The New Yorker Radio Hour - Atul Gawande on Taming the Coronavirus

Episode Date: December 4, 2020

Can a vaccine be distributed fairly? What will be the impact if a large number of people don’t take it—as they say they won’t? Atul Gawande, a New Yorker staff writer who was recently appointed to President-elect Joe Biden’s COVID-19 task force, walks David Remnick through some of the challenges of this pivotal moment. F.D.A. approval of at least one vaccine is expected imminently, but hospitalizations are still rising rapidly around the country, and Gawande is concerned that news of an approval could lead to more irresponsible behavior. “If, once people start getting vaccinated, they start throwing the masks away and you can’t get them to do social distancing,” he said, “then you’re really relying on vaccination as the sole prong of the strategy.” More than forty per cent of people polled say that they are reluctant to take the new vaccines, but Gawande suspects that the real number of resisters may be much smaller. “Part of the reason it’s good that health-care workers would go first is [that] . . . health-care workers are everywhere. Which means we’re all going to know people who got vaccinated, and we’re going to see that they did all right.” New Yorker Radio Hour listeners, we want to hear from you.  We have a few questions about the show and how you listen to it. The survey takes about twenty minutes, and your feedback will help us make our podcast better.  Take the survey here.

This is The New Yorker Radio Hour, a co-production of WNYC Studios and The New Yorker. Welcome to The New Yorker Radio Hour. I'm David Remnick. This is a grave moment in our history. We have just reached a point in America when COVID-19 exacts a toll like a daily 9-11, nearly 3,000 deaths a day. We live now in a strange and liminal state. On the one hand, a vaccine is around the corner. It really is coming. But we're nowhere near containing this pandemic.

Nowhere near the end of the tragedy. None of us wants to hear it much, but this will be the worst of winters. Atoll Gawanda is a surgeon and a staff writer for the New Yorker, and he was just appointed to President-elect Biden's COVID-19 task force. We talked last week about the shape of the months to come. When this began, I read the book about 1918 by John Barry, A terrific book, a history of the horrendous flu that killed millions worldwide and many hundreds of thousands in the United States. And there was all kinds of evidence there about the number of parades and public gatherings that people had heedless of all kinds of public warnings.

And I thought to myself, well, it's not possible that we would repeat these mistakes again, because after all, we learned from history, even if the president of the United States does not. And yet and yet, how is it possible that we made these mistakes? on such a mass scale. Do you lay it all at the feet of the President of the United States? I think there's a big part of this that I lay at the feet of the president. Imagine Pearl Harbor happened. And there was an attack that hit one part of the country. And then we spent seven or eight months deciding whether we were or not going to fight back.

The problems to solve here are really clear. The hospitals learned how to bring people to work and have them succeed. And it was a formula that included masks, included some basic hygiene, some basic distancing, and testing at least everybody who had a symptom and making it possible for them to stay home from work. That's been the formula, is the formula still, for making it possible for people to have resumed a normal life. we did not have a commitment from the very top to make this happen on a national basis. And we are continuing to litigate that issue to this very day. You are now on President-elect Biden's advisory board on COVID-19.

And I wonder what kind of cooperation you're getting from the Trump administration's own advisory board. Well, remember, up until just a few days ago, there was no cooperation. contact allowed at all between any administration officials and the Biden-Harris transition team. I'm sorry to interrupt it to it, but just to be clear here, in a public health emergency, the president's own theories ill-founded and fantastical theories about the election, for three weeks and more, held up any communication whatsoever between President Trump's advisory board and President-elect Biden's. Is that what you're saying?

Absolutely. And I want to, you know, let's put a pin in what that means in concrete fact. Here we had a vaccine trial that came out three weeks ago, followed it just a few days later by another vaccine trial. We did not have access to the information they were getting about. What's the status of those trials? We did not have access to information about supplies. So at the beginning of the year with Operation Warp Speed, the target was 300 million vaccines produced by the end of the year.

Instead, what we're seeing is reportedly 30 million or so by the end of this month. Why? What were the bottlenecks that meant that this couldn't be done? Is it a shortage of raw ingredients? Are they having stockpile problems? Is it a problem with the actual production process? These are brand new kinds of vaccines. and what are they tackling. Now, all of this will be learned in the days to come, but at the present time,

it's just starting to learn this basic information. Now, the Biden administration or administration to B's COVID-19 task force has got a seven-point plan to stop the pandemic. What are the crucial elements of that plan? Well, I think it is still the same story that we've known since April. It's masks and mandating masks. It's testing and being able to make sure there's widespread availability of testing.

It's supplies for the places that are going to need proper gloves, masks, etc. You know, I'm firmly in agreement with where the president-elect has been going on heating the advice from public health people that schools can be opened. but in order for kids to be back in schools, especially elementary and middle schools, there's still a lot of work to do to ensure they have the supplies that they need to maintain distancing, to have the right ventilation, and those are components that are going to be part of this picture as well. Now, one of the signal disasters in the Trump administration was communication, both what the president said about the pandemic and how he said it, the attitude he took toward it, were well over, what, a quarter of a million dead,

a quarter of a million now dead. And the president of the United States doesn't even talk about it on a daily basis. Not a word. No, he's been AWOL. It's interesting, however, in some ways that is preferable to coming in and constantly undermining the public health messaging.

And so the irony is Trump administration scientists and doctors get to speak with one voice about saying, wear your mask, avoid large spaces, please don't travel. So ironically, look, if I have to have President Trump on the airwaves contradicting everybody or being AWOL, I'd rather have him be AWOL. I'm talking with Dr. Atul Gawande of the President-elect's task force on the coronavirus. More in a moment. Obviously, communications is crucial, but something, thankfully, that we can look forward to as a vaccine. But that present. enormous logistical challenges.

What do you see as the rollout for the vaccine? Because clearly the lion's share of that is going to be on the Biden administration. What are the challenges and how do you view that rolling out? Well, this is an undertaking on another scale from anything we've been doing in the last year so far. For example, deploying testing to all the Americans in the country, we have deployed north of 120 million coronavirus tests in the course of eight months. This is going to be 330 million vaccinations twice and hoping to accomplish it in the course of six months or less. This is with vaccines that are a new kind of vaccine that hasn't been produced at this volume before. and that their clinical data is just undergoing review for approval by the FDA now.

The task is muddied by the fact that we don't have a clear understanding of what the supply situation we have inherited from the Trump administration is, and we don't also know even what the prioritization is. So in the next week or so, the first approval from the FDA could come as early as that for a vaccine. And vaccinations would get started 24 to 48 hours after the approval. There's already vaccines flying out on airplane flights to different positions in the country. There hasn't been clear notification how much a vaccine is there, which states will get how much. So I'm concerned that what will happen when the new administration starts is that they will inherit a lot of confusion in the public because each state is now coming to its own conclusion about how they're going to prioritize things.

And there's going to be such demand. People are going to clamor for this vaccine. And if they think that the system is rigged, we will have even more trouble building cohesiveness. And I would think a tool after you, get past nursing home in heavens, which are a couple million people, and people like my brother, people like you who are seeing patients all the time, nurses, emergency, health care workers, all those people getting it because they're coming into contact with it every day all the time. The next level is even harder.

It's almost like some terrible philosophical, moral ethical conundrum that philosophers are faced with all the time in academic papers. What are your discussions like when it comes to those levels? There are 87 million essential workers who are at heightened risk of exposure to people because they are meatpackers that are exposed to coworkers who could have COVID. It's grocery store workers. It's bus drivers who are exposed as people come on and off of public transportation. And there's a lot of unclear.

who's in that category, who's not in that category, and how do you make it simple for people to identify? You know, you'll be able to go to your local pharmacy and get a vaccine, but what they need to know is how do they identify who's the bus driver and who's not? Will the government be able to guarantee us that wealthy people, connected people, won't be able to, you know, know a guy, know somebody? I think this is one of the critical tests and an opportunity. The chance to prove that the system is not rigged should not be underestimated. It's hard because the bus drivers never came before the bankers before, you know, in priority for anything. I can imagine a million ways people paying someone off, $2,500 to get your work ID tag. Again, this is all about rallying people together. It can't just be about the rules. It has to be about how we all understand and work together.

What you're talking about is community and common interest and fairness. And many people are very good about that on the level of rhetoric, but when it comes to the level of their health and their children's health or their parents' health, that's where the rubber meets the road. Yeah, and it's going to be, I think, the math. debate and antagonism we've had over the last few months is nothing compared to the splits we will see over, I want my family to be vaccinated. One person in the family might get vaccinated, another person might not, because they have an illness profile or they have a job that fits in

that way. You'll have children who some families want to have vaccinated, and others will not want have vaccinated because pediatric clinical trials have only just gotten underway, and we won't see those results for a while. So I live in the autism community. I have a child with severe autism, and so I pay very close attention to the anti-vaxxer movement. And the statistics, the numbers of people who say they will not be vaccinated is enormous. And that has implications not only for themselves, but for our overall effort to have herd immunity, doesn't it? It does. One of the questions is it seems to be somewhere around 70% or so of people, if we can get them vaccinated,

that would stop the transmission just through vaccination alone. And if once people start getting vaccinated, they start throwing the masks away and you can't get them to do anything else like distancing, et cetera, then you're really relying on vaccination as the sole prong of the strategy come three, four months. from now. On one level, I think there are lots of things that are keeping that numbers of people who resist vaccination small. What are the surveys indicate now? What are the numbers? The numbers suggest that it's up as many as 40 percent, even up to 50 percent, who have said that they're not ready to take the vaccine if the FDA approves it. However, part of the reason

it's good that health care workers would go first is just demonstrating that we ourselves are willing to get vaccinated. And, you know, like everything else, there's what you read in the news and what you see advertised in ads, et cetera. But then there's what you see in your own society, in your own neighborhood. And health care workers are everywhere, which means we're all going to know people who got vaccinated, and we're going to see that they did all right. Well, what would it take to to eradicate or are we never going to eradicate it? Well, you don't have to get every single human being vaccinated in order to eradicate. You need to get enough people. vaccinated so that the disease stops spreading and dies out. And within a place like the United

States, I'm hopeful that we can get it under control here. But to get eradication, you really have to get the whole world vaccinated. And that will take years. That will take years. Now, if we are well vaccinated, we will feel comfortable over time lifting our restrictions on travel to the United States. It'll become freer for us to travel to many places around the world. But it won't be long. It'll be, you know, a few months in, and we will begin to realize what a lot of public health people like me have been saying, which is this can't just be about distribution of vaccine in the United States. This is also going to need to be about enabling global vaccination. At what point do you think you'll feel comfortable, you atulgawande, eating in crowded restaurants,

flying on planes the way you used to fairly regularly, living life that you lived a year ago? I'm actually a trial participant. So part of the thing that's running through my brain is one of the moments I'm going to feel most comfortable is when I find out whether I got a placebo or I got the vaccine.

What trial are you in, can you say? I'm in the Moderna trial, the Moderna vaccine trial. And I want to see the evidence that that is lasting. So, you know, what is the story three months from now and are the antibodies showing indications that it lasts? I suspect that we'll really feel comfortable that we're able to largely return to normal

maybe in about six months' time. But I'm so desperate to go to a concert. Like music is the thing I miss the absolute most. And, you know, it will be a reasonable calculation but I do want some more information about will I transmit it to any of my patients? You know, might I get an asymptomatic case and turn out to be spreading it to others?

That information will come from the subsequent work in the trials, but that's still some time away. If you get your wish and live music comes back sometime soon in 2021, what's the first concert you'd like to go to? Hmm. I think the last concert I was going to see was a Peter Bjorn and John concert, an indie band, in one of those small, crowded clubs. And, of course, it got canceled.

They got rescheduled. And maybe they will be coming back in the fall next year. I hope they will. I hope so, too. Thanks so much, Atul. Thank you. I talked to Atul Galande last week. He's a staff writer for the New Yorker since 1998, a practicing surgeon in Boston,

and a member of Joe Biden's COVID-19 task force. I'm David Remick, and that's our program for today. Thanks for listening to The New Yorker Radio Hour. We'll see you next time. The New Yorker Radio Hour is a co-production of WNYC Studios and The New Yorker. Our theme music was composed and performed by Merrill Garbus of Tune Yards, with additional music by Alexis Quadrado. This episode was produced by Alex Barron, Emily Boutin,

Avae Carrillo, Rianan and Corby, Calalia, David Krasna, Caroline Lester, Gauphin and Putubuele, Louis Mitchell, Michelle Moses, and Stephen Valentino, with help from Alison McAdam, Danny Bonner, Moner, Meng Faye Chen, and Emily Mann. The New Yorker Radio Hour is supported in part by the Cherina Endowment Fund.