Transcript: America’s Health Future: The Impact of COVID-19 on Our Health Systems


MS. WINFIELD CUNNINGHAM: Good afternoon. I’m Paige Winfield Cunningham, a health policy reporter here at The Washington Post and author of the Health 202 Newsletter, and this afternoon, I’m delighted to welcome our first guest, Dr. Eric Topol, who is founder and director of the Scripps Research Translational Institute and the executive vice president of Scripps Research.

Welcome to Washington Post Live, Dr. Topol.

DR. TOPOL: Thanks, Paige. It’s great to be with you.

MS. WINFIELD CUNNINGHAM: I want to start off, of course, by talking about the search for a vaccine which is something I know a lot of our viewers are paying attention to. We saw this controversy over the stricter standards that the FDA was considering for granting emergency use authorization, and last week, the White House signed off on those standards after the president had indicated he thought they were politically motivated.

Can you give us your response to that? Does that satisfy any concerns you may have had about this process being rushed?

DR. TOPOL: Right. Well, the concerns were that there was tremendous pressure being exerted from the White House to get the vaccines–a vaccine emergency authorized by FDA before the election, and now I think, thankfully, through a lot of efforts, we’ve been able to shirk that, to preempt that.

There will be vaccines approved in the months ahead. Perhaps this is not a formal approval but an emergency authorization, an EUA, and we’ll likely see that towards the end of November or December, at least the first vaccine. But at least we’re taking the politics aside, and it will be done properly through both FDA internal review and the external review. So, we’ve got that on track now, and I feel much better that Dr. Hahn and the FDA people have stood up to the pressure that was just absurd.

MS. WINFIELD CUNNINGHAM: Do you see this move as more important in terms of increasing the public’s confidence in a vaccine, which, I guess, is more of a messaging public perception type of question or more important for ensuring that we know that the vaccine works and is safe before emergency use is authorized?

DR. TOPOL: Right. Well, these are not only some of the largest trials, clinical trials ever conducted, but also the fastest, and what we don’t need at this point is any shortcut, because once a vaccine gets out there, if we see safety issues that crop up that were not previously manifest, that could put the entire landscape of vaccines in jeopardy.

As you well know, Paige, so much is dependent on the public trust, and so we don’t want any shortcuts. We don’t want any rush job. It’s been moving at a velocity that’s just unprecedented, but let’s just–as we get to the last mile of a vaccine approval, let’s make sure we have as much data about safety, which was part of that tightened guidelines by FDA, and also about efficacy, and that was about inclusion of some serious events, not just mild infections, as endpoint of the trial.

So, we’re making progress. I am confident now the review will be done properly, and this is the sort of thing we desperately need to foster the trust of all Americans and around the world.

MS. WINFIELD CUNNINGHAM: You interviewed FDA Commissioner Stephen Hahn last week, and I know that you have previously been critical of how the health agencies respond to certain things. I know there were some controversies about some things that he had said about blood plasma a couple of months ago. I know that he assured you that decisions will be made on science alone.

Has your view of the FDA changed at all over the last couple of months, and can you kind of walk us through that?

DR. TOPOL: Right. Well, I was at the peak of mistrust when I wrote this open letter to Commissioner Hahn because there had been an EUA that was unfounded on hydroxychloroquine back in March that subsequently had to be withdrawn in June because it didn’t work and there were significant side effects.

Then there was the EUA, as you’ll recall, on convalescent plasma, which was such a mistake, because not only was the evidence lacking, but the grandstanding, that is, this very historic breakthrough press conference, just happened to be the night before the Republican convention. This is really extraordinary and unprecedented.

So, I had lost trust in the FDA, but fortunately, through multiple conversations and also seeing the action of Commissioner Hahn with his team at FDA, including Peter Marks and many other people, we saw a whole different tack. And this was standing up to political pressure, and to me, that’s the first independent sign. It’s really great to see, and we desperately needed it.

MS. WINFIELD CUNNINGHAM: And that was a pretty extensive interview with Hahn and really fascinating. What in particular did he say that helped to strengthen your confidence now that the agency isn’t giving into any potential political interference?

DR. TOPOL: Well, I think what was clear is he put his job on the line. He was willing to be fired, and I referred to that. You know, he can only say so much because he still doesn’t want to get fired for trying to stay on the course of getting the vaccines through due process.

But to see that, we haven’t seen that at CDC, and we had a lapse of some of our most important public health scientists who would stand up to pressure. And we just can’t get the bullying, you know, allow that to occur, because too much is on the line.

I mean, the vaccine and, as I know we’ll talk about also, the monoclonal antibodies, these are pivotal parts of our exit strategy to return to pre-pandemic, pre-COVID life, and we just don’t want to put anything at risk.

MS. WINFIELD CUNNINGHAM: We’ve heard Dr. Fauci and CDC Director Robert Redfield say that a vaccine will be widely available to the public by late spring or early summer. Do you view that as a realistic timeline, assuming that we do have some type of EUA by the end of the year?

DR. TOPOL: Yes. I think that 2021 is going to be the year of the vaccine rollout. There will be multiple vaccines, ultimately, and it’s just a matter of getting it to as many people who are willing to take the vaccines as possible. And remember, these are the first-generation vaccines. Likely, over time, there will be even more potent ones, and you could take one of the second generation, if you will, after even having gotten one of the firsts.

So, I think we’ll see great progress over the year, whether it’s by the summer or the fall next year, but we should be able to get this notable goal of population immunity, the vast majority of people to get vaccines. And we also need to have the support, the education about how vaccination is really important so that everyone is willing to get this, and even if we don’t get to 100 percent, as long as we get a significant majority.

MS. WINFIELD CUNNINGHAM: We saw the news yesterday that Johnson & Johnson announced it had paused its late-stage trial after a participant had reported some illness. Does that give you pause for concern? Do we know how serious that is? I know sometimes these things happen during clinical trials. What’s your take on that?

DR. TOPOL: Well, it’s good that a trial was stopped because of a safety concern. That’s the normal action. We don’t know enough about the details.

I mean, we’ve seen a case of this so-called “transverse myelitis” from the AstraZeneca vaccine that is still on hold in the U.S. after now a few weeks. If it turns out that this was a case of transverse myelitis, that would be concerning, but we don’t know any of the details.

My guess is that it will probably be adjudicated not to be vaccine-related or not to be serious, and the vaccine trials will go straight away in the short time. So, until we know more, it’s not–hard to know where this is headed, but most likely, it’s just a matter of days.

And also, it’s good that we’re seeing the independent Data and Safety Monitoring Board making the call as to a suitability for the trial to continue.

MS. WINFIELD CUNNINGHAM: Well, and as you note, we have a number of vaccine candidates now in late-stage trials. Do you see one in particular as the most promising?

DR. TOPOL: Well, what’s great is the diversity. We’ve got mRNA vaccines, which have never been at scale, and they code for the spike protein to develop immune response. We’ve got genetic vaccines, and we’ve got the adenoviral vector vaccines. I mean, it’s just great. We have lots of different shots on goal. It’s really hard to know whether one will have an advantage over another.

There’s also logistical issues, Paige, like, for example, one shot versus two shots initially. Johnson & Johnson is a single-shot vaccine. There’s also issues about refrigeration. I mean, there’s so many different logistical things too.

So, I think it just takes time to play out. We welcome and need all of them because when you’re trying to get vaccination to hundreds of millions of people, you can’t do it with one vaccine. So, we hope all will be successful.

And I think it’s actually exciting. The prospects for safe and effective vaccines in the weeks ahead, I mean months at most, is really a great thing that would be unanticipated just years ago that this would be possible.

MS. WINFIELD CUNNINGHAM: Well, and we know we have several vaccine candidates being worked on by U.S. companies and also several candidates being worked on by pharmaceutical companies in China. What difference do you think it makes in terms of–or any difference in terms of Americans accessing a vaccine if it is a U.S. company that arrives at a vaccine versus a Chinese company first?

DR. TOPOL: Right. Well, I think it all depends on the data. These are large trials that we’re looking at ranging from 30 to 60,000 participants, and so what we want to see is the data. And it’s not just about ideally the safety, how long the vaccines last. A really important consideration, Paige, is we don’t know whether the vaccines will be good for 6 months, a year, multiple years. So, durability of a vaccine protection is also important.

So, it’s just really data dependent. I don’t think that we want to say if it’s made in this country, it’s good or bad. It’s really the dataset and the follow-up and how well it succeeds in the real world.

I think what we’re interested in is that immune response, not just the antibodies, but also the T cell response because that’s kind of a bonus factor. And some of the vaccines seem to have a better T cell, the so-called “CD8,” cytotoxic T cell response than others, and that will be really interesting to see if that plays out to be important.

MS. WINFIELD CUNNINGHAM: Well, and then, as you mentioned, the question of access and the challenging of distributing a vaccine to millions of Americans.

There seems to be a discussion among health experts also about how much hope to place in a vaccine, right? I mean, on the one hand, we’re told that we shouldn’t place all our hope on this because it’s still going to be many months before this can be rolled out. On the other hand, speaking as a mom, it’s hard to not place a lot of hope in this as kind of this endpoint when we can finally–life can feel like it gets back to normal.

How do you think about that, and how do you advise Americans to think about that?

DR. TOPOL: Well, there’s still a lot of pieces that are not resolved. I mean, the vaccine programs are not a true cross-section of the people. So, for example, children, pregnant women, they don’t show up; the aged, that is, certainly over 80 years, not really represented. And underrepresented minorities are underrepresented in the vaccine trials. So, we have some holes in the story that will get filled in eventually.

But I do think that this is something that is going to be the ultimate turnaround and get us past the pandemic, and it’s just now–it’s in our sight. It’s not that far away, and we just have to be patient. I’m confident that we will get through this, and we’ll look back someday and be grateful that the vaccine programs led the charge.

MS. WINFIELD CUNNINGHAM: I want to talk for a couple minutes about antibody therapies. I know you’ve been really vocal about this. President Trump called it a “cure” after receiving the treatment from Regeneron. Is he right about that?

DR. TOPOL: No. There is no cure. There’s no cure for COVID.

But I have to say putting the antics aside about President Trump, I do think that the monoclonal antibodies are the most exciting thing that’s happened so far in the pandemic. And the reason I say that is up until now, it’s been repurposing drugs, like hydroxychloroquine or dexamethasone, drugs that have been known for years and years, and at least for dexamethasone, there was some success. But that was late in the course of a COVID illness.

What’s exciting about the monoclonals is all the data that supports that they could be used preventatively and early, and there are now–two of the different monoclonal preparations are now under review for an emergency authorization. And the sad part about that is the claims about cure and the fact that Trump received this therapy are confounding the story, that is, clouding it, because these antibodies have tremendous promise. And, ultimately, if we can get enough of them and make them at a very low cost, we can really reduce the fatality rate of COVID-19 and maybe even reduce the toll of long COVID.

So, I’m excited about this. I think what we know so far strongly supports safety, and the efficacy looks awfully good too.

MS. WINFIELD CUNNINGHAM: Well, and last week, we know Eli Lilly and Regeneron applied for emergency use for antibody treatments. Do you have any idea if and when we might expect that to be granted, and then at what point can more patients expect to be getting this treatment?

DR. TOPOL: Yeah. That’s a great question, Paige. I’m hoping it won’t be before November 3rd, in some respects, because then it would be seen as pressure from the White House, and there’s been so many examples of that throughout the pandemic. But it might be.

The review here is relatively straightforward. There’s been two Phase 2 trials, one of which, as you mentioned, the Lilly trial, showed reduced hospitalization need and also reduced medical resource need in the Regeneron trial. The data looked–remember, EUA is “may be effective.” So, it’s just a matter of weeks before that happens, and here we are already in mid-October. I can’t imagine it will take that long. Perhaps, certainly, sometime in November, these two antibody preparations will likely get a green light for emergency authority.

Now, the second part of your question is there’s not enough doses. When you think about it, we have 50,000 new infections a day confirmed, and we’re talking about maybe 100,000 doses of these two different antibody preps available imminently and perhaps a million-plus by the end of the year. That’s a tiny amount. There’s going to be–I’ve been using the term–instead free-for-all, it would be a free-for-all chaos because there will be people clamoring to get antibodies who are high risk.

So, I think we’re in for some trouble in that respect, probably a turbulent time until the supply is much better for the antibodies.

MS. WINFIELD CUNNINGHAM: I want to talk again for a minute about President Trump’s bout with COVID-19 last weekend, and during the time that he was in the hospital and then when he got back, there was a lot of widespread speculation on Twitter, on social media, and frustration about, A, how the doctors were communicating and what they weren’t sharing, and then just, B, a lot of kind of rampant speculation, including those in the medical community, about what this or that treatment might mean, about the state of President Trump’s health.

Do you feel as though it’s appropriate for medical professionals to weigh in on someone like the president when they haven’t themselves examined him?

DR. TOPOL: Well, I think this has been a problem because of lack of clear communication. So, the evasiveness, deceptions, which have been rampant from Dr. Conley, is just not acceptable. So, we have to challenge that.

The public has a right to know of the president’s health status, especially when he comes out and makes false claims about cures and how you could have an immediate response to an antibody preparation, which is impossible. So, his doctor should be straightening that out.

And you know, when you have a doctor who writes a memo that the president tested positive for antibody when they just gave him the highest dose of an antibody preparation known to mankind, this is ludicrous, Paige.

So, we have to keep him honest, and we have to show up. We just can’t be sitting on the sidelines being quiet and silent when there’s real problems on the communication.

MS. WINFIELD CUNNINGHAM: Well, on that note, I want to invite you to weigh in more on the president’s health. We know it’s been over a week since the president returned from the hospital, and his doctors say we has tested negative for the virus on consecutive days. Is that sufficient evidence that it is safe at this point for the president to be around other people?

DR. TOPOL: Well, he probably is okay to be around other people, but the problem is they’re not following the CDC guidelines.

First of all, they didn’t have reports of the conventional test, would just be a PCR for the virus and tell us that that was negative. They used this Abbott BinaxNOW test, which is not meant for this, and so they’re using the wrong test.

But more importantly, it is unquestionable to me based on all the evidence that we have and all the deception that the president suffered from a COVID pneumonia, that his chest, lung CT scan was abnormal due to pneumonia, and he also had significant desaturation of his oxygen.

Now, the CDC states that that should be a 20-day time, not 10 days. So, basically, it’s at odds with the CDC guidelines for moderate to severe, that is, a COVID pneumonia case. And that’s unfortunate because this is just not communicated properly, and the wrong tests are being done.

This has nothing to do with having to do a physical examination of the president, Paige. This is about knowing what the guidelines are and the fact that there’s these missing pieces of data that seem to be a recurrent issue throughout the entire communication path of the president’s illness.

MS. WINFIELD CUNNINGHAM: Well, I know we need to wrap up soon. I know we could talk forever about these matters. I just want to ask you one more question. Scientific American recently endorsed Joe Biden for president, and we’ve seen the New England Journal of Medicine call for Trump to be voted out of office. Should scientific publications voice political opinions like this or remain nonpartisan?

DR. TOPOL: Well, yeah, and you can add to that list, Paige, Science magazine and The Lancet, and yes, I do think that we are at a rarified time in our lives as far as politics having invaded science. If we had let science lead the way in the pandemic for the U.S., we’d be in a different state right now.

So, the reckless–the things that have happened since the beginning of the U.S. pandemic with this denial and total mismanagement leads to these important editors of journals and magazines to call for a change and to call out this as “dangerously incompetent,” as the New England Journal put it, and the lies and the anti-science. So, we have to stand up for that, and yes, it’s unusual. It’s unprecedented, but so is our time being unprecedented.

MS. WINFIELD CUNNINGHAM: Well, unfortunately, we’re going to have to leave it at that, but thank you so much, Dr. Eric Topol, for being with us today.

DR. TOPOL: Thank you, Paige.

MS. WINFIELD CUNNINGHAM: We have much more of our program coming up. Please stay with us, and I’ll be back with Laurie Garrett after this short video.

MS. WINFIELD CUNNINGHAM: Well, welcome back. If you’re just now joining us, I’m Paige Winfield Cunningham, a health policy reporter here at The Washington Post, and I’d like to welcome our next guest, Laurie Garrett. She is a Pulitzer Prize-winning science journalists and author.

Laurie, welcome to Washington Post Live.

MS. GARRETT: Thrilled to be with you, Paige.

MS. WINFIELD CUNNINGHAM: I want to start off getting your take on a letter that we saw from a trio of epidemiologists from Harvard, Oxford, and Stanford last week called the Barrington Declaration, and in that letter, they rebuked the heavy emphasis on lockdowns as a response to the pandemic and called for taking more focused measures to protect the more vulnerable, the elderly, while allowing younger folks to have more freedom, to go to work, to go to school, to sort of resume normal life. And this letter generated a lot of controversy. Can you give us your thoughts on that approach?

MS. GARRETT: Well, this is just the final example of calls for essentially trying to get to herd immunity, without a vaccine available, without any other essential interventions taken. In this case, they’re calling it “focused protection.” So, their idea is that they would focus some kinds of rings of protection around the most vulnerable, you know, senior citizens stay-in-your-cage kind of approach.

But the only countries around the world that have had real success in holding their COVID numbers down to quite minimal infections and really small numbers of deaths have been individual nations that have taken very strict social distancing approaches, mandated nationally the use of masks, and then once they got their levels way down and the amount of virus circulating in the nation came to some reasonably low level, then they approached focused testing, focused cluster analysis, contact tracing to find each outbreak as it might occur and stop it before it spread further.

So, we’re talking about countries like Japan, Iceland, New Zealand, Finland, and China, frankly, but here in the United States, we’ve taken a total chaos response. We have a different strategy in every single state, and in some states, we have strategies that vary county by county. We have no consistent pattern of response and no agreed-upon strategic goal from one part of the country to the other and certainly not at the federal level.

So we’re not in a position to sit around waiting for herd immunity, and I would add that more and more nations around the world, especially in Europe, are finding that the major spreaders of COVID-19 are, in fact, the very age group that the Great Barrington Declaration thinks should be allowed to roam freely and no longer be under mask orders or restrictions on their behavior, namely people aged between 20 and 40.

MS. WINFIELD CUNNINGHAM: I want to ask you about that topic of what we know about how much people spread the virus at different ages and particularly on the school issue, and as you know, we’ve seen many, many districts go to all virtual. But what we’ve seen–I know at The Post, we’ve reported this–there have been fewer outbreaks at least at K-through-12 schools than many had originally projected, and I feel like I’m hearing increasing frustration that we took this sort of aggressive approach to schools which, as you know, have huge effects on kids. Can you talk a little bit about that? What’s your own view on the approach we took to schools? Were we overly aggressive, or was this the right approach? Or do we even know that answer yet?

MS. GARRETT: Well, what is the approach that you refer to, Paige? It’s different in every school district in the United States of America. There is no consistent approach to handling the shutdown or reopening of schools, to the policies that would be executed to protect the students and the teachers and the staff in schools and the grandma and grandpa at home that may be affected when the child comes home. There is no single strategy or approach, and so you’d have to ask me about a specific school district and a specific plan.

And, unfortunately, many of the guidances that we were expecting from the CDC that would tell us how well or not well various strategies were working have been squelched.

MS. WINFIELD CUNNINGHAM: Right. So, I want to ask you a little more about that. So, as you mentioned, we don’t have a huge overarching federal strategy, but there’s also the argument that this is a local thing, right? We have different rates of transmission in different areas. We have states that are doing better than other states. The virus moves in different waves around different parts of the country. So how much should the approach be localized versus federalized?

MS. GARRETT: Well, unfortunately, Paige, in the United States, we have little choice in answering this because unlike all of our counterpart countries around the world and certainly every single one of the countries that has successfully brought COVID under control, we have a bottom-up approach to public health, whereas those successful countries all have top-down public health systems.

What I mean by this is that if you are in, say, New Zealand today where it’s a virtually COVID-free nation, they have a national health system and they have a national health policy, and so whatever is decided in the capital is executed nationwide in a uniform strategy. This allows each part of the country to be able to see and anticipate what’s coming from another part of the country and what they are supposed to do to anticipate and deal with it.

Here in the United States, our public health apparatus is localized. It grew historically from the county level, even the town level, and in many states in the United States, there’s no consistent public health law and regulation from one county to the next. And there’s certainly no consistent policy from one state to the next.

Historically, when we’ve had epidemics and outbreaks, the Centers for Disease Control and Prevention has sort of overcome this jurisdictional and legal set of boundaries that hold public health response down at the local level by issuing very strong daily press briefings and guidelines to the states, helping the states to know this is working, that’s working, this is failing, that’s failing, so that we had a fairly uniform response nationwide. None of that has been undertaken by the CDC in this outbreak.

We’re dealing with an epidemic running blind. There have been almost no press conferences of any kind from the Centers for Disease Control, which is staggering. Paige, you’ve been on this beat; you know. In past outbreaks, we often had two or three press conferences daily out of Atlanta from CDC headquarters. We had the National Operations Center located inside CDC headquarters taking phone calls from every single state, the governors, major Fortune 500 corporations and guiding them with responses, what should they do, how should they do it, so that the nation was really coordinated in a single epidemic response. We do not have that today. We have none of that. Zero of what I just described is going on today.

MS. WINFIELD CUNNINGHAM: I know that you’ve taken a lot of time looking at other countries and how they’ve responded to the pandemic, and I’d love to hear which countries you think have done the best job versus not as good of a job in controlling the virus.

And I’d also like you, if you would, to comment on Sweden because its response has become the topic of much controversy and debate. We know it stayed away from the lockdowns early on and had a very high death rate, and yet now it looks like it’s having one of the lowest rates of new cases in Europe. So, what do you think about Sweden specifically and then other countries overall?

MS. GARRETT: Yeah. There are many countries that we should look to that have had tremendous success and that we can hold up as examples to the world, and they are not all rich countries.

I mean, let’s start with the whole continent of Africa, startlingly low levels of COVID-19 across the entire continent. South Africa had a scare, but they seem to have brought it really, truly under control. And I think, you know, six months ago, everybody would have said, hands down, the worst epidemics will all be in Africa because of their resource scarcities and their paucity of health care facilities, but that’s not been the case. And we could talk about why.

And then let me just jump to a few other countries, circle back to whatever interests you. I mentioned Japan earlier. Japan had a very aggressive response. They went on lockdown for six weeks and came out of it with just cluster responses here and there. They have a prevalence of COVID-19–actually, it’s an incidence of 1.2 per 100,000 population, whereas compare that to us, we’re at 66 per 100,000. So, we are far, far worse than Japan.

You can take a country like Vietnam, not a booming economy, not a huge prosperous nation, and yet they’ve had almost no COVID crisis at all. Ditto Laos, Cambodia, Singapore, Thailand, and what’s in common about much of these Asian countries that I’m naming–South Korea would be one that struggled and then brought things under control–is that they had prior experience with either SARS or MERS, the other two big coronaviruses. And they learned a lot from that. They’ve instituted policies that were based from the very beginning of this COVID crisis on their learning experiences with SARS or, in the case of South Korea, with MERS, the Middle East respiratory syndrome virus.

In Europe, the best examples of real success are Iceland, Finland, which has had a far better response to the COVID crisis than Sweden, ranks number one among the Nordic nations, and we might also consider looking carefully at Germany, which is now but had good results before now.

In Latin America, we see some real progress, and it’s hard to name a real success story in Latin America, certainly not .

MS. WINFIELD CUNNINGHAM: Do you project more global pandemic of this nature?

MS. GARRETT: I’m sorry. There’s some technical interference. I’m hearing somebody talk in the background while I’m on the line, and I don’t hear you.

Well, I will speak to you, and hopefully, somebody at your end will correct this issue. But as far as–

MS. WINFIELD CUNNINGHAM: I’m so sorry. We’re having trouble with the audio. Let me ask that again. Do you predict more global pandemics of this nature?

MS. GARRETT: Well, as I said, I think I’m hearing Eric Topol very loud.

MS. WINFIELD CUNNINGHAM: I’m sorry. I think our folks are working on that right now.

MS. GARRETT: But to continue, you had asked about Sweden. So, let me jump to Sweden. Of course, Sweden has been the big controversy of the COVID crisis from the point of view of folks looking for strategies to control the epidemic without hurting their economies, and certainly, Wall Street has had great affection for the Swedish example because it held out the possibility that, yes, you’re going to lose a lot of your old folks, people my age and older. Oh well, that’s a sacrifice you have to make because you want the economy to keep booming. And that seems to be the promise of the Swedish example, which was to take almost no limitations on human behavior and movement, no mandatory mask wearing, leave it to the good judgment of the citizenry to take appropriate precautions.

So, Sweden ranks the highest in the Nordic nations for death toll, both on a per capita and absolute basis. It ranks in the top 10 for death toll on a per capita basis worldwide. It lost a very significant number of institutionalized senior citizens who were in various kinds of senior or assisted living centers across Sweden, and it hasn’t seen the huge economic boon that was expected from taking that stance. While its economy, GDP growth, appears to look better perhaps than some of its Nordic neighbors, it’s not appreciably so.

MS. WINFIELD CUNNINGHAM: Well, thank you for that really interesting response. I know that we were paying a lot of attention to how things were going in other countries, and then, of course, our response has been so challenging that a lot of the focus has been on the U.S.

And I do apologize for the technical difficulties earlier. I think everything is smoothed out now.

MS. GARRETT: Paige? Paige, if I may? I made a mistake, Paige, by not mentioning the most glaring example, and what would that be? The nation that shares the longest border with the United States: Canada. In every single aspect, every single statistical measure of performance in a pandemic, Canada has done far better than the United States. And in some cases, it’s glaring. It’s like we’re on different planets. They share this massive border with us, and yet they have had a very low death rate compared to the United States, a low COVID infection rate, a low daily incidence. In every single statistical measure, Canada has outperformed the United States.

MS. WINFIELD CUNNINGHAM: I know that you have previously praised the handling by George W. Bush of fighting AIDS in Africa and how he approached that. On the other hand, you’ve been extremely critical of President Trump’s handling of this pandemic. Why do you think the U.S. was so unprepared for this crisis? Did you see that coming? And do you think there’s anything the Trump administration has done right in response?

MS. GARRETT: Well, first of all, many of us have been warning for decades that a pandemic, a serious novel organism pandemic was coming, and that we were ill prepared. We underestimated our vulnerabilities. There was a huge amount of hubris in American culture, assuming that we could conquer any microbe that came along. Just like that, we’ll have a vaccine. Just like that, we’ll have a cure. No problem. We’re Americans.

And so, no president–no president in my lifetime has made an appropriate level of financial commitment. No Congress has allocated resources adequately to allow the nation to really prepare itself.

But to be fair, because our system, again, is based on a kind of grassroots public health that starts at the bottom and works its way up, a lot of this funding paradigm depends on what the city councils supported, what local county governments are willing to pay for and states are willing to pay for. And so, we’ve always had a patchwork of ill-prepared areas across the country where governments are loathe to put resources into public health on an ongoing and consistent basis. So, you can compare states and see which states have the greatest vulnerabilities, which states have the fewest number of physicians on the payroll, of epidemiologists on the payroll. There are counties in the United States where there is no physician and no epidemiologist on the public health payroll at all, and that means that they’re loathe to be capable of responding to an outbreak on their own. They’re going to definitely need federal assistance and guidance. They simply don’t have the expertise.

When HIV/AIDS came along, every single response across the board in the United States and in almost every other country in the world was wrong. We really kind of carried out a textbook example with the arrival of HIV/AIDS in the 1980s of how to do it all completely incorrectly, and the primary mistake made in one country after another was to respond not against the virus, but against the people who were at highest risk of acquiring the virus.

So here in the United States, it was anti-homosexual responses, you know, pass laws limiting gay activities, gay individuals, target the gay community and blame them for the virus. In some countries, it was female prostitutes or commercial sex workers who were targeted or IV drug users. Whatever the case, instead of attacking the virus, we attacked the people.

And where are we today? We have nearly 40 million people affected with HIV across the world, about a little over half of whom are in some form of treatment that’s allowing them to lead their lives and raise their children. But this is abominable.

And the big take-home lesson from the HIV experience that I apply to COVID today is that we really have two choices to make. We can either as a global community learn from the HIV experience and say, “Uh-oh. We can’t allow that to happen. We can’t add SAARS-CoV-2 virus to the landscape of permanently dangerous to human beings disease, of a new virus that appeared, and it was allowed to become a feature of the human health landscape going forward,” and where dealing with it costs billions of dollars every year of wealth transferred from the wealthy world to the poor world to pay for treatment and keeping people alive.

If we scale that up to the scale of what COVID is becoming and imagine whether it’s the Regeneron monoclonal antibody therapy that President Trump took or some other form of drug treatment, that we would somehow have a massive operation underway where several hundred million people around the world, billions actually, would require subsidized treatment from U.S. taxpayers and the taxpayers of other wealthy nations in order to keep them alive, or we would simply say, “They’re disposable. No one is going to help them.” And they will die. That’s appalling.

We’re in a situation now where rather than it being stigma against the individuals who are infected that’s been our major political error made, if you will, we’re dealing with red-state, blue-state response to masks and social distancing. So, if you’re a Republican, you’re allegedly anti-mask, anti-social distancing, and if you’re a Democrat, you’re allegedly pro-mask and pro-social distancing.

This is idiotic, Paige. This has nothing to do with science, nothing to do with public health. It’s just pure politics in its ugliest form played out in the United States of America, and the big winner in this political chaos is the virus.

MS. WINFIELD CUNNINGHAM: Well, unfortunately, we’re out of time, but thank you for this lively conversation. Laurie Garrett, thanks so much for being with us today.

MS. GARRETT: Total delight, Paige. Thank you.

MS. WINFIELD CUNNINGHAM: If you’d like to watch highlights from today’s program, just head over to washingtonpostlive.com, and please come back and join us right here tomorrow morning at 10:00 a.m., where my colleague Frances Stead Sellers will interview some emerging young leaders about their work combatting climate change in their communities.

I’m Paige Winfield Cunningham, and thanks so much for watching.

[End of recorded session.]

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