Transcription détaillée : Dr Scott Gottlieb sur « Face the Nation », 19 septembre 2021

Ce qui suit est une longue transcription d'une interview du Dr Scott Gottlieb diffusée le dimanche 19 septembre 2021 sur "Face the Nation".

MARGARET BRENNAN : Alors pourquoi avez-vous écrit ce livre ? Qui veux-tu le lire ?

DR. SCOTT GOTTLIEB: Une grande partie des commentaires sur ce qui s'est passé, ce qui a mal tourné, je pense, était très politique. Il était axé sur un grand nombre d'erreurs politiques qui ont été commises. Je ne pense pas que quiconque ait commencé à se plonger dans les problèmes plus systémiques, les lacunes plus systémiques, les caractéristiques structurelles du gouvernement qui, je pense, nous ont rendus excessivement vulnérables à la pandémie. Et je voulais commencer à raconter cette histoire. Je pense que si nous voulons nous assurer que nous sommes mieux préparés si cela se reproduit, et cela se reproduira, nous commençons - nous devons commencer à examiner, quelles sont les caractéristiques du gouvernement qui ont échoué ? Pourquoi avons-nous été rendus si excessivement vulnérables ? Et il y avait certainement des lacunes politiques, mais il y avait beaucoup de choses sur la façon dont les agences étaient structurées, la façon dont les agences ont répondu, le type de planification que nous avions faite dans le passé qui, selon nous, nous préparerait mieux à cette pandémie qui n'était pas pas à la hauteur de la tâche.

MARGARET BRENNAN: C'est donc quelque chose dont vous voulez que les responsables de la santé publique, les législateurs, tirent des leçons.

DR. GOTTLIEB: Oui, je pense qu'à un moment donné, nous allons commencer à réfléchir à ce qui n'a pas fonctionné. Nous allons créer des commissions, créer des groupes faisant autorité pour essayer, vous savez, de parvenir à un consensus sur ce que nous devons faire différemment pour mieux préparer l'avenir. Et je veux que ce livre fasse partie de ce dialogue. C'était ma tentative de, vous savez, d'exposer ce que je pense que certaines des choses qui nous ont rendus vulnérables étaient et comment nous pouvons commencer à les réparer, comment nous pouvons commencer à renforcer la résilience contre ce type de menaces à l'avenir. J'espère donc que ce livre fera partie de ce dialogue.

MARGARET BRENNAN : Vous avez des anecdotes personnelles là-dedans. En fait, vous commencez le livre en parlant des attentats du 11 septembre et vous étiez un jeune habitant de New York. Pourquoi avez-vous commencé là-bas ?

DR. GOTTLIEB : Oui. J'étais donc en stage ce mois-là. Je me souviens du jour. Et donc j'étais une sorte de travail de swing. J'étais une main supplémentaire. Je n'étais pas affecté à un étage. Et j'étais post-appel, donc j'avais décroché la nuit précédente. Nous avons vu le premier avion percuter le World Trade Center, puis lorsque le deuxième avion a percuté, j'ai été appelé à l'hôpital. Et j'ai passé la journée à travailler dans les étages, essayant principalement de faire sortir les patients parce que nous pensions qu'il y aurait un flot de patients entrant dans l'hôpital, alors nous essayions de nettoyer les lits. Et puis la nuit, j'ai été affecté à un centre de triage à- à Chelsea Piers, au centre-ville, près de- près des anciens World Trade Centers. Et quand je suis arrivé là-bas, je suis entré dans une maison de campagne et c'était une maison de campagne caverneuse et ils avaient installé, à un moment donné au cours de la journée, essentiellement l'équivalent de centaines de lits d'hôpitaux, mais pas seulement des lits d'hôpitaux dotés de personnel. , mais il s'agissait de lits chirurgicaux. Ils disposaient d'équipements médicaux de pointe dans des centaines de stations. Et c'était- c'était comme rien que j'ai jamais vu avant ou depuis. Donc, quelque part, vous savez, autour de New York, quelqu'un avait décidé que New York devait se préparer à un événement faisant de nombreuses victimes, et ils avaient mis sous cocon tout l'équipement nécessaire pour le faire, pour le gérer. Et ils avaient mis sous cocon la logistique pour la mettre en place en quelques heures. Et la raison pour laquelle j'ai raconté cette histoire, c'est parce que rien d'équivalent n'existait vraiment ici. Vous savez, à New York, nous avons eu la première attaque contre le World Trade Center. Il y a eu une décision prise par quelqu'un à un moment donné que New York avait besoin de préparer certaines capacités. Ce que j'ai vu en faisait partie très clairement. Et quand le COVID est arrivé, vous savez, nous avions cette sorte d'illusion que nous nous étions préparés à une pandémie et que nous avions certaines capacités qui avaient été mises sous cocon et des préparatifs qui avaient été faits. Mais ils étaient mal adaptés à la- à la crise à laquelle nous étions confrontés. Et même ceux qui étaient en quelque sorte correctement mesurés par rapport à ce à quoi nous étions confrontés n'étaient pas prêts. Une métaphore pour cela était les masques et les ventilateurs. Nous avions stocké, pas assez, évidemment, des masques et des ventilateurs, et ils n'ont pas fonctionné. Ceux que nous avions ne fonctionnaient pas. Les masques étaient périmés, les ventilateurs n'avaient pas été entretenus. Et c'est juste une sorte de métaphore du manque de préparation. Mais, vous savez, je pense que nous n'avions pas vraiment la prévoyance de comprendre qu'un virus pouvait nous menacer de cette façon. Nous avions prévu une grippe pandémique. J'avais participé à une partie de cette planification en 2003 et 2005 lorsque j'étais à la FDA, lors de mon premier - mon premier passage, mais nous ne comprenions pas vraiment comment la planification dans laquelle nous nous étions engagés pour la grippe ne serait pas applicable à un coronavirus.

MARGARET BRENNAN : Nous nous sommes donc préparés à la mauvaise menace.

DR. GOTTLIEB : Nous nous sommes préparés à la mauvaise menace. Mais même - même si nous nous étions préparés à la bonne menace, les préparatifs n'étaient toujours pas adéquats. Nous n'avions toujours pas le genre de capacités dont nous avions besoin pour, vous savez, déployer les ressources médicales nécessaires. Je pense que nous n'avions pas prévu que dans un contexte de crise mondiale, il y aurait une course mondiale aux chaînes d'approvisionnement nécessaires pour fournir correctement l'équipement médical. Juste les écouvillons utilisés pour effectuer des tests de diagnostic, nous en avons manqué. L'un des goulots d'étranglement pour effectuer plus de tests de diagnostic n'était pas que nous n'avions pas les machines PCR, les machines sophistiquées. Ce n'était pas que nous n'avions pas les laboratoires, nous n'avions pas les écouvillons pour prélever les échantillons. Nous n'avons donc pas compris que si vous aviez une crise mondiale de cette ampleur, tout à coup, les chaînes d'approvisionnement sur lesquelles nous comptions seraient tirées par tous les pays en même temps, et nous ne pouvions plus compter sur elles. Donc, ce dont nous avions besoin, c'était d'un tout autre état d'esprit. Nous devions renforcer la capacité nationale pour faire la production à l'échelle nationale. Nous devions garder l'appareil dont nous pensions avoir besoin au chaud, pas seulement au chaud. Nous ne pouvions pas simplement le construire et le mettre sous cocon. Nous devions le maintenir en activité. Nous devions le garder fonctionnel. Nous avions besoin d'une capacité logistique pour déployer ces outils. Nous n'avions pas la capacité d'étendre les tests de diagnostic car nous ne pouvions pas déployer suffisamment de centres de test. Nous n'avions pas la capacité de vacciner massivement la population parce que nous n'avions aucune capacité sous cocon pour mettre en place des sites de vaccination. Et c'est ce que j'ai vu le 11 septembre. Je veux dire, évidemment petit microcosme. C'était une ville. Ce n'était pas dans tout le pays. Je veux dire, le pays n'aurait pas été capable de faire face à une crise de cette ampleur, mais quelqu'un avait réfléchi à la manière de construire l'appareil et aux moyens de le déployer très rapidement pour une certaine éventualité. Nous ne l'avons pas fait contre une éventualité virale, même si nous avions anticipé et attendu qu'à un moment donné, nous serions confrontés à une pandémie.

MARGARET BRENNAN : Cela fait donc 18 mois maintenant que nous avons été touchés par cette pandémie. Dans le livre, écrivez-vous, le prochain pourrait très bien être une nouvelle variante de la grippe aviaire. Sommes-nous aussi vulnérables à ce type de nouvelle menace que nous l'étions au COVID 19 ?

DR. GOTTLIEB: Je pense que nous sommes toujours vulnérables. Il n'y a rien qui ait vraiment changé en ce qui concerne notre posture. Je pense que là où nous pourrions avoir moins de vulnérabilité, c'est que, vous savez, trompez-moi une fois, nous sommes plus conscients des menaces qui pourraient émerger du monde entier, nous pourrions - nous allons réagir plus rapidement. Vous savez, la prochaine fois que nous verrons une infection émergente, nous n'allons pas attendre six semaines ou deux mois pour commencer à fabriquer les tests de diagnostic. Nous allons donc prendre certaines décisions à l'avance qui auraient pu être prises plus tôt dans le cadre de COVID, n'étaient pas parce que nous n'avions pas correctement anticipé la menace qu'il représentait. Je pense que la prochaine fois, vous savez, nous serons plus enclins à en faire trop et pas trop peu quand quelque chose émergera. Mais en termes de capacités dont nous avons besoin pour réagir, je ne pense pas que nous soyons meilleurs en termes de capacité à mobiliser réellement le type de capacité de fabrication et de distribution dont nous aurons besoin. Nous n'avons pas l'infrastructure pour le faire. Là où nous sommes probablement meilleurs, c'est que nous avons validé une partie de la technologie que nous utiliserions contre une nouvelle menace. D'où l'idée de vaccins entièrement synthétiques pouvant pivoter très rapidement vers un vaccin. Un grand nombre des technologies qui étaient en quelque sorte disponibles et qui nous ont permis de passer très rapidement au développement de contre-mesures dans ce cas ont maintenant été validées. Nous étions à une sorte de point d'inflexion technologique dans le cadre de cette pandémie avec les technologies que nous avons utilisées pour développer nos vaccins et certains de nos traitements. Et maintenant--

MARGARET BRENNAN : C'était juste de la chance, c'est ce que vous dites.

DR. GOTTLIEB: Nous étions à l'aube de - nous étions en quelque sorte en train de faire le pont entre deux états scientifiques. Si cela s'était produit il y a quatre ans, nous aurions développé nos vaccins comme nous développons traditionnellement des vaccins. Nous essayions de faire croître le virus dans des cultures cellulaires, de la même manière que les Chinois ont développé leur vaccin. Vous cultivez le virus en grande quantité dans des cultures cellulaires, vous l'inactivez, vous clivez les protéines et vous mettez essentiellement les protéines du virus dans une seringue qui sert de stock de vaccin. C'est comme ça qu'on fabrique le vaccin contre la grippe. Ce que nous avons fait dans ce cas, c'est que nous avons pu dériver des constructions de vaccins de manière entièrement synthétique juste à partir des seules données de séquence. Donc, si vous regardez le vaccin de Moderna, le vaccin de Pfizer, où je siège au conseil d'administration, même le vaccin de J&J et le vaccin d'AstraZeneca, les constructions ont été dérivées de la séquence. Ils n'avaient pas besoin du virus vivant, ils n'avaient pas besoin de faire pousser le virus. Nous étions donc en plein à ce point d'inflexion où cette technologie devenait disponible, et cela nous a permis de passer très rapidement aux vaccins. Si cela s'était produit dans cinq ans, cette technologie aurait probablement été généralisée. Et ce qui s'est passé dans le cadre de la pandémie, c'est que nous avons en quelque sorte accéléré notre chemin à travers cette courbe technologique parce que nous avons développé les vaccins et nous les avons déployés. 380 millions d'Américains ont reçu un vaccin.

MARGARET BRENNAN : Donc, après les attentats du 11 septembre, nous avons eu ce gros, vous savez, un remaniement du gouvernement américain et vous avez eu une commission sur le 11 septembre. Pensez-vous dans ce contexte maintenant que ce genre de commission est même possible ?

DR. GOTTLIEB: Je pense que c'est- je pense que c'est nécessaire. Je pense que nous allons devoir le faire. Je suis--

MARGARET BRENNAN : Politiquement, est-ce possible ?

DR. GOTTLIEB : C'est difficile, vous savez, et je pense que c'est difficile pour diverses raisons. Vous savez, c'est probablement, je me suis demandé, pourquoi ne l'avons-nous pas encore fait ? Je veux dire, il y a eu des groupes qui se sont réunis, vous savez, l'Académie nationale de médecine, d'autres groupes. L'administration Biden a présenté une sorte de plan directeur de ce à quoi ressemblerait une stratégie pandémique. Mon- mon hypothèse est qu'il est trop tôt. Vous savez, nous sommes toujours... nous sommes toujours aux prises avec cette pandémie. Alors je n'arrête pas de me dire, c'est peut-être trop tôt et c'est pourquoi le Congrès n'a pas convoqué de commission. C'est pourquoi nous ne voyons pas un groupe bipartisan émerger pour essayer de faire ce travail. Vous avez vu des projets de loi proposés, mais rien qui soit une sorte de grand effort pour vraiment proposer une approche globale de la façon dont nous allons mieux nous préparer pour l'avenir. Je pense que l'autre chose avec laquelle nous devrons nous attaquer, ce n'est pas seulement une question de politique du moment et l'incapacité d'obtenir un consensus autour de grandes questions. Et c'est- c'est un problème en ce moment. Je pense que l'établissement de santé publique dans son ensemble a pris un coup dans le cadre de cette pandémie. Et ce n'est pas seulement une sorte de chose républicaine, démocrate, conservatrice, libérale. Je pense qu'il y a beaucoup de gens à travers le pays qui pensent que les conseils qu'ils ont reçus des responsables de la santé publique n'étaient pas précis, changés, n'étaient pas - n'étaient pas formulés d'une manière où ils étaient en quelque sorte immuables, n'étaient pas soigneusement expliquée, n'a pas été propagée de manière à pouvoir être assimilée à la vie des gens. Vous savez, comment porter un masque ? Quel masque dois-je porter ? Quand dois-je porter un masque ? Quand pas ? Et les choses ont changé. Et donc les gens étaient troublés par cela et perdaient confiance en lui. Et je pense qu'il y aura une partie du dialogue que nous avons sur la façon de mieux nous préparer à la prochaine pandémie, je pense, malheureusement, qu'il y aura aussi une discussion sur le rôle que les agences de santé publique et les responsables de la santé publique devraient jouer et dans quelle mesure les décideurs politiques devraient-ils vraiment surveiller ce qu'ils font dans le cadre d'une crise ? Doivent-ils vraiment contrôler ? Ça va être une discussion difficile parce que si nous n'allons pas en quelque sorte soutenir la primauté de la santé publique et des responsables de la santé publique dans le cadre d'une - d'une crise de santé publique, c'est difficile - c'est difficile de commencer, c'est difficile de Commencer. Et je pense que ce sera le premier pont que nous devrons traverser alors que nous entrons dans cette voie.

MARGARET BRENNAN: Eh bien, l'éléphant dans la pièce avec tout ce qui est politiquement, c'est aussi qui était président au moment de la pandémie. Et je veux revenir là-dessus parce que la personnalité était évidemment un facteur ici. Mais votre point plus large est que ce n'est pas un livre sur le leadership de Donald Trump. C'est un point sur l'ensemble du système de soins de santé aux États-Unis. Vous dites que le CDC, qui est censé être l'agence de santé publique de référence, "n'a pas la capacité opérationnelle de gérer une crise de cette ampleur". Donc, si le CDC ne le fait pas, qui le fait ?

DR. GOTTLIEB : Personne ne le fait. Je veux dire, il y avait une perception au début de cette crise que le CDC a ceci, qu'ils auraient la capacité de développer un test de diagnostic et de le déployer et de rassembler les données dont nous aurions besoin et de faire les analyses pour essayer d'évaluer, vous savoir, en quelque sorte déterminer quels seraient les contours de la réponse, et ils seraient en mesure de déployer le test de diagnostic et de déployer le vaccin et de mettre en place cette infrastructure. Ce n'est pas une organisation logistique. CDC a un état d'esprit très rétrospectif. C'est une organisation de haute science qui effectue une analyse analytique approfondie des données qui sont souvent désynchronisées par rapport au moment où les décisions doivent être prises. Ils ne sont pas - ils ne sont pas le JSOC, ils ne sont pas le Joint Special Operations Command. Ils ne présentent pas d'informations en temps réel pour éclairer l'élaboration des politiques actuelles.

MARGARET BRENNAN : Ils ne sont pas une force de réaction rapide.

DR. GOTTLIEB : C'est vrai, ils préfèrent prendre les données, les analyser pendant quatre mois et les publier dans le Morbidity and Mortality Weekly Report. Et l'idée qu'ils allaient pouvoir fabriquer en masse un test de diagnostic et le déployer en avant, ils ont clairement - ils ont contaminé leur propre test. Alors ils- ils- ils ont bâclé la fabrication de leur test. Mais même s'ils avaient réussi, même s'ils avaient parfaitement réussi ce test à temps, ce qu'ils allaient faire - le plan était qu'ils développeraient des tests pour les laboratoires de santé publique. Eh bien, les laboratoires de santé publique dans ce pays, il y en a 100. Ils peuvent chacun faire environ 100 tests par jour. Donc, même à plein régime, si tout s'était parfaitement déroulé, nous ferions 10 000 tests par jour. Nous avions besoin de centaines de milliers de tests par jour. Donc, ce qui devait arriver très tôt, c'était que nous devions nous tourner vers les fabricants commerciaux, comme l'a fait la Corée du Sud, et commencer à produire des tests de masse. C'est--

MARGARET BRENNAN : Nous devions nous tourner vers le secteur privé plus tôt dans la pandémie.

DR. GOTTLIEB : Nous avions besoin d'une approche globale. Nous devions faire en sorte que les laboratoires de santé publique se lèvent. Nous devions simultanément mettre en place les laboratoires cliniques, les laboratoires à l'intérieur des hôpitaux. Et nous devions amener les fabricants privés à développer des kits de test pouvant être utilisés dans tous les laboratoires commerciaux du pays. Cela devait arriver en janvier. À la fin du mois de janvier, nous étions certainement suffisamment conscients qu'il pourrait s'agir d'une pandémie mondiale, que quelqu'un aurait pu appuyer sur le bouton rouge et dire, nous en avons besoin - une approche globale ici. Mais CDC avait le ballon. CDC suivait leur plan standard. Leur plan est de pouvoir faire face à une épidémie lente. C'était quasi suffisant dans le cadre de Zika, qui était une infection à évolution plus lente. Mais dans une épidémie aussi rapide que celle-ci, c'était inégalé. Et, vous savez, pour être juste envers le CDC, de nombreux décideurs politiques ont supposé qu'ils seraient capables de mener à bien cette mission et ont supposé à tort quelles étaient leurs capacités. Maintenant, CDC aurait dû lever la main et dire, nous n'avons vraiment pas cela. Je pense--

MARGARET BRENNAN : Pourquoi ne l'ont-ils pas fait ? Est-ce un échec de Robert Redfield, le chef du CDC, à l'époque ?

DR. GOTTLIEB: Je pense qu'il est très difficile pour une agence d'avoir cette conscience de soi qu'elle n'a pas la capacité de répondre comme on le lui demande. Et je pense qu'il est très difficile pour une agence de s'auto-organiser différemment en situation de crise. Et- et donc ça leur demande beaucoup. En fin de compte, il a été reconnu qu'il fallait marier le type de capacité scientifique des agences gouvernementales avec la capacité logistique de quelque chose comme une FEMA ou un DOD. Lorsque nous avons créé Operation Warp Speed ​​pour essayer d'accélérer le développement d'un vaccin, parce que c'était un mariage entre le NIH, les scientifiques, la FDA, les régulateurs et le ministère de la Défense. Le ministère de la Défense a apporté la capacité de savoir comment augmenter la fabrication et la distribution. Nous devions le faire dès le premier jour. Nous avions besoin d'engager la FEMA et le DOD avec le CDC pour essayer d'organiser une réponse au niveau national, et ça, c'était un échec du leadership politique. Je veux dire, et c'était un échec de vision. Mais, vous savez, il y avait beaucoup de gens qui étaient de bons dirigeants politiques qui supposaient à tort que le CDC avait cette mission.

MARGARET BRENNAN : Donc, en ce qui concerne le public américain qui entend toutes ces critiques que vous formulez, ils se demandent, eh bien, cela a-t-il déjà été corrigé ? Quand tu parles du CDC, tu dis qu'ils ont bâclé le développement d'un test, ils ont fait obstacle aux laboratoires privés, ils ont appliqué un modèle de grippe, le mauvais modèle, ils n'imaginaient pas chercher une propagation asymptomatique, ils avaient un manque de données pour étayer les décisions de santé publique. C'est une énorme accusation. Certaines de ces choses ont-elles été corrigées ?

DR. GOTTLIEB : Certains d'entre eux ont été corrigés. Je veux dire, je pense- je pense que c'est mieux parce qu'il y a une reconnaissance de ces lacunes. Donc ces- ces déclarations, je ne pense pas qu'elles soient terriblement controversées. Je pense que les gens, discrètement ou ouvertement, reconnaissent les lacunes de l'agence...

MARGARET BRENNAN : Nous avons entendu le Dr Deborah Birx dire que sur FACE THE NATION, nous avons entendu Matt Pottinger, l'ancien conseiller adjoint à la sécurité nationale, dire cela sur FACE THE NATION. Je n'ai pas entendu beaucoup de responsables parler du niveau de détail que vous êtes en ce moment et dire que nous avons toujours un très gros problème au CDC.

DR. GOTTLIEB : Eh bien, nous n'avons rien fait pour créer une nouvelle capacité. Ce dont vous aurez besoin à l'avenir, c'est d'une organisation, si vous voulez avoir une véritable préparation à une pandémie, si vous voulez avoir une meilleure infrastructure pour faire face à une crise de santé publique de cette ampleur, vous allez avoir besoin d'une organisation qui est dans le domaine du service - faire émerger des informations exploitables, a un état d'esprit différent autour de l'information, n'a pas besoin d'être la réponse définitive finale, mais sait comment faire remonter l'information aux décideurs politiques qui prennent des décisions actives.

MARGARET BRENNAN : Est-ce une nouvelle agence ?

DR. GOTTLIEB : Je ne sais pas ; il pourrait s'agir d'une nouvelle agence, mais je pense que ce serait une erreur. Je pense que la bonne façon de le faire est probablement de renforcer les capacités au sein du CDC, car si vous essayez de créer en quelque sorte une nouvelle agence, vous allez déclencher toutes sortes de guerres de territoire à travers Washington. Si vous essayez de regrouper des agences, comme nous l'avons fait avec le Department of Homeland Security, vous savez, vous volez les pouvoirs d'autres agences, et c'est toujours difficile. Je pense que cela pourrait résider au sein du CDC, mais il doit s'agir d'une organisation très différente. Vous savez, au fil des ans, le CDC a évolué beaucoup plus vers une mission de prévention des maladies, de réduction des maladies cardiaques, d'arrêt du tabac et loin de son cœur de contrôle des maladies, des opérations à l'étranger. Vous savez, le service qu'ils ont, le service épidémiologique qui va dans les zones chaudes et, vous savez, obtient des échantillons de virus et les ramène et les étudie et développe des contre-mesures, ce genre de partie héroïque de l'agence dont on parle souvent, on en fait des films. Au fil du temps, je pense que cela a été subordonné aux aspects plus politiques de la mission du CDC. Donc, je ne sais pas si vous réformez fondamentalement le CDC. Je pense que ce que vous essayez de faire, c'est de développer une nouvelle capacité au sein de l'organisation qui a une culture différente, un état d'esprit différent, des ressources différentes, des capacités différentes. Le composant qu'ils ont récemment créé, où ils ont créé ce nouveau centre de modélisation au sein du CDC, une maladie - un centre de modélisation pandémique, qui pourrait être...

MARGARET BRENNAN: L'administration Biden l'a fait.

DR. GOTTLIEB : -- d'accord, par l'administration Biden. Cela pourrait être le noyau qui devient, vous savez, la nouvelle fleur à l'intérieur du CDC. Je pense que l'état d'esprit de cette organisation, les personnes qui la composent en ce moment, qui sortent d'un monde de sécurité nationale, pourraient apporter un nouvel esprit de corps dans cette organisation. Et vous pouvez développer cette capacité à partir de là, mais quelqu'un doit la développer.

MARGARET BRENNAN : Eh bien, l'administration Biden a demandé 65 milliards de dollars pour renforcer la préparation à la pandémie. Le Congrès ne l'a pas encore financé. Mais--

DR. GOTTLIEB : Je ne pense pas que ce sera un problème d'argent. Je pense que les gens vont s'approprier les fonds. Je pense que ça va être un problème de stratégie, et c'est vraiment ce que j'essaie de faire ici, c'est en quelque sorte de poser les fondements de ce qui n'a pas marché et comment nous pouvons penser à une stratégie différente. Vous savez, le plan de l'administration Biden qu'ils ont proposé, c'est un plan de haut niveau, il contient tous les bons éléments, mais ce n'est pas encore un plan, c'est plutôt un cadre stratégique pour un plan. Nous devons encore décider quel est ce plan, et il va y avoir un débat intense parce que, vous savez, les missions des gens vont être perturbées. Vous savez, CDC, par exemple, avec les tests de diagnostic. Vous savez, si nous voulions que les fabricants commerciaux s'engagent dès le début dans le développement d'un test de diagnostic, quelqu'un devait partager les échantillons, les échantillons de virus, avec eux. CDC les conservait, ne les donnerait pas aux fabricants commerciaux. Quelqu'un devait créer une sorte de mécanisme de financement pour que les fabricants commerciaux sachent qu'ils n'allaient pas se contenter de payer la facture. Ils auraient fait un pas en avant. Mais à un moment donné, vous avez dû financer cela. Il n'y a pas de mécanisme pour cela. Je veux dire, BARDA aurait pu le faire, mais ce n'est pas vraiment dans le mandat de BARDA. Ils financent des recherches très précoces. Il n'y avait donc aucune agence capable de financer le transfert à un fabricant commercial d'un test de diagnostic. Et j'y reviens sans cesse parce que beaucoup de nos premiers problèmes découlaient vraiment de notre incapacité à faire évoluer les tests. Ce n'était pas seulement que nous ne pouvions pas diagnostiquer les infections et dire où se trouvait le virus. Nous ne pouvions pas dire où ce n'était pas. Ainsi, lorsque nous avons fait les «15 jours pour ralentir la propagation» et les 30 jours suivants pour ralentir la propagation, il s'agissait essentiellement d'un arrêt national pendant 45 jours, une mesure extraordinaire. Je veux dire, une décision historique de fermer la plupart des activités commerciales dans le pays. Très clairement, nous devions le faire à New York. Je veux dire, New York, le système de santé a été piraté à New York. New York était au bord de l'effondrement. La Nouvelle-Orléans était au bord de l'effondrement. Boston était au bord de l'effondrement. Los Angeles avait une propagation omniprésente, San Francisco et Seattle. Austin, au Texas, n'avait pas beaucoup de propagation, pas Jacksonville, pas le Wyoming, mais nous ne le savions pas. Nous avons donc fermé tout le pays, puis lorsque le virus s'est finalement rendu dans le Grand Sud, les gens là-bas ont dit, vous savez quoi ? Nous ne fermons pas maintenant. Vous nous avez dit de le faire au printemps et nous l'avons fait, nous n'avions pas à le faire. Nous en avons fini avec les fermetures. Et--

MARGARET BRENNAN : Et cela aurait pu être évité.

DR. GOTTLIEB: Cela aurait pu être évité car si nous avions eu un test de diagnostic et que nous savions où se trouvait le virus et où il ne l'était pas, nous aurions pu cibler l'atténuation à l'échelle de la population uniquement sur les endroits où le virus était omniprésent et dans les endroits où ce n'était pas encore généralisé, nous aurions pu utiliser des tests, des traçages, des quarantaines pour essayer de contrôler la propagation. Cela aurait fini par devenir une épidémie confluente dans tout le pays, mais nous aurions pu retarder cela. Nous aurions pu retarder considérablement cela et nous aurions pu préserver le capital politique dans des endroits où le virus n'était pas présent, de sorte que lorsqu'il serait arrivé, ils auraient toujours été prêts à prendre les décisions difficiles de fermer des bars, des restaurants, de faire tout le des choses dont nous savions qu'elles allaient contrôler la propagation et nous faire gagner du temps jusqu'à ce que nous arrivions à un vaccin. Mais nous avons essentiellement dépensé cette carte dès le départ. Nous avons fermé tout le pays et nous n'avions pas à le faire. Donc, ne pas avoir ce test de diagnostic, ce qui a déclenché bon nombre des défis auxquels nous avons été confrontés à l'avenir.

MARGARET BRENNAN : Vous dites, "le fait n'est pas que les responsables fédéraux de la santé se soient trompés, le fait est qu'ils travaillaient avec des outils défectueux, des ensembles de données défectueux."

DR. GOTTLIEB : Ouais, alors...

MARGARET BRENNAN : Ils ne savaient pas ce qu'ils ne savaient pas.

DR. GOTTLIEB: Ils n'ont pas compris que cela ne se propageait pas comme la grippe. Ils n'avaient donc pas de diagnostic, alors ils ont dit, eh bien, nous allons nous fier au système de surveillance des maladies de type grippal. Il s'agit d'un système de surveillance qui a été développé, en partie pour faire face à une grippe pandémique, qui surveille essentiellement les personnes se présentant à l'hôpital avec des symptômes pseudo-grippaux et dont le test de dépistage de la grippe est négatif. Mais au cours d'une semaine donnée, 50 000 personnes se présentent à l'hôpital avec des symptômes pseudo-grippaux et sont testées négatives pour la grippe. Ainsi, vous pouvez avoir des dizaines de milliers de cas cachés à la vue de tous grâce au système de surveillance des maladies de type grippal. De plus, cela ne se présentait pas toujours comme la grippe, donc les gens présentaient des symptômes qui ne correspondaient pas à la grippe. Donc, si vous ne recherchez que les symptômes de la grippe, vous ne verrez peut-être pas la propagation du coronavirus. Ils étaient donc très confiants dès le début qu'il n'y avait pas de propagation communautaire. Pendant ce temps, il y avait une transmission communautaire généralisée. Et ce n'est que début mars que Redfield a vu un signal dans les données de New York, a décroché le téléphone, j'en parle, et a appelé Howard Zuckerman, le commissaire à la santé de l'État de New York, et a dit, vous avez un problème. C'était la première fois qu'ils voyaient une valeur aberrante. Mais si vous regardez les données tout au long de février et que vous regardez les pourcentages de personnes présentant des symptômes pseudo-grippaux qui ont été testées négatives pour la grippe, ce n'était pas - ce n'était pas rouge, mais ce n'était pas vert. C'était à l'extrémité supérieure d'une fourchette normale. Donc, si vous regardiez une moyenne sur 10 ans, c'était à l'extrémité supérieure de cette moyenne sur 10 ans, certainement dans le contexte de ce qui se passait dans le monde. Nous n'aurions pas dû en tirer de réconfort. Et donc nous n'avions tout simplement pas les outils, nous n'avions pas d'outils suffisamment sensibles pour savoir qu'il n'y avait pas de propagation communautaire. Et en l'absence de ces outils en place, qui auraient été un test de diagnostic, et en fait un dépistage des personnes, nous n'aurions pas dû être si confiants que cela ne se propageait pas. Nous aurions dû faire les choses différemment en anticipant que cela se propageait probablement, nous ne l'avons tout simplement pas capté, ce qui était en fait le cas.

MARGARET BRENNAN : Vous dites également que cela aurait dû être considéré comme une menace pour la sécurité nationale, et c'est ainsi que nous devons penser aux pandémies. Le président Biden s'est rendu en juillet au bureau du directeur du renseignement national et a déclaré qu'il était généralement d'accord avec cela. Qu'est-ce que cela signifie réellement, cependant? Avez-vous vu la communauté du renseignement, à ce jour, réagir et nous protéger à l'avenir ? Disposent-ils des outils nécessaires ?

DR. GOTTLIEB : Eh bien, écoutez, je pense que la communauté du renseignement dispose de différents outils qui devraient se concentrer sur cette mission. Vous savez, il y a deux éléments à cela - cette idée, que nous devons examiner la préparation de la santé publique à travers le prisme de la sécurité nationale. L'un est l'élément national, comment nous nous préparons, en pensant à cela comme quelque chose qui pourrait être un événement à faible probabilité mais à fort impact. Et comment se prépare-t-on à d'autres événements comme celui-là ? Le risque d'une attaque radiologique, le risque d'un coup de météore. Je veux dire, nous faisons certaines préparations pour des choses qui ne se produiront probablement pas. Mais s'ils se produisent, ils sont tellement catastrophiques que nous devons nous préparer. Cela encombrait-ce-cela subordonnait toutes nos autres priorités nationales. Nous ne pouvons pas laisser quelque chose comme ça nous frapper à nouveau. Nous devons donc nous préparer différemment au niveau national. Mais à l'échelle internationale, ce que cela signifie, c'est que nous nous sommes historiquement appuyés sur les conventions internationales et le renforcement des capacités dans d'autres pays, en allant essentiellement dans des pays qui pourraient être des points chauds et en essayant de renforcer les capacités dans ces pays comme un moyen de créer un début Tripwire pour nous avertir d'une maladie émergente. Nous comptons sur les autres pays pour nous dire quand ils ont une épidémie. Cela a échoué à plusieurs reprises. Cela a échoué dans ce cas, la Chine n'a pas révélé les premières informations, elle n'a toujours pas partagé les souches sources. Mais nous pouvons parcourir une litanie de pays après pays qui ont été l'hôte de nouvelles épidémies de virus de type SRAS, de nouvelles épidémies de grippes, de nouvelles épidémies d'Ebola, qui n'ont pas révélé l'information en temps opportun. Et donc la question devient, pouvons-nous toujours compter sur les réglementations sanitaires internationales et l'OMS et l'Assemblée mondiale de la santé ? Allons-nous tous nous tenir la main à nouveau et promettre que nous le pensons vraiment cette fois et que nous allons partager des informations ? Ou devons-nous engager davantage nos services clandestins dans cette mission ? Et je pense que nous allons devoir impliquer davantage nos services clandestins dans cette mission. C'est l'une des choses dont je parle, parce que c'est un très grand écart par rapport à ce que nous avons fait dans le passé. Dans le passé, on a toujours supposé que cela - que la mission de santé publique était la mission du CDC. Le CDC et les responsables de la santé publique ne voulaient pas que les agences d'espionnage se rapprochent de cela parce qu'ils pensaient que cela nuirait à leur autorité d'agir en dehors des États-Unis, que tout le monde serait perçu comme un espion. Et traditionnellement, a déclaré l'Agence de sécurité nationale, le CDC a ceci, ce n'est vraiment pas notre mission. Cela était considéré comme une sorte d'aspect plus doux de la mission globale de sécurité nationale. Je pense que cela doit changer. Je pense que compte tenu de ce que nous avons vu, pas seulement comment cela nous a touchés, la mort et la maladie, comment cela a changé le cours de l'histoire, l'impact géopolitique. La Chine se serait-elle déplacée vers Hong Kong si le monde n'avait pas été distrait par le COVID ? So we can't allow something like this to happen again, and that's- we're going to have to get our spy agencies involved. There was data very clearly available in China, in Wuhan, that if we were looking for it, we could have detected this much sooner. We could have answered some key questions. We could have seen the asymptomatic spread, we could have seen the human-to-human transmission. There was sequence data that was being- flying around by mid-December inside China, and probably earlier than that, being sent to commercial labs. That signals intelligence that could be intercepted if you know what you're looking for. So there was a lot of information that could have been had. And in the hands of good political leadership, you could have mounted- you could have had some key questions answered early that could have allowed us to mount a more robust response. And a two or four week head start on something like this can make a very big difference.

MARGARET BRENNAN: On the intelligence front, you said it was- you talk about a lot of this sort of towards the end of your book, and this is a more current conversation about the origins of COVID. The president ordered this 90-day review of intelligence and it came to basically no conclusion. What did you learn in the course of your research about the origins of COVID?

DR. GOTTLIEB: I learned that we're not going to answer this question absent one or two things happening. Either we find the intermediate host, the animal that was the- that spread COVID, or there's a whistleblower inside China. Or someone close to this, who knows that this came out of a lab, comes forward, defects, goes overseas, or we intercept some communication that we shouldn't have had access to. Absent something like that, we're not going to be able to answer this question. This is going to be a battle of competing narratives. I think over time, the side of the ledger that- that says that this might have come out of a lab has grown more robust and the side of the ledger that says this came out of a natural species has not really moved. And if anything, you can argue that side of the ledger has been diminished by a couple of facts. Number one, we've looked for the intermediate host and we haven't found it. And number two, the idea that the- the market, this initial market, was the source of the initial spread has been firmly debunked. Even the Chinese acknowledged that. And that was a big part of the thesis around the zoonotic origin, the animal origin, because the idea was that the animal was in that market. We now know that market wasn't the source of the spread, it was a path along the spread.

MARGARET BRENNAN: Beijing has even acknowledged that to a certain extent--

DR. GOTTLIEB: --Beijing has acknowledged it, right--

MARGARET BRENNAN: When you say intermediate host, you mean what happened between the bat and the human.

DR. GOTTLIEB: Right--

MARGARET BRENNAN: Who came in between.

DR. GOTTLIEB: There's an animal, maybe a pangolin, there's some other animal in between and it could have been- it wasn't necessarily a bat, and it could've been a bat to a human, but we haven't found the virus in nature. And there's been a pretty exhaustive search. The Chinese have mounted an exhaustive search. And I don't think that the fact that they've been looking for it proves that they know it didn't come out of a lab. I think that they would be looking for it, even if they knew it came out of a lab. And the reality is if it came out of a lab, the number of people who actually are aware of that could be a very small subset of people.

MARGARET BRENNAN: When you say, came out of a lab, you are saying through a lab accident, not a construct?

DR. GOTTLIEB: Yeah. No, I don't think anyone, and the administration has said this in the intelligence report they put out that they don't believe- they- they've sort of firmly debunked the idea that this was something that could have deliberately come out of a lab or was deliberately engineered. But the possibility is that you've had labs doing research on novel coronaviruses. You had novel coronaviruses being brought to those labs, particularly the Wuhan Institute of Virology. We know that they were doing that research in what's called BSL-2 labs, lower security labs where tight precautions aren't taken. We now know that they were infecting transgenic animals with coronaviruses, with novel coronaviruses--

MARGARET BRENNAN: Transgenic meaning?

DR. GOTTLIEB: --as part of the research. Animals with human--

MARGARET BRENNAN: Partially humanized?

DR. GOTTLIEB: Right, animals with human immune systems. So that- that again makes- is- is another step that makes it more likely that it could have spread to humans because now you're infecting animals with human immune systems, so they're humanized viruses. You're adapting the viruses to animals to try to infect the human immune system. All those set up the conditions for risk. And we also know that the Wuhan Institute of Virology was a sloppy lab. At the time that it opened there was an article in the journal Science raising questions about the integrity of that lab, where scientists at the time that it opened in 2017 said, we're worried about the procedures in this lab. We're worried about the training, we're worried about the way it was built. We know that the lab was conducting high-end research with the Chinese military. The French were in that lab and were eventually kicked out. And the time- at the time that they were kicked out, they were aware that the Chinese military had moved into that lab. So there were circumstances created around that facility and there were operating procedures around that facility that created a lot of risk. That doesn't mean it came out of a lab, but it certainly makes that a suspect location. And there was another lab. The CDC, the Chinese CDC, maintained a lab literally blocks from the wet market that was first implicated in this virus that was also conducting coronavirus research in BSL-2 labs.

MARGARET BRENNAN: So other than the whodunnit factor, why does it matter? Why do we need to know who Patient Zero is and how will that affect the Biden administration's response?

DR. GOTTLIEB: Yeah, it matters a lot because if we determine that- first of all, if we determine if this came out of a lab or we even assess that there's a high probability that this came out of a lab, I think it changes how we try to govern research internationally. We're going to need something like the International Atomic Energy Agency for BSL-4 labs. We're going to have to look much more carefully about who's creating BSL-4 labs, the kind of research going on in those labs--

MARGARET BRENNAN: That's the UN?

DR. GOTTLIEB: Should-- it's going to probably be a global organization, come out of the World Health Organization, some kind of international consensus around providing oversight on these labs because there's a lot of them cropping up right now. A lot of countries are building BSL-4 labs and starting to engage in this high-end research. And the- the most speculative, most dangerous research often goes to the countries willing to conduct it. And the countries willing to conduct it are oftentimes the countries that have the poorest controls. The other thing we're going to need to look at is, do we continue to do things like publish the sequences of novel viruses? So when- when labs create novel compilations, when they create a novel virus for purposes of trying to assess, you know what its- what activity it could have in humans, once you publish that sequence as part of normal scientific discourse and part of the scientific process, you basically provide a recipe to anyone who's a rogue actor on how to manufacture that virus. And I think we're going to have to look at, you know, the- whether or not that's a good idea going forward and maybe not publish information like that, have a consensus that we're not going to publish that kind of information because the other thing that comes out of this is that this hurt us a lot more than it hurt other countries. It hurt the West a lot more than it hurt other countries.

MARGARET BRENNAN: Why?

DR. GOTTLIEB: We proved uniquely incapable of implementing respiratory precautions, getting consensus around things like mask wearing, the mitigation that was required. A lot of countries did better than us. A lot of countries in the Pacific Rim did better than us. And the old doctrine was that no country that's trying to develop a pathogen for a deliberate purpose for- as a bioweapon, and this wasn't a bioweapon. This very clearly was not a weaponized virus. But going forward, a country, a rogue actor that's looking to develop a biological weapon, the presumption was they wouldn't use a respiratory pathogen because it would blow back on them. But now looking at how this disrupted the West relative to other parts of the world, I think that calculus needs to be reassessed. And so it raises the stakes around the risk of doing this research, allowing this research to go on, publishing things that could facilitate this research if we know that there's rogue actors that might be on the margin more likely to look at a novel influenza as something that could potentially be weaponized. And even if you could just develop a respiratory pathogen that could disable, you know, a group of people or, you know, make people sick for three or four days, that might be a weapon you use on troop movements. So, you know, we need to think differently about these risks now, having seen how this disproportionately impacted certain countries relative to others. This was an asymmetric risk to the West and to the United States in particular, relative to other nations

MARGARET BRENNAN: Who handled this the best on the global scale? Quels pays ?

DR. GOTTLIEB: Well, it's a tough question because there were certain countries that kept the virus out or, you know, were able to preserve life, but--

MARGARET BRENNAN: Australia?

DR. GOTTLIEB: Yeah, but the question becomes, what price did they pay for that, in terms of what they imposed on their population, the economic impact? You know, I think if you look at some of the countries in the Pacific Rim like Singapore, Taiwan, South Korea, they handled it very well insofar as they didn't adopt all the same draconian measures that countries like China did where they locked down the entire country, but they were still able to maintain control over it. And, you know, in South Korea's case, they did it through very aggressive testing and tracing. They employed certain aspects of their, you know, state apparatus to basically collect information on people that wouldn't have been feasible in a Western democracy. We would never have tolerated it. But I don't think- people always point to that and say, you know, we couldn't do what South Korea did because they- they used their police state to basically monitor people. That was a small aspect of what they did. I think the core of what they did was really deploying testing on a massive scale, encouraging people to get tested. They literally had testing devices for sale in vending machines, in subway stations, and using that as a way to get people diagnosed and encouraging people to get into quarantine if they have the infection. That was the core of what they did and they did it successfully.

MARGARET BRENNAN: Who didn't handle it well? I mean, do you put the United States on the list of worst responders?

DR. GOTTLIEB: Well, I think it's hard to say who handled it the worst. I think that we're at- we're at the top of the list of countries that were the hardest hit by the pandemic for sure, and had a very difficult time putting in place the measures that were going to help control the spread.

MARGARET BRENNAN: Is that simply just because we track what's happening? I mean, is that an unfair criticism to say, the United States?

DR. GOTTLIEB: No, there's I think there is good enough global tracking among a lot of our counterparts that we can make an assessment that we were disproportionately impacted by this. I mean, there were certainly countries that had a higher death rate on a per capita basis. There were countries as hard, if not harder hit, but of the industrialized countries, of countries that- where there was an expectation that we'd be able to do better, where we had tremendous capacities, where we had a very good health care system, where we had access to the technology, we had the ability to develop therapeutics and vaccines and get early access to them. Relative to what our assets set was, we did pretty badly with this virus.

MARGARET BRENNAN: In terms of are we better now, you wrote that the virus "rode in on the breath of hundreds of thousands of travelers." Both Presidents Biden and Trump put in travel restrictions. Would you tell the Biden administration now to lift them? Because you're arguing they're largely ineffective.

DR. GOTTLIEB: Well, they're largely ineffective now. I mean, I think that if we're going to put in place a travel restriction, you know, you could defend, a- a travel restriction that requires people to be vaccinated to come into the country. If we're trying to create, you know, a bubble around activity in this country and putting in place our own mandates around vaccination, it makes sense to require people to be vaccinated if they come in. That's something I think that's defensible. But the idea of broad travel restrictions based on region, when there's just as much virus here as there are in parts of the world where we're restricting access, I don't think that makes sense anymore. You know, the travel restrictions had limited value early on. I think we over-relied on the travel restrictions and we thought we could actually erect walls and keep this virus out or keep it out for longer than we could. We couldn't. They weren't nearly as effective, I think, as people assumed or even people now sort of surmised. But- but there was some logic in putting in place some travel restrictions early when we knew that there were specific countries, Italy in particular was heavily seeding New York. Obviously, people traveling from Wuhan where there was a raging epidemic, those kinds of restrictions made sense at the time. At this point, there's so much virus around the world, I'm not sure what we're keeping out. We're more likely to have restrictions imposed on us than be in a position of imposing restrictions on other nations.

MARGARET BRENNAN: Well you also make the argument that that can backfire because you say then countries are- are basically not incentivized to come clean.

DR. GOTTLIEB: Well this--

MARGARET BRENNAN: They're- they're incentivized to cover up what's happening.

DR. GOTTLIEB: Right, this gets back to the question of, will we need to rely on our clandestine services more to gather information? So if we go into this, and we've already started down this path, and we go back to the World Health Assembly, the WHO convenes a meeting, everyone comes together and says, we really mean it this time. Now we're going to- if something like this emerges again, we're all going to agree that we're going to share the data, we're going to share the source strains. Well, what did COVID teach the world? COVID taught the world that if you're host to an emerging infection that looks threatening, the first thing other countries are going to do is erect trade and travel restrictions on you and try to isolate you. Like before COVID, that was controversial. The idea of actually isolating an- a nation was highly controversial because there was a presumption that if you isolate a nation that's host to an outbreak, you'll destabilize that nation and make it harder for them to combat the outbreak. But what's the first thing that happened when the British said, we have this- this concerning new strain of COVID called B.1.1.7 that seems more contagious. The French closed the Chunnel, right? So now we've taught nations that if you come forward and raise your hand that you're host to an outbreak, you're going to face some kind of sanction for that. So if that's the case, how can we rely on countries being forthcoming? We're going to have to rely much more on our ability to actively gather the information we need of an emerging outbreak and not just hope that people tell the truth and tell it in a timely fashion.

MARGARET BRENNAN: So away from airports to other borders, here at home. You've advised a number of governors, Democrats and Republicans, on how to respond to this pandemic. Which cities, which states actually handled this well?

DR. GOTTLIEB: I think my home state of Connecticut did a good job. And if you look at what the governor did there, he deployed testing very aggressively early. They rolled out the vaccine on the- on the basis of age. They kept it simple. They got the population vaccinated very quickly by keeping the- the framework by which they were distributing vaccines just simple, you know, older people first and they walked down the age continuum. They put in place community-based sites to try to go into hard-to-reach community and make vaccine accessible. The state has 85 percent of its adult population vaccinated now, one of the highest in the nation. There were a lot of things done early with the testing, the focus on the nursing homes in that state, that I think put it in a better position. Now, Connecticut suffered badly in the first throes of this epidemic, as did the entire tri-state region. That was a time when we were- we didn't know what we were dealing with. I mean, we were literally treating COVID with hydroxychloroquine and Pepcid. So, you know, there was excessive death and disease during that first wave, and Connecticut was not spared that first wave. But I think they learned and put in place a lot of measures that helped them weather this better than other states. Massachusetts, too, I- I worked with Governor Baker up there and had a very heavy focus on testing. In most days, Massachusetts was top of the list of 50 states in terms of the amount of testing they were doing. They pioneered wastewater testing as a way to get an early tripwire. So you shed coronavirus into your feces and so you can actually look at sewage to see when coronavirus levels are rising as a barometer of how much virus is in the population. They pioneered the use of that to be able to detect when the virus was starting to circulate in communities so they could target the public health measures into communities where the virus was starting to spread. So a lot of use of testing very early, I think, put them also in a better position. Now again, the Northeast suffered badly from this virus. You have a lot- you have dense cities, you had early introduction of the virus. But I think relative to where we- they could have been, they made some good decisions.

MARGARET BRENNAN: You named a Democrat and a Republican.

DR. GOTTLIEB: I did.

MARGARET BRENNAN: All of this has become politicized. Do you think that with the rollout of boosters, for example, which is again going to test some of the public messaging and trust, what is the lesson for the Biden administration as they roll out boosters? Do they need to change the playbook from what the Trump administration did?

DR. GOTTLIEB: Yeah, I think the logistical lesson on the rollout of the boosters is that they need to have in place the infrastructure to actually distribute those vaccines in hard-to-reach communities and hard-to-reach settings. And so that- the challenge during the Trump administration, with the early days of rolling out the vaccine, the vaccine was authorized by FDA mid-December. We didn't start vaccinating inside the nursing home until weeks after that, and this was a point in time when the nursing homes were really the setting with the most death and disease. We were losing at the peak about 7,000 people a week across nursing homes in the US. And it was a point, I had talked to some health officials at the time, and I said, we've done everything we can. You know, they restricted access to visitors, they were testing the staff, and they couldn't keep the virus out of nursing homes and couldn't keep the patients safe. And so the only thing, people said to me, the only way we're going to prevent this epidemic from spreading in these settings is by vaccinating the population. So there was an awareness of how important a vaccine was in that setting. But it took a full, probably three weeks, until we really started that because the logistical planning hadn't been put in place in advance of the authorization. So the vaccine was authorized, then they started the process of getting the consents, the informed consent in place to actually go into the nursing homes and start distributing the vaccine. I think what the Biden administration has done here is by backing into an approximate date, and I know they were beaten up a little bit for putting out a date ,but by putting out an approximate date, they're now able to start that planning process in advance and so that the boosters are made available by FDA, if FDA does authorize it and the advisory committee, the CDC ultimately judges it to be appropriate for a certain population, they're going to be ready to start making it available to nursing homes right away. So there's not going to be a delay. So I think they're in a better position. I don't know that the vaccine boosters are going to be controversial from the standpoint of sort of right versus left politics. I think where the fault lines are going to be is on some of the mandates that the administration is putting in place. And I think there the question you need to ask is whether or not the benefits of the mandates in terms of what you're going to achieve is going to be offset by the cost in terms of the acrimony and the political division and the hardening of positions of people who see this as something that's being forced on them where their decision making is being taken away. The more we can allow people to feel empowered around this decision, even people who are skeptical of getting vaccinated, the more likely they are to make the decision to get vaccinated.

MARGARET BRENNAN: So you just emphasized some of the fault lines there. You worked for two Republican administrations, for the Bush administration and for the Trump administration. How does it sit with you when you hear members of your party, the Republican Party, describe all this along civil liberties lines? Not making the medical argument, but simply around civil liberties.

DR. GOTTLIEB: Look, I think it's a misjudgment, because I think that there is- there is this argument that this is an individual choice. Your choice to get vaccinated is an individual choice, and it's not an individual choice. This is a- this is a decision that affects your community. This is a collective choice. If you go- and just like with childhood vaccinations, if you go into a school setting and you're not vaccinated for measles and you introduce measles into that setting, you're affecting your community. So these are collective decisions. But I think to the extent that they're decisions that impact the community, impact your workplace, if you're- if you choose to be unvaccinated, you introduce the virus into your workplace and a worker takes it home and then infects their young child. You introduce it into a school, you didn't vaccinate your child, your child introduces it to the school. I think if we're going to impose requirements on vaccination, to the extent possible, we should be making those decisions at the local community level within the context of the community that's going to be affected by that choice, rather than pull this away and make this a federal decision. So I don't think governors should tell schools and businesses, you can't mandate a vaccine. If a business makes a decision that the only way that I could protect my employees or- or my customers is by having a fully vaccinated workforce, they should have the ability to make that decision.

MARGARET BRENNAN: But it's not just shots, we're talking about masks. I mean, it has become a partisan issue and still is. In the state of Florida, for example, a ban on mask mandates. That is at the local level.

DR. GOTTLIEB: Yeah, and the- and the mask debate is inexplicable to me. I can't- I can't decouple it. I can't explain it. I can't defend it because, you know, at least with the vaccine, there's people- people generally, I worked at FDA and I had- I've treated patients and I've talked, counseled a lot of patients through difficult medical decisions. People generally have an apprehension about taking a medical product, especially when they're healthy, especially for a preventative purpose. I understand just sort of people's general questions and concerns about a novel medical product, but a mask is such a simple intervention. It's not going to cause you any harm. It's just an act of, you know, community responsibility, it's an act of respect. You know, even after I was vaccinated and prevalence levels were very low in my state, I continued to wear a mask in pharmacies and grocery stores. Not because I felt vulnerable. You know, in- in July and August, I felt pretty safe in Connecticut. Prevalence levels were low, I was vaccinated. But other people were wearing masks and I didn't want them to feel uncomfortable. So I think there's sort of an act of civic virtue and so to- to oppose mask wearing, to me, I don't understand that. I can't, you know, even explain the political rationale that this is somehow an exercise of someone's personal freedom, not to wear a mask in a setting where you're trying to protect the people around you. People's hesitancy around vaccines isn't new. People want to understand a medical product before they put it into them, particularly around children. So that is an understandable discussion. You can counsel patients through that. I think- I think there's a lot of people who right now haven't been vaccinated who are persuadable. They just have a long consideration period, and we should respect that. And my concern around, you know, the mandates. And I think, you know, the federal government is well within its right to mandate vaccination for federal workers, for health care workers. I think even mandating vaccination within the Medicare program could be something that's defensible, that providers and health plans need to get a certain percentage- certain high percentage of their Medicare recipients vaccinated. But when you impose the mandate down to the level of small businesses, now you're setting up the political fault lines and you're taking something that was sort of subjectively political, and it's going to be objectively political. Now- now you're going to see the debate play out and you're going to see the governors oppose it, you're going to see the litigation. And so my concern is that, you know, we might have picked up another, we were- we were going to get to 80 percent of adults vaccinated in this country. We're at 75 percent right now. Actually, 76 percent. The Biden administration has done a good job. We were going to get to 80 on our current trajectory. We might have gotten to 82 by the end of the fall, winter. With a mandate, where are we going to get — 86, 87, so we'll pick up three percent, probably most of them have already had COVID. So are you going to get enough benefit from a public health standpoint for the price you pay in terms of hardening those lines? I think that was worth a very vigorous debate. I- I hope the White House had it.

MARGARET BRENNAN: Which governors handled this the worst?

DR. GOTTLIEB: Well, which governors had the worst outcomes? I think in terms--

MARGARET BRENNAN: And by outcomes, you mean deaths?

DR. GOTTLIEB: Deaths. Certainly looking at South Dakota, you know where this was just allowed to travel largely unfettered with public health interventions, where you saw one of the highest death rates per capita. You have to look back and say that was a bad experience. You know, people always look at the deaths per capita and you know, New Jersey is right up there and New York is going to be high. I think we really need to look at the post initial wave period. What happened after that initial wave in New York? Because New York was devastated by this at a time when we didn't know how to treat COVID. You know, we were using Pepcid. We were using therapeutics that clearly had no value. Once we learned how to treat this, once we were able to reduce the case fatality rate by half, by the summertime, and we got there, we got there pretty quickly. States that were still excessively engulfed by this and had a lot of death and disease, those were in part policy decisions. Those were in part, the result of policy choices that those states made. New York and Connecticut and New Jersey didn't have the benefit of making a lot of policy decisions. I mean, by the time that they were- they started to get an awareness of this, they were already so heavily seeded that they were just trying to keep their health care systems operating.

MARGARET BRENNAN: So for Americans who, I mean, if you accept that this has already become politicized and you look ahead to future elections, one of the governors you just mentioned is projected to be a presidential contender. À droite? You have others. So for an American at home, how do they judge response to COVID and say this one worked, this one doesn't. Is it on deaths?

DR. GOTTLIEB: I think it's looking at what happened within the states. There was- there are going to absolutely be disparities in the state-by-state experience. And you know, it's- it's not easy to decouple in every case, the policy from the experience, because, you know, this wasn't an epidemic that was experienced the same way nationally, this was highly regionalized. Some states were made excessively vulnerable through features of the states that had nothing to do with policy, New York because New York City was so dense. But what you were starting to see after that first wave was a much more regionalized experience based on differences in policy approaches. And, you know, certainly Florida made certain decisions. I mean, the governor kept schools open, and a lot of people believe he made a good decision. He- they ignored the advice on six feet of distancing. Probably the single costliest recommendation that CDC made that you had to maintain six feet of distance that wasn't based on good judgment and good science was ultimately changed. And so he said we're only going to maintain three feet, which is where the CDC is now, and was able to keep schools open. But at the same time, you know, they let the virus spread largely unchecked in terms of personal mitigation. People weren't wearing masks. They weren't encouraged to wear masks. Vaccination was encouraged for the elderly population, but not widely. So they didn't aggressively try to vaccinate anyone except their elderly population. So they made policy choices. And the consequence was an infection that largely engulfed most parts of the- of the state. I mean, Florida probably has one of the highest positivity rates of any state in the nation right now. When the seroprevalence data comes out, when the data on- on how many people have had COVID comes out, Florida is going to be up there.

MARGARET BRENNAN: But Governor DeSantis would say, look at the economy.

DR. GOTTLIEB: Yeah, I mean, I'm not in a position to judge his economy relative to other- other states. You know, the decision to try to keep kids in school was the right decision. The decision to let the virus spread the way it has and not even employ mitigation in the school as they're doing now, I disagree with that decision. I think that- that there are things we could have done that were, you know, relatively easy interventions like requiring people to wear masks, trying to get people high quality masks that could have slowed the spread, could have kept certain settings like schools safer. Right now, the epidemic in Florida is largely inside the school. The case- the cases are declining across every age category, except young children because the epidemic has moved into those schools, and Florida has made a decision that they're not going to deploy mitigation in that setting. They're not doing testing in most of the schools, they're not requiring kids to wear masks, so they have spread. Now, it's not clear that those measures are going to be effective against Delta. We're going to find out because in the Northeast, we're adopting those measures and we're going to see whether or not they're able to- we're able to prevent epidemics of Delta in a school setting. But you don't go into a situation like that and tie one hand behind your back because you know what the outcome is going to be. The outcome is going to be that kids are going to get infected with COVID. And there was a study that just came out in Israel showing about 10 percent of kids who get COVID have long- term symptoms. There was a study in England showing about 2 percent have persistent symptoms. That's not trivial. You know, if you end up infecting millions of children and 2 percent have residual symptoms, neurological symptoms, that's a lot of morbidity that a lot of children are going to have to carry for at least some period of time that's going to affect their lives. So I- I wouldn't be cavalier about the risk in kids, even though they clearly do better with the infection than older individuals. And I wouldn't go into these situations, the school situation, without adopting measures that we know can- can potentially prevent the spread. So, you know, that was a decision that is going to- is having a predictable outcome.

MARGARET BRENNAN: I want to talk a little bit about President Trump. So, if I go back in time and I think about the first few days where this strange virus that was just surfacing started to make headlines here at home. February, January, you were starting to see things that weren't yet really being raised as red flags. You were tweeting, you were speaking privately in messages to White House officials. How are you on the outside seeing things that they weren't seeing on the inside?

DR. GOTTLIEB: Well, I think there was- there was a group of us seeing the same things. So there was a group of public health officials that were very alarmed about what was going on. There were people inside the White House who were concerned. Matt Pottinger, who you've spoken to, Joe Grogan, who's one of the people that I conferred with a lot. I remember very- the first conversation I had with him was in- was in January.

MARGARET BRENNAN: You write about that, January 18th.

DR. GOTTLIEB: Right, Martin Luther King Day weekend, told him he should ask for a briefing from the department on this, was very concerned about the spread. So there were people who were concerned about it. I think that there wasn't a lot of organization around the response early on. There was a presumption again that the CDC has this, the department has this, the Secretary of Health and Human Services is in control. So, you know, they let- they let that health care apparatus run with the ball. And then you had White House people who were alarmed, asking for information, but not actively managing it. It really wasn't until probably more like the end of February, the March timeframe. I went back and I met with the President in early March and the vice president, that you saw the White House really starting to get engaged and pull this away from the Secretary of Health Human Services and the health care institutions and start to at least try to more actively manage it. And that was the- the genesis of the Coronavirus Task Force. But the task force wasn't set up in a way to be operational. It was more a policy forum. So it didn't really- it wasn't really discharging orders and actually setting in motion action.

MARGARET BRENNAN: It's been reported that you were actually considered to come and run that task force. That the president was interested in having you come in and run it.

DR. GOTTLIEB: Yeah, that was written in one of the books.

MARGARET BRENNAN: Is that true?

DR. GOTTLIEB: You know, I don't know for sure. II know that there were various points in time that the White House had reached out to me about, would I come in and help them manage certain aspects of this. And every time I said yes. The point at which it felt like it was moving along and it felt real was after the task force. So there was a debate about who should run the task force. The decision was made to put the vice president in charge. It's been reported that I was considered. Yasmeen wrote about it in her book for The Washington Post. Subsequent to that, the president asked me to come in. I met with him, I met with the vice president, and asked me to take a position as, sort of as an adviser or helping oversee the task force after the vice president had been put in charge. That felt like it was moving along and more real. Ultimately, it didn't come together.

MARGARET BRENNAN: Why?

DR. GOTTLIEB: I don't know for sure. I think--

MARGARET BRENNAN: It wasn't your choice, in other words.

DR. GOTTLIEB: It wasn't my choice. I think like anything else, there were probably people in the White House who wanted to see me in that position and probably people in the White House who didn't. And you know, the people who didn't want to see me in that position were able to stall the process out long enough. You know, one thing you learn in government and you've been around Washington, so you know this, if you delay something, you can effectively kill it. And so, you know, if you delay an action, you delay someone coming into a position long enough, eventually either someone loses interest or it just dies on its own accord. And that's effectively what happened. My coming into that kind of a role got delayed in perpetuity.

MARGARET BRENNAN: Mhm. It was reported that that was Alex Azar. Is that the person you're smiling about?

DR. GOTTLIEB: Well, the report on Alex Azar in- in the book I referenced was that, the way I- the report that was in that book was that, the White House- Mick Mulvaney, who was chief of staff at the time, said that if the president put me in charge of the task force, Alex would resign, in the meeting with the president. That's the dialogue that she related. I don't- I don't know how she got that. I trust her sourcing. I know her as a reporter. She has impeccable sourcing. The- the subsequent episode when I was- there was thinking about bringing me in in some kind of role on the task force, I think those were different people. I think that the issues were probably being raised more at the White House level about me coming in.

MARGARET BRENNAN: Do you regret though, not being on the inside? You had been with the Trump administration till 2019--

DR. GOTTLIEB: Yeah, so I regret not being at the FDA. I don't- I don't know that there is much that I could have done dramatically differently inside the White House, and eventually I would have worn out my welcome because it would have been people inside the White House who wouldn't have liked what I was preaching. And by the- by the election, the White House had gone in a much different direction in terms of the seriousness and what they were doing to approach this. If I had been at FDA with my staff, working with the career staff in the device center, I'm pretty confident that we would have made a very hard pivot to try to instigate the private industry to start getting engaged in developing diagnostic tests early in January. There had been times before when we made that call. After Hurricane Maria devastated Puerto Rico, we were very worried that we were going to have a blood shortage in the country because about 50 percent of all the bags used to collect blood in this country, the plastic bags used to collect blood, are manufactured in Puerto Rico, and we couldn't get that facility online. One of the ingredients that goes into making bags is oxygen. We couldn't import oxygen. The only facility capable of manufacturing oxygen on the island we couldn't get started, because we needed- we didn't have enough power to actually start it. So I called around to other manufacturers of plastic bags used for other medical purposes and asked them if they could pivot their production lines into making bags for blood collection. One company agreed to do it. You know, I told the CEO, I said, if you go down this path, we'll work with you, we'll promise you an efficient process. And I said, I'll make it up to you on the back end. When you do this, you know, I'll either- I'll come to your factory, I'll tour your factory. And when they managed to successfully do it, I actually put up a bunch of photos of the production line on Twitter, you know, and basically gave the company some props.

MARGARET BRENNAN: And so you wish somebody at the FDA was doing that?

DR. GOTTLIEB: I think that could have happened- it would have had to happen at the commissioner level, it couldn't happen below that level. It had to be a political appointee, someone who could call a CEO and, you know, make certain guarantees about what- what you were going to afford them in terms of efficiency, predictability to make this pivot because you're asking a company to shut down a production line that clearly they're making, you know, millions of dollars off of and pivot into something where they might not get reimbursed. I couldn't guarantee that Congress was going to come in and pay for those tests. If I would have called any big manufacturer, though, they would have done it. I- I have no doubt about that. That could have been the secretary, that didn't need to be that- just the commissioner, there were other people in the chain of command who could have made that call. But, you know, having been there and having made those calls and having known that CEOs responded positively in moments of public health crisis, that's the one thing I wish I was there to do. And you know, I wrote articles about doing that at the time. I was writing articles in January, this is what we should do. But, you know, writing op-eds and putting things on Twitter isn't like being there in action and being able to pick up the phone and effectuate the action. I wish I was there. I think that that's- the- the FDA and the optives, the operational divisions of HHS, is where the action happens. That's where you can really affect the outcome. Affecting the outcome from the White House, much harder.

MARGARET BRENNAN: But you- it seems like you were trying to affect the outcome from the outside with the op-eds, your television appearances. Given that that's how President Trump received information quite often, do you think you did shape the COVID response?

DR. GOTTLIEB: Well, there were times when the- when the president engaged me, you know, based on my tweets. I talk about one story where I put out a series of tweets right before I went and did a hit on another network, and as soon as I got off, my phone was lighting up. And sure enough, the president had retweeted me and called me later that day and asked me to come down to the White House to discuss the substance of what I had put out. So I think the messages were getting through, but they were getting through at a point when, early on, when the White House was looking for a strategy, was engaged and was sober about the seriousness of this. I mean, after all, the president did make the decision to do the '15 Days to Slow the Spread' and then the subsequent 30 days, a dramatic action. Later on, I think when the White House pivoted and was wrongly advised that really nothing was going to effectuate the spread, there was no way to really stop this, that we were going to be subject to uncontrolled spread, and we just had this sort of power through this. I don't think that the advice I was given was really consistent with where they were going and what they- what they wanted to be hearing and advice that they were going to take. So at that point, I'm not sure my message was breaking through as effectively as it did at the outset. But- because the orientation changed in terms of how the White House was approaching this.

MARGARET BRENNAN: You write in March, when you went in to speak with the president that he was serious, he knew the grave risks. "When it came to the question of mitigation, he was most sold on the ideas before I had arrived." You're describing him as well briefed.

DR. GOTTLIEB: So I was invited in that day by some senior White House staff with the premise, at least as I interpreted it, to help sell the president on the idea of mitigation. And you know, they sent me into the Oval Office and said, you know, you try to walk him through this, explain to him, you know, your position on it. And by the time I got there, you know, I had the discussion with him, but he was- it was very clear to me that he was already sold on the idea, like he already understood what- what the plan was and it felt to me, and I had briefed him before, I mean, I didn't know him well, but I had been to the Oval Office 10 times, eight times to brief him on various things. It felt to me at that point that he was very receptive to what I was saying and wanted to move on to other topics. We were talking about other things in that meeting. So, you know, yeah, early on, I think that the president was- there was a point in time when he was gravely concerned about this and that came out in the Bob Woodward book as well, because over this very time period, when I was meeting with him, he was also meeting with Bob Woodward and expressing his deep concern about- about COVID. So, you know, he was understandably heavily criticized for saying to Woodward, allegedly, that, you know, he was trying to send a more reassuring message to the public because he didn't want to panic people, but privately he was very worried about this. I think that the- the challenge with the White House approach is it wasn't consistent. They didn't follow it through. You know, there was a point in time when they were very concerned about this, willing to take dramatic actions. But later on, their attitudes really changed to the point where when the president was contagious with COVID, he ceremoniously took his mask off. And so what message does that send to the country? So the- the approach in attitude shifted, and I think my view is- and I wasn't close to it at this point, so I don't know exactly what they were being told. They brought in a different set of advisers. But my view is that they were sold on the idea that you weren't going to be able to really affect the spread and that anything you did was just going to have so many repercussions in terms of impact on children who might not be in school, impact on the economy, that the costs were worse than the disease. The president always said that, the cure can't be worse than the disease. You know, and the schools as a perfect example, because- and a perfect example of the lack of effective policy making. So the single reason why most schools remained shut was because the CDC was telling them they had to keep kids six feet apart. If- if CDC had said you can only- you have to keep kids three feet apart, then a lot of schools would have been able to open. And in fact, when the Biden administration wanted to open schools in the spring, this past spring, they got the CDC to change that guidance from six feet to three feet.

MARGARET BRENNAN: And you write, the six feet was arbitrary?

DR. GOTTLIEB: The six feet was arbitrary in and of itself. But if the administration had focused in on that, they might have been able to effect a policy that would have actually achieved their outcome. But that policy making process didn't exist, and the six feet is a perfect example of sort of the lack of rigor around how CDC made recommendations. Nobody knows where it came from. Most people assume that the six feet of distance, the recommendation for keeping six feet apart, comes out of some old studies related to flu, where droplets don't travel more than six feet. We now know COVID spreads through aerosols. We've known that for a while, so how operative is that? The initial recommendation that the CDC brought to the White House, and I talk about this, was 10 feet. And a political appointee in the White House said, we can't recommend 10 feet. Nobody can measure 10 feet. It's inoperable. Society will shut down. So the compromise was around six feet. Now imagine if that detail had leaked out. Everyone would have said, this is the White House politically interfering with the CDC's judgment. The CDC said 10 feet, it should be 10 feet, but 10 feet was no more right than six feet and ultimately became three feet. But when it became three feet, the basis for the CDC's decision to ultimately revise it from six to three feet was a study that they conducted the prior fall. So they changed it in the spring. They had done a study in the fall where they showed that if you have two masked individuals, two people wearing masks, the risk of transmission is reduced 70 percent with masks if you're three feet apart. So they said on the basis of that, we can now make a judgment at three feet is an appropriate distance. Which begs the question, if they had that study result in the fall, why didn't they change the advice in the fall? Why did they wait until the spring? So the whole--

MARGARET BRENNAN: And that's--

DR. GOTTLIEB: --This is how the whole thing feels arbitrary and not science based. So we talk about a very careful, science based process and then these anecdotes get exposed, and that's where Americans start to lose confidence in how the decisions got made.

MARGARET BRENNAN: You do put blame on President Trump for a few things, masking, you- you mentioned there. You said he politicized masks. You say you heard it's because he thought people looked funny in them. You said, you know, he listened to people on the outside too much. But do you think fundamentally, looking at everything you've analyzed, that the outcome of this pandemic would have been different if President Trump wasn't in office?

DR. GOTTLIEB: Well, look, it would have been different if we had different political decisions and the White House was exercising different leadership. There's no question about that. There's no question that the White House made mistakes, and the lack of consistency was a big mistake, and also the lack of using the White House as an effective bully pulpit to really galvanize a collective action that can make a difference on the margins. I mean, when you're dealing with something of this magnitude, little things practiced on a large scale make a big difference. If everyone just washes their hands a little bit more, we talk about these things as public health officials, and sometimes it sounds silly. But we know when you aggregate small interventions on a mass scale, if people just go to the grocery store one less time a week, they wash their hands, they wear a mask. All those little things added up over a large population actually can affect the contours of an epidemic. And so getting people to do that requires galvanizing the public, inspiring the public to engage in certain behavior. And that's where the- the lack of consistency, lack of messaging, allowing this to sort of get divided along political fault lines in the setting of an election when things were already, the temperature was already very high, I think really hurt us. And then there were the discrete policy mistakes, decisions not to do this or decisions to do that. But stepping back from that, I think that there were fundamental weaknesses with our response that regardless of who is in power, we had an ill-prepared bureaucracy. We didn't have the right infrastructure, we didn't have the right agencies. The agencies weren't properly empowered, properly resourced. So even if you had competent leadership, very effective leadership up and down the chain, you still would have had some of the same problems. And that's what I try to get at here is some of those really deep rooted systemic problems with the structure of our response and also the assumptions we made about how we would respond.

MARGARET BRENNAN: So you resigned from the FDA in 2019. Seeing everything you've seen, do you see a role for yourself in government again?

DR. GOTTLIEB: It's impossible to say. I was--

MARGARET BRENNAN: This isn't a playbook for the future secretary?

DR. GOTTLIEB: You know, what I would- getting these jobs in government, so many things have to happen right for these opportunities to be open to you, that anyone who wants to be in a position inside government can't plan for it. So- would I- are there things I'd like to do? Is there unfinished business? Are there roles I'd like to play? Bien sûr. Do I think I'm going to have that opportunity? I hope so, but you can't plan for it. And sometimes writing a book isn't the best way to propel a political career, as you know, because sometimes the best way to get a political job is, write less, not more. So, this certainly isn't, you know, a blueprint for that.

MARGARET BRENNAN: But you do hope that this is a blueprint for some kind of change?

DR. GOTTLIEB: I hope this is the part of the conversation that needs to happen about how we plan differently going forward. And we need to bring together a bipartisan commission. We need to bring together thought leaders to try to develop a plan for the future. The blueprint that the Biden administration put out is basically just a structure of that conversation. That conversation needs to happen. I hope this is part of that conversation. I hope that this book becomes something that people who engage in that discussion read--

MARGARET BRENNAN: A 9/11 type commission?

DR. GOTTLIEB: It will be- it will be something of that ilk. It's going to be something- it has to be. In order- in order for it to be effective, it's going to have to be something that's broadly bipartisan, widely respected, because it's not just a matter of getting the right infrastructure in place, you know, getting the right chess pieces on the board and restructuring the agencies. I think we have to have a more fundamental question, a discussion about what is the role of public health officials in the setting of a public health crisis and come to agreement about that because that's-that's where you're going to get, on the political right, that's where you're going to get a lot of consternation. There's a perception now that public health officials exercise too much power, sometimes on the basis of faulty information, propagated guidance that had a dramatic impact on people's lives, oftentimes that wasn't based on good science. And so the reaction to that is going to be, maybe they shouldn't be so empowered. And I think we're going to have to pierce that discussion, get over that, come to a consensus around that, sort of re-elevate the role of public health in a way that people find acceptable in order to get the right infrastructure in place. I don't- I don't know that the public health community senses that yet, but I- I worry that- that- that discussion is coming and that discussion needs to precede any broader discussion about what will the role of the CDC be? Well, the role of the CDC is going to depend on what you think the role of a public health agency in a crisis should be. Should CDC's guidance be more subject to notice and comment like a regulation or subject to an advisory committee process where there is some public scrutiny? Should they have to re-educate their guidance once they issue it to make sure it continues to be science based? You might bring more structure and transparency around how decisions get made, maybe that's the solution, but that discussion needs to happen.

MARGARET BRENNAN: On the global response, you wrote, "COVID crushed the global order of public health cooperation." Are you saying WHO is just not up to the task?

DR. GOTTLIEB: Well, it's not just the WHO. I mean, past epidemics crush the global order of cooperation, we just didn't learn the lesson. When H1N1, the swine flu in 2009 struck the world, Australia and Canada nationalized the facilities that were producing vaccine destined for the US. They basically held on to our vaccine that was being manufactured in facilities in those countries until they could satisfy their local demand, and then they allowed the vaccine to be shipped here. And we did the same thing. We had a facility in North Carolina that was manufacturing vaccine for the United Kingdom, being operated by GlaxoSmithKline at the time. And we held on to that vaccine and it actually took a call from the British prime minister to President Bush at the time to get us to allow that vaccine to flow to the UK. So we have seen in moments of global- global public health crisis, there's a little bit of every nation for yourself. And so if we want to work on this assumption that everyone's just going to share and you know, lines are going to flow, vaccines are going to flow across borders, it hasn't worked in the past. It hasn't- it didn't work in a setting of COVID. So I think we're going to have to think differently about how we build capacities here domestically to make sure we have what we need to respond to a public health crisis of this magnitude, and not be dependent upon things coming from other nations where those nations are going to want those- those same materials as well.

MARGARET BRENNAN: Was there quashing of information by the WHO?

DR. GOTTLIEB: I think the WHO for too long--

MARGARET BRENNAN: Did they cover up for China is the allegation.

DR. GOTTLIEB: They- they weren't willing to confront China, right? They were- they put out statements extolling China's behavior and how forthcoming China was. I mean, it's part of the record now. Tedros- it's- it's in his Twitter feed. It's in the Twitter feed of the head of the WHO, giving props to China for how forthcoming they were. Now, was some of that an attempt to try to give them public praise because privately you were- you were, you know, giving them a harder sell? I think some of that was going on in the US with some of the tweets and the statements that we were putting out. I don't know that that was happening at the WHO level because I was talking to some WHO officials at the time, and I've talked to a number since. And I think the WHO really did believe China was behaving in sort of an appropriate way and was providing cover for them as they were getting criticized by other parts of the world. Clearly, they weren't, and I think that that was knowable at the time. China didn't share the source strains. Tedros didn't- the head of the WHO didn't want to push China on sharing the source strains publicly because he said, well, they have no commitment to do it, and he's right. Under the International Health Regulations, there was no requirement that you had to share the samples, but the required- there were requirements that you had to share samples of novel emerging resp- respiratory pathogens in other settings. So clearly, the spirit of the International Health Regulations was that this should be shared, but because it wasn't the letter of the law, the WHO didn't want to push China publicly to do it, even though that would have been very helpful for other nations.

MARGARET BRENNAN: You're talking about actual viral samples, not the sequencing.

DR. GOTTLIEB: Right, actual samples of the virus because the sequence alone isn't good enough if you want to develop a vaccine or a diagnostic. You actually at some point need the live virus. Now we eventually got the live virus because we had spread here in the United States. But, you know, at least publicly, we didn't have the virus until there was a case in Seattle. It's possible we got the virus earlier from one of China's neighbors, where there were some earlier spread.

MARGARET BRENNAN: Is that part of the equation being dealt with now?

DR. GOTTLIEB: No, I don't think the WHO has taken any steps to reform how it operates in a global crisis like this, whether or not they're able to- whether or not the organization has a self-awareness to do that and is able to self-organize to actually implement meaningful reform. Je ne suis pas sûr. I think the Biden administration lost an opportunity to compel different behavior out of the WHO by- by simply rejoining the WHO I was critical at the time that the- President Trump made the decision to pull out the WHO I had actually spoken with him directly, urging him not to do it, suggested that there were other ways he could send a strong message to China. Short of pulling out of the WHO But once we pulled out of the WHO and we were going to re-enter, we should have used the reentry to extract some kind of agreement about the WHO engaging in some reform process and as best I know, as best we all know based on what's public, that wasn't done.

MARGARET BRENNAN: Leverage was given up?

DR. GOTTLIEB: The leverage was given up. Ouais.