U.S. Missteps in Handling the Pandemic

[MUSIC PLAYING] Hi, everyone. You're watching Coronavirus in Context. I'm Dr. John Whyte, Chief Medical Officer at WebMD. We have millions of cases of COVID in the United States.

Over 250,000 people have died from COVID-19, and we're heading in the wrong direction. So to help provide some insight as to what's gone wrong, and how do we stop from getting to 20 million cases, I've asked Dr. Howard Koh to join me.

Dr. Koh is a professor at the Harvard Chan School of Public Health, as well as the Kennedy School, and he is a former Assistant Secretary for Health for the US department of Health and Human Services, and a former Commissioner of Health for the Commonwealth of Massachusetts. Dr. Koh, thanks for joining me.

John, thanks so much for having me.

I wanted to put all that bio in there because it shows you know what you're talking about. And you've dealt with public health crises throughout much of your career, particularly in government, as the Assistant Secretary for Health. So what has gone wrong with COVID?

Is it the issue of that it's the novel coronavirus, so there's a lot that we don't know? Is it an issue of lack of federal coordination? Why are we at millions of cases and developing millions more?

So, John, first of all, thanks so much for having me. And you're right, these public health emergencies are just part and parcel of the public health landscape in our generation. When I was first the Massachusetts Commissioner of Public Health, 9/11 and anthrax occurred on my watch, and so that was my introduction to public health emergencies and the need for crisis leadership. That was an unforgettable time for me, now almost 20 years ago, which I can't believe.

And then when I became the Assistant Secretary in 2009, H1N1 was already on the horizon, the last pandemic our country has faced. So I have served in the trenches here at the state and federal level in times like this. John, when crises like this arise, what you need first and foremost is for an empowerment of the top public health agencies and the top public health scientists. You need regular communication with the general public, coordinated and galvanized by the White House, if I can say, so the messages are consistent. And then you need, most important of all, a one government approach where a federal, state, and local leaders are all working together.

Now I've worked for both Republican governors and a Democratic president. And a time of crisis is one where you need a bipartisan, if not nonpartisan, approach when you try to care for all people, and get through the issues, and put it behind us and move forward. So that's what we need, and we've not had a lot of that in the current response, unfortunately, and it's led to so much of the confusion that we're witnessing. So now with the new administration on the horizon, we're hoping some of those trends can change, and we can move forward as one nation and have a united effort for the United States.

When you were leading public health efforts to address some of the crises that you mentioned, was there an attack on science? For instance, people are questioning the facts around the usefulness of the wearing of masks. Did you have to battle that type of misinformation?

No, we did not. I'll just say it very simply. And so this confusion about the basic science has been a very disturbing part of the pandemic response this year. And I worked very closely with Dr. Fauci when I was Assistant Secretary.

That was incredible honor. I mean, he's one of the top public health figures in the world. He's universally respected. And again, in times of crisis, you lean on the top scientists to tell you what scientific facts are. And then you try to shape the best public health guidance around that science.

So it was never put into question, or undercut, or sidelined, in any way. So we've got to get back to a time where we are sending unified messages. And for masks, for example, its universal use is long overdue. I know the President-elect wants to advance that theme, from perhaps the first day, when he assumes office.

And this is a way to promote the power of prevention, not just for you the wearer, but for people around you, the people you care for and love. And people say it inhibits freedom, but I often like to point out that it boosts freedom. It allows you to go out and interact with the public, and hopefully get your school and business back on track. So these are some of the messages that I hope are put forward, sooner rather than later.

How do we address that mindset, though? Where it's, you have your facts, I have my facts? They both can't be right. And we want people to come along without having to beat people over the head. So how do we do it in a way that's respectful of people's opinions, but recognizing everyone can't have their own facts? And at times, we have to do things for the good of the community, as well as for ourselves.

So here is where I think the consistent communication, if not daily communication from the highest levels of government, is very important. We've seen that from a lot of governors in the last 10 months and counting but inconsistently from the federal government. So if we had a daily national briefing-- And we need that. This is the worst public health emergency we've had in a century. We should have a daily briefing, sponsored by the White House, but we're the scientists take the lead and start with the facts and the data.

Should it be the career scientists, as opposed to political? Some politicals are physicians and health professionals, but will it make a difference if it's the career scientists who aren't necessarily influenced by the political nature of the events? We haven't heard enough from the career scientists, have we?

No, we haven't. And Dr. Fauci, I guess you could put in that category. Although, he is in his own leadership class.

But as you know, having worked in the Department, there are many top-notch career scientists at FDA, at CDC, at very senior levels, who have been there a long time and will continue to be there. Is it important to hear from some of them? I'm just trying to tease it out when we think about communications strategies. Because for some people, it will simply be it's one group of politicals replaced by another group of politicals. And that can be very divisionary. As opposed to, if we focus on, as you say, the science and the presentation of the science, we'll do better. Because the example, Dr. Koh, is let's talk about vaccines. In some ways a success story of innovation, right? But people are saying, hey, hold on, it's too good to be true. I don't believe it, so I won't be standing in line. But early on, when we talked about vaccines in February and March, people were thinking, how are they going to queue up and line up? Now people are saying, I'm going to wait. I'm going to wait and see how you do, Howard, before I go. So how do we address that? That's science.

First and foremost, whenever any health challenge comes up you ask, OK who are the top subject matter experts? And let's hear from them. I mean, John, you and I have been in so many briefings in government and outside.

And you would start any briefing hearing from the top subject matter expert. And you give them the stage for the opening minutes, so that you can put the basic facts out there, and then you discuss the options and the implications. With respect to the very important issue you're raising about trust and confidence in a future COVID vaccine, I mean, we're all really concerned about vaccine hesitancy and resistance.

Not just from the general public, but documented increasingly in health professionals. So we've got to reverse that immediately. And one major way to do it is make sure that this FDA approval process, or authorization process, is held at the highest scientific standards, involves outside expert advisory committees, and make sure that the results from the phase 3 trials are transparent and published in high-profile medical journals.

That's the only way to do it. In fact, that's the history and legacy of FDA. They've done that many, many times. So we have to have that happen again. And try to restore the trust and confidence, so vaccines can be accepted and we can get this pandemic behind us.

What do you say, though, to people who will argue, there's been a lot of science that's been politicized? Birth control pills and whether or not they should be over-the-counter, prep for HIV, those are just some of the examples, are those valid comparisons?

I don't think so. Because this is a time of historic importance. And we also know that the science has been evolving rapidly over the last number of months. I mean, we know so much more about this virus than we did 10 plus months ago.

And so as the science evolves, we have to embrace the new learning. Again, defer to the top scientists the top subject matter experts. And then, keep shaping and updating our guidance based on the best science and stressing to the American people. That's the only way we're going to get this behind us.

Otherwise, we're going to be in this for much, much longer. And there's been way too much suffering so far. And so much of it could have been prevented if we didn't have so much confusion. So we've got to rally around and do this as one nation. And that's my overriding thought about this whole response so far.

How long is it going to take to restore trust in some of the previously most trusted institutions, such as CDC and FDA? Let's be honest, there has been some missteps along the way. And you helped oversee those agencies during your time at the Department. What do they have to do to recover from the missteps, some serious, that they've taken over the last few months?

So I'm hoping when the new president gets inaugurated, he will empower his top public health agencies, empower his top public health scientists, and let them do their job. And we have actually seen the CDC, just in recent weeks, becoming a little more forward about their guidance and the MMWR. We didn't see that through the summer and other times when some of their messages got very confusing and started rattling some of the longstanding confidence we've had in that agency.

And that's traditionally been one of the best public health agencies in the world. And I respect so many of my colleagues who are still working there day and night. So I'm hoping that in the right leadership environment, the science can shine and that people can feel empowered to say what the scientific truth is, as uncomfortable as it might be.

John, I know that having served in these emergencies, and having done many, many press conferences through these crises, the first thing to do is get up and tell the public what you know and what you don't know. And lots of times that data has information that you wish didn't exist. I mean, lots of times the information is not good news.

But the challenge of any leader is to speak the unvarnished truth, and put it out directly. And then say, OK, here here's a challenge for all of us, and now we gotta rise up and face this together as one nation. So that's what I'm hoping we can do. And then restore science and credibility for these agencies at the same time.

Tell us your prediction of how things look six months from now.

I think, and I hope, that we're going to be substantially improved. First of all, we are hoping that these two vaccine candidates, hopefully, can pass the FDA standards. And don't want to get ahead of the FDA. We have to let them do their job.

But assuming we have at least two vaccine candidates authorized by the end of the year, and perhaps more. And then this is rolled out according to the criteria that have been crafted by the Advisory Committee on Immunization Practices for CDC, the National Academy of Medicine, and others. And we have the greatest good for the greatest number at the beginning, try to get the supply to meet the demand as much as possible, and then keep emphasizing the need for the power of prevention.

Elevate mask usage, so it's universally done across the country under our new President. So that message is loud, and clear, and not confusing. And then, have all of us working together to support all those aspects of prevention and care.

I would like to think that by sometime next year we will be, hopefully, back much closer to normal than where we are now. Now, this is so complicated. We have all been humbled by this, but we can get through it. And that's where science, and prevention, and public health is so important.

How do we get more physicians, nurses, other health professional, pharmacists, interested in public health? It's going to be a challenge. You know, we wish we had more contact tracers, we wish we had more people going into public health. Do we have a challenge ahead of us, given what's been going on the last few months, to continue to recruit young people to enter the field of public health?

Well, John, on one hand it's not easy. Public health is a tough field, the pay is low, the pressure is high. I'm very concerned for my colleagues at the state and local level who are tremendous public servants and are getting criticized and getting pushback for promoting mask usage and other prevention recommendations.

But on the other hand, John, you're looking at a guy who started his medical career wanting to be the best clinician in the world. And I trained in multiple areas and had several decades of caring directly for patients, which I was privileged and honored to do. But very early on in my career, John, I saw too many of my patients suffering from preventable illness, and it really pushed me to think more broadly about the importance of policy and then, ultimately, prevention.

So that's why you're talking to me from this vantage point right now. And I can tell you that this is the most fascinating and rewarding field in the world. Not easy, often frustrating, but you can't have a more rewarding career than in public health.

So I am passionate about this field. I'm passionate about prevention. I'm passionate about public service and good government. All my students would tell you that.

And so I think this is an area that's going to hopefully attract even more attention the future, despite how challenging it is, because everyone sees the need. And we're not going to have a better and healthier society and world unless we have more professionals like the two of us and many others spending more time and making a commitment for a better future. So that's my hope.

Well, Dr. Koh, I want to thank you for your optimism. I want to thank you for your service at the federal level, at the state level, at the community level. And for training the next group of leaders as well. We certainly owe you a debt, so thank you.

Thanks so much for having me.

And thank you for watching Coronavirus in Context.