Wake Up To Politics - August 13, 2021

Good morning! It’s Friday, August 13, 2021. Election Day 2022 is 452 days away. Election Day 2024 is 1,180 days away.

A quick programming note: Wake Up To Politics will be off next week while my summer break wraps up and I get ready for my sophomore year of college (and first year on campus!)

President Biden is headed to Camp David for the next few days, and Congress will be on recess, so hopefully there won’t be too much news while I’m gone — but I’ll be sure to catch you up on anything that does happen when I get back.

But before I go... Instead of the normal format, today’s newsletter is an interview with Andy Slavitt, who served as a senior adviser on the White House COVID task force in the first six months of the Biden administration.

During his time at the White House, Slavitt led many of the task force’s weekly briefings and played a key role in communicating the administration’s COVID response to the public. He also oversaw Medicare and Medicaid during the Obama administration, and is the author of a new book on the coronavirus response.

Slavitt and I spoke about the current state of the pandemic, his advice for vaccinated people, a new digital vaccine card project he’s working on, and more. I hope you enjoy this interview — and please let me know if you’d like to see more of these types of Q&A’s in the newsletter.

Q&A: Andy Slavitt, former Biden pandemic adviser

This interview has been edited for length and clarity.

I’d like to start with your time on the COVID task force. Would you be able to give a sense of what your day-to-day was like, and of some of the main challenges you were focused on while at the White House?

Look, I think the thing about a crisis is, you always have to pick the most important thing and focus like crazy on that, and then just do the best you can with everything else. And for us with, with variants coming, with new vaccines that had not yet been distributed, without a real infrastructure in place, without necessarily enough production or enough vaccine sites or vaccinators: job one, two, and three was to vaccinate the public as quickly as possible. And speed mattered.

Taking over government in a transition during a crisis is a particularly hard and complex thing to do. President George W. Bush was famous for the level of cooperation he provided in the 2008 handoff and his graciousness and generosity. We were in a slightly different situation, where the outgoing president was reluctant to even concede, and certainly was making it difficult for our transition to happen. So those were the things that we faced every day in the White House.

Is there anything you’re particularly proud of that you achieved on the task force, and is there anything that you feel like the task force could have done better, that you look back and wish you had done differently?

Well, look, when we got there, remember, we had about 2% of adults who had received their first vaccine shot. Most people couldn’t get through to even schedule an appointment, there weren’t enough vaccines being produced, and there was no standing inventory. And only 45% of them were actually making their way into people’s arms. And we had 330-500 people a day dying, we had hundreds of thousands of cases a day. And so to leave on the day that I left, where we were down to 10,000 cases a day, and only a couple hundred deaths, and anybody who wanted to be vaccinated could get vaccinated, was a really important achievement. I think we got out ahead of Alpha, we got out ahead of Delta, and I think a lot of people are here now because we were able to work quickly.

What we didn’t do, what we didn’t get done, is we didn’t figure out how to successfully communicate with people who didn’t want to get vaccinated and who were reluctant to get vaccinated. When we got there, only 40% of the public said they wanted to get vaccinated. And so we made a lot of progress: that 40% became 50, 60, 70%. But there clearly are large segments of the population that we’ve not been able to get vaccinated and that’s something that still haunts us today.

What do you think could be done differently to reach the 30% of eligible Americans who have yet to receive either vaccine dose? Is it, like you said, a communication problem? Is there a shift in strategy that you think is needed?

I think a couple of things need to happen. I mean, first of all, we have to just keep enhancing our understanding of who the folks are that haven’t been vaccinated and why they haven’t been vaccinated. We won’t solve the problem if we don’t seek to understand and to listen. I think there’s a relatively small set of people who are really upset and adamantly opposed to getting vaccinated. There are a larger number of people who say, “if I were required to get vaccinated for my job, or if I were required to get vaccinated to go into large crowds, it’s something I would be very open to doing.”

If you look at people by age group, it’s the perfect slope. People over 85: almost all are vaccinated. People over 50: most are vaccinated. People over 25: 70% are vaccinated. People from 18 to 24: only about 37, 38% are vaccinated. And it’s because people don’t feel the risk. They don’t feel the harm. But it’s not because they’re anti-vax. In fact, almost all of them have all of their other vaccines. It’s just that, generally speaking, they’re not particularly motivated. So there have to be things that enhance that motivation. Being able to get into a ballgame or a college football game, or to attend school: these are good reasons for people to get vaccinated. So I think we need to increasingly amp that up, particularly as the FDA gives final approval for the vaccine, which they’ll do in the coming weeks.

To that end, you co-authored an op-ed recently calling on more businesses to mandate vaccinations. Do you think that governments should also be doing more to require vaccination? Do you think the Biden administration will be moving more aggressively to mandate vaccines in certain situations, or for certain groups of people?

I think everybody has a role to play. The federal government can only do so much. I think employers have a role to play, schools have a role to play, venues have a role to play, and state, city, and local governments have a role to play. I think we can respect people’s rights and their decision to do certain things, but that also doesn’t mean that if they choose not to get vaccinated, that we should put them in a position where they infect other people who can’t protect themselves. And I think that’s the discussion we’ve got to have as a country right now.

You mentioned that when you left the White House, there were about 10,000 cases a day. Obviously, right now, we’re in a very different situation from that. You wrote in June, right after leaving the administration, “If you’re vaccinated, the most important thing you can do right now is go live your best life and make up for lost time. There are far greater threats in your life than the Delta variant.” Is that still your advice for vaccinated people, or would you amend that message today?

No, it’s not my advice today, because we know more than we did back then, and because case counts are higher. I do think if you’re vaccinated, I would still say you can get back a lot of important parts of your life that you’ve abandoned, and I hope people do, because whether it’s school or friendships or other things, these are psychologically the things that keep us moving. So I do hope people get back to those things.

Having said that, we now know that Delta creates more breakthrough cases than there were prior to Delta. We know that Delta not only can be transmitted to people who are vaccinated on occasion, but that they can also transmit it to others. So, I think you have to live your best life. But be cautious. Understand that you can get COVID and you can pass it to other people. And that is a different ballgame than the original version of COVID. You put on a mask when you’re vaccinated for the same reason that you put on a rain jacket, even when you’re carrying an umbrella: sometimes you just need more protection.

What does “being cautious” in this current phase of the pandemic look like to you? Is there specific advice you’d give to vaccinated people wondering if there should be wearing masks, distancing, or taking other precautions?

Unless I’m in a community where there’s no virtually no spread, I’m wearing a mask indoors. And I really only want to go to places where other people are also wearing a mask indoors, because it cuts down really significantly on transmission. Now, it’s not forever, which is why over the course of the late spring and early summer, I think it was good for people to have a break from this. But when we have high transmission periods, that’s really going to be an important layer of protection.

Now, it’s also partly because we have 18% of the public, namely people under 12 and people who are immunosuppressed, who can’t really protect themselves unless we protect ourselves. So I feel a responsibility, until everybody’s in a position where they can get vaccinated, to do this. Now, we may reach a point where everybody has a chance to get vaccinated and some have chosen to and some have not. And that that’s a slightly different dynamic. But that’s not where we live today.

Some of the confusion among vaccinated people has come from the CDC and some of the reversals there on masking guidance. Do you think the CDC has made missteps in how its communicated its guidance to the public?

I think the most important things they need to do are tell the truth, and always follow the science. And I think they’ve done that. I think, in order to communicate well, there’s a couple of other principles, they also need to continue to communicate with the public even in between periods when you’re making changes, so that they there is more continuity. And they need to tell people why, to show people the data. They’ve got to do that. Sometimes they are not able to, but oftentimes, they need to do that.

Another truism that I think we all have to remember is everybody will be critical when cases are going up and people will be throwing around blame. But then when cases are going down, people will think that everything’s going just great. And to some extent, that’s just a fact of life. They can’t necessarily control that. All they can do is continue to tell the truth to the public and base their decisions on science.

You mentioned the mantra, “follow the science,” which President Biden has adopted during his campaign and administration. There’s been some criticism, even reportedly from inside the administration, that he’s hewed too closely to what the scientists have said and gone too far in handing over decisions to them. What do you make of that?

Well, there’s no scientific expertise in the White House. And White Houses by their very nature aren’t designed to look after public health. They’re designed to hear what scientists are saying and then overlay on that what policies are right and what communication is right. So I think when President Biden says, “we’re gonna follow the science,” what he means very specifically is oftentimes, the scientists will say things that are inconvenient, that we don’t like to hear.

And, you know, the last administration, if they didn’t like the message, they would basically stop it from going out or do their best to stop it from going out. And that has many, many painful consequences: many more people died because of our unwillingness to face, to understand the truth. So that’s what President Biden means. He doesn’t mean, though, that he doesn’t have accountability to the public for bringing us through the pandemic, I think he absolutely feels that accountability.

There are a lot of public health experts who say we haven’t done enough to prepare for the next pandemics that might be coming down the pike after COVID. You said “there’s no scientific expertise in the White House.” Do you think that there are changes that need to be made to our public health apparatus, to the White House, to the government in order to prepare for whatever might come next after COVID?  

Well, I don’t think the expertise all has to sit within the White House. And it’s not that there’s no scientific expertise: There’s the Office of Science and Technology, with Eric Lander there. There are people who understand science, but we have to let our agencies do their work. The White House needs to be on top of organizing against the major opportunities and threats in our country, and making sure they’re being addressed. The biodefense apparatus and thinking, which is in some part national security and in some part public health, probably needs some ongoing ownership in the White House. And whether that feels like a National Security Council or a National Economic Council that’s particularly focused on biological threats, it’s clear that we’re going to want the ability over the long term to be able to move quickly and organize different parts of the government against these kinds of threats.

You tweeted a few days ago on the question of verifying vaccinations, “hold on for three and a half weeks and you will see.” Do you have anything you can share about that?

There is a project called the Commons Project that has been coming together outside of government, which is creating a standard for small businesses, the travel industry, and Americans who basically just want their vaccine card to be digital and provable and traced back to a source of truth. People are asking the question, rightly, “I’ve been vaccinated, how do I keep a record of that that I can use and that people will know is truthful?” And I think this group that’s put together these standards has a very workable solution that they’ll be more public about, talking about it in a bigger way after Labor Day.

Can you give any idea of what that solution might look like?

Yeah, I mean, it’s just a single source of truth tied to people’s medical records and vaccination records, that can show up in everything from their Apple Wallet, to any other form that they need in order to show their vaccination status.

One question I know a lot of people have is, what does the COVID endgame look like? How long do you think we’ll be wrestling with these kinds of risk calculations and with COVID in our everyday lives?

Well, I’m going to hold off on predicting what happens, but I am going to say that we have to move Covid from being something that grips all elements of society to something that becomes a manageable challenge, like any other manageable challenge that we have in our lives. And that’s a psychological process for people as much as it is a health and medical physical one. So we have to all kind of recognize that there are a lot of things in life that create risk for us, there are a lot of things in life that are unpleasant, yet we find a way to manage around them.

This becomes much easier to manage the more people that are vaccinated. So the answer to your question will, in some part, be determined by how many people get vaccinated in different pockets of the country. But there are a few things that I would say that, under any circumstances of the future, are important to do. One of them is continuous vaccinations in the US. The second is to vaccinate the globe as quickly as possible, which probably realistically means by the end of 2022. Third means developing an antiviral, an oral antiviral, that can be used. And then fourth is to be able to continue to find new ways to protect the most vulnerable parts of the population. Those things are on our agenda no matter what. And the more progress we make against those things, the more likely it is that COVID will become a smaller and smaller part of our lives.

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