Coronavirus Crisis Update: Dr. Deborah Birx: ‘Moms Out There, Call Your Sons!

Steve Morrison: Andrew and I are delighted today to be joined by Dr. Deborah Birx. Deborah, welcome. You did a couple of podcasts with us earlier, in your earlier incarnations, and we're thrilled to have you with us today.

Andrew Schwartz: We sure are.

Deborah Birx: Happy to be with you all.

Steve Morrison: I'll do a quick introduction here and then we're going to talk about two big things: we're going to talk about some of the recent appearances and statements that Deborah has been involved in, reflecting on her time, her tenure, in the in the Trump administration, then we're going to talk about the time that she was on the road, almost seven months, and what that experience was all about.

Deborah is known to most Americans for her role in as the White House Coronavirus Response Coordinator. She came into that position in March of 2020 and carried forward until January at the inauguration. Prior to that—and I, this is where most people in the world of global health know Deborah, know her very, very well—she's had a long, four-decade long career as a leading immunologist and particularly global HIV/AIDS expert. She served, while at the White House on the Coronavirus Response Team, she also was serving since 2014—I think it was April 2014—as Ambassador at Large and US Global AIDS Coordinator responsible for overseeing the PEPFAR program, the President’s Emergency Plan for AIDS Relief. Prior to that, nine years of directing the CDC HIV program. She's a career military public servant at the rank of colonel, she directed the US military's HIV research program at Walter Reed, and now she is a senior fellow at the George W Bush Institute. Congratulations on that appointment, Deborah.

Deborah Birx: Thank you.

Steve Morrison: It's great to hear that news and we look forward to working with you.

Deborah Birx: It’s great.

Steve Morrison: So, there's been some recent drama, different events in the media, revealing from those who worked inside the White House like yourself what those realities were like. Most recently, March 28, CNN, Sanjay Gupta, hosted a documentary, “Covid Wars: The Pandemic Doctors Speak Out” in which, Deborah, you made some very strong statements around, you know what, after the first hundred thousand deaths, those that followed—which is now over 460,000—a very sizable portion of those could have been prevented. You did an appearance on CBS with Margaret Brennan back in January, a recent ABC appearance as well, and one of the thing—disturbing aspects of all of this is that these appearances by you and by Tony Fauci, by Brett Giroir and others have drawn very stark response and attacks from former president Trump. The day after the CNN, on the 29^th, Trump came out and attacked you as a proven liar. On Saturday, President Trump in his speech at Mar a Lago to the RNC, went out of his way to launch an extended and very vicious attack on Tony Fauci.

So, what this suggests is that former president Trump, while trying to sort of perpetuate the sort of big lie around the allegedly stolen election, is also continuing to really be very belligerent in trying to knock down those like yourself who speak out truthfully around the realities of what was going on within the White House.

So, my question to you is, this is highly personal, and speak to us about how much risk does this put you in and how does this, how are you experiencing this, and then, what are the broader impacts? Is this sort of behavior perpetuating confusion among Americans as to what we’ve just gone through in this in the first year of this pandemic?

Deborah Birx: Yeah well, thank you, Steve, and certainly this pandemic is personal to everybody, to every American and to everyone around the world that has been fully engaged in experiencing that, this pandemic. From the years of working in global health and working globally, you understand that national governments and federal governments and state and local governments are critically important. But also, I have always believed equally important is the community—the community you serve, and trying to understand what the community is hearing.

You know, we've spent decades talking about how diseases don't know state borders or country borders. This pandemic and this virus doesn't recognize party, and I think to politicize this, to marginalize us into camps in our response to this pandemic, has been really unfortunate. It's part of the reason why I wanted to go out to the states, and we'll talk about that later in the podcast, but I think it's really important that we recognize, and I know we all do, that we're Americans here, protecting and responding with compassion and care for each other, and the same time for ourselves and our communities and our families. And I think this virus really will not distinguish your party affiliation, we know it doesn't distinguish by age, we know it does distinguish by co-morbidities.

And I think that has opened up some real opportunity—some devastation for the United States, but some real opportunities for us collectively to face our co-morbidities and really discuss prevention, and I think what's been lost in the dialogue and in some of the back and forth at the partisan level is this has really shown us where our issues are as a country with how we approach prevention and public health.

And I think the opportunities that you, you talked about were opportunities that came to me in less than a week, leaving the administration. I think most people don't realize that the CNN interview was done in January. This time has allowed me to really reflect on changes that we need to make as a country in our public health response, and it's still interesting to me, we really, in the end, get very excited about biomedical interventions. But we have to also recognize that behavioral change and those mitigations that I talked about that have to do with the age of our individual behavioral changes are really critically important.

And then finally to your question, the more we make this pandemic partisan, the more it divides us rather than bring us together. And I think I'm hoping what comes out of this is, and I'm, you know, after four decades in federal service and serving in administrations, I think people don't recognize that the executive branch becomes part of the administration, technically, in each of the presidential administrations, and so I've served technically in the executive branches of government, since Ronald Reagan, the last year of Jimmy Carter's administration. And I think throughout that, there have always been good things that administrations do, and that you want to really applaud and things that we can do better.

And I think it's really important to talk about the things that we as a country can do better coming out of this Covid pandemic, because I think it laid bare some of our social determinants of health and health disparities that I got to see across the country, from our tribal nations to some of the really small and local towns where there is not adequate safety nets. So I think the more that we become divided on this issue, rather than recognizing it as a health issue, the more damaging it can be in the long run.

Steve Morrison: I mean, these appearances with Margaret Brennan, with Sanjay Gupta, I mean, what was the value of that, it seems to me, was speaking honestly about the fact that the task force was a mirage, that there were there were false data being put forward through various channels. You are not the lone person making that claim—there were false claims being made about testing, knowingly, that you had dysfunctionality and lack of true coordination and sort of abdication, all of those things come across loud and clear. And, of course, with that comes the questions that have come back to you and others about, what are the, what are the limits for of service. At what point is your service crossing a line into becoming an appeasement or enablement and the like. And that's a big historical debate about the nature, it's bigger than you, it's bigger than Tony Fauci, it's really about this administration and what we, what we've seen happen and I don't think that debate will necessarily go away. And it's hard to imagine that you will be able to extricate yourself from that debate.

So that's kind of what I'm trying to get at here, is how do you see this and how do you see this moving, because when you speak forcefully and frankly it draws this immediate vicious fire back at you from the former president.

Deborah Birx: Well, I guess, you know, I've worked in pandemics that are highly politicized—certainly HIV was highly politicized, and it remains highly politicized around the globe, which still worries me every day. That creates vulnerabilities that creates marginalization of critical communities that need a comprehensive response. And it's funny because we can see it elsewhere, but we couldn't see it here in our own country, many times. But when we partisanize health and partisanize responses to pandemics, that does limit our ability to respond in a coordinated and comprehensive manner. I think, for the people that I was able to work with every day—and, certainly, I have a long-term relationship with Tony but also Bob and others—I think it was really important that we understand that at the beginning, in March, we were able, through data and through graphs and analysis and projections, to really work with the federal level to do the 15 days to slow the spread and the 30 days to slow the spread. That 45-day element at that time in our country was really critical in this pandemic. And so it's difficult to then compare that time when people were listening and responding to science and data and these kind of analyses of the counterfactuals about what could happen to this country if we didn't slow the spread now, and what it was going to do to our hospitals and to our clients that we were serving because there wouldn't be adequate staffing or even potentially supplies, and the stress that that was putting on our health care delivery system, that 45 days was critical.

That then morphed into very much a focus on the economy, and I think—I think, for those of us who stayed and worked hard, every day, all in different ways, and each contributing in a different way to the response, I think, for many of us, we believe that we could recapture that understanding of how severe this pandemic is and was and would be, particularly with a fall surge. So it was, it was important that behind the scenes, all through the summer the teams are working on therapeutics, working on vaccines, and working on the stockpiles, so you can see—and the data, which obviously was something really important to me. By the time the fall came we had two to three times, two or three log additional tests, PPE supplies, therapeutics, and then the hope of moving towards of vaccines.

But at the same time, we were never able to really move people to testing as a public health measure in itself, which is something I learned and I think Tony understood, and I think Bob understood—that the asymptomatic spread was a really critical component of early spread of this virus in communities, and if you could stop it at the asymptomatic phase, as many universities did through aggressive weekly required testing, then you could really stop that pandemic community spread before it attacked a lot of individuals with significant vulnerabilities to this virus. To me, testing was a critical plank in our public health response, along with masking and physical distancing. But so many around the United States, and so many in leadership really focused on that waiting until the hospitals were engaged, and if you waited until people showed up at the hospital it really—you are so far into community spread, and it was so vast in its spread that you had two to three to four more weeks of really significant hospitalizations and fatalities.

So that's what I was speaking to when I was talking about what we learned in March and April and needed to be applied. And so, if you look at the states that opened slowly, really followed the gating criteria that we had worked so hard on to make sure that Americans would be protected, with a very slow and kind of slow-dimmer-turned-on response—in those states that did that, if you compare to the states that open quickly to the ones that open more slowly and you subtract out the March and April issue, because we didn't have the same level of understanding of this virus in March and April, if you subtract that out, those states did about 20 to 25% better in their fatalities, the ones that open slower. And if you then look at masking and mask mandates and you tried and you normalize for demographics against attracting out the March and April cases and fatalities, you see that states that had a mask mandate did about 20% better in fatalities. So we're not talking about fatalities being zero after that first wave in March and April, but certainly significantly mitigated and attenuated, and some of the states did that incredibly well. Other states focused more on the economic conditions of their state and may not have mitigated optimally. And so that's what I was really referring to in the CNN interview, it was never the intent to say it would have been zero even in states that did extraordinary.

And the final point that I wanted to make is, I don't—when you're talking about behavioral change, it's important not only to show why that change is important, but when those states and when the people do such an amazing job with their behaviors, we should have also applauded them. I think we didn't give enough positive feedback with each of these surges to show that it was them, it was their behaviors, it was their changes that saved their communities. And we probably didn't present enough of the counterfactual that said, if you hadn't done this, this is what would have happened, and this is how many lives you saved. And we should have gone back very clearly and said, you probably saved 25 to 30% of your population by working together as a community.

Steve Morrison: Let me ask Andrew to jump in while we're doing this segment here. Andrew?

Andrew Schwartz: Thank you, Stephen, and Dr. Birx, I want to thank you for your service and all you've done for our country to start. Let's talk about the politics of this a little bit, because you've mentioned the politization. You know now we're faced with, you know, vaccine resistance and some—you know, we have surveys that show that 49% of Republican men don't want to be vaccinated, we have vaccine hesitancy in other communities, and there are politics around wearing masks and reopening, some places are defiant. Just in terms of politics it's become tribal. What do you, what do you think about all this and what needs to happen, and what's going to happen if this doesn't stop?

Deborah Birx: That's a great question. So, you know, in other pandemics, we have had difficulties with our public health messaging, in HIV, in some cases, and didn't adequately engage early on and then came back to try to find them and engage them, and I think what I would like to say to every mom out there, no matter what age your son, if you want your son to survive Covid healthy, tell them, for your, for your peace of mind, to get vaccinated, independent of whether they're Republican, Democrat, or an Independent, no matter their age—to the moms out there, call your sons and say get vaccinated.

I got vaccinated in the last few weeks—I'm really confident in the vaccine, having worked on vaccines for HIV, TB and malaria. This is a very straightforward and safe vaccine, and they know how to modify it to give us boosters if we need those in the future, because, in case Covid becomes endemic. So, this is the time to get those shots. To moms out there, call your sons. This should never be a Republican or Democratic or Independent issue.

Andrew Schwartz: And why do you think this is being perpetuated and drawn along political lines? I mean, it seems like it's a no brainer here. I mean, you know, we need to get to herd immunity, we need to, you know, get people healthy and it continues to perpetuate and we're seeing this from people who ought to know better.

Deborah Birx: You know, I think people have focused on the individual rights piece, rather than the individual health piece. And I know this vaccine will make a difference. So to the daughters out there, I ask you, the daughters and sons, to call your dads. There's a lot of things dads will do for their children, or for their moms that they won't do in national messaging. And this needs to become very personal, family by family, because I want every American protected. What I've seen, having been at hospital after hospital during the height of this pandemic, is that a lot of the spread was happening in personal, family gatherings that should have been celebrations—birthday parties, anniversaries, weddings. I want people to be able to experience those again and not have the guilt that someone got infected during those celebrations because they chose not to be vaccinated. Get vaccinated for yourself, but also your family. If you're not going to do it for America or you think it's an issue that's political, do it for your family.

Andrew Schwartz: Absolutely, I mean, you know, you think it'd be a patriotic thing to get vaccinated as opposed to not get vaccinated.

Deborah Birx: You know, I would have thought that with mass also, but yeah, somehow these really critical public health behaviors that we really need from each other right now, I guess because they became politicized—I still, I'm trying to go through all of my notes that I took at meetings and my thoughts to really, was there a time point that this became more political? Was it because we were an election year? I don't know. I've seen countries politicize HIV in election years, and TB and HIV and election years, and I think that was part of it, but I don't think it explains all of that. This touched some people, they tapped into something that was bigger than the pandemic and public health, and I think we have to figure that out.

I think as a country we should’ve and we need to spend much more time in science, and in elementary school and high school really talking about all of these scientific principles and how vaccines work. We take a lot for granted, because we just accepted them in our lives, but I think this is a real call to action for, really for us to educate. We have elementary school students that know how to code, but don't know how these vaccines work. And really, that's really critically important because they are a helpful group in explaining things to their parents, because they can help explain how these different things work and how their bodies are working. I think we do need to do a better job, not just with STEM, but really taking some of these difficult concepts and making sure that we are really educating people at each step of their development so that they understand science and data and these projections and epidemiology, in a way that it's real in their lives.

Andrew Schwartz: It's a strange cultural phenomenon that a huge swath of the country is so anti-science, and so I think what you're saying is it needs to be a cultural touchstone from early childhood, science is important, science is something to understand and something to embrace.

Deborah Birx: And then it's understandable, I mean it, it was it was interesting to me because people do use data every single day of their lives, you know, they're on Amazon or they're on, and they're calculating, is this the best thing for family, yet when it came to the vaccines, you know, they didn't have that same background and availability of information. And I think this really, we need to utilize this pandemic to really go at that understanding about vaccines and safety and how they're developed and demystify all of these pieces, so that the average person across the country—I mean, I got to talk to literally hundreds of thousands of Americans during this pandemic. These were very smart people that I was talking to, these are people who are running complex farms and complex businesses. Yet there was a real fracture in their categorization and understanding of the science and the epidemiology of this pandemic and I think those are the pieces that we really need to work on.

Andrew Schwartz: It's really funny, though, because I never thought of it the way you just put it. People don't choose a restaurant without looking at data. Yet when it comes to this, they're not looking at the data in the same way that they would pick, you know, what restaurant to go to one Friday night. It's really incredible.

Deborah Birx: Yeah, they're doing this every day on their lives, you know, they're trying—deciding what toothpaste has better whitening and what restaurant has—[laughs]. These are people who are utilizing data every single day, including very intricate data about when to plant their corn, and, you know, what types of chickens to buy and what kind of immunizations to immunize their chickens with, and yet, when it comes to—then there's that disconnect between their everyday life and how they're using data and then this.

And maybe, what I always felt when I was out is, we're, we have to take ownership of that as scientists and public health officials. That we need to spend more time at the elementary school and high school level going in there and talking about and getting a joint understanding of demystifying a lot of this science and preclinical and clinical development so that everybody can understand it.

Steve Morrison: Let's move to discuss your time going around the country. Now, as I understand it, it wasn't a single moment when you decided to do this, but things started to change in April. After the 45-day lockdown mid-April, we had you know, the task—the Task Force gets sort of sidelined, Mark Meadows, Mark Short, others are grabbing control over this as you've described, you became a force of one and have one. Your access to the President, the last access you had was April of 2020. As we got into the summer, Atlas shows up, in the third week of July. As a as a foil as another person, he begins introducing his own parallel data to this. In August, you gave a dramatic statement on CNN warning about what was happening in rural communities across the country. And that provoked a tough call from President Trump to you, so I can understand why you would see that staying in Washington was not a great option. And you didn't want to resign, you wanted to stay relevant and do good deeds in this period of this crisis, so you go out and you do this.

The first question is, this was dangerous, right, not everybody was getting up and traveling all over the country for seven months, so you are pretty expeditionary personality, you're pretty intrepid. You, as we've talked about, you cut your teeth in the worst of the HIV epidemic in Africa and elsewhere, so you weren't shy or deterred from going into the hot zone. So tell us about that, and how did you keep yourself safe in that period, and we talk about like, what did you learn and what did you achieve?

Deborah Birx: Well, first I want to thank the people who made it possible, because obviously thousands of meetings had to be set up across the country with governors and mayors and health officials and tribal nations and chairmans of tribes, and our White House Governmental Affairs did all of that, for me. And often the Vice President dropped me on a trip that he was taking and so Irum Zaidi and I would get on Air Force Two to get dropped someplace—sometimes Minnesota, and then we go out to Wyoming and Montana and back, so half of the trip often we were dropped, and then we would drive through the states to really meet with local communities.

But more importantly, we wanted to drive around and see these communities, try to understand what people were facing, really understand housing, multi-generational housing, and really see that component, try to get an idea of the essential workers out there. And I will just say, I got to meet, had the pleasure to meet many essential workers, because obviously there were people manning the desk and these hotels and manning the drive-through windows at McDonald's and Wendy's and Burger King and Chick Fil A. It did result in significant weight gain, I will just say that. [Laughs].

We were, we really did try to stay safe, and there was a way to stay safe: we followed the CDC guidelines, and that's what really allowed us to make it through this with neither of us becoming Covid infected, despite some of the people in those meetings. We would get calls the next day or emails saying, so-and-so was diagnosed the next day, so we know that there were people we were meeting with who were actively infected. But we masked all of the time and we followed CDC guidelines, and those guidelines were extraordinarily important to keeping us safe.

I think the reason Irum and I wanted to go out is, we were able to, obviously I did a daily analysis of the state of that pandemic send it to senior officials, but also send it to the senior doctors. And so, Bob and, and Brett Giroir and Jerome Adams and Dr. Fauci and Steve have all received the same information of this analysis, and so it is interesting to me that people have said that I underestimated the epidemic. There's a daily report, I can promise you that not one of those daily reports underestimated this epidemic from any standpoint, because I had lived through pandemics and I, and I understood exponential growth, and so I think that was sometimes difficult for governors to understand.

But the Vice President was always very much committed to governors and supporting the states, and it wasn't until reopening, frankly, that—I didn't really understand the limitations of the Federal Government when it came to state and federalism. And I think once I'm—you got so used to global health where there's a national guideline that within days, circulars go to every single community and county. And everyone is following those national guidelines and implementing them at their local level, and so in HIV that happens every day across the world. In the reopening it was clear to me that everyone interpreted that criteria differently. Those were very clear gates, the CDC wrote excellent guidance around how to utilize the gates. Yet a significant number of states did not follow the gates, and so I really wanted to understand what states were thinking, what state, local leaders were thinking, and provide them the information that was tailored to them. So, in addition to physically going and going through this data with them—and I think that was really important, because you had to understand their limitations and what they were up against, and then really doing this well. We do weekly, highly state-specific governors report that was 12 pages of what is happening in your state graphically and a couple of pages of that 12 that talked about specifically a summary of the epidemic and specifically what we thought should be done at that local level.

Steve Morrison: Deborah, you were going out to listen and learn, but you were also going out in order to paint the picture for the governors and leadership in the states of what lay ahead, right, you were there, you were there, trying to sort of bring the big picture across, as this is a huge problem and it's going to get a lot bigger right, you were selling that product to folks. Where did you feel like you got the best listening from the governors and other leaders, where did you feel like you had the greatest impact over the course of those six and a half, seven months?

Deborah Birx: Well, in each of the states, we can really track and trace policies linked to the visits. I want to make it clear, though, we were not only armed with the current data in those states, and we were able to develop very good data feeds, from tests positivity to cases to new hospital admissions to ICU admissions to fatalities, tragically, for many Americans. But we were also able to, to really talk to the local individuals in that state. White House communications also let me speak to regional, local press. And I think that was really helpful, but at the same time, CHOP, David Rubin and his team at CHOP, really put together critical graphics for me about different mitigation parameters and the impact on what we call the replication rate of that virus. And so very early on, we were able to take those to Arizona in June, meet with Governor Ducey and his excellent Dr. Christ, who is an excellent public health official there, go through all of this data and show that they could keep malls open with a mask mandate, they could keep outdoor dining open. They very often had to close their bars, there was just really, indoor bars were not conducive to anything but viral spread at that time.

So, we were able to show that there was a critical middle ground that they could adopt that got you to the same place, nearly, as sheltering in place. And that was extraordinarily helpful because it helped deal with what we knew would be coming: pandemic fatigue. And so, it allowed us to really talk about that there was this scientific evidence that there was a middle ground short of sheltering in place. And I think taking that to states and using that science and data to really portray the impact of a statewide mask mandate, reducing indoor dining, increasing outdoor dining, closing bars, in many cases indoor gyms, really dramatically impacted the transmission rate. And then we were able to show that.

And I really want to thank the governors, like Governor Ducey and many of the other governors who took a chance on that science and data and used that science and data to really drive down transmission in their states, and so that really empowered us to refine those models and get those out to state after state. And that was part of the visits, not just going through their current pandemic state but also showing the impact of these critical mitigations.

Steve Morrison: But you also encountered some defiant governors, right? You, you also, there was a dissonance between your set of messages versus the messages coming out of the White House at that time, too, so you had to fight against that contradiction as well. How did you deal with the defiant governors who didn't want to hear this?

Deborah Birx: You know, I have to say, there were, there were a couple of states that didn't let us come, so we didn't get to go to those states, but that was literally one or two states in the entire of the 44 states that we got to. And even the governors that most people would have said were defiant when they saw the data, I just want to be clear. I have all the 44 governors that I met with, Republican and Democrats, I always felt from them that they were very much concerned about the people in their state. I never got a sense that they were dismissive about any aspect of the health of their state. Their interpretation of the data may have been different than mine—in other words, they may have been weighing the economic impact on their citizenry while I was weighing very much a public health impact on their citizenry, but I felt in those discussions, we were able to come to a very firm common ground. But I will say, many states, I had to go back two and three and four times and also was on the phone with them multiple times, so these aren't one off. You just can't go and deliver a message, you need to continue to listen and understand their unique circumstances and the unique circumstances of their population, and really work with them and find that middle ground constantly, because, you know, these policies are absolutely critical, but they don't mean anything if you have a federal policy and it doesn't get implemented at the state level.

Andrew Schwartz: Let's talk about President Biden for a second. So, President Biden rapidly issued the national strategy, 13 executive orders, three presidential memos and the first presidential National Security Directive, authorized the DPA—it's been described, what he's done is a radical departure from the Trump administration's approach, a turn to an FDR-style wartime mobilization led by national government. What do you make of what he's done so far, and how would you, how would you evaluate?

Deborah Birx: Now, as I said in the ABC interview, he brought a full strength of really brilliant individuals into the White House, so there's a full team in the White House under Jeffrey Zients that is working every, whose only job is the code response, and I think that is really critical to have that, really, power structure within the White House working every day with agencies and working every day at the state level. You know, many of those issues around DPA were obviously also done under the Trump administration, and that's the way we got these vaccines made and we got therapeutics out, so from Remdesivir to supporting Gilead to Regeneron and Lilly and the companies working on monoclonal antibodies. And so I don't want to ever leave the impression that there weren't people at every level working every day within the Trump administration to ensure that testing was improved, that therapeutics and vaccines were available. I think they've done a remarkable job at putting together the federal level communication about what are the best public health interventions that we need to follow as a country in a very consistent manner. That radiates from the White House out through all the agencies, and I think that is critically important when you want people to change their behavior.

You want people to hear not only why it's important but have everybody speaking in the same terminology about why it's important. Because behavior change is tough, it's why I was supportive of the mask mandates, having been out there myself. You need to be reminded, when you're asking people to change their behavior it really helps to remind them every single day, and so it was helpful for me that in every single gas station, it had a sign that said masks are mandated here. The retailers were a critical behavioral change, and with that, with a mask mandate, they're able to then enforce that behavioral change at that public space. Those kinds of things are really important because it's hard to change your behavior, it's really difficult, and I think that's why some of these translations of mandates, rather than recommendations, become critically important so that you can have allies in the retail sector, reinforcing that.

And so, I think, I'm thrilled that vaccines are getting out, I'm thrilled that there is mass immunization sites. I think that was, I think it's really important, I think there's enormous talent in our National Guard, who have helped us every single step of this way. The National Guard was there at every moment helping with testing, helping with saving nursing homes with strike forces, and now helping in vaccination. I'm hoping what comes out of this is a real recognition of how important the National Guard was in the pandemic response, both under the Trump administration and under the Biden administration.

And I'm hoping we find space to talk about that, those kinds of things that went through both administrations, so that people can see that the National Guard is not a politicized group, and when you don't politicize the response and you allow the National Guard to function and help Americans, that they will be highly effective. And DoD, which I was so proud of having come out of the army. DoD, for the first time, engaged in deep, deep ways in this domestic response, from helping with the army corps of engineers, that was very visible. But they sent in frontline healthcare workers from nurses to respiratory therapists to physicians, and, and so the DoD and active duty forces were really integral and part of the response, both under the Trump administration and the Biden administration.

So, I'm hoping when all the dust clears, we can talk about things that were in both administrations that were good things, and the things that we have to change as a country, at the individual level, at the state, local level, and at the federal level in order to be better prepared and more organized as a country and our response to pandemics. I think many of us thought that pandemics were something that happened over there, and we prepared for a flu pandemic here, but everything else was over there and stopping it over there. And I think what this what Covid has really laid bare is the primary countries, and when you look at where the United States is compared to Europe, we look very much, when you look at cases per population and fatalities per population, this really impacted upper-income and upper-middle-income countries in a very dramatic way. And I think it really calls to a different coalition that needs to come together, both globally, the way we continue to work and support low-income and lower-middle-income and middle-income countries, but also a real connectedness needs to be in the upper-middle-income countries to really respond globally to these kind of pandemics.

Steve Morrison: Thank you. Deborah, by the way, on the DoD role, we published just recently—the CSIS Commission, Strengthening America's Health Security, we published a piece, really extensive analysis of DoD’s role here, by Mark Cancian and Adam Saxton from our international security program, which I'll share with you. And also, today we have, I think it's on the order of 9000 professional military medical personnel deployed into the vaccination sites, side by side with the National Guard. That's a huge commitment from DoD, on that side of things.

Let's close with a question around whether there should be a 9/11-style commission in America that could look at the national response—what happened, what worked, what failed. It looks retrospectively, looks forward, it's going to have to touch on some of the critical international dimensions of all of this as well. There's a lot of discussion, there's several bills in Congress that have been put forward, some on a bipartisan basis—Senators Collins and Menendez have a bill in, there's a similar one in the House. We've got other, other efforts underway, some of which were involved with looking at the prospects for this. What's your thoughts on the value of putting such a thing together, and how might it be done in a way that avoids getting trapped in our political decisions?

Deborah Birx: Well, that last sentence is the key part, isn't it, because what we never want to see is, and what worries me, that as a civil servant—you won't, I mean, remember, most of the White House positions are civil servants detailed there from their agencies. If that becomes so partisan, are you going to have only the Democratic civil servants, the Democratic civil servants going into a Democrat White House? I mean, just the fact that we've now, you know, partisanized science and data and pandemics, if this commission can be about learning and not say that this is a Republican or Democrat problem, this is an American problem because disease does not recognize parties. Our social determinants of health and our, our difficulties in those areas with Type II diabetes, all of these things that put individuals at risk, these need to be addressed, and they need to be addressed in a non-political way.

And if that Commission can both applaud the good that happened, really recognize what has to be improved, and recognize also what needs to be improved at the state and local levels together at the national level and what may need to be improved at the Agency level—if we're not transparent and if it becomes then that certain agencies are perceived as being Democrat versus Republican, that also would be really horrible for the national and federal agencies and response to create divides between civil servants about who is a Democrat or who's a Republican or who's an Independent. That would unravel the esprit de corps that exists in many of these agencies. I never felt like when I was at DoD or HHS or the State Department that people's political party affiliation was relevant, I never felt that. But, and so we have to make sure that this commission doesn't create a sense of that because I think that would be devastating, in the long run. I think a lot of good to come out of it if it's not politicized.

Steve Morrison: Thank you.

We ask everyone who comes on as, as our guest on this podcast series to close with just a quick set of thoughts on what gives you the greatest optimism and hope today, at this moment.

Deborah Birx: You know, I was so impressed in March and April, when I called on the millennials to really help me—I do have two millennial daughters—but they were extraordinary, and they helped in both directions. They help communicate to Gen Z about the seriousness of this pandemic, but critically, they help communicate to their parents and grandparents, and I was very worried about Baby Boomers because a lot of Baby Boomers are not rule followers in general, and I really needed them to understand their risk. And I think the children really helped me.

And I just—really, that's the thing about public health: you need to engage the community and you need to find the community that can carry your message beyond public health leaders. And I think there are individuals and there are whole generations that helped carry that message, and now we need all the millennials’ help continue carrying that message right now to get your parents, your grandparents immunized. It's really critically important, independent of party—we don't want to lose anybody else to this virus that we could have prevented. And I think we can all see now, even with consistent messaging, there are significant surges. And so, it's, you have to move past senior leaders’ messaging into the community, owning that message and being able, in a peer-to-peer way, to be able to effectively communicate that message. So, I am very hopeful, because I saw great camaraderie in whole groups that really helped us get that message out, and we need that now around vaccination.

Steve Morrison: Thank you, Deborah, we're really grateful that you spent so much time today with us, and that you were open to talking about some really difficult issues and ones that impacted you personally in very profound ways. And I just want to thank you, as Andrew has, for your service to our country and for your continued friendship towards us and CSIS. Thank you so much.

Andrew Schwartz: Yes, thank you so much.

Deborah Birx: Thank you. It’s so critical to remember you can’t have strategy without science and data, and I think CSIS has always recognized that, that science and data should drive strategy, and I think that institutions like that holding the federal government accountable, independent of administrations, is really key.

Andrew Schwartz: Thanks so much.

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