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Full Transcript: Dr. Deborah Birx on "Face the Nation," January 24, 2021

Full interview: Dr. Deborah Birx on "Face the Nation"
Full interview: Dr. Deborah Birx on "Face the Nation" 01:18:16

The following is an extended transcript of Dr. Deborah Birx's interview with "Face the Nation" that aired Sunday, January 24, 2021, on CBSN and the new "Facing Forward with Margaret Brennan" podcast.  

MARGARET BRENNAN: I want to start on some of the news of the moment where we are with this virus. President Biden rolled out a number of actions on day one: executive order to wear a mask on federal property or traveling interstate, requiring everyone on White House grounds to be tested, quarantining after international travel, forcing agencies to share data. What do you think of what he's done so far?

DR. BIRX: Well, certainly I'm fully supportive of all of those elements. I'm a strong supporter of masks and even mask mandates. I think mask mandates are really critical because you need that constant reminder. I mean, we're talking about our primary tools right now, in addition to the vaccine, is behavior change. And when you're asking people to change their behavior, you need those constant reminders. And when I was on the road, being reminded that I had to wear my mask was very helpful in the mask mandate states. And so fully I- and anything that has to do with data I'm thrilled by. We have some very old databases. We've used a lot of modeling rather than improving the collection of real-time data. I think that's absolutely crucial. And I think the other innovations around really bringing people together, I think having what he didn't- well, one of the executive orders was around the White House coronavirus response coordinator and a deputy. I was an N of 1.  So having a team at the White House that can really respond to this is going to be really, really important, because the amount of work that needs to be done not only at the White House but also at the state level to really ensure that we come out of this in some kind of normalcy by summer will be really critical.

MARGARET BRENNAN: You said you were just one. You were coordinator of the task force. What do you mean, you were just one?

DR. BIRX: There was only one full-time person in the White House working on the coronavirus response. There--

MARGARET BRENNAN: How is that possible? 

DR. BIRX: Well, that's what I was given. So what I did is I went to my- my people that I've known all through the last years in government, all 41, and said, can you come and help me? And so I was able to recruit from other agencies, individuals. And certainly, Irum Zaidi who I brought in from PEPFAR, was my chief epidemiologist and data developer for the PEPFAR program, where we really revolutionized data to really end the- work on ending the pandemic of HIV and TB in sub-Saharan Africa. And so I would be able to wicker together a group of volunteers who really helped me.

And I had one incredible support person, Tyler Ann McGuffee, who really helped make sure I was at meetings on time and didn't miss emails. But there was no team, full-time team in the White House working on coronavirus.

MARGARET BRENNAN: Did you ask for staff and you were denied?

DR. BIRX: I did ask for staff. I think what they're doing of bringing in an expert in testing, an expert in vaccines, an expert in data and data use, not just collecting data, but how to use it successfully, I think all of those pieces are going to be critical for their success, bringing in a full-time supply chain person. And so all of these individuals existed, but they existed in different pockets of government. So as a team, you're constantly having to work outward to getting everybody on board, to making sure the response is as coordinated as it can be.


On vaccines, the president says 100 million doses within 100 days. That's not 100 million Americans vaccinated. What do you think is actually possible? Is that too limited a goal?

DR. BIRX: Well, I know we- we haven't talked a lot, but I am very- I'm very, very hard-driving and relentless on where I think we need to go. And I- I would be thrilled to have 100 million people protected in 100 days. 

MARGARET BRENNAN: Actual shots in arms?

DR. BIRX: Actual shots in arms, individuals in arms. I- I think it's really important to move vaccines forward as fast as possible. I understand- and as I told them right after the election, there's not a lot of infrastructure behind a lot of these initiatives in the federal government right now. And- and I know that they will bring in the infrastructure around that. And so I think things will begin to accelerate, but we shouldn't hold ourselves back. And so we really need to ensure that states that are doing well can even do better. Learn from those states, get that to other states. I think getting more on-the-ground learning- it's why I went out in the field is to really understand what's working at the ground level.

MARGARET BRENNAN: So it sounds like you think it's a little modest as a goal. But

the Biden coronavirus czar, for lack of a better term, told reporters, "When it comes to the vaccine, what we're inheriting is so much worse than we could have imagined." Is that a political statement? Is that accurate?

DR. BIRX: You know, I've been trying to process all the last 11 months because I- it's really important that we understand what worked and what didn't work. And I think I've tried to pull all of this together. And I took extensive notes during the entire process because I didn't want to lose track of what we need to do to make our response better in the future. One of those critical areas, and you're really getting to that essential point, is this idea of federalism on which the United States was built. But that can be taken to extremes. And so the mantra always was federally supported and state-managed, locally executed. 

MARGARET BRENNAN: That was the Trump plan?

DR. BIRX: That was- that was the mantra. But what does support mean? And what does federal support mean? And I think really an understanding of what states need to translate guidance into implementation, what state needs- states need in interpreting data together. They only are seeing their data. But it's really important that they understand what's happening in their entire region because people have been mobile. When we were out on the road, the interstates were filled with people traveling. And so I think this idea of how the- can the federal government be more supportive of the states not just delivering things, but delivering new ideas and new innovations about how to make those things work better. And I think their intent- I hope their intent is to do exactly that. It's why Arum Zaidi and I went on the road.

We went on the road because we wanted to figure out what states needed as far as federal support, how they were interpreting that guidance, how communities were interpreting the CDC guidance. 

MARGARET BRENNAN: We kept hearing time and again from the Trump administration, Secretary Azar in particular, that they were getting that information from the states, that they were being responsive, that all of this was just playing politics when governors complained.

DR. BIRX: So we did work very hard to build a comprehensive database, not without a lot of scars over that last 11 months. It was really important to me personally because in order to have data that's reliable, it's not only the actual number but what the trend lines around that number is. And are there inflection points in the slope of the development of that number? And so really what we tried to bring together is all the testing data, all the case data, all the hospitalization data and certainly all the fatality data to be able to constantly be triangulating data down to the most granular level, because I think that's very important. It's the- where you see success and you really see counties doing extremely well, metros doing extremely well. You've got to get to them then and learn from them because, remember, they're in the middle of trying to stop a pandemic. So they're working very hard with their citizens to stop a pandemic. If you want to learn to- from them, you need to physically go, see what they're doing, and bring those learnings back to other states. I think that's the approach that they're going to take. I think the past administration was focused very much on when we see a data problem- when we see a problem that's illustrated by the data like out of N95 masks, we ship them N95 masks. But when you're talking about translating testing more proactively or strategically, you need real examples about how to do it better. You can't just send more tests. And I think that's the kind of learning, that bidirectional learning between the states and the federal government that I hope is going to increase with the new administration.

Test positivity even going up to 0.1 to 0.3 to 0.5%, tells you that you have expanding community spread. That's the moment to tell that population, that local population, we are seeing more community spread. We need you to do these things. The trouble is, we still are reacting late and that by the ti me we react, the community spread is so widespread that then you have two to three to four weeks of really significant hospitalization rates. And that always concerns me that we don't stop the virus early enough.

MARGARET BRENNAN: The CDC director said that the health infrastructure is "frail and poorly tended." She seems to be saying this is a problem that goes beyond President Trump. That sounds like she's saying the infrastructure was rotting. Is that how you describe it? 

DR. BIRX: Well, that's such an insightful point. It should be-- 


DR. BIRX: It's a very insightful point, because after federalism, one of our biggest problems is we have a complete disconnect between what we call our clinical data systems, what happens at laboratories and hospitals and our public health data systems. And they don't interact in any way. So when we had to build these databases and data streams, we had to bring together public health data with clinical data. And that does not naturally exist in the United States and that has to be fixed.

MARGARET BRENNAN: But we're the richest country in the world. How are we calling the CDC, which is supposed to be the premier agency, frail?

DR. BIRX: Because we haven't valued prevention. And we haven't taken on the difficult task of prevention early enough to really prevent some of these comorbidities. We're very good at identifying them, And the CDC has been great about saying this is where hypertension exists. This is where obesity exists. This is where diabetes exists. This is where our overlapping comorbidities exist. But to really tackle that, you've got to have granular data and you've got to have it really frequently so you can see if your interventions are working. So we've- we have serious problems, but we're not tackling them in this deliberative, data-driven way to really make changes. And I think what the new CDC director is recognizing we have to really bring together are clinical and preventive responses and really be able to show impact.

Because if you can show a governor, which is what we- why we also went on the road, when you can show the governor that within two weeks of a mask mandate, Phoenix's cases began to drop dramatically. Then I can take that to another city and say, this is what the mayor of Phoenix did. Look at the impact it had. This is the data. They can see that then. And then they can say to their population, the reason we're asking you to do this is because it works and it worked in Phoenix. So we think it will work here in Tucson. And that's- that's the kind of information that we need around obesity, hypertension, diabetes. We- we just can't keep ignoring these comorbidities that put Americans at significant risk.

MARGARET BRENNAN: Some would hear you say that and say it sounds like you're blaming Americans--

DR. BIRX: Oh gosh no--

MARGARET BRENNAN: --for their own health problems. 

DR. BIRX:  Never. Never. These health- yes, certain health problems are genetic for sure. But we have created a system that didn't value giving Americans the clear information and the clear ability to respond in a preventive way. We like to treat illness. We're not as good at prevention. And that was very much illustrated in this pandemic. And I would never blame an American because I suffer from the same things. And I- I guess I should be blaming myself. I mean, I was on the road. I gained 15 pounds. I mean, I can tell you, if you eat some of our food that's available to us regularly, you will gain weight. If you're immobile and you're driving around and you're eating McDonald's French fries all the time, it's not a good situation. I'm a direct experience of what that situation looks like. And now I'm going to have to work at that. But encouraging people and showing that work results in outcomes and impact- people will change their behaviors if they know what to do and they get positive reinforcement.

MARGARET BRENNAN: You were often at odds with the CDC, is what I've been told. Is that true?

DR. BIRX: I know the CDC well, so it was diff- let me just be very clear, it was more difficult for them because I knew where the gaps were. And so when I came in, I really asked for those gaps to be addressed. And a lot of it has to do with real-time data and real-time data acquisition and data revolution and data modernization to make things better so that the CDC, the premier public health agency, has daily information on how Americans are doing. Not just in this pandemic, but in general down to the zip code level, so they can be very clear about what needs to be done. So I was very pushy on that. I was also very pushy, and the one thing that's been taken completely out of context is when I was talking about not trusting the CDC data, it had to do with the ethnicity and race of the fatalities early on because of the delay in that reporting. So I was using the information from my European colleagues, and I'm still deeply grateful to them, of understanding who was most at risk for serious outcomes in this virus, because our delay for death certificates that have all that information on can be up to 30 days. 


DR. BIRX: So when you're in the middle of a pan-- and it's gotten better. So that was the argument. They never talked about what was being discussed before and what was being discussed after. I really like to make real-time data better. And the way you make real-time better- data better is you use it.

MARGARET BRENNAN: You said that you thought there might be an American strain of this virus circulating and the CDC says they don't have evidence of that. Are they wrong?

DR. BIRX: Well, there's two pieces of that, to be completely clear. So we certainly in this country had all the setup to develop the same kind of what we call more transmissible strains of the UK, Brazil and- and South Africa. In fact, we had more capacity because we had more ongoing cases and infections continuously in the United States. So, this virus naturally mutates. It's constantly changing, because it's an RNA virus. Some of it is just a mistake and it's a failure and that virus can no longer replicate. Other changes may make a competitive advantage. It's not like it's intellectually trying to make itself more fit. It just by accident makes these mutations. They happen then to be more fit, more able to spread, and then you see this escape. So the way you find them is you constantly are sequencing the underlying cases so you can look for what we call a nodal escape. Where it's enriched, where you see more of these sequences in this area. It's what we've done in molecular biology forever. We didn't have enough of those sequences. So what I was looking at is the rate of rise in the fall-- 


DR. BIRX: --and the case fatality rate. So what I said and what I- so, anything that I do personally, I increased my mitigation in October because I could see this rate of rise. So, I wanted the governors to know what I was concerned about, and I said this could be. I didn't say we had one because of course, until you have all the sequences, you can document it. But certainly the slope of the fall surge was twice as fast and it's lasting longer and, critically, it's been more difficult to mitigate. So Texas and Arizona are doing exactly what they did in the summer that was able to control the spread. And it's not having the same impact. You saw the same thing in L.A. So, what I wanted the governors to be able to know is we could have it,-- 


DR. BIRX: --but we should act like we do have it. On two sides, we should be sequencing more to actually find if we do have it. But at the same time, we should be enhancing our mitigation and going to our communities and saying what's happening in the UK could be happening here and we just aren't seeing it yet. So let's act like we could--


DR. BIRX: --and let's mitigate more.

MARGARET BRENNAN: I want to talk about when you joined the COVID Task Force. So, we're at the end of February. CDC official gives a briefing to reporters that tanks the markets when she says that within the community there may be a virus spreading and it could cause severe disruption to daily life. Dr. Fauci goes on television a few days later and says the risk to Americans remains low. You're watching this and what are you thinking?

DR. BIRX: So I'm in South Africa. We have all of our countries in from all over the world. We're going through- we're working 24 hours a day, but we have a break over dinner. And we're staying at a place where we can cook, and I love to cook. So, we're cooking, we're eating, we're watching CNN. And so over those two weeks of February, we're yelling at the CNN television saying this is going to be a pandemic because the Chinese- what I saw from China, when you overwhelm your hospitals, you have to know that you have broad-based community spread before that happens. Yet they weren't seeing it. And so from the minute I saw the hospitals in China, I was worried that there was large spread, asymptomatic component to this coronavirus pandemic. And that really worried me because what we were looking for is people with symptoms. And so when people were coming into the country, we were looking for people with symptoms.

MARGARET BRENNAN: When you say we, who do you mean? 

DR. BIRX: I mean the United States.


DR. BIRX: Well, the United- I think it was everybody. I don't know who was on the task force at that time, but I think multiple agencies were represented at that time.

MARGARET BRENNAN: That was Matt Pottinger,-- 

DR. BIRX: Yes.

MARGARET BRENNAN: --the Deputy National Security Adviser?

DR. BIRX: Because I have- I've known him and I've known his wife for a very long time. We've worked on pandemics together. Both of us were in Asia during SARS. And so we understood how serious this can go, and I think- I think there was a level of belief that our technology would really save us from this, you know, that we would be able to find all the infections or stop all the infections. But when you have an asymptomatic component, the only way you find them is proactive testing.

MARGARET BRENNAN: And he asked you, Matt Pottinger asks you to come from the State Department to the White House.

DR. BIRX: And I said no about 20 times. 


DR. BIRX: Well, from the outside, everything looks very chaotic in the White House. I had spent--


DR. BIRX: --the first three years of this administration trying to stay out of the swirl, trying to protect the PEPFAR program. We had extraordinary cuts, obviously, every year.


DR. BIRX: The President's Emergency Plan for AIDS Relief. It's what's changed the trajectory of the pandemic around the world, both for HIV and TB. And I'm very proud of the work that the community and I say that community, Global Fund, UNAIDS, WHO, PEPFAR together, along with our HIV advocates and community groups around the- around the world. We've been able to tackle this, but it took all of us together, working together. And I had spent three years just trying to protect the program and keep my head down and get my work done. I had no interest in going into a political space. I'm not a political person. I'm a civil servant. I've never been a political person. I've never worked on a campaign.  I've never campaigned for any of the candidates. I take the Hatch Act very seriously. I- I just am not a political person. So, it would- it never occurred to me to go into the White House until I could see that we were missing pieces that I thought were very important in the response. And so after many weeks of saying, no, no, no, the president announced the new task force with the vice president in the lead. They said this would be very technical, and that I would have a very technical position. And because I thought that I could be helpful, which is the only reason I go and do anything. If I think I have something to add, I feel like it's my obligation to the American public to go in and do that. That's what a civil servant is supposed to do.

MARGARET BRENNAN: Do you feel you made a difference? 

DR. BIRX: Yes.


DR. BIRX: I think the biggest difference was over the testing. So as soon as I- I arrived March 2nd, I talked to the vice president. I said these are the three gaps I think we have. They have to be addressed this week. Every day that goes by, we get further behind. You cannot confront this epidemic by primarily testing, as we have in flu, by small conformational testing in public health labs. When they were approaching it as a flu pandemic, because that is what we expected to happen in the United States, testing is utilized to confirm about every thousands or every hundred thousand case. Flu is diagnosed by symptoms.

MARGARET BRENNAN: But Dr. Fauci, Dr. Redfield from the CDC, they were there.

DR. BIRX: But, you know, when you're in the midst of it and they were very much focused on preventing infections from coming into the United States. They were very focused on that, looking for those symptomatic cases. I thought what I could bring, I had a lot of experience in RNA viruses, RNA virus testing development, vaccine development, but most importantly, experience in trying to get government to work and government to work efficiently and effectively, and change management in government. And I can tell you, change management in the federal government is very different than change management in the public sector- in the private sector. And so I want to- I thought I could bring some of those skills and my focus on being able to read data and being able to see changes early so that people could be alerted early.

MARGARET BRENNAN: So you, as you mentioned, have been a public servant. You were a colonel in the Army?

DR. BIRX: Yes.

MARGARET BRENNAN: An immunologist, you were appointed by President Obama to work on AIDS relief, as you mentioned, at the State Department. Yet your name in the history books is going to be associated with President Donald Trump. How does that sit with you?

DR. BIRX: Well, you know, this is what worries me. When I see how partisan and divided the United States is that then gets played out in the civil service, and if we start looking at technical civil servants as belonging to a political party, we will lose the ability for highly qualified civil servants to come and help. And we have amazingly qualified civil servants. They're at the CDC. They're at HHS. They're at FDA. They're at NIH. And most of the White House personnel are civil servants detailed there from their home agencies. If we start saying if you come in and do this, you are then going to be part of the political apparatus, that is going to be very dangerous for this country.

MARGARET BRENNAN: Do you feel like your work is misunderstood as political?

DR. BIRX: I don't- I think pandemics are always political. That's what, I mean, I've worked in 60 countries. Every pandemic is political because you have to make policy changes to confront them, and policies are often political.

MARGARET BRENNAN: I mean, you worked on AIDS, which is a highly politicized virus-- 

DR. BIRX: Correct.

MARGARET BRENNAN: --in sub-Saharan Africa. But did any of that prepare you for the politics you encountered here with this pandemic in this White House?


And I feel like- it's still difficult for me because I pride myself in being able to always find a way, find a way or make one. When this doesn't work, you go this way. When that doesn't work, you go this way. You find another set of alliances. White Houses function in a pretty- a pretty bureaucratic way, and most of the agencies function in a very predictable and bureaucratic way. But when you remove the infrastructure of the civil servants, then you end up with a lot more very quick right turns, left, turns, right turns, left turns, and that- that becomes less predictable and less able to manage that kind of response and change.

And so I think in some ways people will say, you know, disrupting and change is very important. And yes, disruption and change and inflection points in American history are important. And it's important to recognize those and build on those. But it also in a pandemic can be very, very difficult then to get us back always to the response that we need to have and being able to point out here's where the problems are coming from. That said, I was privileged to work with a whole series of both political and technical people from all of the agencies. CDC was enormously helpful. FDA, NIH and the teams that were working on vaccines, these are dedicated civil servants who gave everything to this pandemic. And so I think as- the other thing I knew is this was historic. And so that's why I kept extensive notes from every meeting, daily reflections to really understand what I was seeing. I wrote a daily report, over 310 of them that went to senior leaders. We created--

MARGARET BRENNAN: Did President Trump read them?

DR. BIRX:  I don't know. I don't know. I sent them up through to the vice president. I had very little exposure to-- 

MARGARET BRENNAN: But you did brief President Trump? 

DR. BIRX: I had very little exposure to President Trump.

MARGARET BRENNAN: So you were looking at all this data. Do you think when you were in the room and briefing, even if it was with other people, do you think President Trump appreciated the gravity of the health crisis you were describing?

DR. BIRX: I think the president appreciated the gravity in March. It took a while after I arrived in the White House to remove all of the ancillary data that was coming in. I mean, there was parallel data stream coming into the White House that were not transparently utilized. And I needed to stop that where people were--

MARGARET BRENNAN: You mean outside advisors? 

DR. BIRX: Outside advisers, coming to inside advisors. And to this day, I mean, until the day I left, I am convinced there were parallel data streams because I--

MARGARET BRENNAN: Disinformation?

DR. BIRX: I saw the president presenting graphs that I never made. So, I know that someone- or someone out there or someone inside was creating a parallel set of data and graphics that were shown to the president. I don't know to this day who, but I know what I sent up and I know that what was in his hands was different from that. That worries me because at any moment- I've built my career on data transparency and accountability. It is very important to me that we all agree how the data is collected and how we use it- use it. We don't cut it in pieces and say we're only going to look at it in this six weeks because it makes us look better. Or we're all going to look at it in these two weeks because we look better than Europe in these two weeks. You can't do that. You have to use the entire database-- 

MARGARET BRENNAN: Who was doing that? 

DR. BIRX:  To this day I don't know. I know now why watching some of the tapes that certainly Scott Atlas brought in parallel data streams. I don't know who else was part of it, but I think when the record goes back and people see what I was writing on a daily basis that was sent up to White House leadership, that they will see that- that I was highly specific on what I was seeing and what needed to be done.

MARGARET BRENNAN: So the chief of staff is not saying, wait a second, this is our official coordinator listen to her and her only? Listen to you? No one was saying that?

DR. BIRX: No one said that to me.

MARGARET BRENNAN: To the president? 

DR. BIRX: I- I don't know if they were saying it to the president. 

MARGARET BRENNAN: Do you think the president was just distracted by the political implications and the campaign?

DR. BIRX: You know, I always wonder that, and, I mean, the worst possible time you can have a pandemic is in a presidential election year. I just want to be frank. There's politics and there's policies and there's pandemics. But in an election year, everything takes on a different perspective. I think the White House personnel were very focused on this pandemic in March and April. I think once the country began to open and it was clear to me that they weren't going to follow my really gated criteria that I had worked hard on. And the reason that gating criteria was so important to me is it combined the insights of Tom Frieden with Zeke Emanuel and Scott Gottlieb. I took- they had the three sentinel papers on how to open America safely--

MARGARET BRENNAN: How to open restaurants, how to let people dine indoors-- 

DR. BIRX: I combined all of that together for these great gating criteria. So in calculating everything with the slow reopening, I didn't think anyone could get to Phase 3 until August. And you can see in the states that followed either that criteria or similar criteria, that's how long it took them. And by then, we had the fall surge coming. I wanted to keep the summer quiet so that we could build capacity to get to what we all knew would be a much more difficult fall.

MARGARET BRENNAN: What were the biggest obstacles to you communicating that, though? I mean, were there COVID deniers in the White House?

DR. BIRX: There are people in the White House and I think people around this country, because I've had the privilege to meet them and listen to them and hear them, because I wanted to hear what people were saying. There were people who definitely believed that this was a hoax.


DR. BIRX: I think because the information was confusing at the beginning. I think because we didn't talk about the spectrum of disease, because everyone interpreted on what they knew. And so they saw people get COVID and be fine.

And then they had us talking about how severe the disease is and how it could cause these unbelievable fatalities of our American public. I mean, so every American life lost, I mean, I haven't slept in 10 months or 11 months because those were the numbers- that's someone's parent. That's someone's grandparent. My great grandmother was lost in the pandemic flu. I know what that feels like from just listening to my grandmother. To have that others feel that same level of pain and loss when it was preventable or could be preventable was really excruciating. So--

MARGARET BRENNAN: So you don't blame the president's own language of calling some of this politically motivated, a hoax? It was a phrase he used at one point.

DR. BIRX: You know, when you have a pandemic where you're relying on every American to change their behavior, communication is absolutely key. And so every time a- a statement was made by a political leader that wasn't consistent with public health needs, that derailed our response. It is also why I went out on the road because I wasn't censored on the road. I was able to speak freely about mask mandates, closing bars when you're in the middle of a surge, closing indoor spaces where people are going to take off their mask and be inside. We know those are--

MARGARET BRENNAN: You felt censored?

DR. BIRX: --spreading events.

MARGARET BRENNAN: You felt the White House was censoring you?

DR. BIRX: Well, if you noticed, I was not able to do national press. The other thing that was very important to me is I was not going to go outside of the chain of command. And so if our White House comms group did not put me out, I didn't ask to go out. I- because there was so much leaking and so many parallel stories being leaked to the press that did not have grounding in truth that I didn't want to ever be part of that slippery slope. I know people started it with good intentions of trying to inform the American people, but then it became a way that they could silence those who didn't agree with them. And so I knew that every time I had a significant disagreement in the White House that within days a story would be planted.

MARGARET BRENNAN: Who was doing that? 

DR. BIRX: I think a lot of people were doing that.

MARGARET BRENNAN: And meanwhile, Americans are dying. Tens of thousands, hundreds of thousands at this point. I mean, there was a long stretch of time right before the election where we didn't hear from you. We didn't hear from Dr. Fauci. We didn't hear in the public space from Dr. Redfield in the midst of this national crisis. Do you think the administration was suppressing vital information to win the election?

DR. BIRX: I don't know what their motivation was. I know that I was so frustrated by the end of May going into June by the lack of reaction to what I could see in the middle of May coming, that it and that- you combine that with the gating criteria not being utilized, that I realized that the only way, if I could not get a voice internally, that I could get a voice out at the state level because I could see the governors on the governor's call weekly and I could see how deeply they were concerned about every one of their citizens. Most of them were not in the middle of an election campaign. And so by going out and working with the governors, I- two things happened. One, I got to see amazing things that are best practices and really bring those back. And what I've learned from Detroit and Chicago and Arkansas and Alabama and Texas and Arizona and up through Connecticut- I mean, it's just been amazing to be able to see really great solutions and try to bring those back. But that was the place where people would let me say what needed to be said about the pandemic, both in private with the governors and then in following up, doing press to talk to the people of that state. They also would let me do regional press. And really, I want to thank the comms team who let us go out regionally to speak to people in the States when I could see changes coming and the comms team every week would ask me for a list where were- where were my concerns? And then 10 individuals or so went out that week and did- and just blanketed regional press to really say these are the things you need to do. It was difficult during the- during the run-up to the election. That was the time when one of my daily reports- there was by that time 200 of them. That was when one of them was leaked, right before the election. So clearly there was some intentionality there. And I was talking about how severe the epidemic was in the Northern Plains states and saying if that epidemic gets into our populous states of California, Texas, Florida, New York, that this would be an early surge to what we expected in the winter with the expansion of this virus. And so I was very worried. But others were worried, too. I want to make it clear this was just not Debbie Birx. There was a coalition of- of four of us at the beginning, from Steve Hahn to Bob Redfield to myself to Tony Fauci that- making it clear that we would- we would make sure that we could get the information out to the public in one way or the other. It's why I sent the information to all of them every morning, because I never knew who would have the ability to do press.

MARGARET BRENNAN: Did you ever consider quitting? 

DR. BIRX: Always.

DR. BIRX: I mean, why would you want to put yourself through that, um- every day? Colleagues of mine that I had known for decades- decades in that one experience, because I was in the White House decided that I had become this political person, even though they had known me forever. I had to ask myself every morning is there something that I think I can do that would be helpful in responding to this pandemic? And it's something I asked myself every night. And when it became a point where I could- I wasn't getting anywhere and that was like right before the election, I wrote a very detailed communication plan of what needed to happen the day after the election and how that needed to be executed. And there was a lot of promise that that would happen.

MARGARET BRENNAN: Because you knew at that point that the election was a factor in communication about the virus?

DR. BIRX: Yes. Yes.

MARGARET BRENNAN: Did you ever withhold information yourself?

DR. BIRX: No. 

MARGARET BRENNAN: Some people felt you became an apologist for President Trump. They look at that moment in the briefing room, you know the one I'm talking about, when he came out and he talked about injecting bleach and you were sitting there and he looked at you and he asked about ultraviolet light and heat--

DR. BIRX: See, that,--

MARGARET BRENNAN: --and you start talking about fevers. You didn't say no.

DR. BIRX: No, no. OK, so--


DR. BIRX: --so let's go back to that, because that's a really critical moment. He was not speaking to me. He was speaking to the DHS scientist that was two seats over from me that entire time. When he finally turned to me and said, is it a- could this be a treatment, I said, not a treatment. You can look at the transcripts. Not a treatment. That dialogue was between the President of the United States and a DHS scientist. I have always been respectful of offices, and you can see I don't criticize people specifically in public. I- I don't think that- I always think that you need to transcend that and you need to find a way to communicate effectively where you're not criticizing a person in public. So when he did turn to me at the very end of that dialogue, I said, not a treatment.  Now it's in the transcripts. It never got picked up by the press as that is what actually happened.

MARGARET BRENNAN: Your answer when he said, bleach, you said not a treatment?

DR. BIRX: Not a treatment. When he turned to me and said, what do you think? Could this be a treatment? I said, not a treatment. But that moment was- that was completely lost. And then there's, you know, skits on Saturday Night Live.

 I mean, when you're a scientist who's grounded themselves in data and combating epidemics and working with communities and working with governments to change the future of people's lives for the better and then you get- this is what- when you talked about, was I prepared for that? No, I wasn't prepared for that. I didn't even know what to do in that moment. I think, you know, that's when you're in that can't let the floor swallow you up moment. I mean that conversation between two people was going on in front of me.  And I- I to this day don't know what to do when that happens. I think now- I think there's some people who thought that I would just stand up and take over the microphone from the President. I don't know what people's expectations were in that moment.

MARGARET BRENNAN Well, sometimes people say, well, Tony Fauci, when that happened to- to him, he would sort of gently come back up to the podium and set the record straight if he disagreed with the President.

DR. BIRX: Well, he was given the opportunity to do that, though.

MARGARET BRENNAN: And you don't feel- you don't feel you were given the opportunity to respond?

DR. BIRX: Not until he turned to me and said, could this be a treatment? And I said, not a treatment. You know, in that- in that moment, you know, people then want to define you by the moment and I understand- I, look, I understand how perceptions go. And I understand- I understood when Matt Pottinger was- was calling me to go into the White House and try to support a comprehensive coronavirus response by utilizing the strength of the federal government would be a terminal event for my federal career, which is part of the reason why I didn't want to do it. 

MARGARET BRENNAN: A terminal event?

DR. BIRX: A terminal event. I know that I wouldn't be allowed to really continue successfully within the federal government. You can't go into something that's that polarized and not believe that you won't be tainted by that experience or how people interpret you in that experience. So I knew that part of it. I didn't want that to happen. But, you know, I had to psychologically prepare myself for that event because- and that was the discussion I was having in South Africa with my colleagues, that if I go and do this, there will be really no option to return to PEPFAR, or to return to my home agency, the CDC. I had always planned on retiring after 40 years. I ended up staying a little bit longer to get through this. Transitions are always very interesting. I actually love transitions because it puts new people's eyes on your program. It makes you better and makes you better as a program to have to explain the strategy to others and to have others' insights into your program.  But it's also sometimes a difficult time and I did want to shepherd the PEPFAR program through that. But that was not a choice now, I- and I knew that in that moment. But I didn't know- I- I didn't really know how the White House functioned until you get inside of it and see it.

MARGARET BRENNAN: And this will be the end of your federal career?

DR. BIRX: Yeah, I will need to retire probably within the next four to six weeks from CDC.

MARGARET BRENNAN: And how have you made peace with that, that this pandemic, this once in 100 years pandemic that is projected to kill half a million Americans by the middle of next month that you're leaving in the midst of this, that you will be associated with it? Have you thought and digested that?

DR. BIRX: Well, what I do know and what was reassuring to me all along is I knew this would be studied. I knew that the emails, the reports that I wrote, the request to expand testing, the how to improve therapeutics, all of that, all of that would eventually come to light. Maybe not in my lifetime.

MARGARET BRENNAN: You feel you'll be vindicated?

DR. BIRX: I'm not looking to be vindicated. I'm looking to be able- in that moment I think my service was important. I think it was important to make progress in testing. I think it was important in making progress with some of the therapeutics. And I think it was important to really- we had great innovation in vaccines. I also wanted to make sure that we had some of the tried and true vaccines under development. And I think that the history will show my real commitment to ensuring that the subunit vaccines continue to move forward. It's really important because those subunit vaccines can be made in high volumes and would be very important for a potential booster in the future, but also important to the global community. And so there- there are places where I know I had an impact, but that's not- I never allowed myself- I was focused solely on the mission, and the mission was to try to save as many American lives during this pandemic as possible. And so I couldn't get distracted on vindicating myself or getting the information or telling the, you know, coming back to the press and saying that's not what happened. That would waste my energy in that moment of staying focused completely on that data and ensuring that I was seeing everything that was going on so that I could convey that not only to the federal leadership, but convey it directly down to the states. It's why we started writing the governors' report. There were just four of us that wrote that. It took us all weekend, but it was worthwhile because it said to the governor, this is what we're seeing nationally and this is what we're seeing specifically in your state. And it was a dialogue that allowed us to come to a common understanding of what we were seeing and what they were seeing of how to work together more effectively.

MARGARET BRENNAN: I read a Washington Post profile of you from back in 2019 before this, and it said, "When she's working on a vital public health issue, Birx will do whatever is necessary as long as she thinks she can make a difference."

DR. BIRX: True. And it hurt my family. You know, all of this- I have two daughters in their 30s who had to live through this and watch their mother, these things said about their mother, to become a skit, I mean. I have two grandchildren, daughters. You know, I think, I felt the whole time that I also had to be serious to be taken seriously, and I couldn't ever let emotion come into this, that no matter how frustrated I got, no matter how beaten down I got, I had to keep pushing as hard as I could. And I think Matt Pottinger knew that I'm very resilient, but this tested my resilience. Because it tested my family and the things that were said that were so untrue, all of that about Thanksgiving.

MARGARET BRENNAN: You were accused of gathering with people outside your household because you went to a beach house with them?

DR. BIRX: Yeah, there- there was no one outside of my household. I have one household. We happen to live between two houses because I had to protect them from me when I was out on the road. I couldn't let myself because I- when I came back I quarantined. Yes, I relied on testing at day five, six and seven, which eventually CDC came to part of the guidance. But if I had an emergency at that house, I wore a mask the whole time because I had to protect that household at all costs. I have a 92-year-old mother and a 96-year-old father and a- a daughter that's 38 weeks pregnant. I had to do what was necessary for the country, but I also had to protect my family. And so the implication that I wouldn't follow CDC guidance- I followed CDC guidance and that's what protected me. I mean, I was on the road for six and a half months. I was in the White House during the hot- one of the hottest hot spots of viral transmission and I remained negative because I followed the CDC guidelines. That's why I know they work and that's why I take it very seriously.

MARGARET BRENNAN: Did any of your children ask you to quit?

DR. BIRX: No, I think they've always- they knew what I was trying to do. You know, I'm very lucky to have two daughters that believe their mother can make a difference. And so they would never ask me to do that because they know that I would leave if I felt I was ineffectual.

MARGARET BRENNAN: Well, this summer, you gave an interview. Then you went silent for a while. But you gave an interview on CNN and you said the virus was extraordinarily widespread. 

And then President Trump tweeted. He blasted you for saying that. Did you ever speak to him after that?

DR. BIRX: I hadn't seen him for months before that or months after that, but that was like--

MARGARET BRENNAN: You're the coordinator of the COVID Task Force.

DR. BIRX: --that was a- that was an extraordinary moment because I also got yelled out by the speaker, who I have tremendous I mean, obviously,--


DR. BIRX: --women have gone through a lot to get in their positions. I have tremendous respect for women and women leadership. I know what they've had to go through to get to where they are. I also have now much more respect for women who are involved in journalism because when I was on the road, I could see that dynamic. It's also why I started calling on all the women first, because, you know, they would be out-shouted sometimes by their male colleagues. I mean it's difficult out there. Gender is still a very real and very difficult piece. But I wanted women to know that you can work. You can be a scientist. You can hold your head high, and you can help. And I think we do bring a different piece to the puzzle because we're always concerned about our families and that community piece in a way that sometimes our male colleagues aren't. And that's not a criticism. It's just how fundamentally we function in the American society.

MARGARET BRENNAN: Speaker Pelosi said she didn't have confidence in you because you were working for President Trump.

DR. BIRX: And so that was very hard because I have known her from the HIV world, and I have tremendous respect for what she brought early on. She was one of the few who stood up along with Barbara Lee and said, this is a problem and America needs to do more. She stood up in San Francisco. She stood up and- and understood that people were at risk and need to be supported and not traumatized and stigmatized. So in my mind, she's a political hero for what she has done in HIV, which, you know, I've spent a lifetime on, along with TB--

MARGARET BRENNAN: So that stung? 

DR. BIRX: Oh, that was hard. But she's not the only one, I think she gave voice to what a lot of people were thinking of, how could you? I think they looked at going into the White House as somehow supporting a political party or a political individual. There are technical people that are brought in for their technical expertise.

MARGARET BRENNAN: But you often were perceived as explaining some of the things President Trump said rather than correcting him. 

DR. BIRX: Well, when people asked me a question, I feel like I have to respond with what my perception of that moment was. And so there were three sentinel- or four sentinel events that I think I'm highly criticized for. One of them is the 40,000 ventilator issue. And--

MARGARET BRENNAN: This is a- this was the governor of New York saying he needed 40,000. You said, no, you don't. You need something like 4,000. So this is in the- in the heat of the moment in the spring.

DR. BIRX: Yeah. But that started the whole cascade of the- in the- that's when I had to stop looking at Facebook and Instagram, because in that moment they interpreted that as me supporting the president when what I was saying was, you're using an unmitigated model. And yes, that's how bad things could be if you weren't mitigating. But you were mitigating. So your need is going to be significantly less. And the reason that was important in that moment is in that moment we had 12,000 ventilators in the stockpile. 


DR. BIRX: We had 16,000. Four of them were in maintenance- 4,000. We had 12,000 ventilators. Now I just want to thank the ana- the head of anaesthesia who called me, who is head of the Association of Anesthesiologists, and called me and said, you know, Dr. Patter- I think it's Dr. Patterson, we can convert our ventilators. Well, that opened up a potential for 60,000 potential- 40 to 60,000 additional ventilators. But when New York said they needed 40,000, at the same time then governors started calling from all over the country saying, well, I need 10 and I need 20. By the end of that first week with that one Governor Cuomo announcement there was a request for almost 100,000 ventilators.

MARGARET BRENNAN: And we had a fraction of that in the US stockpile.

DR. BIRX: And so what I was worried about is people would start to panic about not having access to the care that they needed, and so it was our job to try to figure out what other options there were from splitting access to ventilators. So two people on one ventilator, utilizing anesthesia ventilators, utilizing high throughput, high volume O2 outside of ventilation. We had- that was a very critical, mad scrambling event for myself and I think many others. And I just want to thank many people who came forward and said, this is- this is a solution, this is a solution, and that is a solution. But we also remodeled what people would absolutely need. And then we realized that we could move ventilators potentially from states that weren't having an outbreak to states that needed them and backfill them with additional--

MARGARET BRENNAN: Was that the moment, though, that that moment in the spring, is that the moment you looked at the task force and you said we have a serious problem here, this is not going according to plan?

DR. BIRX: I think everyone knew that.

MARGARET BRENNAN: When did that hit you?

DR. BIRX: Everyone knew that. Everyone knew that from, I would say, March- March 8th on.

Because you only had to look at the slopes of the curves in these major metropolitan cities to understand what was happening and understanding if you're seeing that rate of hospitalization, how much community spread there was.

MARGARET BRENNAN: But you were trying to get Americans just to wear masks. And the president himself was undermining you. He wasn't wearing one. I mean, you would go out and talk about it can be a fashion statement from the podium. I mean, you were trying to make it light so people would accept it. But all these guidelines are getting undermined by the president himself. Is there ever a way to make that scenario work?

DR. BIRX: Well, you have to, because that's the president. So you have to figure out how to get that message out when you can't get it out from the head of the country. And that's our job. You don't give up. You don't say, well that didn't work so of course you know, everything is going to be terrible. You've got to try to make it the least terrible it can be. I mean, you can't ever in any moment when American lives are at stake, say, well, this is just too hard. I'm giving up.

MARGARET BRENNAN: But where's the vice president in all of this?

DR. BIRX: The vice president knew what I was doing.

MARGARET BRENNAN: You mean he knew that you were telling the governors privately to do things that the president publicly was making light of? When he was saying you don't really need to wear a mask, or pushing to reopen the economy faster than your guidelines would allow, Mike Pence knew that? 

DR. BIRX: He knew what I was doing because--

MARGARET BRENNAN: And he supported it?

DR. BIRX: --I don't- I'm not a person who would go out on their own and not do, you know, I wouldn't go--

MARGARET BRENNAN: Why would you have to be sneaking around? You're the head of the COVID Task Force and tens of thousands of Americans are dying. Why is that a covert operation?

DR. BIRX: Because if this isn't working and you're not going to get that to work, you have to find another solution. I mean, you can't just say, well the president is saying this so I'm going to give up on the 50 states, the District of Columbia, and the territories that we support. I couldn't do that. I mean I- and others couldn't either. I mean, there was a team of people going out and supporting this approach. I felt all along that if we could have put 20 or 30 full-time CDC personnel in every state for long term assignments, six- six months assignments, they could help states get over these barriers and understand and help support states translate their guidance.

MARGARET BRENNAN: But the CDC didn't do that. They didn't want to do that?

DR. BIRX: They sent people out for short- short term. And these are the kinds of things because that's what they're historically used to doing. I think these are the things we have to work on in the long run of how we really respond to a pandemic, which is part of the reason why I'm going to take time to really reflect on this, organize all my thoughts and put together what really worked, what could be expanded, what kind of legislative fixes do we need? Are we in a- do we accept federalism when a public health- being able to save Americans with a comprehensive national public health response is critical.

MARGARET BRENNAN: Leaving it up to the states, is that the way it should be in a pandemic, is the fundamental question?

DR. BIRX: Yes. 

MARGARET BRENNAN: So when you were going out there to the governors, I mean, tell me about some of the restrictions that- some of the resistance from governors, because you're going out there and you're telling them to wear a mask, to limit indoor dining. And for some of these Republican governors, that would mean going against the head of their party to do what you're telling them to do.

DR. BIRX: You know, I don't know if that was as much as the dynamic as they were dealing with Republican legislatures and legislators that really didn't- and it's why I started meeting with the legislature and it's why I started meeting with county commissioners, because you needed every single level of government then to work together to ensure that, again, we're talking about behavioral change of American citizens. And everyone then had to endorse it. The governors, the mayors, the county commissioners. I was in states in the middle of this country where the senior public health person, the senior public health person, said to me, why don't you believe that we should go for herd immunity?

MARGARET BRENNAN: Meaning just let everyone get sick and see how it plays out.

DR. BIRX: Because in the- many of the farmlands, you do that sometimes when you have a really bad swine virus or- you let it run through the herd and rebuild the herd with resistant, um--

MARGARET BRENNAN: And you said we're dealing with human beings and lives?

DR. BIRX: Yes, but I mean, you have to- you have to let people talk about what they're thinking. You have to be able to provide an environment where people can honestly say what they are thinking because then you can't confront it. If we keep pretending that everything is fine and we're not listening to people and listening for where they're coming from, we're not going to make the changes that we need in order to be successful. And so I think, you know, that was the other reason of going out to really understand what governors and mayors and local public health and rural public health individuals and community members were seeing and thinking.

MARGARET BRENNAN: Well, Sturgis, this motorcycle rally in the middle of South Dakota, thousands of people gathered with no mask. How much responsibility lies on the shoulders of the governors running these states like that in South Dakota?

DR. BIRX: A lot. A lot. But let's recognize what's happening right here, right now in the District of Columbia. There are National Guard troops here from every state in the Union, probably, young individuals who are most likely to have asymptomatic infection if they do get infected. And they're congruently living and eating maskless, 25 to 30,000 of them from all over the United States.

MARGARET BRENNAN: Do you think this inaugural gathering is a massive super-spreader event?

DR. BIRX: It could be. When you bring 30,000 people together where you know that they're most likely to have asymptomatic infections and you haven't prescreened, pre-tested, and serially tested all of these troops. These are dedicated troops. They're going to do their mission. I can promise you that they will sacrifice their own health to do their mission, because that's the- that's what I came from. You sacrifice for others out of the military. They will do their mission.

MARGARET BRENNAN: But then, I mean, you compare this where people may or may not be tested, but they're wearing masks. You compare that to the super-spreader event that was held--

DR. BIRX: They are not wearing masks. Did you see the pictures of the National Guard? They can't wear masks. They're communally eating and communally sleeping--

MARGARET BRENNAN: When they're eating and sleeping--

DR. BIRX: Yeah.

MARGARET BRENNAN: --I hear you.  

DR. BIRX: --so we have to be careful in every single thing. There shouldn't be it's okay here and not ok there. We have to be consistent. Sturgis was not okay. Birthday parties, not okay. Bringing together family members indoors, maskless, none of this. We have to be very clear to the community. And yes, we're going to make mistakes. We all make mistakes, we're human. If you made a mistake, if you had a gathering, at least get tested, wear a mask around those vulnerable, assume you got exposed and are infected and wear a mask around those vulnerable. So if you went to Sturgis, you should have worn a mask when you came home. If you got exposed potentially here when you go home until you're 10 days out and you avoid getting with your vulnerable family members. We- that's what I do to really ensure that you're protecting each other.

MARGARET BRENNAN: How did the task force, which you led, and those around the president, President Trump, who--

DR. BIRX: I was the coordinator, I didn't lead the task force.

MARGARET BRENNAN: You were the coordinator. But how did the task force allow the president, who calls himself germaphobe, to get COVID himself? How did that happen?

DR. BIRX: There were only two people who regularly wore a mask in the White House.


DR. BIRX: Myself and Tyler Ann McGuffee. 

MARGARET BRENNAN: Who was that? 

DR. BIRX: My- the support person that I had from HHS. 

MARGARET BRENNAN: So the staff around the president was not wearing a mask? 


MARGARET BRENNAN: He's the commander in chief. This is a national security risk. How is that possible?

DR. BIRX: I think people believed wrongly that testing- testing would be adequate. 

MARGARET BRENNAN: So how is that possible?

DR. BIRX: I think they believe that testing is a surrogate for a public health intervention. Testing, I think, is part of your public health arm- armamentarium. And I always want to be clear about that. I think testing is critically important and equal to masking and physical distancing and handwashing, because I think testing allows you to see the silent epidemic and you can't find them unless you're proactively testing. So I am a strong proponent of testing, more testing, and testing people who have no symptoms.

MARGARET BRENNAN: But did you say, "The President of The United States needs to wear a mask." Did you press Mike Pence on that? Did you press Mark Meadows, his chief of staff?

DR. BIRX: There are multiple communications about masking. And this gets into the data issue. Remember when I was talking about the stream of data coming in? People were interpreting the hospital mask data, the difference between an N95, a KN95,  surgical mask and cloth mask, to say that cloth masks don't work because in this hospital setting, it didn't work. That was different. Remember, in a hospital setting, you're trying to protect the nurse or the doctor from what's out here. We were asking people to wear a mask to protect others from them. So it was a very different context. And so they were mixing data that didn't have anything to do with the relevance of masking as a public health measure to changing into masking as a personal protective measure.

MARGARET BRENNAN: But did you ever say you're misunderstanding this? You need to wear a mask. These are close quarters and you're way too close to the President of the United States? You're nodding, yes, you had that argument?

DR. BIRX:  Not with the president, I mean, I- I didn't have that kind of access, but to certainly people around the president. Yes.

MARGARET BRENNAN: And they just didn't take it seriously?

DR. BIRX: They believed that the testing protocol would be adequate to protect the president. Pe- I just want to make it clear people were concerned about the president and wanted to protect the president. I don't want to think- have the understanding that there were frivolous people in the White House, that people were very concerned about the president. Mask- they believed that testing would be a reasonable substitution for people masking.

MARGARET BRENNAN: How sick did the president actually get?

DR. BIRX: I don't know. I don't know. I don't know, but I can say that certainly they thought he was sicker than the first lady because they wanted to get him additional therapy. 

MARGARET BRENNAN: Do you think his life was in danger?

DR. BIRX: You know what I know- just to be very clear, what we know in the data, for people over 70 even today, about 18 and 19% of people over 70 who get this virus are hospitalized. And of all people over 70 who get this virus, 10% of them succumb to this virus. One in 10. To me, that's a very, very serious illness. If you knew that your parents had a one in 10 chance of dying from a virus, as I do, you would do everything to protect them. The president was over 70. So, do I believe that adequate, constant public health surveillance and measures were put into place based on his age alone, not even taking into account everything else? No. But they weren't put in place for the entire country, and that was what my message was.

MARGARET BRENNAN: Did anyone ever say this is a national security risk and we need to nail down who brought this in and who infected the commander in chief? 

DR. BIRX: I never heard those conversations.

MARGARET BRENNAN: There was no serious contact tracing that happened after the fact? 

DR. BIRX: I don't know if there was contact tracing or not. I- you know, it's not something that I was responsible for. The health and welfare of the president falls to the White House medical team. I know many of those individuals. They are very serious individuals. I am sure that they took this seriously. I know they took his care very seriously. I know they took the care of the first lady very seriously. This virus, I think people really just couldn't wrap their heads around that you could have a virus that caused almost no disease, such mild disease that the person didn't think they were even infected and they were spreading the virus to others, and such severe disease that it could kill your grandparents. And I think that's still hard for people to wrap their head around because they have the experience of losing a parent or grandparent, they understand the severity of the disease. If they only see the disease from their college students who got it and there were no consequences in the moment, we still don't know what kind of chronic, what we would call morbidity could come from this when they are 20 or 30 years older, we don't know. And we just should be really honest. We don't know that mild disease might not lead to significant long term health crisis or health consequences. We don't know that. So we just have to be honest. We don't know that. But from their perspective, they saw their 18-year-old get infected and it was no big deal. So when you have that experience, being able to effectively communicate that spectrum of disease so that people understand that their behavior impacts the vulnerable individuals in their community at the same time that they themselves may not develop severe disease is really important. And I feel like that communication piece was never really understood at a level to- to really push people to action.

MARGARET BRENNAN: And last question to you, what was your biggest mistake?

DR. BIRX: Well, I'm categorizing- I'm going back through all of my notes from 11 months to really try to understand where I could have been better when. I think there is- I- I always feel like I could have done more, been more outspoken, maybe been more outspoken publicly- publicly. I didn't know all the consequences of all of these issues. When you're put into a new situation and you only know one person in the White House, you know, and you don't understand the culture of the White House, it's very difficult to get your footing. I'm not making excuses. I'm just saying I didn't know how far I could push the envelope. I'm known for doing that, particularly in private. But it was very difficult for me at day one to really understand that. And that's the kind of piece we needed from day one. 

MARGARET BRENNAN: You wish you pushed harder? 

DR. BIRX: Yes.

MARGARET BRENNAN: On anything in particular? 

DR. BIRX: Well, fundamentally testing, I mean, I- I really believe that proactive testing, as we've seen happen in universities- universities that tested weekly, at a minimum, of every student, required testing, not voluntary testing, required testing independent of symptoms, had infection rates of about 10% of what the universities that tested the way we do in the United States, focused on people who have symptoms, letting people who want to come in and get a test, get a test, where you're testing a lot of worried-well that may not even have exposure, but not routinely making sure that young people in the community are repetitively tested so you can find the asymptomatic infections. Young people are responsible, and they will isolate if they know they have the virus. But you cannot expect them to be isolated as young adults if they don't have the virus. And it's our job to figure out how to make testing available for them. I think still there's not enough testing of people under 40. We need to make testing kind of fun and interesting. It's why I pushed so hard to get those antigen tests out there, because even for all of their faults, if they find 50 or 60% of the asymptomatic individuals who are spreading the virus, that is an enormous public health impact. So sometimes we let the perfect be the enemy of the good. And I think a lot of the issues that we have, in addition to the other public health, behavioral change. And then the final piece is making things too complicated. I went out right before Christmas to six states because I was worried that the- this highly sophisticated tiering of individuals was going to be really difficult for states to execute--

MARGARET BRENNAN: You mean, how states are setting the guidelines on who gets the vaccine when? 

DR. BIRX: Yes.

MARGARET BRENNAN: You think it's overly complicated? 

DR. BIRX: I think it's very complicated. 

MARGARET BRENNAN: But that came from federal guidelines.

DR. BIRX: I- it came from the ACIP. I think they had--

MARGARET BRENNAN: Which is part of the CDC. 

Dr. BIRX:  I think- well, it's an independent body, but I think they had- they certainly had the best of Americans at heart. But in a pandemic, you have to simplify things. You have to make it so states have an easy way to do it and document it that the right people are getting the immunizations. And we knew, it's not that we didn't know who was at greatest risk for severe disease. We knew that. We know that. We know that today. And I think we were trying to balance the fabric of society with those at greatest risk. But when you're in the middle of a surge and you know that before Christmas, we had an unbelievable surge across the entire country. Yes, the Northern Plains and the Heartland was improving and the Rocky Mountain states, but the whole rest of the country had rising cases. And then we put out- so the governors, the public health individuals are focused on talking to the hospitals, making sure they have PPE, saving as many lives that they can, and then we put out this very complex guidance. So I went out right before the holidays to talk to governors and say, if you're willing to think about simplifying this. Think about immunizing everybody over 65. Just do your health care workers. Absolutely. They're on the front lines. But then everybody else do by age, because we know that that's the risk of severe disease.

MARGARET BRENNAN: Would you tell governors now, do that, throw out whatever new federal guidelines the Biden administration issues and just go with large portions of the population? 

DR. BIRX: Well we see states that are being successful in doing that. One of my first states I went to was West Virginia, because they're rapid adopters. You know, they really look at their population. The other thing that wasn't taken into account is every state has a different population of percent of their population that's over 65, and it ranges from 11% to over 22%  And so not only do you have to like, ensure that they can have access to vaccine, but you need to then redo how you're putting out vaccines so that the states that have a higher proportion of individuals over 65 get more vaccine than the states by population that have only 11%. I mean you've got to really adjust to make sure that there's equity. And so I think some of the states have figured this out. They're- they- and the proof will be in the pudding. Did they save more lives? I am very- I am encouraged that our numbers are going in the right direction. It says to me that Americans are trying their best to follow the guidelines. And I- I hope and I believe that they will continue to understand that masks work. And if we have more contagious virus, masking more will have even a greater impact and a critical impact, along with the physical distancing and handwashing. But we need to do more testing and we really need to ensure that we can support the states in their vaccine delivery.

MARGARET BRENNAN: Thank you for- for your time. 

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