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tv   After Words Deborah Birx Silent Invasion  CSPAN  July 5, 2022 4:37pm-5:37pm EDT

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coverage of the u.s. response to russia's invasion of ukraine bringing the latest from the president and other white house officials, pentagon and state department as well as congress. we have international perspectives from the united nations and statements from foreign leaders all on the c-span network, c-span now free mobile up and c-span.org/ukraine. web resource page where you can wash the latest videos on demand and follow tweets from journalists on the ground. c-span.org/ukraine. >> welcome doctor birx, i'm going to call you debbie. i've known you for many decades, we've all known you in the public health field. it is a privilege for me to be here with me to talk about the brilliant new book. you know stt simply. you know explain the title
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silent invasion and you know the reasons you wrote the book what you talk about a little bit at the beginning of the book. yeah, great professor and i'm gonn >> i'm going to call you larry, so thank you, it is an opportunity to be with you again. we've had a long careeree togetr battling pandemics around the globe making sure the most vulnerable are served and i hope we take that message here in this country but i called it silent invasion to raise the alert despite the capacity we hadn't been diagnosing, truly diagnosing respiratory diseasesi ever in this country. i was confronted in africa, actually 1998, treated as malaria first amend something else and then it's something else and maybe tuberculosis and maybe hiv and it was presumptive
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and we didn't know specifically harming the people here inhe africa. we worked with the private sector and now we can diagnose hiv tv matter where you live in africa the matter if you are the farthest end of the road or a metropolitan area. to come back to the united states and find out 99% of flu was diagnosed presumptively as we were only surveying for symptoms of respiratory diseases and making assumptions about what people were infected with, i found that really shocking in this day and age. the 20th century. not the 21st century. so i really wanted to alert americans to the fact that we still could suffer a silent invasion. this virus came to us silently because we were not testing what our common respiratory diseases are and if you don't know it's
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flu then you don't know if it's not flu. and so it's really a call to action for definitive laboratory diagnosis of all of our respiratory diseases so that we know what's here, and we know what's coming and i think even today the virus is silently moving around our communities and we are not adequately making it visible to the american people. yeah, i'm i want to talk i want to dig in a little bit more as we go along your remarkable career with. you know hiv tb malaria and also, you know, ebola h1n1 influenza sars on zika. so we want i want to get into that kind of rich history that i know that you've had and you've been really leading the public health response in american globally for such a long time, but there was another you know, the idea of silent invasion you
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make another point of quite forcefully and i think you know in the book about the silence of asymptomatic spread. and you talk a lot about the idea that you know, if somebody has flu, you know, they seemed they they have symptoms and their their but you can have a lot of spread before there are symptoms arising. can you talk a little bit about that part of the silence? yeah. so thank you this virus in many age groups is invisible and then very visible in a group of age groups and people with comorbidities that and having severe disease and dying. so if you don't see it, and you don't see it coming then you miss all of the tools that we have to utilize them so that americans not only can survive but thrive and i also use silence invasion because i'm i'm come out of a family of a lot of
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scientists. we're big science fiction fans, so i want to really give voice to those of you who love science fiction. this was not science fiction, but i think in a way many of the science fiction books have been talking about pandemics and global spread for a very long time and that as a societies were not and i think i'm hoping and that's why there's an appendix at the end with clear legislative fixes that need to occur. i just feel like even today with all the tools. we have we we were main vulnerable to silent invasion community by community because we're not up the asymptomatic spread. yeah, i love you know this the science fiction, you know when i grew up it was kind of wasn't science fiction. my favorite book was the microbe hunters. i'm you know, the early story of you know, a people that are
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looking into anthrax and and and and tb was just you know, it fascinated me at the time. so one of the things that you said you wrote the book for you know, i you know, you said you were riding it not to condemn not to commend but to recommend and i and we're gonna i want to get at the very end of our interview debbie the idea of you know what you're what your blueprint for the future. but let me take you back now. i think i want to go back to the beginning both to the early days, but also to something that you said early on that you would compelled to accept the job knowing who donald trump was talk a little bit about why when you got the call you you were reluctant, but you answered that call. well for those those global public health people who have
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known me for decades know that when i see an injustice when i see an inequity when i see that that results in people's lives being altered. it is something i'm a compelled to address and so in january i could see this virus coming and obviously i was responsible for sub-saharan africa and asia and i was very worried about everybody that we serve there community by community and i i looked at the data myself and i was like this is going to be serious. so my first step was to go to the white house to the africa bureau of the nsc the national security council and say to them i need to have an emergency meeting with all of the african diplomats and so before the end of january, we've got all the applicant african diplomats in the indian treaty room, and i'm going through why i'm concerned. i have dr. fauci talk. i have dr. redfield talk about what we were doing domestically.
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so that africa could know and cable back to their country's two things that we need to rapidly develop tools and that they can tell their ministries to utilize the capacity that we built over the last two decades with pepfar and i wanted them to know that our resources were available to them immediately. and so i'm trying to get africa and asia ahead of the curve and we're sending out cables through our state department to all the embassies about my concern and how to utilize pep bar dollars to expand testing and let the ministries of health know the depth of my concerns and i'm assuming that the same things happening in the united states, but then i just watched over february i was over in africa most of february and i'm watching and i'm watching the nightly news and i'm watching the reports of the press conferences. the tours, and the president are
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holding and they keep talking about the risk being low and that we only have this handful of cases and then we're going to close our air i were going to close to china, but we're going to let all of the expats come back and we're only going to screen by symptoms and i was like, the virus is everywhere. so i did have a friend in the white house who's was the husband to obviously in pottinger who i knew quite well and i felt like they weren't acting so i'm sending him all these messages and data about how severe i think this is going to be and he's taking it to the task force and he's telling me they're not listening and i'm like, please tell them again and i'm like pushing out these messages and he's calling me and saying you need to come back and help but of course, you know, my commitment words to the people i
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was and frankly i knew about the white house. i knew how i frank, i frankly knew how i would be perceived even though i was a civil servant and had nothing to do with trump political machine. i knew if i went into the white house to help that all of their perceptions about the president would also become their perceptions of me because most people in america didn't know me overseas people knew me but not in america and we all knew you here for sure in the field so i get saying no, but i i could just see the tsunami coming and i felt like the diamond princess was such a real example to me about how america was misjudging this pandemic by only testing symptomatic people and the people that they were living with and not testing the crew on that diamond princess and only
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looking for symptoms the crew was much younger. i knew the virus was spreading through the crew. i just i just like we weren't utilizing all of what i had learned and others had learned by working globally on pandemic after pandemic to bring that knowledge base to the united states. so finally out of frustration. i answered the call and came back. yeah. do you regret it? all debbie? i mean looking back and seeing what president trump did in downplaying. well, i'm gonna we're gonna get into that because you talk a lot about that in the book about, you know, flu-like illness low risk and other kinds of issues like, you know bleach and so forth. do you do you what do you think when you think back to those days those early days? well, how do you reflect on it? well, the reason i don't regret
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it is because i know what happened upon my arrival, you know, those people who know me know that doesn't matter who's president. i've worked with presidents across the world. i don't care who's president. i don't care who's prime minister. i don't care who's minister of health. i believe that i can assemble the right data to convince them to do the right thing and i had seen that happen throughout my career. i saw african presidents finally. let us address the lgbt community to people who inject drugs to people who are in prisons who let us do the right thing to prevent hiv and to prevent and to treat those who needed our treatment so i believed having worked with so many that with the right data, i could convince the president and the vice president that this was serious. and and so i arrived with my list. i was really happy that first
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week that immediately when i said to the vice president. here's a list of people to immediately call to the white house. we have to have our commercial laboratory developers make tasks not just pcr tests, but antigen tests and antibody tests and we've got to have it immediately and you got to get them all here by wednesday. they were all there and so there was a lot of action that first week both on pushing therapeutics pushing vaccines pushing testing getting people to take this much more. seriously. i just want to thank my european colleagues because obviously i knew a lot of them from working on the global fund for nearly a decade and they helped me they sent me their data they were about two weeks ahead of us and i used that data for the european travel ban the 15 days to slow the spread and the 30 days to slow the spread and if people go back and i think when history is written they'll see
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that that first wave compared to many other countries was much more contained than any other wave subsequently and i think as a country we reacted seriously in those three to four weeks and then we didn't and that was very disconcerting to me on certainly the i talk about the book how the president got very different analyzes from his economic his cea team and really that unraveled the president's confidence that my data was, correct. yeah, you you show. so i mean for me in reading the book the one thing that comes across as your love of data, and you know, you're frustration when it's not there when it's not. accurate when it's not comprehensive when we're having to borrow data from other countries to make decisions here
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when we should be at the vanguard that really came through before i kind of go on and i want to look more in depth at the us response and also a little bit about the early days in china. i can't help but ask you didn't really feature in the book, but you you talk a lot about africa you have you probably you know, the one american in this nation that knows africa and and it's intersection with disease more than anyone else. what do you make of how covid is as transpired in africa? we thinking that it would be cataclysmic and you were warning that early on. and yet they you know, there's that there's some evidence that there's been less severe disease. maybe that's a reporting issue. maybe that's an issue of of just simply having a younger population. what's your how what's your take
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on africa and covid? well there that's a brilliant question and and it intrigues me and it treats me to today certainly. some of it is testing and reporting, but you cannot hide severe covid disease and you can't hide most of the covid deaths and i i've said that across this country to many governors and mayors. there will be a full accounting state by state county by county by what actually happened but in africa they were blessed by three things that were really critical across the main part of africa that most people know around the equator going north. in south from east to west africa, the median age is between 15 and 14. so 15 50% of their population is younger than 14 and we know from data now that this virus was very selective in general for
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the elderly. and so if you look at the continent and that includes north africa, which is a very different situation i can talk about that separately. but africa is a continent has less than 9% of their population over 65. we have almost 20% i think the other big piece of it though is obviously with the history of hiv and tb a lot of the individuals in the 90s in the early 2000 before pepfar on the global funds to come to hiv, you know, millions and millions of people so it emptied out a lot of the people who could have been 30 40 and 50 on at this point. we've changed as a community. ability for people in africa to thrive despite. hiv tbm malaria, i think the second point is much lower comorbidities compared to the united states much less obesity. and that's why if you look across namibia south africa botswana and eswatini where they
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do have older individuals where they do have more comorbidities. you see a higher fatality rate from covid. and so the younger generation the less comorbidities certainly under reporting, but i can tell you when you look at access deaths on you don't see the same level of excess deaths and 2020 and 2021 that you see in the developed world. and i think it's really a wake-up call because like you larry we all thought pandemics wouldfi be horrific and low and low middle income countries and in the end, this pandemic singled out upper and upper middle income countries and there was no natural allies of those countries because we are all focused on low and low and middle income countries so there were no more channels to share information between our european colleagues in the u.s. and
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central american colleagues in canada. we thought it was going to be there and it was here. i think this opens up a glaring mistake we all made the last two or three decades, establishing clear data exchanges among the upper income countries. >> very important points. briefly on the early days of china and wuhan and what the president knew or should have known and when and also reflect, there was a significant clash between the white house and china on a number of issues but particularly the lack of early
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reporting and lack of early reporting in an honest way for human transmission and it ultimately led to the president sending a letter to secretary, un secretary-general giving a 12 month notice of withdrawal from who. part of the all unfold in the white house and play into the early days of u.s. covid response and the global covid response? >> i wasn't here and could never really understand. when i arrived at the white house, no one gave me any cia or other cables to suggest that there was information coming in through secure channels how severe this would be.
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when i heard bob woodward interview i was shocked as america was because when i arrived, when i say no one, i mean no one in the white house from the nfc to the cia to the vice president of the president, no one shared with me that they had an understanding about the severity. my feeling was they are not taking this as significantly as i think it's going to be and why we have to make these changes but that was very disconcerting to me, the interview was june or july of 2020, i was shocked and still no one showed me that actually existed so to this day i've never seen that document that talks about the severity. the reason i knew it g would be severe is you could see on social media the hospitals were
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going overwhelmed in january and at the same time saying we don't think there's human to human transmission so if i'm seeing social media posts, the who should have been seeing the social media posts and should have gone to the world and said this virus highly contagious spreading rapidly and result in significant illness and those over 70. i am still surprised by that, the data was out there, it may not have been coming from china but that was the whole reason for putting who representatives in every country, so you weren't always reliance on just the national reporting. after what happened with stars, i thought we learned that lesson collectively as a community but
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i think it's against that early misleading about human to human transmission, i think it resulted in a lot of countries making poor decisions about not developing and taking it as seriously as they should have. ... you know, you heard dr. burks say that you got to the white house and none of our most sophisticated machinery of government, you know cia intelligence national security white house staff were seem to be aware of the seriousness of it. i mean, that's a stunni seems to a deal where the seriousness of it. i mean that's stunning. >> i think nfc was because matt was trying to get them back here but i don't think the agency really was at thing discretely.
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>> would you include the cdc and that? >> you know i don't know what the cdc was thinking at that time but i can tell you that they did not prepare the country for a countrywide pandemic that was evident already in china. what do i mean by back? getting up the data stream that you needed ringing in the commercial laboratory developers. you know it's great that they work on tasks for the public healthey lab. health lab that we all met public health labs. they are not what we call high throughput laboratories. this platforms were in general platforms that could do a handful are less than 100-ton a day. we were going to need millions a day so we had to bring on board our commercial laboratories. until nancy mad' that comment at the end of february, i don't
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know -- >> justur so our audience knows she's the official at the cdc. >> when nancy said she was worried, but that was the end of february. i was worried six weeks earlier. i wasn't here. i didn't watch it. i try not, i not, i don't know what data they had or didn't have. i just know when i write on the second of march we were incredibly flat-footed as a country. >> you know a lot of your book particularly in the first half was about the u.s. response so i wanted to dig in here a little bit. you talk about missteps and i thought we would start with the missteps and get onto the operational things.
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testing was a big part of the story and you started talking a little bit about the labs and just expand on that. why was the cdc seeming to be soft based on testing kits? and also talk about their communication with epidemiologists and others. just take us back to those early. difficult times in our testing capacity in their testes kits. when w.h.o. had a test kit when our allies like germany were using better test kits the cdc decided to develop its own. tell us a little bit about that story. >> to this day i don't know why it happened. i got so frustrated after he left in january of 2021 with the
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covid response. i talked to thee laboratory the big commercial laboratories and i said what kind of dialogue were you having with the cdc and dhs and how come we didn't have these tests and what was going on and what they told me they were calling the cdc in january. saying how can we help, how can we help and what do think you were going tore need and the cdc told them they were going to need help. i think, i guess working in resource limited settings high never turn away help even if you're not sure you absolutelyab need it. when people say how can i help i give them a list. because you know you can't know how bad things are going to get so you prepare for the and hope for the best. and in my mind because so many
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people focus on contamination. in my mind that is not the problem. the problem was they needed tests are lowve throughput platforms because they firmly believe that they would only be randomly testing a few samples in each of the public health labs and they'd be able to track this virus solely through symptoms. they had the symptomatic model of how they were going to prepare an how they had surveillance around the country all based on symptoms. there was nothing in there about widespread commercial level tesf us who have battled pandemics paaround the globe we had a legp because we know most viruses are invisible. and most of the transmission is occurring in an invisible way.
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>> hiv is a great example. >> yeah so you are early on i talked with a lot of cdc colleagues and i was talking with him about house so much of the spread in hiv was -- and we weren't able toco change the pandemics course until we startedmp working with young people and finding the asymptomatic virus and getting them on therapy and working to prevent new disease. we weren't successful until we did that. so what i heard back from the cdc in that meeting if they went back to the cdc in atlanta and said well she thinks, she doesn't understand how viruses are transmitted and she's trying to use thehe learned model which wasn't my point at all. my point was you can't see the virus. eiyes it's being spread in a different way but you have to
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make invisible viruses visible and they completely discounted what i said because they were like let's use this on malaria and ebola. she hasn't worked on the flu. we have all worked on the flu. if you work on a nationally you've worked with the flu and you worry about evianus flu. what concerned me than concerns me now that unwillingness to listen to others' ideas. i think the cdc has gotten quite insular by being in atlanta and i do think they really have to be much more open to really looking transparently at the date and letting the day to teach them and get them out of their perceptions and assumptions and into a place that really is data-driven. >> the idea of you know in theai
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beginning there was this resistance against the ideas of the asymptomatic spread was a major factor in transmission of kobe two. >> and that continued. that's was so disconcerting to me because obviously fda, those of us who worked with the fda for a very long time understand the limitations of these control panels that they have developed a control panel obviously for systematic disease because that's the only thing that they were looking for so they had to 'validate the new tests. as late as july i'm trying to convince them in the cdc that antigen test can't be used in asymptomatic patients. it took an entire 12 months in addition to condense both of them you could use antigen test
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prior to having symptoms and that really held back states because cms and other payers were able to pay for tests that the d.a. and the cdc couldn't detecting could be utilized for a diagnosis. so we got in our own way several times. >> yeah. testingou was one of the misstes i suppose is an understatement. there were some other areas. let's think about personal protective equipment. we remember early on with new york hospitals flooded with cases and cases spreading around the world and we ended up with u the shortage of personal protective equipment. and also a lot of confusion around the science messaging in
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terms of masking and what kind of masks. one of the things you said in your book really i learned a lot on why did we assume the n95 respirators that people wouldn't wear them. talk a little bit about the shortages and other shortages ventilation oxygen and then zero in on that and the early days of masking and even today masks have become aom flashpoint. >> soyou know really critical important question larry because we are vulnerable today to lack of essential medicines and it was clear and it's clear now the disruptions in the supply chain and we don't have any of those
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essential medicines here. i will never forget the admiral coming into the task force one day, i think it was april or may. it all blurs together sometimes when we have a supply shortages and he came and said i'm out of propofol and for those of you who don't know that's an anesthetic that people use when people have to be on ventilators so the individual is put into a sleeping state so they don't fight the ventilator. it's really critically important and we were running out. so not only did we have masks and did not have gowns are loves her ventilators now we are running out of essential beds for hospitals and none of these things are made here except for it n95 and i heard so much about
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our supply change -- supply chains in the fabrics that are usedat for mass are used for gowns. so people who are make in gowns we couldn't get gowns and it should be a national security issue that we do not have capacity in this country to make the essential medicines that we needed in a time of crisis and we have to have congress address this. it is critical for our health and welfare in the future. it will take some time and yes in certain cases we are going to have to pay a little bit more. in exchange we will run out of propofol. i just want to thank that group a cause they were under enormous pressure. and i've never said this before. they didn't really talk about it in the book but when i came back
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and found out we only had 12,000 functional ventilators in the stock pile, 12,000 total. and so the innovation that came from our anesthesia colleagues and jerome adams who pointed this out the with the filter change we could use the anesthesia machines. all of this innovation and creativity i want to give voice to that in the book but i think the masking issue illustrates what fundamentally is wrong with us in america. because we get so wrapped up in the periphery that we don't make the commonsense common sense judgments that a lot of our friends and family around the world did. that cloth mask work because
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they utilize e them during sars. early on it was the sires and we know the cloth mask for highly effective and i mean highly of 40 to 50% and we had to rely on data from the japanese in october. this is a study we should have been doingng in january to prove the efficacy of the mask. when you tell the american people that they should wear cloth mask because it's going to hold their droplets back from getting into the air. then tell them at the same time it won't prevent droplets from coming in, it's the same piece of cloth on both sides. they are telling people to make two ply out of minimum cloth mask and at the same time not telling them it's bidirectional. that confuses the american
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people.an no one will understand why it only works when you breathe out but not when you pretend. now we know you need a tightfitting mask and you do much better if you have the charge fabric layer and the n95 and those are available to the public now. i think we just weren't transparent enough with what we knew and what we didn't know and made common sense recommendations to people. >> course early on w.h.o. was not recommending them. so a mask is become a symbol of covid and they still are. still part of what you might call the covid culture war. there were some other
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interventions that we made in one of your chapters is called 15 to 30 days. that's about the lock down. tell us a little bit about that and what went on at the white house. >> when i came in that was part of my first week moving from the risk is low to risk of serious illness ands extraordinarily high. we are ready so far behind and i just want to make it clear you don't do a lock-down unless there is a crisis. we were and crisis. what was happening in italy i had model c out the fatality rae in italy and what they were learning and they still had extraordinary fatality rates. i was looking at our fatality rates and those individuals over 70. if you are 70 and diagnosed with
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covid, 30% of those individuals were succumbing to this virus. so we didn't have a the treatmet and we didn't know about clotting and we didn't have ventilators and we didn't have ppe. we were barely keeping up and they just want to be very clear we were behind in the human capacity to treat these patients. we didn't have enough human capacity. if we had had 25 new york's inner cities without a lot down we would ended up with hundreds of thousands and millions of people dying for that so the models were saying and i took their input and model what would happen if we did what italy did or europe did with a lot down and by limiting it to 10 to 12
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metros it would go to 25 and 220,000 americans lives lost. it was really modeled by the city itself and the bedroom communities based on what was happening in new york. as a country we prevented a catastrophic event and i mean truly catastrophic. not enough people to care for the sick, no ventilators, no ppe for our nurses and doctors in most of the hospitals. there are 600 -- 6000 hospitals and only four or 500 hospitals had to confront this high covid load. that's what america did. america stoppedhe the spread frm how much damage it could do but we probably weren't clear enough to the american people on how
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they are proactive behaviors changed the course in that first wave. certainly a lot of european countries did work -- worsen the first wave that we did and i'm talking about small percentages. nothing to be really proud about that we could have lost so many more americans with a footing that we are on. i just want to make it clear we were not preparing for a pandemic in this country. we were preparing for containing the virus and have very small number of americans. >> yeah,ea sure. one of the things i was struck i in the book was an e-mail exchange ahead he had with a high-ranking government official and you said vaccines wouldn't be enough and we have to rely on
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behavior change and the answer back was what behaviors and use side because of all the things you have been tellingee them abt the haters that needed to be changed. we have talked about a lot of the negative things in america you know the shortages of essential medicines in ppe testp lock-downs. but you also talk about the bright spot and if there were any triumphs of america it's the triumph of american science. particularly operation warp speed which i don't think the president got credit for and you and also we have got these new message rna vaccines that were super effective. are still very good.
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tell us a little bit about the success that we had in our science communities. >> firstt and foremost i'm so grateful to the private sector. the one thing that this white housewh got right and got right for ppe and for testing and got right for therapeutics was they believe that the private sector was supported and their technical capacity and niche and innovation and creativity in their relationship with biotech and universities and big pharma which unleash their capacity that they would respond in unprecedented ways and they did. we had a meeting with the laboratory developers on the fourth of march and i had tests rolling out in the hospitals
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within two weeks. they worked around-the-clock rate abbott roads and thermal fischer. these people dropped everything in their entire corporations in churning out these high-quality tests and not only rapid high throughput pcr's the pcr's that were helpful in our tribal nations and engine test. we had all of that within a matter of weeks to months and so that public-private partnership was extraordinary and then they went above and beyond in that big testing companies abedin rhodes. by work done hiv test my whole life and it was the same equipment. every night they compiled all the data fromso the day so i cod
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see what the test positivity rates were in the country. i had no datastream, none. the private sector did that for me. the private sector realigned their entire supply chain based on data and i'm just so proud of them. they took less profits to ensure hospitals had what they needed to protect our nurses and their doctors and to give their patients the drugs they s neede. i would say to them this is where the viruses and this is where it's going and cardinal house and henry shyne and all of these direct supply companies they realigned everything. it was based on equity and that was just so amazing to me. i want the american people to know that we have learned now how to deal with the pandemic
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and be the private sector part of the plan. we need them sitting at the table and we need to know what their ramp up capacity is because they did that for us. i just wanted people to be able to see what i saw what the tribal nations did and what universities did. there were universities that works that whole summer of 2020 to fully open by the fall of 2020 with all the people pointing fingers at them and saying you can't do this, it's not safe. they use the tools of testing and information behavioral change information to keep each other safe and those universities and those boards of trustees that believed in their students and open fully they taught meve so much because it s those universities today and
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yesterday and all three 2020 whom i was tracking the data in the universities they tested independent of their systems had much less committed to spread. it shows a roadmap of the way through this not limiting students at 70s. ensuring students have bequeathed tests. they totally changed the number of students who werefde impacte. the other thing the universities taught me was so important and why wantedd to get to every stae in to most universities to sit down with their students and their faculty to go through how they are confronting the pandemic. i was so impressed by her gen-z'ers who understood that for many students that was their only bad they are only ability to be in college in their own ability to work in college towns
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and they supported one another. they supported each other's mentalue health issues. it was so inspirational to me to see you what they did and what ourde tribal nations did and whether governors did independent of red, blue word democrat or republican. they heeded the call in those days of 2020. america stronger than what you see out there in the media because people really were doing the right thing across the country and really helping one another. >> that's a good point. private sector universities and tribal leaders c i was personaly working at georgetown so i can attest to that small laboratory of behavioral change. we g have only got about 10 minutes and i've a bunch of
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things i want to get through. since you are so global and i'm so global talk a little bit about the global responsibility in the united states. i'm thinking particularly about vaccine inequity in their early decisions about. purchase agreements with their vaccine companies and global scarcity and now there's more vaccine infrastructure that talk a little bit about all the vaccines in the inequities because i know it's near and dear to your heart. just the was not inequity of thee vaccines, it ws the inequity of access to gloves and access to mass and downs in public equipment and access to therapeutics. we have learned a lot about these vaccines. these vaccines are not want to protect countries from infection
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and reinfection. we just have to admit that and that's why i'm excited with the work. you can change an adjuvant and potentially increase the durability from four months to multiplee month. right now we should be very clear about who b needs to be vaccinated and boosted and we have to be talking with african countries in the colleagues around the world about identifying those individuals with diabetes and hypertension obesity and asthma steroid dependency in cancer t treatment and making sure they are vaccinated and boosted and then we should be working around-the-clock to do with what we did with pepfar. pepfar worked with a large pharmaceutical companies and the large pharmaceutical companies agreed on a patent protection
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waiver that allowed new hiv drugs to be made by non-branded suppliers expedited and approved by the fda in a parallel mechanism to ensure they were safe and effective and allowed us to buy those. we were able to bring the best treatments to sub-saharan africa and asia and around the globe. that should be happening right now with covid therapeutics that we know how to do it and we know how to distribute it and we need to use the distribution mechanisms that we utilize with pepfar. we need to get drugs to the remote villages. we could get vaccines the most remote villages. i feel like we are still not taking advantage of everything that wee have learned to the decades. i find that there are pandemic people that look at it as this pandemic and the rest of us
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who've been through a pandemic for a decade and know how to confront these. they reallyy need to be talking to those individuals and not people within the united states who have never confronted a pandemic before this one because we know how to work with communities and local government to ensure access. we have significant access problems in this country right now and it's part of the reason why the t red counties which somehow people are thinking that they say that they voted for trump it's like a justification for them not doing well. we need to be looking at red counties right now and say what is the problem? the play with the problem is. i was out there and there's no health care. there is no primary care physician. they are getting their eye care fromng walmart and their health care from emergency rooms three hours away.
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address with access and barriers are in reality, not what you think they are. get out there and see what they are and fix fix it. we should be using data in real time. no one should be dying of covid. let's all agree to that and figure out why it happened and fix fix it. fix it then. don't publish a study fourr months later. fix it in real time and make the dataem transparent and available to every american so they are empowered with the ability to make decisions to increase their risk and the risk of their vulnerable family members. i saw this for decades in sub-saharan africa. anyone can learn thisav information. he don't have to b' a ph.d. and you don't have to be an m.d.. it's our job to make it understandable. it's not our job to point fingers and implied if you voted for trump you are more likely to die of the disease.
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if they are in a remote county that is on us. it's so disappointing to me to see it still politicized even in the media about red and blueat counties. that should be a call to action. that should be a call to all of us who work in public health. >> i have intentionally not thrown president trump into this but i think our listeners want to hear reflections aboutut tha. talk a little bit about the trump administration and comparing influenza to low risk and other things like the virus goes away. sunlight, leached hydroxy chlorine. it must have been frustrating for you.
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we have only got literally a minute or two. if you want to spend 30 seconds on that and then just tell us about what you think and hope for four the future. >> ssfrustrating but not impossible. that's the message i want to leave with all of you. youyo find yourself in situatios and people would say things about you and it really doesn't matter because you were there for one reason. no matter how frustrating, i've been frustrated my whole life with hiv with many leaders who would tell people if you took a showerll or slept with a. all of this magical thinking and this is not unusual. pandemics are clinical and it's our job is public health people to get in there and work every day and do the right thing. some of its evident in some of it's not evident. it isn't about you.
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about what you know and making that translate into saving lives. the last chapter of 40 pages as we continue to make missteps in 2021 and now 2022 because we are panned it -- doing pandemics by polling and what we think the american people are willing to do. give them the data could show them in real-time and they will do the right thing. i just don't understand this unwillingness to put all of the data up county-by-county and race and ethnicity. you can blur it enough thatt there's no violation of hipaa. we do it every day of pepfar. gov. ask where there's a physician and nurse practitioner and look at how underserved their red counties are. we can fix fix it but we have tt the right data.
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magical thinking was prominent in the trump administration. it bleeds into our current administration we just can't let that happen. i know mays coming and people will say look how low the case counter but you know what follows may? a summer surge in july and august across the southern states so let's get ready now and do the right thing. >> thank you. noamma chomsky just a master cls and master class and i want to thank you for your service. he talked about the importance of public health science data and supply chains -- supply chains inoo things that people need to do particularly the pen takes on what we need to do. we thank you noam chomsky doctored deborah birx. >> thank you professor.
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is a follow-up to book you wrote in 2008 also about the generation. if you could start by telling us how you define this cohort of young americans and not so young americans that you've wri

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