S1: Five years ago, the virus that was in the news, mostly in West Africa, but occasionally here in the U.S., was Ebola. It was a frightening time Ebola caused fevers and hemorrhaging and had an average fatality rate of 50 percent, and it was during that outbreak that I had dinner with the journalist I know. And I met his wife, Dr. Celine Gounder. Celine is an infectious disease expert and she’d been doing volunteer work in Guinea. And I was really struck by how unflappable she seemed, even though we were talking about this terrifying disease.
S2: The reason I was not scared with Ebola is because I was going with an American aid organization. I knew we were going to have the personal protective equipment we needed and I knew how Ebola was transmitted. So I knew that as long as I was careful that it was relatively within my control.
S1: That kind of control she’s talking about has been hard to come by in her work on the coronavirus, both in terms of how easily this virus spreads and also what she can do to protect herself.
S2: I work at Bellevue Hospital in New York. I see patients there and we have been in rationing mode since the spring. You have to go to this window, show your I.D. They give you three and ninety five masks for the week, you know, so that’s being rationed. I have been still in in November.
S1: Yeah. Yeah. Oh my God.
S2: And I have been using the same face shield since March. I just wipe it down at the end of every day and put it in a paper bag in my locker. The fact that we would have allowed ourselves to get to that point in this country is just unacceptable this week.
S3: And this point in the pandemic feel particularly fraught. Cases are exploding. The holidays are looming. Effective vaccines seem to be on the horizon, but aren’t here yet. And Celine is in the middle of it all, not just as a doctor, but as a member of the Biden administration’s coronavirus advisory board, a group of 13 people whose ideas and expertise will shape how the incoming administration responds to covid-19.
S1: Does the weight of being on this task force add a level of of, I don’t know, fear or responsibility for you?
S2: To me, it’s it’s empowering to to be included in a group like this, it’s a huge honor and privilege, but it also makes me feel like I can do something about it. You know, all of the scientists who have been studying this, who have great ideas about how we can use the new knowledge and tools that we have to control the virus, I can help funnel that into policy and action.
S1: Celine is looking forward to gaining some control over the virus on a personal level and a national one. But of course, none of that can happen yet. The transition is still in limbo.
S2: I am really worried about the next two months, really about what’s going to happen, because we are not being given the information we need, which means that that will slow us down even come January 20th. And I really do think a lot of people are going to die as a result of these delays.
S3: Today on the show, we talk with Celine about what the Biden team wants to do, how they’re going to go about it, and whether they can get a divided America to trust them. I’m Lizzie O’Leary. And this is What Next TBD, a show about technology, power and how the future will be determined. Stick with us.
S1: A big part of what Celine Gounder is doing this week is being a spokesperson, getting the Biden message out about what they need and what they plan to do. The president elect has talked about appealing to governors to, you know, try to enforce mask mandates. Do you think those would make a difference? Because there are places like New York where you and I both live, where those are in place, and yet we’ve got big outbreaks in different communities?
S2: Well, I think the key is that, one, how enforceable is a mandate to who is issuing the mandate? Is it somebody that these communities, you know, respect, believe, trust? And I think that makes a national mandate, both the enforcement issues as well as the trust issues, very challenging. I do think, you know, a mandate coming from a governor, for example, a governor of South Dakota that would be taken very differently, would be received very differently by people in South Dakota than if the president were issuing that same mandate.
S1: Should we have a national testing plan or has the boat sailed on that already?
S2: So the current administration has actively discouraged testing, has said, oh, we’re testing too much. That is definitely not what you’re going to hear under the new administration. If anything, you’re going to see a massive ramping up of testing and really trying, especially in communities of color that have been really hard hit to make sure we have much better equity in access.
S1: But who’s who’s responsible for that? Is that this sort of patchwork we’ve got now of some states, some cities, some urgent cares, or is it the federal government saying, OK, we’re doing widespread testing?
S2: Yeah, this is a place where you’re going to see the federal government really stepping in. One of the places where they could have a real impact is invoking the Defense Production Act.
S1: That would mean the federal government could compel manufacturers to crank up production.
S2: President Trump has done this to a limited degree, but the Biden team wants to use the law more broadly, both with respect to personal protective equipment as well as scaling up production of test kits. So I really do think we need a national plan here, and that will include testing not just people who have symptoms, but people who have no symptoms.
S1: Expanding testing and encouraging mask mandates are things President elect Biden could do once he takes office in January. But that’s two months from now. Normally, an incoming administration would be getting information from the outgoing one, but Silene says that’s not happening. How much does President Trump’s refusal to concede and the sort of official transition being stuck in limbo, how much does that get in your way?
S2: Well, that’s a huge problem. We know historically that transitions are a real period of vulnerability for the country in terms of national security, and that’s whether that’s a foreign threat, you know, a terrorist threat or a threat like the coronavirus. And so that really could very well translate into Americans dying unnecessarily. To give you some examples of the kind of information we want and we can’t get, how many gloves do we have, how many syringes, where are we in negotiating contracts with pharmaceutical companies, with the logistics of delivery? Where are we in terms of developing databases to track who’s gotten vaccinated, who needs to be vaccinated? I mean, those are things that are in a way, boring nuts and bolts kind of stuff. But that’s the stuff that you need to be able to plan a big response like this in terms of scaling up vaccinations.
S1: You know, even if the two really promising looking ones, Pfizer and Moderna, if they are skilled up distribution is this huge challenge. How are you all thinking about vaccine distribution and getting it into the communities that that need it most?
S2: So, one, you have to scale up the manufacturing. This is where really moving forward with the transition is really going to be important because we need to have a better understanding what’s happening on the inside with the pharmaceutical company capacity. And then once you’ve manufactured these doses, how how do you distribute them and where? And some of that will depend on the characteristics of the vaccines. So, you know, the Pfizer vaccine needs to be deep frozen at minus 70 Celsius. Well, most family doctors I don’t know that any family doctors have the capacity to store a vaccine at that temperature. A lot of community hospitals will not have that kind of capacity either. And so what you’re really looking at is having probably big academic hospital centers, major health systems, maybe pharmaceutical retail chains have. Central depots where they can do that kind of storage, but that means it’s going to be harder to deliver that vaccine in particular to rural areas. So my guess is you’re going to see the Pfizer vaccine really targeted to urban areas that have the capacity to deal with what we call that cold chain of freezing, whereas the Moderna vaccine, which is which has less stringent temperature requirements and is relatively stable for a month at higher temperatures, you’re going to see the Moderna vaccine probably prioritized for rural areas. And as you know, a couple other vaccines emerge from the pipeline. You’ll see further and further sort of targeting based on how easy it is to get those vaccines to those parts of the country, how effective those particular vaccines are for certain patient populations. You know, you might have Pfizer here in New York City and you might have Moderna in rural Wyoming.
S1: You know, listening to you describe the kind of logistics around that, I keep thinking about communities that have been particularly hard hit when we are talking about black and brown communities, indigenous communities. Is there, I guess, a painful chance that given the kind of medical infrastructure that some of these vaccines require, that they’re going to be doubly hit in the vaccine rollout process?
S2: Yeah, this is something that we’re really attentive to. And it is a tricky one because there are issues of vaccine skepticism and hesitancy in some of these communities for good reason. And if you say we’re going to prioritize communities of color for vaccination, there will be a contingent of people who will say, oh, so we’re going to be guinea pigs for this new vaccine. So you have to address those very real concerns even while you are trying to prioritize them. Because the fact is, these are communities, whether it’s the Navajo in the Southwest or the South Bronx here in New York City, is their communities have been hit really hard and continue even now to be hit harder. So we really do need to prioritize them if we’re going to maximize the impact of the vaccines.
S1: Well, we’ve been talking about trust, and I have to ask you about one of your colleagues on the advisory board, Zeke Emanuel, who quite famously wrote an essay saying he’d like to die at 75. And that made a lot of people in the disability community really angry. How do you get their trust? I noticed the president elect mentioned them specifically in his speech. How do you get their trust with him as a part of this group?
S2: Well, I don’t really want to speak to to Zeke in particular. But in terms of the disability community, Ron Klain and I actually cohosted a podcast together. He had to step away for Biden campaign. We’re going to be the chief of staff. Yeah, he’s going to be the chief of staff for president elect Biden. And Ron and I interviewed early on during the pandemic, Rebecca Coakley, who’s with the Center for American Progress, who is a disability rights activist, really did listen to her concerns, were really very much attentive to the needs of that community as well. So we are taking notes. We are reaching out to people from the disability community to better understand what policies they need.
S4: We’ll be right back.
S1: You haven’t just worked on Ebola, but also tuberculosis, HIV, and there’s an example that you cited in a Twitter thread from the spring that I want to talk about, you did a lot of work in sub-Saharan Africa. You wrote this series of tweets from the spring where you compared what was happening with covid to HIV in South Africa and in particular, Thabo Mbeki lies that that HIV did not cause AIDS. I wonder what you learned from that experience in terms of what happens when misinformation and disinformation come from people in power?
S2: Yeah, that was a very sad situation. So President Thabo Mbeki, the president of South Africa at the time and Minister of Health Shabalala, both claimed that HIV did not cause AIDS. I think part of the reason for this is had they recognized that HIV caused AIDS, that would have implied certain responsibilities for the government to provide antiretroviral therapy for HIV to its people. And they were touting things like garlic and beetroot as cures for HIV, not unlike the current president touting hydroxy chloroquine or even bleach as solutions here. And I think those are really efforts of trying to distract and deflect responsibility and distract from the problem at hand. Unfortunately, in the context of HIV in South Africa, hundreds of thousands of people died unnecessarily. This has been studied and modeled by epidemiologists to figure out how many people died as a result of not starting widespread treatment sooner. And I think there will be similar accounts of how many people died unnecessarily here in the United States because of failed policies.
S1: But, of course, 70 million people voted for President Trump. And I guess I wonder, how do you reach those people if they don’t want to listen to the incoming administration and listen to the advice of, you know, public health experts like you?
S2: There are different kinds of authorities we turn to. There are the doctor forces of the world, people who are infectious disease specialist, getting death threats, we should note. Yes. Yes, exactly. And that’s just sad and terrible. That kind of thing is happening, which speaks to the level of discourse about this issue. But there are authorities like Dr. Fauci, who, you know, are truly expert in this area, who have lived through many epidemics, who have real life experience responding to them, and then you have other kinds of authorities. So these might be elected officials, these might be cultural or religious leaders from a community. And I think we need to tap into that to, in a sense, the left brain and the right brain. You need to tap into the cognitive as well as the emotional. And I’m not sure that we’ve really done a very good job with the emotional. And that’s really going to require no one listening a lot and then figuring out who are those leaders, the the political and cultural and religious leaders in these communities who we can partner with, who we can arm with the best science, but then let them be the ones that are communicating to their own communities in a way that is well received.
S1: Yeah, I mean, there are no religious leaders on the Biden coronavirus advisory board, no prominent Republicans. Is that a mistake? Do you need them?
S2: I don’t know that you need them on the advisory board, per say.
S5: But I do think we need to be including Republicans and religious leaders and cultural leaders as part of the messaging strategy, that there is no question. I thought somehow that once people saw this with their own eyes in their own communities, that it wouldn’t be a hoax anymore, that this would be real. I mean, this reminds me of the conversations we had in West Africa about Ebola for a long time. In the beginning, people said, oh, Ebola is a hoax. Ebola is not real. But they came around to believing in Ebola more so than we have to believing in coronavirus, which I think is striking and really speaks to the level of distrust and polarization in this country right now.
S6: Before I let you go, are you hopeful or are you too busy to kind of wrestle with emotions around that?
S2: I’m hopeful to sort of quote Bill Fagih, who was CDC director. You know, he he likes to say that we need a healthy dose of skepticism and pessimism. You bring in those people on the outside to occasionally give you a little advice. But in your day to day, working in your day to day colleagues, you want the most optimistic people possible, because once you start to turn cynical, that’s really disempowering.
S5: That’s when you give up. That’s what leads to people saying, oh, well, I’m going to get sick anyway, why do anything? And then once you get to that point, you’ve lost the battle. This is where I think it’s really important to understand there is light at the end of the tunnel. We just need to get through the tunnel. We have vaccines that will be coming in several months. We just need to get from here to there. And so all of these things you can do now, the mask wearing, the social distancing, being outdoors, if you’re around people outside of your household bubble getting tested, all of that will save lives.
S6: Dr. Celine Gounder, thank you very much. My pleasure. Dr. Celine Gounder is an infectious disease specialist at Bellevue Hospital in New York. She also hosts the podcast’s American Diagnosis and Epidemic. That’s our show for today, TBD is produced by Ethan Brooks and edited by Allison Benedikt and Torie Bosch, TBD is part of a larger what next family. And it’s also part of Future Tense, a partnership of Slate, Arizona State University and New America. Have a great weekend and please be safe. We’re off next week for Thanksgiving, but we’ll be back with a new episode in December. And Mary Harris will be back in your ears on Monday. I’m Lizzie O’Leary. Thanks for listening.