Transcript: Dr. Scott Gottlieb on "Face the Nation," September 19, 2021
The following is a transcript of an interview with Dr. Scott Gottlieb that aired on Sunday, September 19, 2021, on "Face the Nation."
DOCTOR SCOTT GOTTLIEB: I think that the public health establishment as a whole has taken a hit in the setting of this pandemic, and this isn't just a sort of Republican, Democrat, conservative, liberal thing. I think that there's a lot of people around the country who feel that the advice they got from public health officials wasn't precise, changed wasn't- wasn't formulated in a way where it was sort of immutable, wasn't carefully explained, wasn't propagated in a way that it could be assimilated into people's lives. You know how do I wear a mask? What masks should I wear? When should I wear a mask? When not? And things changed. And so people were confused by it and lost confidence in it.
MARGARET BRENNAN: You say the CDC, which is supposed to be the gold standard public health agency, doesn't have an operational capability to manage a crisis of this scale. So if the CDC doesn't, who does?
DR. GOTTLIEB: Nobody does. I mean, there was a perception early on in this crisis that the CDC has this that they would have the capacity to develop a diagnostic test and deploy it and gather the data that we would need to sort of scope out what the contours of the response would be, and they would be able to deploy the diagnostic test and deploy the vaccine and stand up this infrastructure. They're not a logistical organization. CDC has a very retrospective mindset. It's a high science organization that does deep analytical analysis of data that's oftentimes out of sync to when the decisions need to get made. They're not the Joint Special Operations Command. They don't surface real time information to- to inform current policymaking.
MARGARET BRENNAN: They're not a quick reaction force.
DR. GOTTLIEB: Right. They'd rather take the data, analyze it for months and publish it in the Morbidity and Mortality Weekly Report. And the idea that they were going to be able to mass manufacture a diagnostic test and forward deploy it, they clearly- they contaminated their own tests. So they- they- they botched the manufacture of their tests.
MARGARET BRENNAN: We needed to turn to private industry, earlier in the pandemic.
DR. GOTTLIEB: We need an all of the above approach. Certainly by the end of January, we had enough awareness that this could be a global pandemic, that someone could have hit the red button and said, we need it- and all of the above approach here. But CDC had the ball. The CDC was following their standard blueprint. Their blueprint is- could keep up with a slow moving outbreak, but in a fast moving epidemic like this, it was unmatched now. CDC should have raised their hand and said, we really don't have this. I think--
MARGARET BRENNAN: why didn't they?
DR. GOTTLIEB: I think it's very difficult for an agency to have the self-awareness that they don't have the capacity to respond the way they're being asked. We need to get FEMA and the DOD engaged with the CDC and try and organize a national level response and that that was a failure of political leadership. I mean, and there was a failure of vision. But you know, there were a lot of people who were good political leaders who wrongly assumed the CDC had this mission.
MARGARET BRENNAN: You say the point isn't that federal health officials were wrong. The point is they were working with faulty tools, faulty data sets. They didn't know what they didn't know.
DR. GOTTLIEB: They didn't understand that this wasn't spreading like flu. If you're just looking for flu symptoms, you might not see coronavirus spreading. So they were very confident early on that there was no community spread. We should have been doing things differently in anticipation that this probably was spreading. We just weren't picking it up, which in fact was the case.
MARGARET BRENNAN: You also say this should have been viewed as a national security threat, and that's how we need to think of pandemics.
DR. GOTTLIEB: I think the Intelligence Committee has different tools that should be focused on this mission. We have to look at public health preparedness through the lens of national security. We make certain preparations for things that are unlikely to happen. But if they happen, they're so catastrophic that we have to prepare. We cannot allow something like this to hit us this bad again, so we have to prepare differently domestically. But internationally, we rely on other nations to tell us when they have an outbreak. That has repeatedly failed. It failed in this case, China didn't surface the early information. They still haven't shared the source strain. So the question becomes, can we still rely on the International Health Regulations and the W.H.O. in the World Health Assembly? Are we going to all hold hands again and promise that we really mean at this time and we're going to share information? Or do we need to get our clandestine services more engaged in this mission? And I think we're going to need to get our clandestine services more engaged in this mission. 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 answers. Some questions we could have seen the asymptomatic spread. We could have seen the human to human transmission. 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: 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 of two things happening. Either we find the intermediate host, the animal that was the one 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 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 that this came out of a natural species has not really moved.
MARGARET BRENNAN: When you say came out of a lab, you were saying through a lab accident, not a construct.
DR. GOTTLIEB: The administration has said this in the intelligence report they put out. 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.
MARGARET BRENNAN: Why do we need to know who Patient Zero is?
DR. GOTTLIEB: If we determine that this came out of a lab or we even assess that there is a probability that this came out of a lab, I think it changes how we try to govern research internationally. 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? 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.
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MARGARET BRENNAN: 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. I think what the Biden administration has done here is by backing into an approximate date, they're now able to start that planning process in advance. 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 in the 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.
MARGARET BRENNAN: 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: Yeah, look, I think it's a misjudgment. 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 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 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.
DR. GOTTLIEB: 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. 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. 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. 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. 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 hope the White House had it.
MARGARET BRENNAN: Which governors handled this the worst?
DR. GOTTLIEB: Certainly looking at South Dakota, 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. Once we learned how to treat this, once we were able to reduce the case fatality rate by half, by the summertime, when 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 important policy decisions. Those were in part, the result of policy choices that those states made.
MARGARET BRENNAN: I think about the first few days where this strange virus that was just surfacing started to make headlines here at home. You were starting to see things that weren't yet really being raised as red flags. How were you on the outside seeing things that they weren't seeing on the inside?
DR. GOTTLIEB: 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, they let- they let that health care apparatus run with the ball. And it really wasn't until probably more like the end of February, the March timeframe that you saw the White House really starting to get engaged and pull this away from the Secretary of Health Human Services and 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.
MARGARET BRENNAN: It's been reported that you were actually considered to come and run that task force. Is that true?
DR. GOTTLIEB: You know, I don't know for sure. 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. 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.
MARGARET BRENNAN: Do you regret though, not being on the inside? You had been with the Trump administration until 2019.
DR. GOTTLIEB: So I regret not being at the FDA. I don't know that there was 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. 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 and developing diagnostic tests early in January.
MARGARET BRENNAN: And so you wish somebody at the FDA was doing that.
DR. GOTTLIEB: I think that would have had to happen at the commissioner level. It couldn't happen below that level. If I would have called any big manufacturer, though, they would have done it. I have no doubt about that. 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-ed's and putting things on Twitter isn't like being there and actually being able to pick up the phone, effectuate the action. I wish I was there. I think that that's- the- the FDA and the OPHHS, 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 BRENNA: As you write in March, when you went in to speak with the president that he was serious, he knew the grave risks.
DR. GOTTLIEB: 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? 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. And the schools is a perfect example of the lack of effective policymaking. 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 has said you can only- you have to keep kids three feet apart, then a lot of schools would have been able 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 that the six feet was arbitrary.
DR. GOTTLIEB: The six feet was arbitrary in and of itself, nobody knows where it came from. 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 had 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% with masks if you're three feet apart. So they said on the basis of that, we can now make a judgment that 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? This is how the whole thing feels arbitrary and not science based. So we talk about a very careful, science based process and 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, 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, 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. 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. 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.
