berkeley to talk about ronald reagan's career and political movement. he's the author of several books, age of reagan series, greatness and patriotism is not enough, about the scholars who changed the course of conservative politics in america. join in the conversation with your phone calls, facebook comments, texts and tweets. in depth with steven hayward, live sunday at noon eastern on book tv on c-span2. ♪♪ >> weekends on c-span2 are a intellectual feast. every saturday, american tv with america's stories. brings you the latest in nonfiction books and authors, funding for c-span2 comes from these television companies and more, including comcast. >> do you think this is just a community center? no, it's way more than that.

>> comcast is partnering with a thousand community centers so students from low income families get the tools that they need to get ready for anything. >> comcast, along with these television companies support c-span2 as a public service. >> welcome, dr. birx, i'm going to call you debby, just, you know, i've known you for many decades. we've all known you in the public health field and it's a real privilege for me to be here with you, you know, to talk about your brilliant new book. i want to use, you know, start simply. you know, explain the title, silent invasion, and you know, the reasons you wrote the book, which you talk about a little bit in the beginning of the book. >> yeah, great, professor. and i'm going to call you larry, so, thank you. it's really an opportunity to

be with you again. we've had a long career together, battling pandemics around the globe and 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 really raise the alert that despite the capacity we hadn't been diagnosing, truly diagnosing respiratory diseases ever in this country. i was confronted that in africa, actually in 1998, where fever was treated first as malaria and then as something elgs, and then as something else and maybe was tuberculosis and maybe it was hiv and presumptive and specifically harming the people of subsaharan africa, and we worked with the private sector and now we can diagnose hiv tb and malaria no matter where you

are in subsaharan africa, the end of the road or a different area. to come back to the united states, find out 95, 99% of flu was diagnosed presumptively and 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. something appropriate for 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 flu, then you don't know if it's not flu. so, it's really a call to action for definitive laboratory diagnosis of all of our respiratory diseases so 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, and i want to talk-- i want to dig in a little bit more as we go along about your remarkable career with, you know, hiv, tb, malaria, and also, you know, ebola, h1n1 influenza, sars 1, zika. so 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 america and globally for such a long time. but there's another, you know, the idea of silent invasion, you make another point of quite forcefully, and i think in the book about the silence of asymptomatic spread. and you talk a lot about the idea that, you know, if somebody had flu, you know,

they think they have symptoms in there, but you can have a lot of spread before there are symptoms arising. can you talk a little about that part of the silence? >> yeah, so thank you. this virus in many age groups is incredible and then very visible in a group of age groups and people with comorbidities that and having severe disease and dying. and 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 silent invasion because i'm coming out of a family of a lot of scientists, we're big science fiction fans, so i wanted to really give voice to those of you who love science fiction. this was not science fiction,

but in a way many of the science fiction books have been talking about pandemics and global spread for a very long time and as societies we're not ready 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 were remain vulnerable to silent invasion community to community because we're not picking up the asymptomatic spread. i love science fiction, when i grew up, it wasn't science fiction, my favorite book was the micro hunters. >> yes. >> the early story of people looking into anthrax and tb. it 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, when you said you were writing it not to condemn,

not to commend, but to recommend. and we're going to-- i want to get at the very end of our interview, debby, the ideas of you know, what is your blueprint for the future. but let me take you back now. ng i-- i want to go back to the beginning. both to the early days, but also, to something that you said early on that you were spelled to accept the job, knowing who donald trump was. talk a little about why, when you got the call, you were reluctant, but you answered that call? >> well, for those -- the global public health people who have known me for decades know that when i see an injustice, when i see an inequity, when i see that it results in people's lives being altered, it is something i'm compelled to address, and so in january i

could see this virus coming and obviously, i was responsible for subsaharan africa and asian and i was very worried about everybody that we served there community by community, and 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, national security council and say to them, i need them to have an emergency meeting with all of the african diplomates and so, before the end of january, we've got all the african diplomates in the treaty room and i'm going through why i'm concerned. i have dr. fauci talk, and dr. redfield talk about what we were doing domestically so africa could no and cable back to their countries 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 pep far and i wanted them to know that our resources were available to them immediately and so, i'm trying to get africa and asian 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 far dollars to expand testing and let the ministries of health know the depth of my concerns and i'm assuming that the same thing is 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 that the task force and the president are 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--

we're going to close to china, but we're going to let all of the ex-pats 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 was the husband to-- honestly pottinger, who i knew quite well and i felt they weren't acting so i'm sending all of these messages and data about how severe i think this is going to be, and he's taking it to the task force and telling me they're not listening, i'm like please tell them again. ... come back and help but of course, you know, my commitment words to the people i was and frankly i knew about the white house. i knew how i frank, i knew how, 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. i can't say no but i could just see the synonymy coming and i felt like the diamond princess with 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 their crew on that diamond princess and only looking for symptoms. fcra was much younger. i knew the virus was spreading through the crew. i just felt like we weren't utilizing all of what i had learned and othersed have learnd by working globally in pandemic

after pandemic to bring that knowledge base to the united states. so finally out of frustration i answered the call. i came back. >> do you regret it at all, debbie? i mean, looking back and saying what president trump did in downplaying, we'll get into that because you talk a lot about that in the book about flulike illness, low risk and other kind of issues like with bleach and so forth. what do you think when you think back to those early days? well, how do you reflect on it? >> the reason i don't regret it is because i know what happened upon my arrival. 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 get as prime minister.

i don't care who was minister of health. i believe i can assemble the right data to convince some to do the right thing, and i've seen that happen throughout my career. i sawaw african presidents finay let us address the lgbt came unity 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 treat those in need of 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 so i arrived with my list. i was really happy that first week that immediately when i said to the vice president,o here's a list of people to immediately call to the white house, we have to have our commercial laboratoryom develops

make tests, not just pcr test but antigen test 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. igu just want to thank my europn colleagues because obviously i knew a lot of them from working on the global fund for nearly a decade, and they helped me. they send 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 will see that that first wave compared to many other countries was much more contain 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. that was very disconcerting to me. certainly, i talked out in the book how the president got very different analyses from his economic, tce 18, and really that unraveled the president's confidence that my dataa was correct. >> yeah, you show, i mean, for me in reading the book the one thing that comes across as your love of data, and her frustration when it's not there, when it's not accurate, when it's not comprehensive, when you are having to borrow data from other countries to make decisions here when we should be at the vanguard, that really dcame through. the foreign kind of go on and want to look at more in depth of the u.s. response and also bit about the early days in china. i can help but ask you, didn't really feature in the book but

you talk a lot about africa. you have, you probably you know the one american in this nation that knows africa, and its intersection with disease more than anyone else. what do you make of how covid is transpired in africa? we are thinking of the cataclysmic and we were warning the early on, and yet there's some evidence that there's been less severe disease. maybe that's a reporting issue. maybe that's an issue of just simply having a younger population. what's your take on africa and covid? 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 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 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 would be horrific and low and low middle income countries and in the end this pandemic singled out upper and upper middle income kind of incredible and there was no natural a lions of those countries. we were all focused on low and low and middle income countries. so again, there were no formal channels to really share information between our european colleagues and the us and our central american colleagues and and canada and we would because we thought it was going to be there and it was here and i think this is really opens up a glaring a glaring mistake that we all made over the last two or

three decades is really establishing clear data exchanges among the upper middle income and upper income countries. yeah, very very important point just very briefly on the early days of you know, china and wuhan and you know, what what the president, you know knew or should have known and when and also just reflect a little bit about you know, there was a significant clash between the white house and and china on a number of issues. but particularly the lack of early reporting and and lack of early. reporting in an honest way in terms of human to human transmission and then that ultimately led to the president sending a letter to secretary gutierrez the un secretary

general and not giving a 12-month notice of of withdrawal from from who how did you know how did that all unfold in the white house? and how did that play into the early days? of the us covid response and the global covid response you know larry i wasn't here and i could never really understand. so 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 about how severe this would be. so when i heard that bob woodward interview, i was as shocked as america was because when i arrived and when i say no one i mean no one in the white house from the nsc to the cia to the vice president of the

president. no one shared with me. that they hadn't understanding about the severity. you you know, my feeling was they are not taking this as severely i mean as significantly as i think it's going to be and that's why we have to make these changes, but that was very disconcerting to me to find out i think that woodward interview was june or july of 2020. i was shocked on and still no one showed me that that actually existed so do this day i've never seen that document that talks about the severity the reason i knew it was going to be severe is you could see on social media that the hospitals were getting overwhelmed in january and at the same time china saying we don't think there's human to human transmission. so if i'm seeing the social media post the who should have been seeing the the social media post and they should have gone

to the world and said this virus is highly contagious spreading rapidly and in significant illness. those over 70 and i you know, i i am still surprised by that the data was out there. it may not have been coming from china per se but you know, that was the whole point of putting who representatives in every country is so that you weren't always reliant on just what the national reporting was and after what happened with sars. we i thought we had learned that lesson collectively as a community. but i i think once again that early misleading about human to human transmission, i think resulted in a lot of countries making very poor decisions about not developing tasks and not really taking this as seriously

as they should have yeah, such an important point. i want to stress what the one of the points you made because 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 stunning. and state the nsc was because that was trying to get me back here, but i don't think the agencies really were acting including cd recently. would you saying would you include cdc in 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 a country-wide pandemic that was

evident already in china. and what do i mean by that getting up the data streams that you needed bringing in the commercial laboratory developers, you know, it's great that they worked on tasks for the public health lab, but we all know public health labs. they're not what we call high throughput laboratories the platforms that they made the tests for were in general platforms. that could do a handful or less than a hundred tests a day. we were going to need millions of tests a day so we had to bring on board our commercial laboratories until nancy messi'' a made that comment the end of february. i i don't know. i haven't saw our audience knows senior official at cdc. yes, so in nancy said she was worried but that was the end of february. i was worried in six weeks

earlier so i don't i wasn't here i didn't watch it play out. i i try not. i don't know what data they had or didn't have. i just know when i arrived on the second of march. we were incredibly incredibly flat-footed as a country. yeah, and you know a lot of your book particularly in the you know first, you know third to half was was about the us response. so just i wanted to dig in here a little bit debbie the the you talk about missteps and bright spots and and i thought we would let's start with the missteps and then get on to the bright spots obviously operation more speed but testing was was a big part of the story and you started talking a little bit about. the labs and and just expand on that. you know, why was cdc seem to be so off based on its testing

kits. i know at the and also talk about their communication with state epidemiologists and others, you know, just take us back through those early very very difficult days in our in our testing capacity in our test kits when i when when who had a test kit when our allies like germany were using better test kits cdc decided to develop its own. just tell us a little bit about that story. yet to this date. i you know, i don't know why it happened. i got so frustrated after i left january of 2021 the covid response. i talked to the laboratories our big commercial laboratories and said to you know, what kind of dialogue were you having with the cdc and hhs and asper and you know, how come we didn't have these tests and what was going on? and what they told me was they

were actually calling the cdc. in january saying, how can we help? how can we help we can help develop commercial tasks. what do you think you're going to need and cdc told them they weren't going to need help. and i think that i guess from working in resource limited settings. i never turn away help. even if you're not sure you absolutely need it when people say, how can i help i give them a list because yeah, you can't know how bad things are going to get so you prepare for the worse and hope for the best but you prepare for the worst. and in my mind because so many people focus on the contamination in my mind. that is not the problem. the problem was that they made it tasks for low through foot flat platforms because they firmly believed that they would

only be randomly testing a few samples in each of the public health labs, and they would be able to track this virus solely through symptoms. they had this symptomatic model of how they were going to prepare and how they had sentinel surveillance around the country all based on symptoms. there was nothing in there. about widespread commercial level testing and i think for those of us who have battled pandemics around the globe. we had a leg up because we know most viruses are invisible. and many of the most most of the transmission is occurring in an invisible way and hiv is a great example of that. yeah, so, you know early on i had a meeting with a lot of cdc colleagues and i was talking to them about how so much of the spread in hiv is asymptomatic and we weren't able to change

the pandemic's course on the continent until we started working with young people and finding the asymptomatic virus and getting them on effective therapy and really working to prevent new disease. we weren't successful until we did that and so what i heard back from the cdc years that we're in that meeting is they went back to the cdc in atlanta and said, well she thinks you know, she doesn't understand how viruses are transmitted. she's trying to use a bloodborne model for a respiratory disease, which wasn't my point at all my point. was you can't see the virus? yes, it's being spread in a different way, but you have to make invisible viruses visible and they completely discounted what i said because they're like, oh she's just worked on hiv tb. malaria and zika and ebola. she hasn't worked on flu. well, of course, we all have worked on flu of you working

internationally you work on flu, and you're worried about avian flu. so, you know, it was just it was that dismissiveness. that concerned me then that concerns me now that unwillingness to listen to others ideas. i think 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 data and letting the data teach them and get them out of their perceptions and assumptions and into a place that really is data driven? yeah, and the idea of you know, the you know at the beginning there was this resistance against the idea that that asymptomatic spread was was a major factor in the transmission of sars covey too and and larry that continued and that was so disconcerting to me because

obviously on fda was a proof those of us have worked with fda for very long time understand the limitations of these control panels. and so they have developed a control panel obviously from symptomatic disease because that's the only thing that they were looking for so the control panels to validate the new test we're symptomatic disease. so as late as july, i'm trying to convince them in the cdc that the antigen task can be used in asymptomatic patients. it took an entire 12 months in addition. to convince both of them that you could use antigen test prior to having symptoms and that really held back states because cms and other co-payers were willing to pay for a test that the fda and the cdc said couldn't detect and couldn't be

utilized for definitive diagnosis. yeah, so we got in our own way several times. yeah, so the testing was really one of the you know missteps i suppose would be an understatement. you know, there were some other areas that i we discuss. what about let's think about personal protective equipment in masks. we remember early on with all the with new york hospitals flooded with cases and cases spreading around the world and and we we ended up with a shortage of personal protective equipment. and also a lot of confusion around around the science messaging in terms of masking and what kind of masks there was. it was in one of the things you said in your book that really i i learned from a lot was you know, why did we assume for example the kn95 respirators that people wouldn't wear them

that there were less comfortable. where was the data? so talk a little bit about ppe shortages and other shortages of ventilation oxygen and then and then you know zero went on on masks and and the early days of masking and really we're even today masks have become a flashpoint in the united states. so, you know really critical important question larry because we are vulnerable today. to lack of essential medicine and it was clear and it's clear now when there's disruptions in the supply chain, and we don't make any of those essential medicines here. i'll never forget admiral polo check coming into task force one day. i think it was april. or may or i it all blurs together sometimes about when we had these supplies shortages. and he came and said i'm out of

propathal in days. and for those of you who don't know that's an anesthetic kind of that people use when people have to be on ventilators so that the individual is put into a sleeping state so they don't fight the ventilator it really critically important and we were running out. so not only did we not have mass that we not have gowns. do we not have gloves do we not have ventilators? now we're running out of essential meds for a hospitals. and none of these things are made here except for n95 and that i learned so much about our supply chain and our spun fabric and the same kind of fabrics that are used for mass are used for gowns. and so people who are making gowns switched over to mass then we couldn't get gowns. you know, it should be a national security issue that we

do not have capacity and this country to make the essential medicines that we need in the time of crisis, and i'm hoping that's why it's in the appendix. 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 but in exchange we won't run out of propathol so i just want to thank the supply chain group because they were under enormous pressure from me and i just want to i've never said this before i didn't really talk about it in the book, but when i came back and find found out we only had 12,000 functional ventilators in the stockpile 12,000 total and so the innovation that came from our anesthesia colleagues who

called us and jerome adams who pointed this out that with a filter change we could use the anesthesia machines. i mean all of this innovation and creativity. i also wanted to give voice to that in the book, but i think the masking issue illustrates what's fundamentally wrong with us in america at times because we get so wrapped up in the the the periphery that we don't make the common sense judgment that a lot of our our friends and family around the world did and asian new that cloth mass worked because they had utilized them during sars and so early on and with this sars covey, too. we know now that cloth mask. we're highly effective when i mean highly effective 40 to 50% with the original variant and that we had to rely on data from

the -- japanese in october. i mean, this is a study we should have been doing in january to prove the efficacy of the mask. and so when you go out and tell the american people that they think it's they should wear a cloth mask because it's going to hold their droplets back from getting into the air. but then tell him at the same time, it won't prevent droplets from coming in. it's the same piece of cloth on both sides and they're telling people to make two ply at a minimum cloth mask and at same time not telling them that it's bi-directional. that confuses the american people. i mean no one will understand why it only works when you breathe out but not when you breathe in. i mean now we know that you really need a very tight fitting mask that you really do much better if you have the the charged fabric layer, that's in

kn95s and n95s. and so now those are to the public. but i think we just weren't transparent enough with what we knew and what we didn't know and then make really common sense recommendations to the american people. yeah, and of course early on cdc and who were not recommending masks, correct? and so we we've really you know this kind of the symbol of masks have become a symbol of covid and they still are they're still you know part of what you know, you might call the the covid culture wars. there were some other interventions that we made one of your one of your chapters is called 15 to 30 days and that's about the lockdowns. tell us a little bit about that and what went on at the white house. you know. when i came in that was part of my first week, you know to move

us from risk is low to risk of serious illness in specific americans is extraordinary high and we were already so far behind and i just want to make it clear you don't do a lockdown unless there is a crisis and we were in crisis we could see what was happening in italy i had modeled out on the case fatality rate in italy and they're excellent medical care and what they were learning and they still had extraordinary case fatality rates. i was looking at our case fatality raids pace fatality rate in those individuals over 70. that means if you were 70 and diagnosed with covid 30% of those individuals were coming to this virus and so we didn't have a treatment. we didn't know about clotting we didn't have ventilators and we didn't have ppe and we were

barely keeping up and i i just want to be very clear we were behind in the human capacity needed to treat these patients. i mean we didn't have enough human capacity if we had had 25 new york's in our city's greater than a million people without a lockdown. that's and you how you end up with literally hundreds of thousands to millions of people dying. and so that's what the modelers were saying. i took their input and modeled what would happen if we did what italy did or europe did with the lockdown and that's where by limiting it to about 10 metros 10 to 12 meters you hundred thousand people die in the first surge if it goes to 25 metros. you have about 240,000 american lives lost and so it was really modeled by our metros both the city itself and the bedroom communities based on what was happening with spread in new york and i think as a country we

prevented a catastrophic event and i mean truly catastrophic not enough people to care for the for the sick no ventilators. no ppe for our nurses and doctors and most of the hospitals we had 6,000 hospitals in the end. probably only four to five hundred hospitals had to actually confront this high covid load and that's what america did america stop the spread of that first wave from how much damage it could do, but we probably were not clear enough to the american people how they're proactive behaviors change that course in that first that first wave certainly a lot of european countries did worse in. first wave then we did by a by a bit and i'm talking about small percentages and nothing to be really proud about but we could

have lost so many more americans with the footing that we were on because i just want to make it clear. we were not preparing. for a pandemic in this country. we were preparing for containing the virus in a very small number of americans based on symptoms which failed us. mm-hmm. yeah for sure. i mean one of the things i was struck by in the book when you when an email exchange you had with a high ranking government official and you'd said to you know, you know that we need that, you know vaccines wouldn't be enough we have to rely on behavior change. and then the answer back was you know, what behaviors and then you just side because of all the things you had been telling them about the behaviors that would need to be changed. they didn't seem to get it. well, we've talked about a lot

of the the negative things in america, you know the shortages of essential medicines ppes testing masks cruise ships lockdowns. and but you also talk about the bright spots and i think you know if there were any, you know if there were any, you know triumph of america. it's a triumph of american science and particularly operation warp speed which i don't think president trump gets enough credit for and you and and also, you know the fact that we you know, we've got these new messenger rna vaccines that we thought we were going to be super effective and but but are still very good. so tell us a little bit about you know, the success that we had in our science community. so first and foremost, i just want to you know, i'm so grateful to the private sector. i mean the one thing that this

white house got right and got right for ppe got right for testing and got right for therapeutics and vaccine was they believed if the private sector was supported and their technical capacity on leashed and their innovation and creativity and their relationships with biotech and universities and big pharma if we on unleashed their capacity that they would respond and unprecedented ways and they did and you know the group of that company we had a meeting with the laboratory developers on the first on the fourth of march and i had tests rolling out to hospitals within two weeks. they worked around the clock the abbots the roach the becton dickinson's and the hologic came on board the therm of fishers these people dropped everything in their entire corporations moved to churning out these high quality tests and not only you

know rapid high throughput pcrs, but these really these critical desktop pcrs that were really helpful in our tribal nations and antigen test and we had all of that with in a matter of weeks to months. and so that public private partnership was extraordinary and then they went above and beyond in that this big testing companies abbott and roche. well, i knew that they could see their equipment because i worked on hiv test my whole life and it's the same equipment and so i knew they could see the data every night and so every night they compiled all the data from that day, so i could see what the test positivity rates were in this country because i had no data streams 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 profit to

ensure that specific hospitals had what they needed to protect their nurses and their doctors and get the patients the drugs they needed and so i would say to them. this is where the virus is. this is where it's going and cardinal health and mckesson and henry schein and all of these big direct supply companies. they realigned everything and senate based on the data based on equity and that was just so amazing to me that i wanted the american people to know that we learn now how to really deal with a pandemic we need 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 and i i just wanted people to be able to see what i saw what the tribal nations did.

universities did there were universities that worked that whole summer of 2020 to fully open that fall of 2020 with all of the people pointing fingers to them and say you can't do this. it's not safe. they use the tool of testing and information. just behavioral change information to their students to keep each other safe and those universities and those boards of trustees that believe in their students and open fully. they taught me so much because it was those universities today yesterday and all through 2020 who i was tracking their data and the universities that tested weekly independent of symptoms had much less community spread among their students. so it showed it showed the road map of the way through this not limiting students activities,

but ensuring students had weekly testing totally changed the amount of the number of students who were impacted. but i think the other thing that universities taught me which was so personally important and why i wanted to get to every state and to most universities is to sit down with their students and their faculty and their administration to go through how they're confronting the pandemic and i was just so impressed by our gen ziers who understood that for many students. that was their only bed their only desk. they're only ability to be in college. they're only ability to work were in those college towns and they supported one another and they supported each other's mental health issues, and i just it was so inspirational to me to see what they did what our tribal nations did what our governors did. independent of red or blue or

democrat or republican? they answered the call in those days of 2020 and i just america is is stronger than what you see often on the media because people were really doing the right thing across this country and really helping one another. yeah, that's a good point. i mean, you know the the private sector universities states tribal. tribal leaders. i was personally involved a lot of georgetown so i can going to test to that kind of, you know, small laboratory of behavior change. we've only got about 10 minutes and i have a bunch of things. i want to get through one of the things, you know, it would be easy to skip but since you're so global and since i'm so global talk a little bit about our global responsibilities as as the united states, and i'm thinking particularly about vaccine in equity in our early decisions about pre-purchase

agreements with our vaccine companies and what role that may have played in global scarcity. i know scarcity is not as big an issue now, it's more vaccine infrastructure, but talk a little bit about, you know, global vaccine and other kinds of inequities because i know it's near and dear to your heart. well, and it was just not the inequity of the vaccines. it was inequity in access to gloves access to mass access to gowns access to protective equipment access and what was really worrying me right now is access to therapeutics because we've learned a lot about these vaccines but these vaccines are not going to protect countries from infection reinfection, and we just have to admit that and that's why i'm excited that to look at the subunits because you can change subunit adjivants and and potentially increase the durability of protection from infection from four months to to

really multiple multiple months, but iht now we should be very clear about who needs to be vaccinated and boosted and we ought to be talking with african countries and our asian colleagues around the world about identifying those individuals with diabetes hypertension obesity asthma any kind of steroid dependency cancer treatment and making sure that they're vaccinated and boosted and then we should be working around the clock to do what we did in pepfar on pepfar was brilliant because it worked with the large pharmaceutical companies and the large pharmaceutical companies agreed to this patent protection waiver that allowed new hiv drugs to be made by non-branded suppliers expeditedly approved by the fda in a parallel mechanism to ensure that they're safe and effective and allowed us to buy

those and so we were able to bring the best treatment to sub-saharan africa and asia around the globe that should be happening right now with covid therapeutics. we know how to do it. we know how to distribute it and we need use the distribution mechanisms that have utilized in pepfire and we can get drugs to the most remote villages. we could get paxilva to the most remote villages. we could get vaccines to the most remote villages. and so i feel like we're still not taking advantage of everything that we've learned through the decades. i find that you know, there's the pandemic people that look at this as this pandemic and then there's the rest of us who have been dealing with pandemics for a decades and know how to confront these and they really need to be talking to those individuals and not people within the united states that have never confronted a pandemic before this one because we know how to work with communities and

local governments to ensure access and we have significant access problems in this country right now, and it's part of the reason why the red counties which somehow people are thinking if they say that they voted for trump. it's like justification for them not doing well. that public health does not do politics. we should not we should be looking at red counties right now and say what is the problem? i'll tell you what the problem is. i was out there. there's no health care. so don't tell them to go to their primary care physician. there is no primary care physician. they're getting their eye care from walmart. they're getting their healthcare from emergency rooms three hours away. so, you know address what the access and barriers are in reality. not what you think. they are get out there and see what they are and fix it. we should be using data in real time. no one should be dying of covid. let's all agree of that. and we take every death figure

out why it happened and fix it. fix it then don't publish a study four months later fix it in real time and make the data transparent and available to every american so they're empowered. with the ability to make decisions to decrease their risk and the risk to their vulnerable family members. i saw this for decades in sub-saharan africa. it is possible anyone can learn this information. you don't have to be a phd you don't have to be an md. it's our job to make it understandable. it's not our job to point fingers and imply that if you voted to for trump, you're more likely to die of a disease that's on us if they're in a remote county that's on us i just it is so disappointing to me to see it's still politicized even in the media red and blue counties. that should be a call to action. that should be a call to all of

us who work in public health to change this. yeah, and you know, i i i've intentionally not broad president trump into this but i think our listeners would want to hear just your reflections about that. you've talked a little bit about. the trump administration in comparing it to to influenza to low risk other things like the virus goes away a sunlight bleach hydroxychloric when it must have been very frustrating for you as a as a world-renowned scientist and public health professional to be in the white house at that time. we've only got a literally a minute or two. do you want to just spend you know say 30 seconds on that and then just tell us about your you know what you what you think and hope for the future. well frustrating but not impossible.

and and that's the message. i want to leave with all of you. you find yourself in situations and people will say things about you and it really doesn't matter because they're you're there for one reason serve the american people and no matter how frustrating i've been frustrated my whole life in hiv with many leaders who would tell people if you just took a shower or if you slept with a virgin, i mean all of these magical thinking and and this is not unusual pandemics are political and it's our job as public health people to get in there and work every day to do the right thing some of its evidence some of its in evident. it doesn't matter. this isn't about you. it's about what you know and making that translated into saving lives the whole last chapter over 40 pages is on we continue to make missteps in 2021 and now 2022 because we're doing pandemics by polling. by what? we think the american people are willing to do.

give them the data. show them in real time and they will do the right thing. i i just don't understand this unwillingness to put all of the data up county by county by age band and raise an ethnicity. you can blur it enough that there's no violation of hipaa. we do you can blur it enough that there's no violation of the mac. we do it every day at pepfar.gov. at gps mapy every facility where there is a physician weather isn't nurse practitioner and look at how underserved are red counties are. went to fix this. we can't but we have to get the right data and utilize it. magical thinking was prominent in the trump administration. i fear at times it weaves itself into our current administration, and we just can't let that happen. i know me as calming and what people will say is look how low the case counts are.

but you know what follows may? a summer as surge in july and august across our southern states. so let's get ready now and do the right thing. >> well, thank you. i mean, debbie, just, you know, a master class. i wanted to thank you for your service. you talked about the importance of publicc health science, data, supply chains come all the things that america needs to do. i recommend that everybody read this book, particularly appendix but what we need to do, and just our hats off to you and deep thanks to you, dr. deborah birx. >> thank you, professor. >> be up-to-date in the latest in publishing with booktv's podcast about books. with current nonfiction book releases plus bestseller lists as well as industry news and trends through insider interviews. you can find "about books" on

c-span now, our free mobile app or whatever you get your podcast. >> there are a lot of places to get political information but only at c-span2 you get it straight from the source. the matter where you are from or where you stand on issues, c-span is america's network. unfiltered, unbiased, word for word. if it happens here or here or here, or anywhere that matters, america is watching on c-span. powered by cable. >> hello, everyone. welcome to the national book festival. >> over the past 21 years in partnership with the library of congress booktv has provided in-depth uninterrupted coverage of the national book festival featuring hundreds of nonfiction authors and guests. and on saturday booktv returns live and in person to the

library of congress national book festival. all day long you will hear from and interact with the guests and author such as librarian of congress carla hayden, journalist david maraniss, wider clint smith, and more. the library of congress national book festival live saturday beginning at 9:30 a.m. eastern on c-span2. >> are right. we had a fantastic lunch speaker. this is a real treat to welcome dr. bjorn lomborg to steamboat institute. dr. lomborg is the president and founder of the copenhagen consensus center. he is the author of the best-selling "false alarm: how climate change panic costs us trillions, hurts the poor, and fails to fix the planet." he will be signing copies of your books that you brought with you in the foyer after his presentation. dr. lomborg challenges mainstream concernsme about development and the environment and po a