Photo: CSIS
Photo: CSIS
J. Stephen Morrison: Good afternoon, good evening, good morning wherever you are, and welcome to the Center for Strategic and International Studies, CSIS. Welcome to those who are assembled here in person and those who are coming in remotely online. I’m J. Stephen Morrison, senior vice president here at CSIS, where I direct our global health work. We’re thrilled today to host this event to celebrate and discuss the newly released “Nightmare Scenario” – I have my own copy here – “Inside the Trump Administration’s Response to the Pandemic that Changed History,” authored by Yasmeen Abutaleb, a Washington Post national reporter covering health policy, and Damian Paletta, co-author and colleague from The Washington Post, the Post’s economic editor. Congratulations to both of you and thank you for taking time to be with us.
Damian Paletta: Our pleasure.
J. Stephen Morrison: Fifteen months ago, Yasmeen mentioned to me in a phone conversation that she was working on a book. It seemed to me that she was pretty busy at that moment in time already. She seemed to be feverishly busy, and she said: Well, of course, I’m also writing a book. And when I saw Dan Diamond’s piece, the preview on the book about a week before it came out, I contacted her and said: I guess you were serious. (Laughter.) I guess I needed to take this pretty seriously, because the book is coming out. And sort of what seemed to me in kind of rocket speed, all things – all things considered.
And so, we invited the two of them, Damian and Yasmeen, to come and be with us and to do a podcast, which we completed and which will come out tomorrow, and to do this event. And I also want to offer a special welcome to Yasmeen’s husband, Ibrahim Alkhalaf, and her parents – Yasmeen’s parents, Hanan Elbakry and Mohammed Abutaleb. Welcome. It’s great to have you here with us. There was a very nice tribute in the book to all of you from Yasmeen, as well as to Damian’s parents. I also want to offer special thanks to my colleagues who helped pull this all together. Most notably Michaela Simoneau, who worked tirelessly; Michael Rendelman on our production staff here today; Graham MacGillivray; Dhanesh Mahtani; and Chris Barnett. So, thanks to all of them.
Yasmeen, Damian, and I are going to have a conversation for the next 35 minutes or so, and then we’ll reserve some time at the end – 15 minutes or so – for questions from the audience assembled here. And there’s a microphone right over here, so any of you who wish to offer some questions or comments please come over at that time and speak from there.
I want to open with a very basic question. We’re seeing a steady stream of volumes coming out on the Trump administration and its response in 2020 to the unfolding pandemic. We have Lawrence Wright’s “The Plague Year,” Andy Slavitt’s “Preventable” just came out, Michael Lewis’ “The Premonition,” just to name the most – the most obvious. Now we have Nightmare Scenario. And so, Yasmeen, I’m going to ask you to open up.
What is it that distinguishes, in your view – what is it that sets the “Nightmare Scenario” apart from others? You’re striving, both of you, to integrate your different approaches. You didn’t begin as close friends; I gather you became close friends in this process. You were trying to transcend the daily reporting and put forward another account that was at a higher and more coherent level. So, what sets you apart from some of these other volumes? Welcome and congratulations.
Yasmeen Abutaleb: Thank you. Well, I think Damian and I brought a unique perspective. I’m a health policy report. Damian was a White House economics reporter, and now the economics editor. And throughout the pandemic, the forces that were constantly against each other was whether to have a public health response or an economic response. And for whatever reason, the White House and the administration didn’t view those things as complementary or working hand-in-hand. It was this constant tension of do you have shutdowns, do you implement masking and social distancing? Or do you full reopen the economy and try to convince people that things are back to normal? There didn’t seem to be a middle ground between those two forces pulling against each other.
And so I think Damian obviously has a pulse on the White House and the major economic players. I had a pulse on the health agencies and the health people in the White House. And between the two of us, we knew who the key personalities were driving the response. And I think that was a big part of our book, was to really understand the main characters’ backstories, what motivates them, what might have motivated them in this crisis and influenced how they made decisions. And we were also squarely focused on the administration’s response and not on other aspects of the pandemic – which are, of course, equally as important. I think some of the other books also look at other aspects. Like Lawrence Wright’s book looks at anti-vaccine hesitancy and where it all started. Michael Lewis’ book looks at the people who were warning about a pandemic for a long time and why that went ignored. And we were just focused on the crisis in 2020 and the administration and political response to it.
J. Stephen Morrison: Thank you. And, you know, when I first saw that you were – you were partnering with Damian I thought, well, this is the first book in which we have an economist coming at this problem. So, Damian, what’s the subtext? What’s the – what’s the economic argument that you built into this?
Damian Paletta: Well, every crisis comes down to money. There’s always a financial element of every crisis. And when I covered the financial crisis during – I was at The Wall Street Journal at the time, in 2008 and 2009. And I though some of the best journalism out of that crisis was written by financial writers, who kind of understood the, you know, economic forces at play. And so here we have another crisis that starts with this kind of microscopic bug, or – you know, the coronavirus. And then it manifests itself through the entire economy. There was a point in April where we were losing a million jobs a day. I mean, it was just unbelievable.
And so I think what Yasmeen and I brought to this were we were subject matter experts. You know, we were not, you know, political scribes. You know, we were really immersed in the economics and the health issus at play. And we were – you know, we didn’t parachute into this story. We were in this story from day one. So, I think what made our book, you know, so hopefully valuable to readers is that it gives them the full picture of all these forces that were pressing on the White House, and the way the White House was pressing back.
We came to this really understanding the people. We talked to them on their good days and their bad days. We had good days and bad days. Like, we were on this every step of the way. And I think hopefully that really kind of comes through in the book.
J. Stephen Morrison: You know, when I – when I look at this book and I think, OK, you talked to 180 people. You probably had five or six conversations with some of those people. Hundreds and hundreds of conversations and hours. And people had to trust you. They had to believe that you were going to hold their confidences and be fair and accurate in your description. But there’s a lot of animosity, and hostility, and fear running through this narrative. And there’s a lot of – this is an administration known for endless spins, falsehoods, conspiracy theories and the like.
So, you had to – I would think you had to worry a lot about how are you going to assemble a narrative that people who lived through this story – and we all lived through this story. And it’s an odd book to reread. I mean, in some ways reading the book is like reliving this and remembering vividly some of these things, but then going, aha! So, you did cast a light on some of those dark corners, many of those dark corners, where you weren’t clear on exactly what was happening.
Damian Paletta: Can I just say what that looked like? There was a – we turned in a section of the book to our editor, Jonathan Jao at HarperCollins, who we adore. And he – we had a Zoom with him afterwards – after he read it. And he said, gosh, this is depressing. And we’re like, depressing good or depressing bad? (Laughter.) You know, like, so we didn’t want to write a depressing book. But you’re right, we were living this. Like, this was – every time you go to the grocery store and there was a line for two hours and there was no toilet paper. Like, this consumed all of our lives.
And you know, we were writing about something – this wasn’t some, you know, thing that no one could relate to. This is something that everyone was going through. And obviously people who lost loved ones and whose family members were really sick, I mean, it was a much different scale. So, we’ve – that almost made it easier for us to do these interviews, and we know how important it was. It wasn’t like they would lose focus and want to talk about something else. Like, this was what consumed them. And it only got more intense as the year went on.
J. Stephen Morrison: Now, it seems to me that the core – at the very core of the book is Trump, his decision-making process, his leadership style, the inner circle that he constructed around himself. And it was particularly dramatic in terms of the decision points on testing, on masks, on reopening. You walk us through an array of decision points where the particular style of decision making, and calculation proved to be monumentally important on setting us into one direction or the other. It’s a particularly bullying and erratic style.
You keep saying over and over again “bullying.” You also keep saying over and over again through the book, no one’s in charge. Or, somebody’s kind of in charge, but only for a period of time. And then it gets grabbed by – the ball gets grabbed by someone else. So, Yasmeen, what we were – tell us, what we were you trying to leave the reader with, in terms of a set of conclusions or deep impressions around the centrality of this leadership style? What were you trying to convey?
Yasmeen Abutaleb: Well, I will say on the “no one’s in charge” piece of it, it almost became a running joke last year in the newsroom. Because we’d write a story, like, every week or every two weeks about how it wasn’t clear who was in charge. And at one point an editor asked for a story about who’s really in charge. And we all kind of threw up our hands and were like, I feel like we’ve answered that question.
But it was so important to the response because it meant that when it came to testing or when it came to supplies, it was not clear – there was no national plan to coordinate where to send tests, and where to send the supplies for them, or where to direct the limited supply of N-95 masks, and gowns, and gloves for hospitals. And because of that, you had the states competing against each other. At one point there actually was a sufficient supply of tests for the country, but it didn’t look that way because he supplies for the tests – to actually run them; the swabs and the reagents – weren’t being directed to the right places. So you had tests sitting unused that could run hundreds of tests. And you didn’t have technicians or the right supplies to use them.
And when I – we were talking to sources for this book they said: We tried to resolve these issues the best we could from our perch, but these are things that only the federal government can do. Only the federal government has the full picture of which state needs which supplies, or which state needs the tests this week, and how you direct them from there. And so without that, because the president was so fixated on reelection and what it would mean if the federal government owned this response we have this scene where he’s yelling at Alex Azar about the fact that the government took on testing. And he asks him, what idiot had the federal government do testing?
Because of that, no one would really step in and create a national plan and help resolve some of those issues. The states just can’t do that on their own. And some mid-level FDA employee can’t resolve that either. That’s something that really has to come from the White House and then be directed down. And everyone has to know who’s running that.
J. Stephen Morrison: Damian, do you think that there was hope that things might have been – kept on track into the spring of 2020, and then you reach these decision points, and at each point it’s something other than the pandemic that dominates the calculus? You know, it’s impeachment, it’s the Chinese trade deal, it’s the reelection campaign, it’s reopening the economy, it’s the Wall Street marketplace?
Damian Paletta: Yeah. They kept – you’re right. They kept overcorrecting, I think. So there was this – so, obviously, they did the China trade deal on January 15th. The China travel ban is January 31st. You know, February was kind of lost to the testing fight. And then March 11th was when the president announced the Europe travel ban. And then there was a period from March 11th through the end of March when, you know, the White House was actually kind of working together. And the country, I think, was kind of behind him.
J. Stephen Morrison: The country was pretty unified, too.
Damian Paletta: Yeah. You know, it was tough times. We saw what was happening in New York, particularly. And I think people said, OK, this is the real deal. Let’s kind of lock arms and get this straightened out. And then there was – then there’s a dramatic moment in the book Yasmeen and I wrote that took place in the Yellow Oval Room – which neither of us had ever heard of before reporting this. And it’s on the second floor of the White House, in the private residence. And it was a Saturday night. And it’s when Birx and Fauci kind of confronted Trump – who had wanted to reopen – at this point, he was itching to reopen.
And, but Trump was really rattled by the scenes he saw on TV of the hospitals in Queens with bodies in gurneys and stuff. And Birx said to him: That’s going to be every hospital in the United States is you reopen. And he kind of froze. And so he agreed to continue, you know, the shutdown for another month, even though a few days later he started doing everything he could to ratchet it back. And I think if you look, there was just all – they never really stuck with anything for too long, right? It was always: Here’s an idea, and then let’s water it down, or make changes because it’s not playing well politically. And I think that just kind of got worse as the year went on.
J. Stephen Morrison: One of the things that – as the year went on – that comes across in your account is that you had this inner circle that echoed the thuggish behavior or the – you had the – and put an emphasis on the economics and the reelection campaign, and that sort of false dichotomy. Meadows, Marc Short, Kushner to some degree, Alex Azar got kind of – his survival strategy was to basically jump on board with those folks. And they had the power to enforce the boss’ choices. And they also had the power to turn on the forces outside the White House – at Fox News, Ingraham, online – in echoing – augmenting and echoing all of this.
And you begin to paint the picture of how those pressures come to bear on the – what you call the doctors, right? Tony Fauci, Deborah Birx, Stephen Hahn, Robert Redfield. And I’d like to turn to talk about them, because after April, they start coming under pretty intense pressures. And efforts to stigmatize, vilify, threaten them, marginalize them. And they hang together, it seems to me. And they never – there’s no mass resignation and there’s no Saturday night massacre. They sort of get bounced around and brutalized in different fashions. But you get this outcome where they’re still there on the day that – you know, they only step down right before President Biden’s inaugurated.
So, Yasmeen, how do you make sense of this? How do we make sense of this outcome?
Yasmeen Abutaleb: Well, I think the President was very attuned to what the perception would be if he fired one of his top health advisors so close to the election. And Damian and I also report on this pact that three of the doctors make together – Dr. Birx, Dr. Redfield, and Dr. Hahn – where they decide – they’ve all thought about resigning at one point or another. They all feel like they’ve had it. They don’t know why they’re hanging in there. And they say, if one of us gets fired the other two will resign. And Birx communicated this pact to the White House. She told Marc Short and Mark Meadows that they had made this pact.
And I think also the weekend that Alex Azar almost got fired and then didn’t, was also indicative of what the President’s thinking was at the time. The White House was unhappy with him. The President was unhappy with him. But the vice president told him: You can’t fire your health secretary in the middle of a pandemic this close to the election. You can’t convince people things are going well and we have it under control and then be getting rid of your health team. That indicates that there’s a problem, or there’s a failure somewhere, you didn’t pick the right people to lead right now. And so I think that was such a big motivator that, no matter how frustrated he got, he knew the perception of getting rid of a top medical or health advisor with just a couple of months to go the election indicated that something wasn’t going well.
J. Stephen Morrison: You know, your account of these personalities, and the complexity of their personalities, and the complexity of the choices that make – they make, and their resilience – their remarkable resilience. They shared some common features, like their years of working on HIV and working through HIV crises. Damian, how do you think we’re going to look at these figures? Are these historic figures now, in your mind?
Damian Paletta: Yeah. Well, I feel – I truly in my heart feel that Birx and Fauci will – are two of the most important figures of this century and will be remembered and studied in 100 years. I really do. And I feel like we owed it to readers and the public to really understand them and to present them in a three-dimensional way – you know, flaws and all. And they – we saw them on television. You know, we heard them in the press. Fauci was, you know, not shy when it came to giving public remarks.
But there was so much going on beneath the surface. You know, his relationship with Peter Staley, the AIDS activist, the relationship with his wife, the way that he was backchanneling with public health leaders in cities and states who were giving him accurate information about what was going on in terms of mass shortages and testing. I think understanding these people and what they were like is really important to understanding the response to the crisis. And, you know, I kind of think about it in simple terms. How do small fish avoid getting eaten by a shark? They swim together, you know?
And so there were times, I think, when Birx was, like, really annoyed with Fauci. But they had this kind of relationship that they knew they needed each other. And there were points too when Hahn and Redfield could count on them. They had this almost like kind of therapy group where they met and got together quite frequently and discussed kind of the issues of the day. So, yes, they’re tragic figures. And, yes, they at times made mistakes, and were bullied. And I think there were things they wished they could have done differently. But they did stand up to a president in a way that few people have ever done before. And in Fauci’s case, you know, he kind of outsmarted him on a number of occasions.
J. Stephen Morrison: I mean, they were able also, it seems to me, ultimately, to fed off Scott Atlas and Michael Caputo and these strange characters that got introduced as surrogates, or fake surrogates, at different points. But you – what you paint, Yasmeen, in this is, it seems to me, very empathetic to them. I mean, it seemed to me that as you dug deeper into the story and trying to understand who these people were and how they interacted and understood one another, and the situation. I mean, they – any other – any other – when you read the story, and the abuse and threats that they and their families experienced, you think: Any normal person would have said enough is enough. I’m out of here. And they didn’t.
Yasmeen Abutaleb: Yeah. I think that’s why Damian and I felt like it was important to really paint three-dimensional pictures of these doctors, because you could watch the press briefings, or watch their public remarks on TV or, you know, from wherever they were giving a briefing, and just think: Why would they say that? That’s such a – that’s obviously not true. They’re being bullied or pressured. Why aren’t they standing up to pressure? But then when we started to get a fuller understanding of all the different forces that they were dealing with – within their agencies, within the White House, from the public, from people they knew and respected who were also applying pressure on them to do more – we realized what a difficult position they were in a lot of the time.
And obviously there were some tragic mistakes that were made out of the FDA, out of the CDC. There were some calculations Birx made that didn’t end up panning out in the way that she hoped. And we tried to document those as well. But I think we looked at their histories, we looked at their experiences, what sort of motivates them and influences their decision making and saw people who were trying to do what they thought was the right thing in the moment. And it didn’t always look like it from the outside. And it didn’t always end up working out that way. Obviously, the FDA authorizing hydroxychloroquine was a huge mistake, and an example of them succumbing to pressure early on which, you know, paved the way for much more political interference.
But it wasn’t malicious. And I think they did want a better response at the end of the day. It was just the method to getting that done and to – some of these people weren’t strong enough to stand up to the political forces, I think. But I think we wanted to portray them in that way, not as malicious actors but as humans who were battling a lot of different forces and doing what they thought was right, which was sometimes misguided because of what might have been most important to them at the time – whether it was staying in the President’s good graces, or keeping their job, or trying to please some faction. They were always at odds with someone.
J. Stephen Morrison: Yeah. I mean, they were battle tested, several decades of working HIV. They had lots of political experience – certainly Birx and Fauci did. They also had a protector in some form in Vice President Pence, don’t you think?
Yasmeen Abutaleb: Absolutely. I think we were surprised to learn that they all, I think, saw the vice president as their only true ally through the course of the response – which I don’t think is what most people would have guessed, watching from the outside.
J. Stephen Morrison: And, Damian, what are we going to make of Pence, ultimately? Where does he fit in this story?
Damian Paletta: It’s a great question. Yasmeen and I felt like Birx was an incredibly complicated figure, and I think Pence is similarly very complicated. You know, he – whereas the president was very dismissive of science and had kind of anti-vax tendences, I think, Pence, you know, listened to them. He had an open-door policy with them. He wanted to hear their thoughts. He made it – you know, he helped Birx travel the country and speak to governors and local officials so that she could get her message out. I think he sympathized with her.
Now, you know, when push came to shove, he always, you know, rallied behind the president. And especially as the campaign got closer, he did whatever he could to kind of exude this idea that the economy was roaring back and that everything was going to be fine. So, you know, in some respects he stopped short of doing what the doctors wanted. But he did make them feel like that he would listen to them. And I think that continued up until the end. Like, they really felt like he was the only person who would try to take their message and deliver it to the president, even if the president didn’t want to hear it.
J. Stephen Morrison: Yeah. One of the powerful messages that come through your book is the deep damage to CDC and FDA, of varying type. So I wanted – Damian, you could start. Maybe tell us, you know, how do you estimate – how deep is the damage? How deep did the damage run for FDA. And maybe Yasmeen can talk about CDC. And how easy is it going to be to recover and repair?
Damian Paletta: Sure. Yeah. I mean, I think it’s one of the most – what’s one of the most lasting legacies of this crisis in terms of the public health response is that, you know, 30 percent or more of Americans still won’t get the vaccine. And part of –
J. Stephen Morrison: So you’re tying – directly tying the assault upon FDA, drives down public trust and confidence, and we’re paying the price today with 30 percent hesitancy and refusal on the vaccines?
Damian Paletta: Yes. I do.
J. Stephen Morrison Direct link?
Damian Paletta: I think there’s a direct link. And I think it’s going to be an enormous tragedy heading into the fall and winter if you have – not just 30 percent, but in some areas it’s 60 or 70 percent of the country. And I think when the public health agencies take such a political battering, and especially when these public health agencies make some mistakes along the way, it makes it easier for people not to believe them and trust them.
And so we have a near-term crisis, which is there’s millions of Americans who are not vaccinated heading into the fall and winter, OK? And then the medium-term crisis is there’s going to be another pandemic. It’s going to look different. t’s going to kind of sneak up on us. And we’re going to need to have trust and faith in our public health agencies. And if that’s not restored or repaired in some way – and it’s going to take a conscious bipartisan effort to do that – then we’re going to be really in for a world of hurt.
J. Stephen Morrison: Now, Hahn – as Yasmeen referenced – Hahn stumbled on the hydroxychloroquine. He stumbled on the convalescent plasma. He really got whacked in the public domain. He had various people pull him aside and say: Look, dude, you know, you just made a terrible mistake. And this is your warmup for the vaccine trial you’re going to face when those results come in. But he ultimately kind of recovered and stood his ground. He had – he still had power, right, in terms of he was the guy who was going to allow the vaccines to go forward, right? Say a bit about that.
Damian Paletta: Yeah. (Laughs.) I mean, obviously none of our book is funny, but this was actually very ironic, was that Hahn, no matter how much he was pushed around and bullied by the president, by Azar, and everyone else, he was almost unfireable, you know? They could not fire him because then no one would get the vaccine. You know, you can’t fire the guy in charge of making us feel like this is safe. (Laughter.) Otherwise, the president will be, like, just go ahead and inject this in your arm. People will say, forget you. (Laughter.) So he was – he was actually protected by circumstance, more than anything else. Is that right, Yasmeen?
Yasmeen Abutaleb: Yeah, I think that’s absolutely right. There were so many discussions about whether to fire Steve Hahn. They were unhappy with him. I think the thing that we were struck by learning was how angry they were at him for so many months after the FDA revoked its decision to authorized hydroxychloroquine. They didn’t talk about it in public as much, but they were really angry with him. They felt like he wasn’t on the team anymore, and he was going rogue. And then, of course, when he does his apology tour after the disastrous rollout of their convalescent plasma decision, they feel like he’s off the reservation. They can’t control him anymore.
And they do discuss a couple of times pretty seriously whether to fire him, including in September. And then, you know, they say, we just – we cannot do that. We cannot fire – the vaccines are going to come in a month or two. If we fired him a month or two before they come, even if they put a –
J. Stephen Morrison: It’ll be chaos.
Yasmeen Abutaleb: It’ll be chaos. Even if they put a career official as the interim, it looks like a completely political decision. And it would have been. I mean, they were – they were unhappy because they felt like he wasn’t moving fast enough.
J. Stephen Morrison: Yasmeen, talk about CDC and the damage that it experienced. CDC, it seemed to me, was more vulnerable. It had some unforced errors. It had deeper interference and attacks. It had less – it had less to fall back on in terms of an internal constituency within the United States to defend it.
Yasmeen Abutaleb: I think CDC faced a particular challenge because it’s not a regulatory agency. So they couldn’t – when they put out their guidances for how states should reopen, or when they should reopen, or how businesses should move forward, no one was bound by it. They could look at it as a guide or as advice, but that also made it, I think, much easier for the White House to interfere to a degree that I don’t think a lot of people could have anticipated. There’s one scene in the book where they dress down Bob Redfield in the Oval Office over guidance for religious houses of worship. And they basically make him rewrite it with a White House aide. And then that’s the one that moves forward.
So I think that was – that was so damaging to the agency’s legacy. And you still see it playing out. When the agency this year announced vaccinated people didn’t have to wear masks indoors or outdoors, that decision was rolled out kind of chaotically. And a lot of people thought it wasn’t done well, they didn’t communicate it well. So it’s still recovering. And I think it’s going to take a long time for the public to see it as, you know, what it was before, the world’s leader in public health and the agency that they should follow, and whose advice is trusted.I think whichever side of the political spectrum you’re on, there’s no guarantee anymore that it’s purely science, public health based, and free of political interference.
J. Stephen Morrison: So we’ve got this trashed institutional landscape. And then you have Operation Warp Speed, that delivers a miracle to people.
Damian Paletta: Really a miracle.
J. Stephen Morrison: So how do we make sense of that? How did that happen? Why didn’t that get trashed?
Damian Paletta: I mean, I think it just speaks to the badassness of science, quite frankly. (Laughter.) And how there’s some really smart people who were moving heaven and Earth. Working with government, absolutely. I think, you know, people in the White House deserve credit for making this happen. It is amazing that they got this vaccine so quickly – multiple vaccines. It is incredible. And saved tons of lives. And, you know, I think that’s the bright spot in this whole thing. I think, Yasmeen, the fastest of a vaccine ever before was four years.
Yasmeen Abutaleb: Mmm hmm.
Damian Paletta: And they did this one in less than a year and, you know, with amazing results. So I think that, you know, should give us hope that science, you know, working with the government, can do things that we never could fathom before.
Yasmeen Abutaleb: Well, I think Operation Warp Speed was also an example of how much better the whole response could have gone if it had had the elements that Operation Warp Speed had. There was clear leadership. It was clear who was in charge. The agencies were working together. HHS had a clear role, the FDA had a clear role, DOD had its role. And it was – it was clear what the lines of communication were and what everyone’s role was. And everyone abided by that. And it was freed of political interference from the White House.
There were public statements that might undercut it from time to time, but the actual organization and the partnership between the government and the companies was regimented. And, you know, you had months of Slaoui running it, and then various people from DOD and HHS in key leadership roles. So I think it was the hardest part of the response and the one they executed on the best because they were focused, the money was directed, and they didn’t let themselves get off track.
J. Stephen Morrison: And I want to encourage anybody in the audience who cares to pose a question, there’s a microphone right there. There’s some weird interaction here where the response to the pandemic, the testing debacle, the reopening debacle, the masking politicization, et cetera, et cetera, leads you to realize that there’s going to be mass death and chaos, the abdication of federal responsibility, et cetera, et cetera. And in an odd way, it seemed like the psychology flipped around to, well, vaccines are going to rescue us from our own – the disaster we’ve created. And so let’s not – let’s not trash this. Let’s make this work.
I mean, they seemed to be willing – they brought $18 billion. As you say, they created a structure. They brought in DOD, BARDA, NIH, the vaccine developer partners. They made some clear decisions and then they moved forward. And you know, Moncef Slaoui, he entered this pretty – with lots of trepidation, right? I mean, he was – when Pence called him up, he was, like, talking to his wife, like, am I nuts? (Laughter.) But he struck a deal, and he stuck with it. And I don’t know if you have any further thoughts on Operation Warp Speed.
Damian Paletta: Well, I would just say that it was the miracle that the country and the world needed. You know, there were so many mistakes. And our book chronicles so many things that could have gone right and went wrong. And it’s important to remember that there was an amazing development in the – you know, towards the end of last year that really – even though the wave of death from November through, you know, February was astronomical, there was this amazing development that kept it from being even worse. And I think we should always remember that and learn from it.
J. Stephen Morrison: Yasmeen, any additional thoughts?
Yasmeen Abutaleb: Well, I think with –
J. Stephen Morrison: Jon’s going to hit us with a hard question in a moment, so I’m just – (laughter) –
Yasmeen Abutaleb: I think with Operation Warp Speed it was really remarkable how everyone was focused on the same goal. There were no rivalries. There was no backbiting in that initiative in the way that there were in other parts of the government’s response. And you saw everyone playing their role. I was really struck by, you know, the fact that FDA just cleared the way so that the companies could get through the various phases of their clinical trials and the regulatory process without any holdups. And the way the money was directed, and the way the government helped outfit manufacturing facilities. They just thought through every step of this. And it also just, I mean, made us wonder what would have happened if they would have taken that approach to testing, to supplies, to other aspects of the response where it would have been much simpler than it was for the vaccine.
J. Stephen Morrison: Thank you.
Jon, over to you.
Jon Alterman: Thank you. I’m Jon Alterman. I run the Middle East Program here. Congratulations on the book. Thank you for your excellent reporting, which I’ve really been enjoying.
As you know, there are a lot of other books out now. And the other topic everybody is talking about is how divided we are as a country. And one of the themes that people keep talking about is how we’re divided because there are these coastal elites who care about expertise and science and bad-ass scientists. And there are a lot of people in the country who just distrust that, who distrust the whole system. And as you report in the book, how does – what insights have you gained on those sorts of splits? What insights have you gained about how much of the country doesn’t believe in science, doesn’t care about science, distrusts all the people – the Tony Facuis and the Deborah Birxs, who are the heroes of your book. And they think these people are just taking care of themselves. What has the reporting told you about that problem that we all have going forward?
Damian Paletta: Well, I think we have a lot – that’s a great question. I think a lot of the people you mention go to the doctor, and they go to the dentist, right? So they trust their scientists. And I think where it gets more complicated is when you’re talking about, you know, political leaders or public health leaders in Washington, and the way their messages get interpreted or attacked. And so I think, you know, we have a lot of work to do as a country to separate, if we can, the public health messages that we need to understand and trust during a pandemic from the kind of normal politics that both parties engage in every day.
And, you know, Yasmeen and I believe there’s going to be another pandemic. You know, there always is another one. And it’s going to look different. And there’s going to be different leaders, you know, next time. It’s not going to be Fauci and Birx. t’s going to be someone else and it’s going to be a different president. And the ability of – or, the willingness of the country to believe these people and follow their lead I think is going to be incredibly important in determining how the country, you know, responds.
J. Stephen Morrison: Yasmeen.
Yasmeen Abutaleb: Well, I think one thing that Damian and I learned in reporting the book was the fact that people were hearing a different message about how seriously to take the pandemic, how to protect themselves, how to protect their families depending on where they lived and whether they believed the president and his political advisors, or whether they believed the scientists, was really damaging. And I can speak for myself, I didn’t fully appreciate how difficult public health messaging is, especially in a crisis that’s moving that quickly.
And there are going to be stumbles. You know, we’ve seen it still in the last couple of weeks and couple of months. But there was this unnecessary divide with masks, and with how serious it was or not. And I think that people need to hear the same message – or, at least a similar message – from the ground up. From their local leaders, from their community leaders, from their governors, and then from the federal government. Or else, it’s like a pick your own path to what works for you. And I think that’s what ended up happening.
J. Stephen Morrison: Thank you.
Jeff.
Jeff Sturchio: Thanks, Steve. I’m Jeff Sturchio. I’m a senior associate here at CSIS and chairman of Rabin Martin, a global health strategy consulting firm.
You know, I have two questions, if you’ll allow me. The first is up to pick up on the previous question. I’m interested not so much in the relationship between the people in the administration and the implications of what they did for how the country understands expertise and how we make decisions. But I’m really interested – I’m about halfway through the book now, so, you know, I’ve picked up on many of the things that you’ve been talking about. But I’m interested in the internal processes of decision making and how those interact with the organizational structure of the government.
Because, you know, let’s – you were just talking for the last 20 minutes about how the same government that completely botched testing and masking and social distancing also came up with Operation Warp Speed – which, you know, I agree with Damian, was – it was nothing short of a miracle, having vaccines that effective in that short a period of time. The question I’d just – I’d be interested in your comments on, since you’ve interviewed so many of these people, the people just below the Jared Kushners and Marc Shorts and all the intrigues in the White House, and interacting with Trump and Pence, and Birx and Fauci and others on the task force.
All of the, let’s call them bureaucrats – I don’t mean that pejoratively – but, you know, these are people – you know, those of us who’ve worked with government agencies, you know, we have incredibly – people who can deal with incredibly complex public issues who are often the most – the best in their field. They work with billions of dollars on things that affect millions of people every day. How do they reconcile the craziness that was going on in the White House with what they knew should be done? You know, the people who were reviewing dossiers in the FDA? The folks, you know, at BARDA, who were making decisions about investments in Operation Warp Speed? Because it has to set up a terrific cognitive dissonance in them. So that’s one question.
The other is, will we learn from this experience? Now, you know, the last six months – or, at least since January 21st – have been encouraging, because the vaccine rollout, you know, picked up speed and we’re doing well, despite the issues around vaccine hesitancy. But as one of you said – I think it was Damian – there will be another pandemic, right? We know that bugs just keep looking for hosts that they can infect and do their thing. So will we be as helpless before the next pandemic? Or will we learn how to prepare for these things and to make the investments in public health infrastructure, and all the other things that we saw were gaps in response to COVID, so that we don’t live through this same craziness again?
Damian Paletta: Well, I’ll take the second question. (Laughter.)
J. Stephen Morrison: Kicking the tough one over to you, Yasmeen.
Damian Paletta: Yeah. (Laughter.) There’s a part of our book where we mention the Spanish flu, and the debate about masks, and the fights about masks. And I think there was even some murders about whether people should wear masks. And it was almost exactly 100 years earlier. And very – you know, respiratory virus, I don’t think it was asymptomatic spread, but, like, was just mowing people down. And there was a lot of debate about civil liberties. And President Wilson didn’t want to focus on it, and kind of downplayed it. And, you know, messaging was really bad. I think they, like, strongarmed the media into not covering it.
And it was amazing the parallels between that and this, you know? Like, a lot of the same debates they were having about political leadership and believing scientists we had again. And so, you know, I don’t think it’ll be another 100 years until we have the next respiratory virus outbreak. The question is, can we learn from this more quickly? And can we almost rebuild the CDC and FDA, not with more money necessarily, but with a kind of structure that Democrats trust, and Republicans trust, and doctors trust, and nurses trust, and families trust? So that when they’re given information from these agencies they feel like, you know, it’s solid.
Nancy Messonnier, you know, a top official at the CDC, on February 25th was brutally honest and couldn’t have been more prescient when she said: It’s not a matter of if but when this is – there’s going to be community spread. And, you know, Trump blew a gasket when she said that because the stock market fell like 1,000 points. But she was right, you know? And that’s what we needed her to be in that moment, was to warn us to, like, get ready to lock it down. Kids are going to have to stay home from school, you know? We’re going to have to, like, dial it back a little bit. And when we have people like that who we can trust and believe, and who are given, you know, the authority to speak, I think we benefit. You know, maybe then we do dial it back a lot more in February and March, and this thing gets snuffed out faster.
But the fact that she was essentially told she couldn’t speak publicly for the rest of the year and there were political officials that kind of stepped in. As you mentioned, Dr. Atlas comes in and kind of sidelines Birx and Fauci in terms of public messaging. That’s when, you know, all hell breaks loose, I think, in terms of communication, because no one knows who to believe. And, as Yasmeen said, people kind of picked their messenger. And that’s really dangerous.
J. Stephen Morrison: Yasmeen, maybe we can turn to the dissonance question, but add into that also something that we had talked about earlier, which is how lasting is the damage to CDC on this? Because that dissonance was corrosive. So maybe you can offer your thoughts on Jeff’s question, and add a bit with a specific focus on how quick can we repair it?
Yasmeen Abutaleb: I think within the agencies you saw a lot of sort of – not mid-level, higher than mid-level – people who ran certain departments or had leadership roles that were obviously below the secretary or director level actually many times going way beyond their job description to try to address issues in the response. You saw – there’s an example in the book where there’s a two-weeks testing shortage because Jared Kushner and his team wanted to launch this drive-through testing initiative, where you would have drive-through sites at CVS and Walgreens and a number of retail sites. But they hadn’t resolved the supply issues or made sure that there were enough supplies to do it.
So the testing manufacturers go to the FDA and say: We can’t get swabs. And you see this herculean effort across the government – from FDA, to HHS, to BARDA – to airlift a DOD plane to Italy, which was the only place where they could get the swabs. They airlift the DOD plane. An HHS official is the one who signs off for the plane to go. He was not the one with the authority. But the pilot had emailed saying: Someone needs to tell me I can go. And he says: I’m telling you to go. Go. And then someone says, who actually has the authority? And he’s like, it doesn’t matter. It doesn’t matter right now. (Laughter.)
And the plane goes. And they airlift back, I think, 20 million swabs. And so you saw a lot of people step up where they could, but I think there was immense frustration because they weren’t resolving systemic issues in the response. They could address an acute crisis when it came up, and step up, and try to find the resources for it. But I think that’s how they dealt with that cognitive dissonance, that even though this was a disaster, and the government bore so much of the blame, they felt like they could step up where they could to try to resolve acute issues as they came up. But it was, of course, enormously frustrating because they knew what had to be happening for things to be going better, but they just didn’t have that kind of power in the positions that they held.
J. Stephen Morrison: I did a series of interviews of senior folks at CDC and different places about – which borders on the question that Jeff raises – about 20 interviews. Sort of confidential interviews with people who were – some of whom we’ve referenced – who were in very sensitive positions. They were the professionals. They were the most respected. And across the board, they were traumatized. This wasn’t just dissonance. This was – they felt that they had been brutalized, that they’d been transformed into instruments of anti-science, that they had – that their mission had been flipped into something that was just ghastly. And they felt victimized by this. Now, that’s perhaps the most extreme expression of what happened in this period.
Let’s close on a positive note here. (Laughter.) This book is meant not to defeat us. t’s to inform us and to think about the future, and to provide an intelligible set of narratives – which I think you’ve done a great job of helping us make sense of what we all lived through. And maybe we prefer to move on, but you’re forcing us to come back and read your book and benefit from it. (Laughter.) So what’s the – what’s the closing optimism and hope that you bring to this? Because you’re both very analytic and incredibly committed to this, and fastidious in the way you’ve pursued the story. But you’re both optimists too, I sense. So, Yasmeen, where do you see the greatest hope and optimism looking at this story?
Yasmeen Abutaleb: I think, obviously, so much of the book focuses on what went wrong, and where people made mistakes, and where people weren’t acting in the country’s best interest. But there’s also stories in there of people who really tried to step up, who really tried to address crises, even though that wasn’t their job. And you saw networks of health officials on the ground trying to band together and resolve issues that way as well. o I think you saw a lot of people step up and try to fill in voids where they could.
And I think we were encouraged by the fact that so many people wanted to talk to us, even though it was very difficult for them that they were reliving such a horrific yea that they felt a lot of, I think, guilt and responsibility for. But they wanted people to learn from this. And they wanted someone – we heard from a number of sources, you know, I don’t really want to relive this, but I want somebody to be able to pick up this book in 10 years, or 20 years, or 50 years and make sure this doesn’t happen again.
And I think we see a lot of conversations happening now that have been kind of brushed aside – aside from maybe the public health/health policy crowd – about chronic underfunding in public health and what it meant in this crisis, and what could have happened if you had county and state health departments that had had the resources they needed. Look at structural problems in the CDC, even independent of political interference and the issues with the administration last year, what needs to be addressed within the CDC so it can be ready to step up next time? There are a number of issues that had nothing to do with the last administration.
And so I think if those conversations continue and there’s more than just an infusion of cash to deal with the crisis, and people start to really think about this because we saw it play out in such a catastrophic way, that that could be a really important legacy of this pandemic. And I think we see the conversations happening, and hopefully that they’ll move forward and result in some long-term action.
J. Stephen Morrison: Thank you.
Damian, you get the last word here. Well, I get the last word. But you get the last – (laughter) – you get to do the benediction here. What gives you hope and optimism?
Damian Paletta: I think that we shouldn’t lose sight of the fact that we got through this. You know, I mean, the death toll is astounding. And you know, it’s so hard – you know, my great-aunt died of coronavirus in November. So many families will never be the same. But there were – you know, the heroism we saw in the hospitals, and among the first responders, and the teachers, and all these people who stepped up to do things that they never thought they would be called on to do, I think should give us hope in the American spirit.
You know, that even though the politics of this were crazy and frustrating at times to people, and the message was confusing – you know, we were dealing with something that, you know, hadn’t really come in 100 years. The American people kind of rallied and answered the call. And there are lessons that we can learn. You know, there are things that next time we need to do better. And as – you know, as a public and as a government and everything. But I think when you look at all the people who did step up, many of them will never have books written about them. think that gives us a lot of, you know, reason for hope.
J. Stephen Morrison: Thank you. Thank you.
Well, I’m so impressed by what you’ve done. And when you told me that you barely knew one another when you started this project, I find that kind of astonishing too. You’re clearly – you’ve grown to be great friends and colleagues in the course of this. It’s not always the case when you do these things together. And the product of all of this is really impressive, and valuable. And we thank you for that. You know, you really – I can’t imagine what an extraordinary exertion this has all been for both of you and your families that stood by you. So congratulations and thank you.
Damian Paletta: Thank you so much.
Yasmeen Abutaleb: Thank you. (Applause.)
(End.)