How Long This Could Last

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S1: So, Beth Cameron, you ran the White House Office on pandemics. For how long?

S2: I ran the White House Office of Global Health, Security and Biodefense from fall of 2016 until March of twenty seventeen.

S3: So from the inception of the office into the transition to the Trump administration, I gotta ask, with everything going on right now, like how much sleep are you getting?

S4: Not a lot, but I think I’m not. I think I’m not alone. And I think, you know, some of the sleep that I’m losing is is not just because of the fact that I work on this issue for a living. I’m also dealing with, I think, what most Americans are dealing with, some aging parents, an aging grandfather who just got out of a rehab center and just trying to make sure that we know it’s going to be happening. This is really uncharted territory. I think maybe even especially for those of us that work on the issue.

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S5: Charting uncharted territory like this. It used to be Beth’s job. She’s called her office in the White House to kind of smoke alarm for global pandemics like the one we’re in the middle of right now.

S6: But shortly after Beth resigned, the Trump administration decided that office, the tracks, pandemics, we don’t need it.

S7: Part of the reason I wanted to talk to Beth is that last week she wrote an op ed for The Washington Post where she didn’t mince words. It read in part, The federal government’s moving too slowly due to a lack of leadership. But when I got Beth on the phone, she had this really practical energy. It was like she was allergic to finger pointing.

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S1: When the president says stuff like this pandemic was unexpected. I just wonder if it bugs you.

S4: Honestly, that doesn’t bug me. It doesn’t bug me because this is potentially a once in a 100 year event and no administration was gonna be fully prepared on day one for it.

S8: Beth is prepared, though, after spending years scheming out what an illness like Covered 19 could do to the United States.

S6: She’s got thoughts on why an America first approach won’t work here and how long our national lockdown could last. I’m Mary Harris. You’re listening to what next. Stick with us.

S7: The White House pandemic team that Beth Cameron ran back in twenty. It was created in response to a different public health crisis. Ebola. Because when Ebola started to spread, it became clear just how hard it was gonna be to coordinate a federal response. And remember, during Ebola, only 11 people actually got treated in the U.S.. Many of them health care workers who’d been abroad.

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S2: There was a need to figure out how to bring people who are infected with Ebola, who are Americans living in countries in West Africa, who were responding to the disease. And so figuring out how to medevac them, let us to look into our capability to medevac patients with Ebola, which was not where it needed to be in 2014. It led us to realize that there are going to be a lot of community concerns about bringing people with Ebola into the United States. There were concerns about how to treat them and where to treat them. So all of these things really brought into sharp focus our own preparedness for a disease like Ebola in the United States and how unprepared we were both at a public health level, but also really at a community level. There was so much fear and also stigma associated with Ebola in those those months when we were really actively watching the cases spike in West Africa and so much concern in the United States. There was a lot of lessons to learn about clear, constant communication and organization between the domestic and the global response.

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S1: Yeah, I mean, I was just stunned by how many tools it took to coordinate the response. And obviously that was a much smaller response, whereas if you had to make decisions like travelers would need to funnel to just a few different airports. So only a few places were taking on some level of risk. And then you had to coordinate with homeland security and Customs and Border Protection and the CDC and the Health and Human Services. And so because there’s so many agencies, so many people involved, it became a reason for why your office was created. Can you, like, put me in the room when all these agencies are talking to each other just to get an idea of how hard it is to coordinate?

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S2: Yeah, so I’ll put you in a couple of different rooms so there are rooms happening on different levels during Ebola. There were rooms that were daily meetings or every other day meetings that were happening at a working level. And at that time I was a director, not the head of a directorate. And so I was in those rooms listening, getting an update from CDC experts on the ground beaming in from Liberia. What’s the situation? What do you need? Are there things that people are worried about raising? And then the next room was raising those issues up a level to people that could make decisions about allocating resources and solving problems. If there were differences of opinion between departments and agencies.

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S9: So there were literally like two rooms, like one room where we’re just like figuring it out in the other room, where we’re deciding who we’re gonna tell at the higher level and what we’re gonna tell them.

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S2: More than two rooms, so regular working level meetings to develop a rapport between all the people actually actively working this problem and to allow a space for people across departments and agencies to dock in with each other on an every day or every other day basis. Then there were rooms where people were actually taking the biggest problems and fielding them up to deputy secretary level, really decision makers. And then, of course, there is the room that, you know, the president and the cabinet were sitting in where they were, you know, making decisions about, you know, very large changes that we might want to make in our outbreak response.

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S1: It’s funny listening to you. I feel like what you’re saying is pretty empathetic. You’re talking about how government is made up of human beings, and that’s part of why these decisions are so hard. And that’s part of why you believe that your office was so important and critical to moments like these. I mean, since you’ve spoken out, people within the administration, people who have been inside the administration have pushed back pretty hard on the idea that closing this pandemic office was a problem. Did you watch that press conference where the president spoke about this?

S10: So I did watch the press conference.

S11: So what responsibility do you take to that in? The officials that worked in that office said that you that the White House lost valuable time because that office wasn’t disbanded. What do you make of that?

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S10: Well, I just think it’s a nasty question, because what we’ve done is I have also read a lot of the articles that have come out since. My perspective on this is my own perspective. And I think everyone is welcome to their perspective. And at the end of the day, it is the White House and the National Security Advisors job to organize their staff as they see fit. My perspective is that when I walked into the National Security Council staff, there wasn’t an office that was completely and totally focused on pandemic risks. Ebola made absolutely clear to me that a pandemic like the one we’re facing now would be even more challenging, I think, for all the reasons that the world is now realizing. Watching it unfold.

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S4: But at the end of the day, I firmly believe that you need to have at least one high level official responsible for responding and a group of people who are seamlessly coordinating within an office led by a senior director who can directly report on this issue as their primary responsibility every day to the national and homeland security adviser.

S5: So in the last few days, individuals have been struggling to make decisions to protect themselves and their communities and their families.

S9: I wonder if there are more measures you’d like to see the government taking.

S4: I think the federal government has a really important role to play. I think the community also has a really important role to play.

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S10: I think one of the roles is something that we’ve been seeing in the last couple of days, which is setting a tone of clear communication about the risk. And so the most recent press conference that I saw, I think the tone about the urgency, the lengths that this could possibly last, reinforcing the public health guidance about social distancing. I think all of those things are really important roles for the federal government to play.

S9: But at the same time, we had reporting yesterday that the president was saying, governors, you need to act on your own and if you need supplies, go out and get them.

S12: So I don’t think that that’s the right approach. I think that that governors and states and mayors have a responsibility to their own citizens. But I do think the federal government has a responsibility for putting out there, for lack of a better word, the grand challenges that we face and putting on the table ways in which to solve them. So I would like to see the government make use of the Defense Production Act to spur manufacturers, to make more ventilators, to spur some innovation challenges in personal protective equipment, manufacturing, and then even ventilators for low resource settings. Those are just a couple of the areas where I think we’re going to fall short. And we’re I think the federal government could come out and say this is an all hands on deck approach where we want to see manufacturers, medical supply companies, foundations and technical experts come together in an organized way to solve a really big problem, not only for the United States, but for the world.

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S9: Yeah. There was this editorial in The New York Times today that talked about FDR and his reaction to the Great Depression. And they talked about basically sending people to work to make more respirators, make like have a government jobs program for people who are unemployed now. I just wonder if you think we need to be thinking big like that.

S13: So I absolutely do think that we need to be thinking big. And this is a global challenge. The supply chain for ventilators and personal protective equipment, the drugs and vaccines that will hopefully be developed and manufactured. These are global commodities and it’s a global pandemic. And moreover, the truth I’d like to communicate is that the US has the tools, the technology and the capability to solve these problems. In fact, I think with our science and technical base, we’re uniquely qualified to help solve these problems. We should lead on these things and we should lead on them for the benefit of the world.

S9: Do you see that happening right now? People sharing internationally and cooperating?

S13: So I know that the scientific community and the public health community are sharing best practices internationally and that there are a lot of global discussions. I’m not seeing as much evidence of that in the press conferences and the discussions that our federal government is having. And I’d like to see more of them. And we have to be talking to partners and allies all over the world because there will be good ideas everywhere. There will be commodities everywhere. And we’re going to have to share not only our ideas, but potentially those commodities as we watch this pandemic spike in different parts of the world over the next several months. So not just toward them for ourselves. So first and foremost of certainly not hoarding it all for ourselves, but that that actually could be an approach that ultimately doesn’t even benefit us because the ventilator supplies in the world are not just based in the United States. So we have to figure out how to share our responsibility in this pandemic.

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S9: A lot of leaders have started talking about the way we think about coronavirus and that we need to start thinking about it in terms of a war. Do you think we need a wartime stance here?

S13: I do think we need a wartime stance. I’ll I’ll use those some language from some of my public health colleagues and foundations. I think that the term war is sometimes a challenge for for people that don’t like to think about the U.S. going to war. It’s something it’s really challenging for me as someone who came out of the Department of Defense when I talked to my public health colleagues, some of them get nervous about how we use that language. So I’m thinking through other ways that we can talk about it. But I think in reality, we are talking about a massive effort where we should be putting funding into health, security and biodefense. The way we’re putting funding into all of our other national and global peace and security programs.

S7: Beth says part of the trouble with marshalling an effort like this is that success means people don’t get sick. It can look like we all got worried for no reason and then folks start to let down their guards.

S13: The tendency is going to be to fight the social distancing measures because people need to to go back to their daily lives to get a paycheck. And I think that is going to mean that we’ll see spikes affecting the most vulnerable over a much longer period of time if we if we don’t try to actually suppress it now.

S9: So we’re talking about like a big wave. But you’re saying actually this might look like a bunch of smaller waves as people let their guard down, go back to work, start living a more quote unquote, normal life.

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S13: I think that’s a concern. And there was a great paper that came out this week from Imperial College looking at two different approaches that the United States and the United Kingdom could take. One is mitigation. So social distancing and measures sort of short of large scale closures, like school closures, for example. And the other is suppression. So really taking the time now to try to get the number of cases down to a very low level so that our health care system can not only catch up, but so we can actually, you know, not have a situation where we see spikes waxing and waning over a longer period of time.

S9: I think that same paper said that we ought to get that maximum benefit, may need to stay indoors, do what we’re doing now for 18 months.

S13: It does say that. And so the question is, how long will it take to get a therapeutic or some therapeutics? Certainly it will take twelve to 18 months to get a vaccine. That seems very clear from all of the experts that I trust. But if we are lucky enough to find some medications that might be able to stem this outbreak in the most vulnerable, maybe it won’t be 18 months. But this is the question. I think one of the challenges, of course, with with talking about this outbreak and being asked to think forward is nobody knows. Nobody knows how long is the right amount of time. Nobody knows when the all clear signal to go back to our daily lives is going to be. But I took that paper as as a clear signal that if we have any chance of stemming the tide, we’re going to we’re going to be doing what we’re doing. Many of us are doing right now for several months. And I think that means really thinking about how we go about our civilization in a way that can provide basic services and care and payment to people in our own countries. While this is happening.

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S5: Beth Cameron, I’m so grateful for you joining us today.

S13: Thank you so much for having me. I really enjoyed it.

S8: Beth Cameron is the vice president for Global Biological Policy and programs at the Nuclear Threat Initiative. Before that, she was a senior director for global health, security and biodefense on the White House National Security Council. And that’s the show here. What next? I’ve been asking you to send me voicemails so I can hear how you’re coping with Corona virus. And I got to say, y’all have really come through.

S14: Hey, Mary, my name is Carrie Williams. I’m in Seattle, Washington. I have an extended family that’s across the country and just sort of spontaneously last week on Friday, we started having a face time check in my two parents who are both in their 70s and my three siblings. We do a check in where we see how each other is doing emotionally and physically. And we talk about what our goals for the day are. We’re taking it a little bit one day at a time.

S15: Mary, this is Matt Earley calling from Madison, Wisconsin. Last week, we got the mandate to shut our offices down and to start working from home. And I’m having a really hard time keeping my concentration up already. Yes, I’m going for walks when I can hang out with my animals.

S16: Enjoy your social distancing. Yes.

S17: Hi, Mary. My name is Dorothy. I’m in California in the Central Valley, not in San Francisco. I’m raising my two grandchildren who are eight and nine. They will stop going to school on Thursday. So then we’re going to all be home together. We’re doing a lot of hand-washing and crafts, playing dolls. We’re trying to eat well. I hope you two are doing well and keeping my fingers crossed.

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S5: But we want to stay connected, especially right now when it feels like we’re all on our own little islands. So call us tell us what you’ve been up to. Tell us how you’re helping out people around you.

S8: You can reach us at 2 0 2 8 8 8 2 5 8 8. That’s 2 0 2 8 8 8 2 5 8 8. You can also just tweet at me.

S5: I’m at Mary’s desk. What next is produced by Mary Wilson. Jason De Leon. Danielle Hewitt and Morra Silvers. I’m Mary Harris. I’ll talk to you tomorrow.