Podcast: The Race to Vaccinate: Dr. Atul Gawande Provides Perspective

TRANSCRIPT: The Race to Vaccinate: Dr. Atul Gawande Provides Perspective

Atul Gawande:

Again and again, our health system has demonstrated what we've seen over the last year, which is that we're all breakthrough and no follow-through.

Ian Bremmer:

Hello, and welcome to the GZERO World podcast. Here, you'll find extended versions of the interviews from my show on public television. I'm Ian Bremmer, and it's been just over a year, can you believe it? Since the first cases of coronavirus were reported in the United State. As the death toll climbs and new, more contagious strains spread across the world, the battle is far from over. Today, we're talking about the race to vaccinate hundreds of millions of people and how to prevent the worst case scenario from playing out. My guest is Dr. Atul Gawande, a leading public health expert and surgeon who served as pandemic advisor on Joe Biden's presidential transition team. Let's get to it.

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Ian Bremmer:

Atul Gawande, great to be with you sir.

Atul Gawande:

Great to be with you.

Ian Bremmer:

Let's start with something you tweeted last week, something optimistic. Johnson & Johnson just released their latest results, and you said we miraculously have at least three safe, highly-effective vaccines, miraculously is quite something for someone with your background, tell me why you're so shocked.

Atul Gawande:

The Johnson & Johnson shot is a one-shot vaccine as opposed to two shots, so much easier to administer, refrigerated and it had 100% effectiveness against hospitalizations, and deaths, and severe disease after 48 days. That is what we hope for. The headlines were all about the fact that they came out as being 72% effective in the United States, the Moderna and Pfizer mRNA vaccines were like 95%. And there was disappointment about that. But the reality of this is, this is a highly-effective vaccine. It stops people from getting sick. If some people have some sniffles and mild effects from the coronavirus, that's okay. This is going to stop the deadly disease, and that is the ultimate goal of the vaccine.

Ian Bremmer:

If Americans come in and they are offered the J&J vaccine instead of Moderna and Pfizer, you are telling them, "There is no problem. You should absolutely take that." Right?

Atul Gawande:

Yes. I am worried that there were going to be people who are going to say, "Hey, I'm going to wait until there's more supply of the other vaccines." Right now, with hundreds of thousands of people actively infected circulating, the most dangerous thing for you is getting the coronavirus now versus a vaccine now, and taking the shot that you can get is going to be the most valuable thing. Then, we are bound to, from what mutations are developing, end up needing boosters down the road anyway, so take what you can get.

Ian Bremmer:

Now, as you said, there are other variants. We're hearing an enormous amount of news about, in particular, the South Africa variant, where the vaccines that have been developed are effective but are not as effective. How significant a gap is that as the South Africa variant likely becomes much broader spread here in the United States?

Atul Gawande:

I find it alarming the South African variant and the Brazilian variant that also has a similar mutation, both have landed in the United States and are starting to spread. And they are showing that they are only partially effective, the vaccines have some partial effectiveness against these variants. We have to wait for some more data, both the Johnson & Johnson vaccine, Moderna vaccine, and Pfizer vaccine, the argument is it appears to be reasonably effective, effective enough to provide some significant protection, and we're even seeing some signs that they protect against the most severe disease, hospitalization and death. But it is worrisome that there is so much virus circulating. We're seeing mutations develop that start to evade the vaccines, that's going to make boosters, updated versions of these vaccines, inevitably necessary.

Ian Bremmer:

Now, in an environment where most of the people that are getting coronavirus are asymptomatic or have light symptoms, is that an environment where it just becomes much, much more likely that not just the South Africa variant, but other newer, more competitive variants for transmissibility are just going to be a reality?

Atul Gawande:

Well, not necessarily. First of all, you got to understand, this is mostly driven by human behavior rather than the lack of resources in low-income countries. India was on the same pathway the United States was on. It was about to become the number one source of virus in the world, and then in September they had a concerted campaign to get people wearing masks. They now have incredibly low rates of circulation. They put our country to shame. What I would say is the where you have wide amounts of virus circulating, because there has not been a concerted effort, we see that in Brazil, to wear masks and get the basic measures into place, those will be places that are sources of more mutation.

Ian Bremmer:

We see it in Brazil, we see it in South Africa, we see it in the United Kingdom. The three places where I've heard broadly named variants, that is not coincidence, I take it.

Atul Gawande:

That is not coincidence. It is precisely those places where we've had a substantial amount of increase in spread. The variants are driving more hospitalizations and deaths mainly because of just being more contagious. Now, the good news is Israel has already hit high enough levels of vaccination that they're seeing a drop in infection rates and hospitalizations, and it's significant because Israel is about half the UK mutant virus. That means that the Moderna and Pfizer vaccines they've received are effective against the UK variant, that's the one that in the United States is also spreading quickly. We're in a race to get people vaccinated to provide that protection even against some of these variants. The South African and Brazilian variants are more concerning for evading some of the vaccine protection.

Ian Bremmer:

Now, Israel, a tiny population, about 7 million people, but over 50% of all Israeli citizens at this point have gotten at least one jab. What else have we learned? Because we're many months away from that in the United States, but we're on that trajectory. What have we learned so far from Israel that will be applicable here in the United States?

Atul Gawande:

So, a couple of things we've learned from Israel. Number one is that, boy, buy the vaccine in large quantities early, and they got those commitments, so they got the supply they needed. Second is they're a country that have universal healthcare coverage, everybody has a doctor and are enrolled in well-organized systems, so that they could identify the high-risk groups, notify people to get in, and then work with the doctors in the health system to enable the delivery. That is what we did not do.

Ian Bremmer:

So, we've talked about some of the vaccines in the United States. Of course, in the world, the Chinese vaccine is going to be what a lot of people are experiencing or Chinese vaccines. How confident are we that the Chinese vaccines, the Russian vaccines, are going to be suitable for purpose as they start producing and exporting in large numbers?

Atul Gawande:

We really need to see more of the data. The measure to me, everyone's been focused on the effectiveness against the virus on a overall level, but as I alluded to earlier, the critical measure is how much do they avoid serious illness. These vaccines in China produced by... Also being produced in Russia, there's one that also we haven't seen clinical data on that's being distributed widely in India.

Ian Bremmer:

From India. Yeah.

Atul Gawande:

Those are going to be... Seeing what the actual effect is on the rates of hospitalization and deaths is the critical thing. You can see this shut down the spread of a very serious disease, and dangers to the healthcare system, not to mention people's lives. That could happen still with these vaccines. We just haven't seen the data.

Ian Bremmer:

Any reason to believe that, again, you're seeing this all over the world right now. If you're getting a Sputnik V vaccine as opposed to nothing in a country like Argentina, your view would be take it or actually we just don't know?

Atul Gawande:

My view on it is we just don't know. It's a problem that vaccines are moving out, that the public hasn't been given a chance to evaluate what the actual data is. When it comes to Moderna, Pfizer, Johnson & Johnson, Novavax, there's a transparent process with FDA getting to review the actual raw data itself to see that it isn't doctored, that it's being interpreted correctly, and they're in well-run trials, where you can see what the results are and know that they are safe and that they are effective. With these other vaccines that are being distributed in other countries in the world, that information's not been available and you are seeing significantly higher rates of hesitancy about taking those vaccines in those environments. It's a straightforward thing, you just have to be more transparent.

Ian Bremmer:

We're a federal system. I mean, state governments, local governments have lots of different authorities. What can we do in the near term that will start to make a meaningful difference in the effectiveness of vaccine distribution in the US?

Atul Gawande:

I'm running vaccine distribution right now with a team of people and a partnership I put together at Gillette Stadium, Fenway Park and beyond. What I can tell you is, number one, the situation until just recently was that you had people signing up for slots and then no certainty that the vaccine would be there, and either the slots would have to be canceled or the slots would suddenly open up magically overnight because you didn't have the plans in place. That is the biggest thing that needs to change right now is getting much better predictability about how much vaccine is coming.

Ian Bremmer:

Do you feel comfortable this idea that the Pentagon might actually provide troops with FEMA for vaccination centers across the country? Is that something that we are well-trained, well-capable of actually doing and not stepping on the feet of the existing distribution plans that we have in place?

Atul Gawande:

I've also been involved in scaling mass testing and, I can tell you, the National Guard was absolutely critical in being able to get to hotspots and deploy testing to know where things were running out of control in nursing homes, and in many communities. The National Guard can be a vital element for driving staffing. Also, what we've seen is just changing the rules that you don't have to have nurse or paramedic level people required to give vaccination. In my state, and many others, you have seen that they've allowed basic EMTs to be able to provide the vaccines, pharmacy technicians, and I think we can get to the point where well-trained lay people could eventually be able to provide these vaccines as well with the right supervision.

Ian Bremmer:

So, if you think about the billions and billions of dollars that are now being invested in everything from the vaccines themselves to health preparedness, to emergency response, what are the things that you think will change in a dramatic way as a consequence of coronavirus and how we think about health and disaster response?

Atul Gawande:

Well, again and again, our health system has demonstrated what we've seen over the last year, which is that we're all breakthrough and no follow-through. There are major gaps in our ability to make sure that Americans get the basic capabilities that assure people their... Your 80-plus years that you can have, if you have the appropriate access to diagnostics, and treatment, and ability to afford them. I think what we are discovering is the basic public health precepts that apply in this pandemic, why can't we get testing? Why can't we get the vaccinations distributed? Applies to the fact that we have a third of our counties that also don't have obstetricians, and obstetrics units, that even more don't have inpatient psychiatric beds. We have massive problems with lack of access to the key things that make a difference in people's lives, problems in making them affordable, and getting them to the point where you can actually get high volume delivery efficiently and it doesn't have to cost the crazy amounts it does.

Ian Bremmer:

And I know you've done a lot of work on the ground in India over the years, work that's really made a difference to health on the ground. What surprised you about the response, both the initial response, when they first found out about this disease, as well as where it's been going? Again, I know there have been big successes. You alluded to some of them at the beginning.

Atul Gawande:

The striking thing about this pandemic is that if you looked at the rankings of who has the greatest pandemic preparedness in the world, the United States was number one on every ranking, and you would've seen places like India near the bottom. Instead, what you found was that the single most important factor was, do you have leadership that communicates a clear acceptance of the seriousness of the pandemic, mobilizes the public and the government to tackle the problem, and then uses you whatever resources you have at hand to succeed? In the top 10 of performers were Vietnam, Thailand, India, as well as Australia and New Zealand, and that is all about political leadership. Turns out that communications and organizing together allowed people to fight off the virus with basic tools like testing and simply wearing masks.

Ian Bremmer:

Is that also playing through in terms of anti-vax sentiment across those countries and our own?

Atul Gawande:

Well, I think it's too early to say, there is hesitance, for example, in India about taking the vaccines related to the lack of actual trial knowledge, and you have doctors questioning whether they're ready to administer it. When you have though the profession coming behind, transparent information about the safety and effectiveness of vaccines, we are seeing fear being replaced with confidence in many populations around the world, including ours, where the number of people who are becoming unwilling to take the vaccine have dropped enormously thanks to seeing neighbors, your healthcare professionals start receiving the vaccine and doing okay.

Ian Bremmer:

What's the one thing that we are not yet on a path to fixing in the United States? I mean, again, you are working in the transition. There are so many things that you can focus and prioritize. Where's one area that down the road you think the United States is going to need to actually pay a hell of a lot more attention?

Atul Gawande:

Well, one area that we identified in the transition, advised the administration, and they've started on, but it's a long pathway, is developing better antiviral drugs. It's going to take more than the vaccine. You have, as we talked about, the mutations that can make the vaccines less effective. We're going to have a while before everybody gets treated, and the monoclonal antibodies, the high cost infusions like the president got, the mutations are also evading those drugs as well. What we need are oral and low-cost antivirals. Those are critical to allowing you to be able to treat more broadly. And we have not had a concerted effort to develop those kinds of solutions. They've often come from other countries, such as taking steroids when you become hospitalized with COVID, and that cut death rates by more than a third, there's more opportunities in that kind of space.

Ian Bremmer:

Your work in the transition task force, at that level, responding to this crisis, what's the thing that, going into it, you really didn't expect?

Atul Gawande:

I did not expect how just normal and rational the process was. We identified on the advisory board a whole range of issues, and then systematically you could work with the leaders right on up to the President-elect, then, Biden and Vice President-elect Harris, and you would have a review of the data, the review of the issue, you could make recommendations, decisions would be made, and people would stick with those decisions and then execute on them. I know that seems simplistic, but it was such a bomb for my soul after being involved in the coronavirus for the entire length of the process and not experiencing that as we tried to tackle these issues, that's allowed for this action to move much, much faster.

Ian Bremmer:

We saw Ron Klain, the White House Chief of Staff, recently said the Trump administration had virtually no vaccine distribution plan. As a member of the transition team's COVID task force, is that what you found as well?

Atul Gawande:

The answer is yes. There's a basic set of things when you're talking about vaccine distribution. You have to have a plan for what the resources are, a plan to support staffing for all the vaccinators. You have to have IT systems to enroll people. And you have to have a system to arrange for the billing to get the money from the insurers. Most of that was not in any sort of plan or organization, and we are seeing the consequences of it with difficulties people are having and getting enrolled, a lack of coordination and just a million different scheduling systems. And then a lot of complexity around how to make sure that the reimbursements come back so that places can afford the resources to build all of the staffing and what needs to be done here. So, yes, a problem.

Ian Bremmer:

One of the reasons, I'm sure you felt so comfortable in the process, because you were surrounded by some of the best known and most experienced experts in the field. Do you worry, given that there's this overwhelming focus on the healthcare side of this, that actually the pendulum swings too far and the focus on the basic economy, the focus on what's required to get things back open will actually get short shrift?

Atul Gawande:

No, I am not worried about that. It's very clear that the agenda needs to be informed by the scientists and the healthcare people, but the decisions are ultimately political decisions over the key trade-offs people are willing to make and not willing to make, and not being mistaken that the scientists are making the final call on the prioritization and choices.

Second of all, it's very clear that our ability to rebound as an economy depends on your ability to address the pandemic. Two-thirds of the job losses were in face-to-face professions, whether it's airline workers, hotel and the hospitality industry, and those were not regulated or shut down, haven't been shut down for months. The reason people aren't flying, the reason people aren't in hotels, the reason people aren't often turning up in my office for healthcare is because of fear that they will get sick and be harmed by the virus. That is going to be the single most important problem to solve in order to rescue the economy as well.

Ian Bremmer:

Atul Gawande, thank you so much for joining.

Atul Gawande:

Thank you.

Ian Bremmer:

That's it for today's edition of the GZERO World podcast, like what you've heard? Come check us out at GZEROmedia.com and sign up for our newsletter, Signal.

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The GZERO World podcast is brought to you by our founding sponsor, First Republic. First Republic, a private bank and wealth management company, places clients' needs first by providing responsive, relevant, and customized solutions. Visit firstrepublic.com to learn more.

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