Call Me Back - with Dan Senor - Presidents and Pandemics - with Tevi Troy

Episode Date: September 17, 2021

Books and essays discussed in this episode: Shall We Wake the President: Two Centuries of Disaster Management from the Oval Office by Tevi Troyhttps://www.barnesandnoble.com/w/shall-we-wake-the-president-tevi-troy/1132107909 “Presidents and Public-Health Crises” in National Affairs by Tevi Troyhttps://www.nationalaffairs.com/publications/detail/presidents-and-public-health-crises “Operation Warp Speed: A Story Yet to be Told”by  Alex Tabarrok in Marginal Revolutionhttps://marginalrevolution.com/marginalrevolution/2021/09/operation-warp-speed-a-story-yet-to-be-told.html 

116,000 American soldiers died in World War I, and something like 43,000 of them died from flu. Welcome to Post-Corona, where we try to understand COVID-19's lasting impact on the economy, culture, and geopolitics. I'm Dan Senor. Are we living in peak politicized times? Well, one test that pundits and the media frequently point to as Exhibit A is how our elected leaders have responded to the current pandemic.

Just about every move by our current president, his predecessor, or governors in different states, whether it was Cuomo in New York, Gavin Newsom, who's just coming out of the California recall, Ron DeSantis and Greg Abbott, mayors, and even county health commissioners, they all get instantly analyzed in a political frame whenever they take a certain action in response to the pandemic. Is this new? Are there nakedly political motives and various actions on public health? Are our leaders communicating too much information or holding back what we need to know? Are they unleashing all the forces of government to mitigate the pandemic or not enough? For some historical comparisons, I checked in with my friend Tevi Troy. Tevi's a rare breed in public

life. He's an author of numerous books on the history of decision-making in the White House and also a practitioner, having worked in senior positions in government, in the U.S. Senate, the White House, and in cabinet agencies. Tevi is a PhD best-selling author and presidential historian. He's a former White House aide and former deputy secretary of the Department of Health and Human historian. He's a former White House aide and former deputy secretary of the Department of Health and Human Services. As deputy secretary of HHS during the George W. Bush administration, Tevey was the chief operating officer of the largest civilian department in the federal government with a budget of $716 billion and close to 70,000 employees. Prior to that, Tevey served in several White

House positions, including assistant for domestic policy to President George W. Bush. Tevey is currently at the Bipartisan Policy Center, where he is a senior fellow focusing on the study of the presidency. He is the author of the bestselling book, What Jefferson Read, Ike Watched, and Obama Tweeted, 200 Years of Popular Culture in the White House. He's also the author of Intellectuals in the Oval Office, in which Tevi warned in 2016 that we were unprepared for coronavirus. His most recent book is called Fight House, Rivalries in the White House from Truman to Trump. He's written over 300 published articles for the New York Times, the Wall Street Journal, the Washington Post, Politico, the Atlantic, and many other publications, too many to list here. How should we think about what a president or any other elected leader can and cannot do during a pandemic? This is Post-Corona.

And I am pleased to welcome my longtime friend, Tevi Troy, to the Post-Corona Podcast. Hi, Tevi. Hey, Dan. Thanks for having me. We are indeed longstanding friends, and dating back to the 1990s when we both worked in the Senate. Right. So we were both, we were colleagues in the Senate. I was working for then-freshman Senator Spence Abraham from Michigan, and I recall you were working for Senator John Ashcroft from Missouri. Is that right? That is correct. Yeah.

That's right. And then you've gone on to have a fascinating and very diverse career, extraordinary public servant, some of the high points I talked about in the intro, one of which landed you as Deputy Secretary of Health and Human Services in the Bush administration, which gives you a unique perspective of Health and Human Services in the Bush administration, which gives you a unique perspective on some of the issues we're going to talk about today, but you've also written extensively, both in the books we cited in the intro and some other pieces. I want to start with that.

So we are dealing with a moment that every pundit is observing feels like living through a public health crisis that is highly politicized that that actually the is if the public health crisis weren't bad enough it is exacerbated by the intense choose your choose your term polarization uh socioeconomic hyperbolic stratification whatever it is that the context has made the public health crisis worse and has made politicians behave more badly. And two things are interesting. One, in the national affairs piece you wrote in 2017, you actually predicted that if we

ever faced a future public health crisis, it could fall victim to a more political environment. But you also, both in that piece and in your book, Shall We Wake the President, you chronicle how other presidents have dealt with public health crises. And I'm actually struck by how little attention, other than your writings, maybe John Barry, a couple of others, but how little attention it's received. And I want to just spend a moment on that because you spend a lot of time on it. So let's start with Woodrow Wilson. So Woodrow Wilson is the first quote unquote modern president that had to lead our country through a pandemic, through the Spanish influenza in 1918. How did Wilson engage and lead the public during that crisis on the public health side? Yeah, unfortunately, I have to say he didn't. He was kind of disconnected at the time. He was

focused on World War I. He stepped away a little bit from it. First of all, there are three things that I would say that the Wilson administration did wrong. Number one is they were propagandizing in a way that would be really uncomfortable. Today, they had the Center on Public Information led by a guy named George Creel, and they were trying to put out positive news about the war and suppress bad information. Obviously, the information about this flu that killed over 600,000 Americans, a lot of them younger Americans, was bad information that they didn't want to highlight. Number two is there was very little information sharing. So you had some communities had different responses to the pandemic.

For example, St. Louis put into effect social distancing requirements and Philadelphia did not. St. Louis had one fifth the death rate of Philadelphia. So different communities, if they had gotten some kind of national level of information or good advice. And this is because mayors and governors were just making vastly different decisions independently. That is absolutely correct. Yeah. And the White House, the federal government did not weigh in with guidance. That's correct.

Okay. And then the third thing, and this is the thing I highlight the most in my book, is the most direct involvement that any historian has found of Wilson getting with this particular flu was when his own personal doctor, who's a Navy physician, told him that a lot of American soldiers were dying on the troop transports to Europe because they were in close quarters and the disease actually may have started on a U.S. Army base in Kansas. And so a lot of U.S. soldiers were dying as a result of these troop transfers. You know, 116,000 American soldiers died in World War I, and something like 43,000 of them died from flu, from this particular flu.

And could you argue he didn't have a choice? I mean, I know you write in your book that Wilson was contributing to the pandemic by continuing the mobilization of troops, quote, even as World War I was winding to a close. So you're basically arguing he should have fought the war differently at that stage of the war, given what he knew that so many of our troops were getting infected? Well, I don't know if he was fighting the war differently. This was one month before the hostilities ended. And Wilson is confronted with a meeting in the White House where they discuss the issue. And then his doctor is making the case for stopping the troop transports. And the guy who's the equivalent to the army chief of staff says, we absolutely cannot stop them. They are essential to the war effort. And Wilson acquiesces and just lets the troop transports continue. So again, this is towards the end of the hostilities. And Wilson really just didn't engage sufficiently to see if there were any alternatives, other ways to do it. Maybe we had enough troops there on time.

I don't know if any of those boats that left after October, whatever, when the meeting happened and November when the war ended, if any of those boats actually led to troops that contributed to the war. Remember, it was multi-weeks to get across the Atlantic. So the one major decision that Wilson had to face on the pandemic is one in which he really did not do anything to stop the pandemic. Now, again, the president's leaders have to deal with multiple issues, and there were war concerns as well but on the pandemic front he really didn't do anything to address it so in april 1919 wilson himself contracts the spanish flu shortly after according to one historical account shortly after arriving

in paris for the for the for the big four peace talks so So Sarah Fling, who's a historian, notes the number of members of Wilson's entourage had caught the flu during a transatlantic voyage in February 1919, including his daughter Margaret, several members of the Secret Service, Wilson's stenographer, and his chief usher. The news of Wilson's illness was initially hidden from the public, with the Associated Press reporting flatly on April 5th that the president was, quote, not stricken with influenza. So it seems that whether or not he got it, people around him were pretty sure were getting it. And the White House kept that under wraps. Absolutely. There was a real crunch on information. And I think they controlled information, limited information in a way that, as I said, we would be uncomfortable with today. within a year or so, he was bedlaid and his wife was basically running the country and making the

decision. So something happened to him where he became ill and was no longer the robust person he had been previously. And he died, what, three, four years after leaving office? Yeah. So he died shortly after leaving office. And he was never the same after that Paris trip. But also, he went around the country on a train trip to promote the League of Nations, which he did not succeed in that effort because the Senate never ratified it. But on that train trip is when he got much worse and may have had some kind of stroke. Okay, so now let's fast forward to FDR and polio. So when did F, when do we think FDR contracted polio? We're actually not fast forwarding that much because I believe it was in 1921

when he contracted something. He didn't know what it was. A doctor came and actually misdiagnosed what happened to him, charged the family $8,000, which is a lot of money for the misdiagnosis. But what happened is FDR does get polio and loses the use of his legs for the rest of his life. So that's pretty significant and severe. However, and this is a great example of grit and perseverance,

he doesn't give up on his political career, and he becomes governor of New York and vice presidential candidate, and then eventually becomes president. But he's in a wheelchair. And again, you talk about suppression of information. The American people really didn't know that he was in a wheelchair that was kept from the American public. And I actually point this out in my book that there was really never a movie that showed FDR in a wheelchair until the movie Pearl Harbor in 2001. There was a fictionalized version, I guess, in the movie Annie has a fictionalized vice president of Roosevelt in a wheelchair. But I'm talking about a historically accurate film, as much as Pearl Harbor was.

You know, a movie that's purported to be historically accurate, that didn't happen until 2001 that they show him in a wheelchair. And again, unless you lived through that time, which neither of us did, it's hard to appreciate how serious polio was as a public health crisis. Right. So this was a thing. This was a disease. This was that was afflicting thousands and thousands of people. You write in your national affairs piece that it hit its peak in 1952 with a record of 57,628 polio cases in the United States. So this was real in the lives of a lot of families and a lot of communities across the country.

Yeah, I think the more sobering statistic is that it was paralyzing about 35,000 people annually. So the number of cases is one thing, but it was paralyzing about 35,000 annually, which is a huge number. Okay. But President Roosevelt did speak out about terms of like battling polio and fighting this public health crisis was comparable to fighting a war, which at the time he was leading us in the middle of World War II. That's absolutely true. But he kind of took a different perspective than what we expect of the president today. And this is one of the themes of my book, Shall We Wake the President, about how expectations have changed of what the federal government can do. He was really

about promoting the March of Dimes, which was a charity that he helped start that was trying to help victims of polio and also helped sponsor some of the research that eventually led to the vaccine. So he was about private sector charitable efforts to fight the disease. And it's not like he had the same kind of a vast federal public health bureaucracy that we have today. And did the public associate his leadership? I mean, I take your point that there weren't vast federal resources, so he was relying on the nonprofit sector. It's sort of hard to imagine that right now. I'm trying to imagine a president saying, we're going to rely on, you know, nonprofit organizations to fight COVID.

Did the public just kind of accept that, that his prescription or his approach to leading during this crisis was okay? He was like, people weren't outraged. Why isn't the president doing more? Why isn't the government doing more? You write in this piece, the 14 years from 1937 to 1950 saw about 230,000 cases of polio in the U.S.

That is an astonishing number, given the size of the U.S. population at the time. One would think in current, if you compared it to the current context, that people were just annoyed, frustrated, unsatisfied with the extent to which the President of the United States was doing something about this. People's children were getting, to your point, people's children were paralyzed. Yeah, there's two things going on, Dan. One is the level of expectations from the federal government. What do the American people expect the government to do? In the Constitution, for example, it doesn't talk about pandemic disease. It doesn't talk about crisis.

It doesn't talk about emergencies. So there's no, originally in the conception of this country, no expectation that the federal government gets involved and stops these kinds of things. And it's really in the FDR administration that things start to change with the New Deal and also with World War II. America just gets much more involved in the individual lives of its citizens at the national level. And then internationally on the world stage, it gets much more involved. And so there's this massive transition taking place in that administration. So that's one thing that the expectations of the federal government were

lower at the time. The second is, yes, it was a terrible disease, but at the time people understood that there were terrible diseases and it was kind of baked into the cake and the life expectancy was much lower. People didn't expect to live long, healthy lives until their seventies, eighties, and nineties, like, like we do today. And I don't want to say life wasn't precious, but people would have multiple kids understanding that some of them might die in childbirth or in childhood. And it's just a different way of looking at life and a disease than we have today. Okay, let's fast forward to to President Reagan during the HIV AIDS epidemic. So the numbers are actually astonishing. I mean, people, again, if you didn't grow annual number was 50,628 deaths.

Over 39,000 New Yorkers, where I live, alone, over 39,000 New Yorkers died of AIDS-related causes in the 80s. Overall, close to 700,000 Americans have died from AIDS, which is more than the 675,000 deaths, U.S. deaths, from the great influenza, the Spanish flu that we're just talking about, of 1918. And it's comparable to the number of U.S. deaths so far in the U.S. from COVID. So compare how Reagan administration dealt with that crisis relative to these other examples we're talking about, Wilson during the Spanish influenza or FTR during polio. So I think there's kind of a differentiation to be made between the historical reputation of Reagan on this. And I think he gets terrible marks from many people,

including many activists. And they can call him Adolf Reagan and stuff like that. And the actual response, which was not great, but not as bad or as horrific as it said. So by 1983, his HHS secretary, Margaret Heckler, is in hospital holding the hands of an HIV patient, which is a big deal because at the time we thought it was communicable by touch, by breathing, whatever. And we now know that it's not. And that was by design. I mean, he did that to make a statement publicly. It was open to the press. And then also there's some criticism of Reagan for not talking about it enough. He does go to HHS, I believe, in 1986 to talk about the important

work that the HHS workers are doing in terms of fighting it. And he mentions it in his 87 State of the Union address. But there's also a sense, and Gary Bauer has talked about this, he was a domestic policy advisor, that Reagan really believed in cabinet government. And he wanted the people from HHS to be out there doing the talking on this issue. I mentioned Margaret Heckler, but also C. Everett Koop was famously very involved in this. And one of Reagan's biographers even says there was Reagan who pushed Koop into getting involved in speaking out on HIV AIDS rather than the other way around. So I think the Reagan administration definitely also initiated an initial ramp up of funding to fight HIV AIDS. I mean, there's a guy named Anthony Fauci you may have heard of,

who initially made his name. Who? I think I've seen him on TV once or twice. He hasn't been on this podcast yet. No. I'm looking forward to it. But it may be the only major media that he hasn't hit yet. But But Fauci initially makes his name in helping to fight HIV AIDS and working. And he was very criticized initially by the HIV AIDS activist community. And he eventually built a rapport with them and really worked very hard on that. And, you know, being the face of the federal government on the crisis. So I think the Reagan administration was a little slow to act on it. It was not optimal, but it's not as horrific as they've been portrayed. Fast forward to today. So if we had a pandemic sometime in the future,

public health crisis, that was as deadly as, say, SARS, which was far more deadly than COVID, but as contagious as COVID, as C-19. So if we had a public health crisis where something as contagious as Delta was spreading around without a vaccine, or at least not a vaccine at that point, and as deadly as one of these earlier pandemics like SARS. You're painting a picture in which gradually there have been higher and higher expectations for our political leaders to manage through a public health crisis. And at the same time, the environment has gotten more politicized.

So it's like a toxic brew, right? Like the environment is more politicized and people's expectations of politicians and government is higher. And then if you throw into the mix, a future crisis that is highly contagious, highly infectious, and more deadly. What is, like, how prepared are we for that kind of environment? It feels like we're barely hanging on now. Yeah, it's true. We're not prepared. And that would obviously be a much bigger problem.

But the one positive note I would put in those two negatives that you say is that our capabilities are much better. I mean, even if Woodrow Wilson had been the best flu response guy in history, which he clearly wasn't, what could he have done? I mean, there was no capability to make the kind of mRNA vaccine that we have today. And we just didn't have the tools back then that we have today. So I think that while that would be a horrific situation, it is really a nightmare scenario, we do have much more capabilities and ability to combat these things. And look, the only way we seem to be making any progress on the virus front at all is through the vaccine. Vaccine, again,'s not perfect in that Delta is still spreading it, as you mentioned, but the likelihood of death or hospitalization, if you are vaccinated, is significantly lower.

So the vaccine has improved things. I think Delta has kind of knocked us back for a loop. And, you know, a couple of months ago, we were sort of meeting unmasked and, you know, a little more comfortably. And now people are getting nervous again. But the capabilities and the ability to develop that vaccine in nine months is really astonishing and something that we should celebrate. The president, who as we've talked about offline, the president, and you've commented on elsewhere, that gets the most criticism is President Trump's handling of the pandemic. And he sort of becomes the poster child, the epitome of a highly politicized figure

trying to figure out how to navigate during a highly politicized time, during very high expectations of our government during a public health crisis. How do you think President Trump did? Yeah, this is an important point that I often talk about, which is that there are some things that are within a president's purview, and there are some things that are not within a president's purview. The president doesn't, for example, develop the test at CDC, which CDC messed up on. The president doesn't develop a vaccine himself. The president isn't out there either rescuing people in case of a flood or administering some kind of healthcare response. So the president can't be involved in the micro stuff.

The president can be involved in the macro stuff. And the most important thing a president can do in a crisis is communicate effectively in a way that conveys information to the American people, accurate information to the American people without panicking. And I think on the communications front, Trump did a bad job. I don't think there's any two ways about that. I think he got us involved in unnecessary fights and disagreements about masks, about hydroxychloroquine. It just wasn't necessary to go down those paths. And there wasn't a sense that you could trust everything that was coming from those White House briefings. The bleach thing aside, there was just a question of whether they were giving you full and accurate information

every day. And I understand there's a lot of information swirling around. Sometimes you know stuff. Sometimes you don't know stuff. Sometimes you're given information that's untrue. It sounds like President Xi gave Trump some information that was just not accurate. That doesn't mean he should have passed it on, but nevertheless, that is an issue. So the communications front, I think, was a real problem. On the other hand, the development of the vaccine, the Operation Warp Speed, and I think that Secretary Alex Azar and Paul Mango, who's one of his top aides, really deserve a lot of credit for this. They realized early on that they were writing contracts, large grants to pharmaceutical

companies, and they really had no say on what was happening with those grants. And they said, you know what, we're dispersing money. Let's use that money to develop what we need, which is a vaccine. And it really is astonishing that we were able to get that vaccine in nine months. And I'm not sure it would have happened in another administration. I mean, I think the Trump administration was kind of known for knocking down red tape and bureaucratic barriers, often being criticized for it. But so I think that was a huge accomplishment. While at the same time, I think the communications are the mess. So you mentioned the CDC and the CDC's failure to produce an easily accessible, easily usable, widely available test early on.

We had Sid Mukherjee, Dr. Sid Mukherjee, on the podcast a couple of weeks ago and he he points out that i think it was something like 40 days from when the first case of covid was identified in seattle in the seattle area in washington state it was 40 days from then until there was actually a cd cdc approved widely available test and he just argues vociferously that 40 days is a lifetime, multiple lifetimes in terms of a pandemic response. And the idea that this pandemic, that COVID was swirling around our country for 40 days before people were able to do tests, set us so far back so early on that it's a big reason we are in the hole that we are in today. And you worked in the middle of our federal health care infrastructure. So I guess I have two questions. One is, and others have made this point, no matter who was president,

certain mistakes like the CDC's failure to produce a test would have been the case regardless of who was president. I think people don't understand that. They think the CDC is a federal agency. It reports ultimately to the chief executive of the country, the president of the United States. If you had a competent president, he would have like kicked the CDC into high gear and said, produce a test, not in 40 days, but in four days or in 14 days. And, and, you know, others who are closer to this, I think like you, actually argue that it's a lot more complicated than that. And you can't directly tie it to the president, whoever that president is. Oh, I would agree with that. I do not blame Trump for the

screw up of the CDC that did not allow a test for 40 days. And Dr. Mukherjee is completely right. But I think you need to explain this a little bit more in that the reason it's such a problem not to have a test is one of the reasons that we in the U.S. don't worry about communicable diseases is because one of our lines of defense is that we can track, trace, test and isolate people who have a disease, a communicable disease. This happened with Ebola, for example. I mean, there were some spread of Ebola beyond what should have been, but it was a handful of cases because we could test people rapidly. We could then trace who they met with. We track where they go and then we can isolate them. So we have good, what's known as infection controls. We have good infection controls

in this country. And without testing, you're kind of at a loss. You don't know how to stop the spread. So the, and where the spread is going. So Dr. Mukherjee is right that those 40 days were unconscionable. I don't think it would have been better under a President Clinton or President Obama or President Trump or President Biden. I think that is a CDC problem. And beyond what you were saying, it took CDC 40 days to develop a test. It was CDC and FDA were both telling other outside actors not to develop tests. Why? Which is really unconscionable. Why? Because they wanted control.

They think that they should... And other actors were what? NGOs, research institutions, private companies? A lab in Washington State, you mentioned that there's a case in Seattle. There was a lab in Washington State that was developing a test and FDA said, stop what you are doing.

So there, these federal agencies, they, you know, we talked about the growing expectations, these federal agencies, they feel like they can run things by Dick Todd and they can tell outside agencies what to do, outside entities, what to do and what not to do. And I think that was a problem in this case. They were preventing outside actors. And one thing we've seen in Corona is the great response of many actors in the private sector who just wanted to help, who wanted to develop vaccines, who wanted to take their clothing factories and turn it over to making masks. They wanted to develop tests. They wanted to do the research. And the private sector in this country has so many great capabilities. And in some cases, you had the public health authorities telling them not to do it.

There's also an issue with masks a little bit where they were saying early on, don't wear masks. The masks aren't effective. And I think that led to a lot of debate about masks later on. reminder listeners so so so dr fauci and other leaders within our public health bureaucracy argued early on against wearing masks because they were worried there was going to be a run on masks if everyone started wearing masks if the mass public started wearing masks and if there were a run on masks then our then our health care workers wouldn't there'd be a shortage of masks for our health care workers i'm just trying to, I mean, there was a reason behind. Yes. That was the point I was going to make, that they strategically said, don't wear masks, people, because they didn't want the masks to

run out for frontline healthcare workers. And there's a way to deal with that saying we have a real shortage of N95 masks. Please don't use those to preserve those for healthcare workers. But if some private sector entities want to, you had sports teams, for example, developing masks with, you know, you could have gotten a New York Jets mask to make you happy, Dan. I actually did have a Jets mask, but it came late, but go ahead. But you could have said, okay, certain types of masks we should reserve for frontline workers. But there is some evidence that masking is effective and try and get whatever mask you can. If it's a cloth mask or a temporary mask or a gauze mask, whatever it is, let's see if we can get the population widely masked. And I think that would have helped early on,

but instead it became a political thing. And people said, well, they told us not to wear masks because masks aren't effective. And then later on, when public health switched on a dime, and then all of a sudden they said, everybody must mask. And people who were a little skeptical, that's what you told us earlier, not to mask. So they gave a body of evidence for people to question the whole masking concept. And in terms of these big agencies, the CDC, the FDA, the NIH, there have been many criticisms that they failed to amend, suspend their rules, their processes, their various regulations in the midst of the crisis to make things happen more quickly, deploy resources, deploy funding more quickly, give more emergency approvals for whatever was being proposed at the given moment.

There was almost an expectation that these agencies could reform in the heat of a crisis. Again, you worked in the middle of all these agencies. Is that a reasonable expectation that the agencies and our president should have done something to make these agencies reform in the heat of a crisis? Or is that the wrong way to look at it? These agencies operate with such long lead time that if you want reforms in place that create that kind of optionality, you have to build those capabilities and those options in long before the crisis, not when the bullets are flying. Yeah, it's obviously hard to change these agencies and they are slow and they are bureaucratic. But let me give some credit.

I mean, FDA did help accelerate the development of the vaccine by looking at things a little way and going in a slightly different way and going with the emergency youth authorization for the vaccine initially, rather than making it go through the full approval process at first. So I think there were some missteps, and I'm happy to criticize them. And as you saw, I did criticize CDC and FDA on the issue of the testing initially. But later on, FDA did work as part of Operation Warp Speed, and it couldn't have worked without FDA to develop a vaccine more quickly than we've ever seen anything like that develop. But the larger point, let me just finish quickly, is that it is hard to reform these agencies. You can't expect them to reform

overnight. And I hope that some of the failures of the agencies in this period will spur some long-term reforms so that they are more nimble in the future when the bullets do start to fly. Back to your point about the Trump administration getting more credit or deserves more credit than it gets on Operation Warp Street, which I completely agree. And it's a point I've made repeatedly on this podcast. It was it was an it was extraordinary. It was sort of government response to a crisis, I think, at its best or close to at its best. There was a piece by Alex Tabarrok in Marginal Revolution, which is Tyler Cowen's blog. And he says, and he writes, Operation Warp Speed was by far the most successful government program against COVID. But as of yet, there is very little discussion or

history of the program. He says, there are many questions that we still don't know. Who wrote the contracts? Who chose the vaccines? Who found the money? Who ran the day-to-day operation? How was the DPA used? Who lifted the regulations? How was the FDA convinced to go fast? There's like a whole story here that we don't know. And it's not just like interesting, kind of who was in the room and who made the decision, kind of Bob Woodward type of reporting. It actually is hugely relevant to how the government, whether or not Operation Warp Speed was a model for dealing with the crisis. And it seems like we know so little about how they did what they did. And there are important learnings here for how to think about models for the future in the midst of a crisis where we need government to do something,

whether it's a public health crisis or not. It takes time for the historical record to develop. You and I both served in the Bush administration. The oral histories that say what people did, their kind of unvarnished views of things, are taken by the Miller Center at the University of Virginia. They do a great job. Those don't come out until 10 years after an administration ends. The archives don't open up for years in many cases. So that's one thing. The historical record is hard to find initially, and you've got to wait until some time passes after administration. That's number one. Number two is, I frankly think that there are some journalists, public health people who don't want to tell the story of Operation Warp Speed in a positive way because they dislike the Trump administration. And so there's less of

an interest in having some public health historian or public health expert writing that book or that article because it's just not where the media wants to be focused. Speaking of where the media gives credit, there was, and we alluded to this, that, you know, there's this point that if President Biden had been in power or President Obama had been in power, the crisis would have been managed better. And we have a historical comparison, which is how the swine flu was managed in the U.S. And many experts point to that as very successful. And you've written a lot about this. It was a very successful management of the crisis by the Obama administration. Ron Klain, who today is President Biden's chief of staff, at the time he was vice president Biden's chief of staff, and he was the coordinator. He was the czar for managing these public health crises. And he has said that we did everything wrong.

I quote Ron Klain about the U.S. management of the 2009 swine flu. We did everything wrong, and 60 million Americans got H1N1 in that period of time. And it's just purely good luck, I think he said, fortuity. It's just purely fortuity that this isn't one of the great mass casualty events in American history. Had nothing to do with us doing anything right. Just had to do with luck. So Ron Klain says says we got it all wrong the only reason it doesn't look as bad as it did is because while 60 million people got swine flu

we just lucked out that swine flu wasn't more deadly or we would have had i think what he's saying millions and millions of dead americans and it would have looked a hell of a lot different yeah i was really surprised to read that quote by klain, and I would love to see more about that and specifics on what he was talking about. My sense was that, and I wrote about this in the Wall Street Journal at the time, was that the Obama administration was caught a little flat-footed in that this was March of 2009. If you remember, their first nominee for HHS was Senator Daschle. He didn't get confirmed. So as of the time that swine flu emerged, not only was there not an HHS secretary, but none of the top politicals were appointed. And so they were kind of searching for what to do. And it seemed to me that they dusted off the Bush pandemic plan that I had worked on,

and that President Bush had urged us to develop after reading the John Barry book on the 1918 flu. And they did some things like they deployed antivirals. They, in addition to deploying- Hold on, just for our listeners, because you were in the thick of it, and I want to just provide the proper context so people know what we're talking about. So John Barry wrote this book about the Spanish influenza. It's regarded as like the single best historical account of 1918, 1919, 1920 in the pandemic.

And it's harrowing. Yeah, it's harrowing. By the way, I highly encourage our listeners to read it. We'll post it in the show notes. I think I've referred to it several times on this podcast over the past year. Bush happens to read it in what year? 2006? 2004.

2004. Okay. So you're working for President Bush. President Bush happens to read the Barry book in 2004. Why? I mean, it wasn't like a topical book. Someone just recommended it to him? Bush was a huge reader.

He read something like 60 to 90 works of serious nonfiction every year. He loved history. He loved biography. And people don't give him enough credit for what a serious reader he was. And so in the course of reading this, that book was kind of had a moment in, I guess, 03 or 04, and he read it. Okay, so he reads the book, and then what happens? Just briefly, I want our listeners to understand what followed after Bush reading that book. He tells his staff that if this thing ever happens again, he wants to make sure the U.S. is better prepared than we were in 2004. That Barry book is pretty harsh on Woodrow Wilson. Than we were in better prepared than 1918. Than we were in 1918. He is pretty harsh. Barry is pretty harsh on Woodrow Wilson appropriately, as you and I discussed earlier. And so Bush directs his team to develop a pandemic plan for what we should do in case there is a flu in the future.

And I worked in the White House. And just to be clear, previous presidents, Reagan, Bush senior, Clinton, you know, go back, Carter, Nixon. I mean, all these presidents had all lived through periods that were obviously after the 1918 Spanish influenza. So they too could have been aware that we could have faced a public health crisis at some point on this scale. And I'm not saying they chose not to do it, but this was just not on their radar. It got on Bush's radar and he got the government in gear. That is absolutely correct. Bush decided to make this one of his signature issues. And he directs his White House staff, but also HHS to start developing a plan for pandemic flu. And that included bolstering the strategic national stockpile so that we have countermeasures, increasing coordination within federal agencies, but between the federal government and the states and locals,

also increasing monitoring of diseases to see if something is emerging, and development of better vaccines. At the time, we were using egg-based vaccines. We started talking about moving to cell-based vaccines because the egg-based vaccines are literally based on the chicken supply. And if you run out of chickens, if some kind of disease destroys the chicken population, you're not going to have eggs and you're not going to have the vaccines you need. So we wanted to move to a cell-based vaccine development. Now we've moved it to mRNA vaccine development, which is another step forward. So Bush takes these initial steps that I think were helpful to the Obama administration in their response to swine flu, but they basically became the playbook

for how to deal with pandemics going forward. So then why didn't some of these steps that he took more helpful during the management to the coronavirus? So we developed a three layer of defense strategy. Number one was international monitoring. So we know what's going on abroad. And so we're prepared for it before it hits our shores. Number two was a system of infection controls, track, trace, and isolate so that if something hits our shores, we can narrow it down to where it is and prevent it from spreading further. And number three is the use of the strategic national stockpile to have countermeasures in place to respond to a pandemic.

Now, each one of those failed us. And let me explain a little bit why. On the international monitoring front, there was too much reliance on China. Now, you might say, oh, that's dumb to rely on China. China got burned with SARS in 2003. SARS emerged. China didn't want to share information about it. It became a big problem in China. It eventually reached your native land of Canada. It did not reach American shores, fortunately. But China was burned by SARS, and there were some indications that they

were going to be more communicative, and they were more communicative about certain flu strains that developed over the next 10 years or so. So we felt like China had become a better actor on this front. I think we were wrong to count on that, and also the WHO was a little too trusting of China. So we failed on the international monitoring front to know the extent of this disease and how it was developing and what a danger it was to us. On the infection control, track, trace, and isolate, we already talked about the testing debacle. But without testing, you can't do any of those things. And so we were left without our kind of home domestic defense strategy. And then the third thing

is the Strategic National Stockpile, which has countermeasures, both antivirals and also vaccines. So vaccines prevent and antivirals help diminish the symptoms. And I wrote about this in 2016 in my book, Shall We Wake the President, that while we have responses, we have countermeasures for flu in the strategic national stockpile and in large amounts. We have nothing for coronavirus. Now, I was talking about SARS-CoV-2 because I'd never heard of it and nobody had heard of it at the time. But I was worried about MERS and SARS and certain coronaviruses that had emerged over the last decade. And I argued that we needed to have something in the strategic national stockpile for dealing with coronavirus. We didn't. And so that third line of defense, having some kind of response capability in terms of countertops, heeded your advice, heeded your, you know, been more responsive to your concern.

What would be an example of what we could have stockpiled, what we could have developed years before? We could have developed this vaccine earlier. There's a guy named Jason McClellan, who's a researcher and doctor at University of Texas at Austin. My grad school alma mater, by the way. And he put in a grant application in the early 2010s for some kind of cross-platform coronavirus vaccine. And he was the one who helped isolate the molecule that was used for developing the vaccine

in Operation Warp Speed. But back five, seven years ago, he was already putting out grant applications asking for funding to develop a vaccine along these lines. And his grant was rejected. He actually quite cheekily tweeted out the grant rejection and the language of the rejection, which basically said not relevant to this time. We aren't really concerned about coronaviruses. So we could have done that earlier. I think NIH could have focused more on coronavirus as a problem and seen what kind of antivirals are out there. You know, in this all, let's talk about hydroxychloroquine. I mean, we have found some countermeasures in terms of things that work to alleviate the symptoms of coronavirus, of SARS-CoV-2.

It was slow going. It was spotty. It was imperfect. But we now know better how to treat this disease today than we did back in March of 2020. Perhaps some of those learnings could have taken place earlier with more research and more focus. So again, three layers of defense, they didn't work. Okay, before we move off the topic of public health,

and we just have a few minutes left, we've had Scott Gottlieb on, your former colleague, and you and Scott have published a lot together. And he talked a lot about our intelligence capabilities or whether or not we should be more focused on our intelligence capabilities or whether or not we should be more focused on our intelligence capabilities globally to catch kind of smaller localized outbreaks of what of of kind of little fires that could that could burn up into or spread to pandemics earlier, and we don't have the capabilities now to, you know, keep our eyes on these risks or these threats. You yourself have written about this in various pieces,

about our ability to kind of catch localized threats before they bubble up. How serious do you think the deficiency of our capabilities are in that area? And how big a priority should it be? Well, first of all, there is an entity that is supposed to be doing this. It's called the World Health Organization. But we found them to be wanting in the last couple of years. And so I think the US is going to have to develop more robust capabilities to do this. Now, part of the problem is that, you know, you and I love America, but not every country out there loves America. And so it's harder for U.S. officials sometimes to do that kind of monitoring. Also, sometimes there's suspicion that public

health officials, international public health officials might be intelligence officials, even though we have a strict policy against that. So the lack of trust... Explain that. We have a strict policy. So meaning So the lack of trust. Explain that. We have a strict policy. So meaning our public health officials that are supposed to be engaging with public health officials in other countries are not allowed to be in the intelligence gathering, the sort of national security intelligence gathering business. Is that true? Is there like a firewall? There is supposed to be a firewall, but not every country trusts it. So basically, if U.S. public health officials show up in a foreign country and start sniffing around purely for collaborative reasons to prevent the outbreak of a pandemic, the government in that host country may say, be suspicious.

These guys are effectively the CIA. Yeah, there is that kind of suspicion about them. Again, even though we do have that sort of firewall where we say we don't use our health officials for intelligence capabilities. You know, there used to be a joke if you meet the kind of USIA official at the embassy in Germany is probably a CIA person. You know, there are jokes about what the cover jobs are for intelligence officers in other countries. We're not supposed to use health people as cover for intelligence officials. But again, given that the World Health Organization can't do it, and the U.S. is limited in some of the places it can go, although the U.S. can do a lot and that's why they can't do everything, we are going to have to rethink this. And I would

like to see some reforms at the WHO where they are better at doing it and more capable of doing it and a little more trustworthy and a little less um a little less uh i guess kowtowing to china on these issues all right i will i'm going to leave it there you're not only a terrific guest but you're a terrific listener fan of the podcast so and you send me a lot of great ideas and feedback so i i i look forward to having you back on the podcast, Debbie. Thanks for being here. Thanks, Dan. It's a terrific podcast. I listen to it all the time.

I really enjoy it. And just so we don't annoy our friend John Putthorst, let me just say that his two episodes with you on Broadway and on Hollywood were absolutely fantastic. And I urge anyone who hasn't listened to it to listen. And if you have listened, listen again. So we've got to be sure to put in the show notes the exact episode numbers so people can follow Tevi's clarion call to listen to more pod on the post-corona podcast. Pod on the pod. I love it. Thank you. All right. Take care. Thanks, Tevi.

That's our show for today. If you want to keep up with Tevi, follow him on Twitter at TeviTroy, T-E-V-I-T-R-O-Y. You can also find his work at the Bipartisan Policy Center on their website, bpdcdc.org. That's bpdcdc.org. We'll also post that in the show notes. As for the books I mentioned in the intro, they're all worthwhile. They're both fascinating history and very accessible. You can purchase them at Barnes & Noble or any other independent bookstore or that e-commerce site, which I think they're calling Amazon. Post Corona is produced by Ilan Benatar. Until next time, I'm your host, Dan Senor.