▶ Watch Video: CDC revamp comes at an “inflection point” for agency, Birx says
The following is the full transcript of an interview with Dr. Deborah Birx, former President Donald Trump’s COVID-19 response coordinator, that aired Sunday, Aug. 21, 2022, on “Face the Nation.”
MARGARET BRENNAN: Good morning, Dr. Birx.
FORMER WHITE HOUSE CORONAVIRUS RESPONSE COORDINATOR DR. DEBORAH BIRX: Good morning, Margaret. Great to be with you.
MARGARET BRENNAN: You know, this was an incredible acknowledgement by the CDC Director just a few days ago about the agency that she runs and Dr. Walensky said to CDC employees “To be frank,” quote, “we are responsible for some pretty dramatic, pretty public mistakes, from testing to data to communications. This is our watershed moment.” And she outlined these proposed changes to institutional culture, accountability, communication, timeliness. Do you agree, doctor, with her diagnosis?
DR. BIRX: Well, I’m thrilled that she had Jim Macrae and did this work, because a lot of directors would have just tried to tweak, and tweaking the agency at this point was not going to be successful. This is an inflection point. I think she recognizes that, and I think she- we all should be proud as Americans, that the Director was willing to do this hard work to find the issues, and now they have to be fixed.
MARGARET BRENNAN: And they have to be approved still by the HHS Secretary. I mean, do you think that it is enough for a bureaucracy to try to fix itself, or does Congress need to step in and legislate here?
DR. BIRX: Well, there’s certain things that Congress needs to do and thank you for recognizing that. And frankly, that’s why I wrote the book, it has 11 pages of what Congress needs to do. And the number one thing is to stop trying to create a parallel data system. In many countries, the public health system and the clinical system are one. In our country, they have been separate, and it has failed us. And there is a way to really get real-time data from our clinical care system, from our hospitals, from our clinics, and from our laboratories. And rather than creating a parallel system, it all starts with the data, and they need to create a public-private partnership between our clinical care systems and laboratories and- and the CDC and- and ASPR and NIH so that the data is available in real-time.
MARGARET BRENNAN: And that is one of the chief criticisms that you had. I mean, back in January of 2021, when we spoke, I remember you saying you didn’t trust the CDC data that you were getting during the Trump administration. You said the ethnicity and race of COVID fatalities sometimes was delayed as many as 30 days and you started going to the hospitals to try to get that data. So if Dr. Walensky is saying that this is a problem, how does she actually fix it? Are you saying that the government can’t do it alone, that it needs private industry to step in?
DR. BIRX: Yes, and that was the way we were able to get the data. First and foremost, in March of 2020, all of our data that I used to warn Americans of who was at risk for severe disease, hospitalization, and deaths came from our European colleagues. That in itself should be an indictment of our system. Secondly, throughout this- throughout the time, reporting was coming in extraordinarily slow from hospitals through a system that CDC had created. And I know this created controversy, but for three months, I asked the CDC to fix its system and develop a partnership with clinics and hospitals and laboratories, and they wouldn’t. And so that’s why I asked all the hospitals to start reporting and they did. And so I think sometimes we hold ourselves back. The private sector is willing to help us, you know, they- they have people working in these communities. They want everyone to do well to thrive and survive. And so I think we’re just not tapping into the system that the United States utilizes for healthcare delivery and because of that, there’s extraordinary delays, and critically, there’s incomplete data. And so decisions are made, and this is another issue I’ve had with the CDC. I’ve asked them over and over again, if you’re going to issue guidance, like five days in return to work in a mask, show the data transparently that you utilized to come to that decision. Because I think when Americans saw that it was a very small number, that they would have really reconsidered those guidelines. And so you really need the information. Americans are smart, they can process the information, give them all of the data.
MARGARET BRENNAN: Sorry, to pick up on what you just said, you are saying that the current CDC guidance of being able to return to work after five days if you wear a mask is based on flawed data?
DR. BIRX: Well, it’s- it’s based on what we call in medicine, a convenience data set, rather than all Americans. We’ve had millions and millions of infections, and we could have tracked Americans over that time period. The federal- the federal government was sending out tests. So we could have said to people, test on day three, test on day six, test on day nine. They would have seen that the antigen test was still positive in most cases out to 9, 10 and 11. And we have to assume, until we have better data, that you’re infectious if your antigen test is positive. So we had, and I think this is the problem, they’re not willing to accept that what we have as data that we can interpret and really talk to the American people. I’ve studied- I’ve worked on pandemics—
MARGARET BRENNAN: But why would the CDC- why would the CDC do that? Are you suggesting that there is a concern here due to the worker shortage or political interference? Why would they tell people to return to- to work if there’s no way they’d actually have cleared the virus within a short period of time?
DR. BIRX: Well, there definitely was a worker shortage. But I think when we have that happen, we have to be very clear. We can say to people, we think you’re still shedding some virus and that’s why we’re telling you to wear a mask, and a crude indication that you’re still shedding virus is your antigen test. And so we’re really not using the tools that we have to ensure Americans can both survive and then thrive. And we do have tools. We have so many better tools now.
MARGARET BRENNAN: Well, I raise political interference, because as you know, during the Trump administration, and you felt some of this, that was one of the criticisms, that there was political interference with the doctors and with the science. But when it comes to the CDC advice, I mean, if you go through it, people may forget we- we had field hospitals in the middle of Central Park and refrigerator trucks moving dead bodies. We’ve come a long way here, but the CDC guidelines on masks was wrong. It was wrong when it came to the tests they were trying to create and deploy. They were telling people to take their temperature, not realizing there was asymptomatic community spread. Are we at the point where you cannot rebuild public trust? I mean, is the agency worth reforming?
DR. BIRX: Well, the way you rebuild public trust is be transparent. And I think that’s in the report: better data, better accountability, better transparency. But they also have to believe, and this gets to the culture piece, people can understand complicated issues. It’s your job as a public health official. That’s what public and public health means. Your job is to take complex situations and data, and create graphs so that people can understand why you are making those recommendations. Recommendations that are created out of lack of transparency, and out of a black box where you can’t really follow the logic is what leads to fracturing and trust. And you really have to work to reestablish that. It can be done, but they have to change how they collect data, how they present data, and how they communicate to the American people.
MARGARET BRENNAN: So there is supposed to be a new booster coming soon, that will help protect against new variants like Omicron. Who should get that booster shot?
DR. BIRX: Well, I think we, again, have to be very transparent about what we know. We have to be able to say we didn’t study asymptomatic spread and so we don’t know if these boosters protect against asymptomatic spread or not and we don’t know if they do protect how long they protect. And I do believe early on the shots do protect against infection, but it’s time limited. Unlike the pox viruses that we’re talking about in monkeypox and that vaccine, which induces what we call almost sterilizing immunity, so you never get infected for long periods of time, these COVID vaccines can’t do that. They can protect against severe disease and hospitalization. But even from Delta and Omicron, it’s clear that that wanes. And so that’s why these boosters are so critical and that’s why we ought to be having age-specific recommendations for these vaccines, because they’re critically needed in certain age groups to protect against severe disease and hospitalization and deaths.
MARGARET BRENNAN: I want to ask you about monkeypox. It was first detected in May in this country. Now it’s a public health emergency and there are reports of it spreading among children, particularly in the state of New York right now. As parents send their kids back to school, what do they need to know?
DR. BIRX: Well, I think what was so disturbing to me about monkeypox is a lot of the issues that got us into the ditch with COVID were repeated. Those mistakes were repeated with monkeypox: not adequate testing early on, not making tests available in every community that you knew was at risk. I mean, we had the roadmap of who was at risk. We should have immediately made it- tests available through the gay and bisexual network. They are very responsible people. They’re very knowledgeable about prophylactics and preventing disease, because they’ve been doing it for decades. This is a highly informed group. If they had communicated to that group, if they had provided testing, if they had provided vaccines to all of them in May, we wouldn’t have this problem in August. And so five months have gone by. Just like what happened with COVID, lack of preparation, lack of engagement, lack of utilization of the tools that we had in real-time to prevent this 14,000, and probably it’s well over 20,000 now. And remember, it can be spread, yes, skin-to-skin, but it can also be spread through clothing and linen. And so that’s- we just have to tell people, if you have any kind of lesion, please get tested. Because you can spread it unknowingly to your household. You can spread it unknowingly to your family members. You can spread it unknowingly to your friends and to your children. And I worried about- in long-term care facilities because it could – excuse me – also spread in long-term care facilities because of laundering. We should know right now, is monkeypox killed in cold water, or do you need to wash the clothing and everything in hot water? I mean, these are practical solutions that the American people need.
MARGARET BRENNAN: And before I let you go, I want to ask you about the vaccine because you said there is one available. The CDC director said this week, we don’t yet know how well this vaccine will work in this particular outbreak. What do people do with that?
DR. BIRX: Well, the way you figure out if it works or not as you collect data. So if we had been immunizing the gay and bisexual network where we first saw the disease in Europe, beginning of May, and prevented the spread in that network, we wouldn’t have 14,000 cases right now. So that’s how you do public health. You utilize your tools, and you collect data on the population level. Again, not convenient samples, not 10 people or 100 people, but 100,000 people, a million people and we have that capability. It’s the 21st century. We know how to collect data and make it anonymized. We have been doing this for decades in Africa. I can tell you of the 18 million people on treatment in Africa whose virally suppressed in real time. So you know, it can be done. We need to translate what we’ve learned of how to actually combat epidemics in real time to America. I realize we haven’t had to do it for a century. But we know what works because we’ve been doing it elsewhere for many, many years, and we know how to work with communities. We know how to translate data into action. And I think what keeps getting missed is implementation, implementation, implementation.
MARGARET BRENNAN: Dr. Birx, thank you for your time this morning.
DR. BIRX: Thank you, Margaret. Always good to see you.