government and in the private sector, this podcast has made a really big difference.

Andy Slavitt  27:56

I know you were thinking that.

Ashish Jha  28:04

But it is time for us to think about the next phase of dealing with this virus. And we are working really hard to make sure we are prepared. If there are future searches, we have a strategy for identifying variants that may be a problem. The ending of the public health emergency does not mean giving up on COVID giving up on fighting of the COVID. We’ve heard the President say this over and over again, that COVID has not done and we’ve got to keep pressing the fight against this virus. And you’re gonna see the US government continuing to do that it’ll be in a different form, it’ll look a little different than you know, the name of the team driving it at the White House will be different. But the bottom line is that the efforts to make sure that COVID continues to be surprised that it does not cause disruptions does not cause illness, serious illness and death. That effort does not let up on the public health emergency hands.

Andy Slavitt  29:04

Shut. Thank you for your service, and for of course being in the bubble.

Ashish Jha  29:07

And thanks for having me in the bubble.

Andy Slavitt  29:24

Thanks to Ashish, Friday, we are going to be concluding our third year anniversary week and what a party it’s been. I hope you guys have been celebrating at home with Sheryl gay Stolberg, who’s been covering the pandemic for the New York Times nonstop since April of 2020. And she’s written some great pieces. Her work goes very, very deep, particularly with a focus on this origin story. And this notion of a lab leak versus animal spillover. So Cheryl is here and we great conversation Shouldn’t we’re going to explain some of the things that have been happening since she’s been covering COVID from the beginning. We will talk to you Friday

CREDITS  30:15

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.