The Man With the Plan to Beat the Pandemic

I’ve never covered a moment that simultaneously merits so much despair and so much hope. It’s dizzying. The Biden administration takes office with over 25 million Covid-19 cases nationwide, over 420,000 Americans dead, and new, highly contagious variants of the virus stalking our future. It’s as grim a situation as I’ve seen. But for the first time, we can do more than hide. We can immunize. Getting a population of 330 million to herd immunity is a hellishly difficult undertaking in the best of circumstances, and these are not the best of circumstances. Still, speed matters: Getting to herd immunity a few months faster could save hundreds of thousands of lives. Dr. Vivek Murthy was surgeon general under Barack Obama, and is Joe Biden’s nominee for the same position. He’s also co-chair of Biden’s coronavirus task force. In this episode, Murthy walks me through the Biden administration’s plan to beat the coronavirus. We discuss America’s botched vaccine rollout efforts, what the choke points are now, whether the Oxford-AstraZeneca and Johnson & Johnson vaccines will be approved, why the U. S. government should be shipping out free masks, what’s blocking 24/7 vaccination sites, the F. D. A.’s overly conservative approach to at-home testing kits, what we can and can’t do after getting the vaccine, the vaccine failures in blue states, how to change the minds of the nearly third of Americans who are vaccine-skeptical, why persuasion is as much about listening as talking, the new coronavirus variants, and much more. You can find transcripts (posted midday) and more episodes of "The Ezra Klein Show" at nytimes.com/ezra-klein-podcast, and you can find Ezra on Twitter @ezraklein. Thoughts? Guest suggestions? Email us at [email protected]. “The Ezra Klein Show” is produced by Rogé Karma and Jeff Geld; fact-checking by Michelle Harris; original music by Isaac Jones; mixing by Jeff Geld.

Speaker names marked ? are inferred from speaking time and the show’s known hosts — they are not voice-verified.

• 0:05Ezra Klein?

  From New York Times Opinion, I'm Ezra Klein. This is the Ezra Klein Show.

• 0:17Ezra Klein?

  There are few administrations outside of wartime that come in with their definitional tasks so clear. But the Biden administration, there is no doubt about what it has to do.

• 0:33Ezra Klein?

  The coronavirus has now killed more than 400,000 Americans. We have hit the kinds of numbers that the mind repels from. It's more Americans than died in World War II. Reading these numbers, it dulls you, but these are so scary. We are seeing more than four times as many cases each day as we did in September, more than four times. We know, we know that more contagious strains are circulating here. So a sharp acceleration of cases in the coming month or two is really likely. This is not the worst. Ron Klein, Joe Biden's chief of staff, has predicted that more than 500,000 Americans will have died from the disease by the end of February. We've moved into these numbers that the mind is repelled by, but it is so many people. It is so many broken families.

• 1:19Ezra Klein?

  But this is one of these moments when despair leans right up against hope. The science came through, the scientists came through. Pfizer and Moderna, they developed amazing vaccines, genuinely amazing, so much better than we could have expected, that are over 90% effective. There are other promising vaccines coming from Oxford and AstraZeneca, from Johnson & Johnson, from Novavax. So unlike every other moment in this crisis until just a couple of weeks ago, we can do more than hide. We can fight, we can immunize. But immunizing more than 300 million people, it's a hellish challenge, no matter how you do it. But it's really rough in an era of rampant polarization and disinformation, when state and local governments are so strapped, when the federal government is

• 2:03Ezra Klein?

  so denuded of talent, so demoralized.

• 2:07Ezra Klein?

  In the effort that will define how we live and for many of us, whether we live over the next year, Vivek Murthy was Surgeon General under Barack Obama. He is Joe Biden's nominee for Surgeon General, and Biden named him as co-chair of his Coronavirus Task Force. Murthy also weirdly looks a lot like me, or maybe I look a lot like him. It's very creepy when we turn on the camera here, but you can Google it. People put up pictures of the two of us together. He's also the author of what turned out to be an incredibly timely book, The Healing Power of Human Connection in a Sometimes Lonely World. The world got a hell of a lot lonelier right after he published it. At any rate, he's got an extraordinarily hard job here, but so do we all, actually. This is not going to be an easy six months, so I asked Vivek here to join us, the first

• 2:49Ezra Klein?

  guest on the show, to walk me and us through what the Biden administration is planning to do, to answer my questions about where we could do more and why we're so far behind, and to talk through what our daily lives are going to look like over the next six months. My email is [email protected]. I'm excited to be here. I hope you email me and let me know who you want to hear on the show, what you like about the show or don't like, and any other feedback you may have. Here is Vivek Murthy.

• 3:20Ezra Klein?

  You're coming in as co-chair of the Coronavirus Task Force. It's a huge job at a really scary time. How are you?

• 3:29Speaker 01

  You know, I feel okay. There are days where the gravity of this situation, you know, and then the responsibility that I've given, like, you know, hit me more than other days, but every day, as I look at the numbers, I'm just reminded just how important this is for our country to get this right, this pandemic response. And the truth is, Ezra, it's been personal as well. You know, our lives have been turned upside down a bit by this virus, in some cases, a lot. You know, our kids aren't going to school the way they could. We can't see family and friends, but we've also lost family members to this virus. Just a few days ago, in fact, I got word that my uncle, my grandmother's brother, in fact, my great uncle, unfortunately was infected and passed away.

• 4:12Speaker 01

  And his wife got infected as well, his son, his son-in-law. Fortunately, the rest of them are okay, but it marked our sixth family member that we've lost to this virus. So the consequences are very personal. I'll just have to say, and as you know, I think about... Another sort of cost of engagement, which is time with family. One thing COVID this whole year has, I think, really emphasized to me, and I know to many others, is just how important our relationships are to one another. And I've just really been blessed to have been in a situation where I can be at home and be with my kids and my wife and extended family more. I know that stepping into this job will mean stepping away from a lot of time with them,

• 4:54Speaker 01

  but it feels like a sacrifice worth making, and I hope that they will understand that as they grow up, because I do believe that all of us have to do everything we can at this moment to stop the spread of COVID.

• 5:05Ezra Klein?

  We're talking on Friday, the 22nd. The Biden administration has been in office for three days. Congratulations. You presumably know more about the state of vaccine supply and rollout than you did a week ago. What do you know now? Where are we?

• 5:21Speaker 01

  So what I've been doing, just to be clear, is I've been working very closely with the team over the last few months as part of the transition effort. And now I'm going through a confirmation process. So technically, I'm not part of the team yet until I get confirmed by the Senate. But what I can tell you is that what we've learned over the last several months in particular is that we've got a lot of work to do to really build a kind of vaccination campaign that we need as a country. There was a lot of work done in the prior administration to develop a vaccine in partnership with companies to help figure out how to get that vaccine to states.

• 6:01Speaker 01

  But the work after that, the work that actually makes the difference between whether a vaccine sits in the fridge or gets into your arm, that work still needs a lot more investment of resources, time, and coordination. And we've been spending a lot of the last couple of months talking to governors, to mayors, to local and state public health officials, to community organizations, to doctors and nurses, and hospital systems to get a sense of what needs to be done, what resources they have. And what we hear often is that there's a tremendous amount to still build up if we want the channels in place to get people vaccinated, if we want to root out the misinformation that's still all too rampant. And if we want to give states a clear sense of supply as well, because many of them don't

• 6:46Speaker 01

  know that they're getting supply until just a few days before, so which makes it really hard for them to plan. So there's a lot of work to do, and that's what we've got to focus on over the coming weeks.

• 6:56Ezra Klein?

  I've heard state officials, governors and others saying they're not getting the supply they were promised. Is there less supply than we thought?

• 7:04Speaker 01

  Well, that's part of what we're trying to assess. You know, every conversation that the team had prior to inauguration that I was a part of indicated that, number one, there was confidence from the companies that they could deliver on the numbers that they said. But what was less clear to us was just how much was still in the federal government and in the system. And that's what the team is looking into right now. We still felt comfortable, though, that overall that we could get the supply that we needed over the next few months. But we knew also that the supply would be tightest early on as companies were ramping up and as states were also figuring out how best to move the vaccine around and deliver it directly to people.

• 7:45Ezra Klein?

  So right now, is the constrained supplier distribution is the thing that you're most worried about, that we don't have enough to deliver? I recognize there's still some effort to figure all that out. Or is it that, once it is delivered, that last mile has not been sufficiently built? There are places that need more federal government help than they've had, that it's really that getting something we already have into somebody's arm that is the holdup?

• 8:08Speaker 01

  So the tricky part right now, Ezra, is that we're concerned about both, and we've got to work on both simultaneously. I think the concern about supply will start to ease more as the weeks progress because the companies will ramp up their ability to produce vaccine. We're certainly concerned on both sides of it. But it's also different depending on where you are in the country. There are some states which have adequate supply, and there are challenges building enough distribution channels to actually get the vaccine out there. And they're dealing with long lines of people and far more people who want appointments that can actually get them. And there are other places where their struggle is, you know, we've got the demand, but they don't have enough supply. This is part of what will be a hallmark of the Biden team's response, is to also try to tailor

• 8:52Speaker 01

  their response to the community and its needs, recognize that there's not one size fits all. And that means that not only do we need to be ready to tailor, but we have to be ready to listen on a regular basis because people's needs are going to change. A community may be doing great on supply today. Maybe struggling in two weeks, they may have enough distribution channels today, but you know, in a few weeks, when they open up to more priority groups, they may suddenly find that they need help in building more community vaccination sites or in getting local pharmacies up and running. A tailored response has got to be the hallmark of how we distribute this vaccine around the country.

• 9:25Ezra Klein?

  One thing that has simply been confusing to me, in the places where we do have shots out there, why aren't vaccination clinics open 24/7? Why aren't more of the normal rules of engagement being broken for this nationwide mass mobilization effort?

• 9:40Speaker 01

  It's a really good question. And this comes to a broader point Ezra, which is, we have to start treating this like the national emergency that it is. Covid's not sleeping. It's not, you know, turning off at 5pm. It's continuing to spread around the clock. And so our response has also got to be around the clock. And there are some states and localities which have actually set up 24/7 operations for vaccinations, but we've got to enable that in far more places. If you ask like, why hasn't that been done so far? There are actually a couple of reasons why. I think one is that many states have lacked the resources to set up such operations and they've told us that they lack those resources. They've been asking for funds for many months now. Some funds did come

• 10:23Speaker 01

  through during the transition period and a bill that was passed by Congress and signed by the president, but they also need far more. The other challenge though for them Ezra is person power. And it's the fact that to deliver these vaccines, you need people who are both setting up the venues, but also injecting the vaccine into people's arms. And that is starting to become a real constraint for many places. And so part of what we have to do and what we have been planning for is expand the pool of vaccinators using both federal assets in terms of, you know, personnel from the federal government, but also relaxing certain restrictions and enabling people like retired nurses and retired doctors to come into the workforce and to help deliver that vaccine.

• 11:06Ezra Klein?

  Without asking you to criticize the former administration, because I know you're a polite guy and you guys are all trying to get through a transition here. I don't understand why these things weren't done before. The idea that we would need personnel to get a vaccine out there. The idea that we need sites at which a vaccine could be delivered. The idea that we would need money with which states could do the vaccine. I want to say the Trump administration did something really profoundly important in Warp Speed. There's a lot about Warp Speed that was a good program. But we are not talking, and you saw the column I wrote on this, probably. We are not talking about the hard parts here, the really unusual decisions. That you would need people and places and money was always obvious.

• 11:51Ezra Klein?

  And we did have in place a very big vaccine development program. I don't understand how we, and to some degree, maybe even how the states weren't better planned here. And people's lives will be lost because we wasted all of this time. Like, what went wrong here? What needs to be learned?

• 12:09Speaker 01

  Well, Ezra, listen, I completely understand your frustration. And I don't think you're alone. I think there are many people who have wondered why we didn't get to this point earlier. And, you know, not having been in the prior administration, I can't explain exactly what the thinking and reasoning was. But I do think, you know, looking at it from the outside, that there were a couple of critical decisions that had to be made. You could say they're perhaps philosophical decisions. But from the federal government's side, one of those decisions is deciding at what point your responsibility ends and everyone else's responsibility begins, namely states and local communities. And it seems like from the outside that there was a notion that when it came to vaccine delivery, for example,

• 12:51Speaker 01

  that responsibility was to help facilitate the development of the vaccine and then get it to states. And then they were responsible thereafter. I think this was, you know, also echoed in other parts of the response regarding testing and other response elements, where it seemed like there was a transfer of responsibility to the states at some point. I think philosophically, the current team thinks about this a bit differently, which is that the responsibility of the federal government is to use any and all assets to respond to this pandemic until the job is done. And there's no place where we say... You know, okay, well, we'll stop at this line, you know, and then it's, you know, everyone else's problem after that.

• 13:34Speaker 01

  It's all of our collective problem until the job is done, until cases come down, until deaths come down, until we can get back to our way of life. I don't doubt that there were many people in the administration who had many of the ideas that President Biden announced in the national plan to address COVID-19. I have no doubt, and I don't have a doubt about that, because many of these career officials who have been there for many administrations are people that I know and have worked with closely. When I was Surgeon General, they're brilliant, they're thoughtful, they're experienced. But to really take those ideas and translate them into action, whether it's building community vaccination centers, or whether it's getting pharmacies online, or whether it's driving

• 14:17Speaker 01

  to get all the resources to states and communities that they need to hire vaccinators, that requires not just ideas, it requires execution and political will. And this is where we realized that for a pandemic to be addressed adequately, for our response to be strong and effective, it requires not just science and scientists, it requires our political apparatus to work in unison with science and not in contradiction to science. It requires us putting aside partisan differences and realizing we've got to pull together to get our communities what they need, when they need it. Otherwise, we're not going to get through this pandemic alone. There are times, you know, when we are 50 states, and there are times where we're one nation. This is a time where we have to be one nation.

• 15:02Speaker 01

  And if we don't do that, then we are not going to turn this pandemic around, and we are going to continue to lose more people to this terrible virus.

• 15:11Ezra Klein?

  You have a $20 billion plan to accelerate the vaccination rollout. There's other money elsewhere in the rescue package, particularly in the areas that will hire 100,000 healthcare workers, which could help with this. But all that money is in this $1.9 trillion mega package, which includes things like a $15 minimum wage, and a big boost to the child tax credit, and a lot of different things that I think are good and I support. But $1.9 trillion packages take time to pack. Can you act? Can you get the states the resources they need? Can the federal government begin to throw its might around before that whole package is passed, before that $20 billion is legislated? Are there other places to draw money from, other things you can do?

• 15:54Ezra Klein?

  Or are we really waiting on that entire package for this response to get into gear?

• 15:59Speaker 01

  Great question. We are absolutely not going to wait. And there's a lot we can do right now. And it's already started, as you may have seen. We can today start the process of setting up community vaccination sites in partnership with states all across the country. Right now, we can mobilize federal officials, including our Public Health Service Commission Corps officials and Medical Reserve Corps members from the other uniformed services to actually deliver vaccines and to help train others to be vaccinators. We can work with pharmacies right now all across the country to ensure that you can start getting vaccines in your neighborhoods, at your local pharmacy.

• 16:43Speaker 01

  Those are all things we can and should and will do right now. And so we can't afford to wait. But what we also know is that those resources are going to be important in the medium to long term, because if we want, for example, to get schools open, we've got to not only provide clear guidance to schools, but we have to provide them with resources to put safety measures in place. We've got to also ensure that people have the sick leave, for example, they need, the paid sick leave, so that if they have symptoms, they can stay home and don't have to choose between their health and their job, so that if they get a vaccine and feel a little unwell for a day or two afterward, like getting perhaps body aches or a low-grade temperature

• 17:26Speaker 01

  as some people do, that they'll be able to stay home and that the possibility of those side effects, it wouldn't be a deterrent to them getting the vaccine. These are all the things that we need that funding for. But make no mistake, we don't have to wait for that funding to act, and we can't. We've got to get started right away. And that's why you already saw the President Biden start to take action with a series of executive orders. But FEMA has already begun, started to work with states to set up these community vaccination sites. Conversations are ongoing with the pharmacies to make sure we can stand up a nationwide pharmacy program. And so there's no time to lose, and the action is already starting as we speak.

• 18:07Ezra Klein?

  So the failure of governance at the federal Republican level, I think, I will say in my voice, it was too little planning. There's also been a problem at the state level, including, I think, particularly in many blue states. I'm in California, which I think fits this description. New York is another one, where the problem, I think, has been actually too much planning, requiring too much information, making things too complicated. California had very complex guidelines for who would be eligible. And the Health and Human Services Secretary, Mark Gailey, recently said, "Those really thoughtful guidelines led to some delays in getting vaccines out into our communities." It's been a lot of efforts to try to balance equity and age. There's been a push from the Biden administration

• 18:52Ezra Klein?

  to relax this, to make sure vaccines are getting out into people's arms, as opposed to go into waste because you couldn't find somebody qualified. Do we need to learn some lessons on flexibility here that we got wrong at the beginning of this?

• 19:04Speaker 01

  I think there is an important lesson to be learned here, which is that it's not just the guidelines that matter, it's how they're rolled out and communicated that really matters as well. When it came to the creation of the guidelines around priority groups, who should be given the vaccine first, second, third, et cetera, that was done very carefully with input from the National Academies of Science, Engineering, Medicine, with input from scientists who are part of the Advisory Committee on Immunization Practices. The challenge is in rolling it out to states. I don't think it was conveyed clearly enough to them where they needed to adhere tightly and where they could be flexible. And the

• 19:48Speaker 01

  truth is that these guidelines work best when they are guidelines, when states can use them as a backbone, but when they have the flexibility to move forward quickly through these, depending on their ability to distribute vaccine. And some states went ahead and took that approach from the outset and decided to open up a little bit more because they felt that they had the capacity to deliver. But others didn't, because they felt that they needed to perhaps get through the 1A category, which included healthcare workers and Residents of long-term care facilities before they got to anyone else. So I do think this is a great example of how even the best of science and guidance can sometimes not make the full impact that it needs to be and can sometimes end up being a constraint

• 20:32Speaker 01

  if it's not communicated about like in the proper way. And lastly, this is another example also of why bilateral, two-way communication is so important. What we heard from many state and local officials is a desire for more pre-decisional communication and for more ongoing, true dialogue, not one-way conversation where they're just kind of giving directions and told to go out and execute. They wanted to be able to give feedback to the federal government about what's working, what wasn't working, what was confusing and what was clear. And so part of what we've got to do moving forward is recognize that nobody has all the answers here. The federal government can come up with its best possible recommendations, but it's states and local communities that are on the front lines.

• 21:16Speaker 01

  They've got to be able to have the opportunities to form the relationships to tell us if the resources, the guidance, the direction for the federal government is actually working or if it's not. And that's really on the federal government to make sure that it's reaching out and building those channels for regular communication.

• 21:32Ezra Klein?

  But in a number of cases, the states have gone beyond where the federal government was. Governor Andrew Cuomo in New York signed an executive order declaring that people who vaccinate outside of prioritization protocols will be fined up to a million dollars and risk losing licenses. After California said, yes, give the vaccine to anybody over 65 if you have it in Los Angeles, the mayor Eric Garcetti said no to that. He said, that would be politically easy for me, but it might mean some wealthy retiree on the West Side gets this. When an essential worker doesn't, he then later accepted those new, more flexible guidelines. There has been a fear that if the vaccine goes to the wrong people, if it gets to people out of order, that it'll be such a violation of fairness that you really have to protect against that.

• 22:15Ezra Klein?

  But when you work so hard to make sure the wrong people don't get it, you also sometimes make sure nobody gets it because you don't have the people who do qualify in front of you. So I do wonder if there's more to it than just not enough communication with the federal government. If maybe there's been too little urgency about just getting this out and recognizing that means you'll get, in some cases, people in the wrong spot in line against the ideal.

• 22:37Speaker 01

  So Ezra, this goes to communication with the public, right? Because if you think about it, part of what many state and local leaders were responding to was a worry that if they went outside a category before the prior category was done, that it would be unfair and it would also be perceived by the public to be unfair and that there could be repercussions there. But here's the reality. The reality is that there is not a system in place or a means to deliver an outcome where we get through everybody in one category and then move to the next category. Because it will take a while to get to every single person in each category, but we can't wait and sit on supply while people are losing their lives. We've got to keep putting people into the system.

• 23:21Speaker 01

  And what this means is that there are going to be fits and starts to the system. There are going to be some people who get vaccinated while others don't get vaccinated because maybe they didn't know where to get vaccinated, they couldn't get an appointment, and that will feel unfair for a portion of time. But look, this is where I think if we had to do this over again, what would have been ideal was to actually present these guidelines to the public and to have an open conversation about what the implementation was going to look like. To say, "Look, we are trying to balance speed with fairness. We need to move fast because lives are being lost. Fairness, we've got to observe because this pandemic has made it so clear that there are some groups that have been much more deeply affected than others and we've got to make sure they have access to this vaccine." But that balancing that is not going to be easy

• 24:06Speaker 01

  and that some states are going to do it differently. And here are the costs and the trade-offs involved in moving fast versus sticking solely to these categories. These are not simple discussions to have, but the truth is, we have to at least try to have these discussions and set expectations properly. I don't think that expectations were clearly enough set for the public about what this would look like. And in the face of that, you had people trying to do what they thought was best with the best of intentions, but it led to a lot of confusion and it led to, I think, a lot of understandable anger as people saw supply sitting on shelves, as they saw others jumping the line. And they wondered, you know, where is the guidance coming from? Who's in charge, you know, of making these decisions? And sometimes in the federal side, the most important thing you can do

• 24:51Speaker 01

  is not necessarily to make the decision, but it's to create an opportunity to have the dialogue, to create transparency, to set expectations so people know what to expect.

• 25:00Ezra Klein?

  So all decisions about fairness are much harder and require much worse trade offs in a situation of scarcity. So I want to talk a bit about how we can increase supply. Data from Moderna's clinical trials showed that people between the ages of 18 and 55 who received two half doses of vaccine showed an identical immune response to standard two doses. Is this something the administration would consider doing, doing half doses for younger people?

• 25:25Speaker 01

  Well, changing the dosing structure is an area that absolutely merits study, but it doesn't merit adoption at this point, given the data we have. What the Moderna data doesn't tell us is how robust and long-lived that immune response is. If people get a half dose and seem to have a response, but then it goes away after a few weeks, that doesn't offer the kind of protection that people ultimately need. So I think we have to be cautious about looking at the limited data from these trials because they were done in a very specific context. And it's really the, both the robustness of the immune response, but also the time course of it, the longevity that really matters here. And if we were

• 26:09Speaker 01

  to do that, if we were to go to a half-dose regimen based on such limited data, I think that that would be inconsistent with the larger mission and approach that we want to take, which is to be driven by science. And God forbid, if we did that and had an outcome where many people who went through the trouble of getting the vaccine ended up not being protected in a month or two months, and then had to be re-vaccinated again based on the original formulation, we would in fact utilize more supply of the vaccine while not achieving the same results we otherwise could have achieved if we had followed the science.

• 26:41Ezra Klein?

  Can I ask about that line? I hear a lot of things justified on driven by science. And I take what it means, but there's a lot here that science just doesn't have the data to tell us. I mean, it seems that we're just have to make a lot of decisions here, not knowing everything we would like to know, not having every study we would like to have, but also knowing that no matter what trade off we make here, lives could be lost in one direction or another. And so sometimes I feel like when people say driven by science, I mean, driven by certainty and that the question That is separating a lot of different people arguing in this debate is how much information, how much certainty they want to make a decision under a situation where the trade offs are so harsh

• 27:22Ezra Klein?

  in both directions. But can the science really tell us this? I mean, it's all just making judgments based on what evidence we have. It's not an ultimate answer science can give us, at least not now.

• 27:33Speaker 01

  So I'm really glad you brought that up Ezra, because I think this is such a critical point to underscore, which is that following science does not mean that you only make decisions when the data is 100% certain. And I mean, this is really critical because if you if you take that approach, then following science can be paralyzing. It can be an excuse for inaction. When we think about a science informed approach, to me, what that means is we look to understand what data we have, we don't have, and that we make the best judgments we can based on that data. But if you look at this particular decision with the vaccine, for example, about half dosing the vaccine, or even the other question Ezra that has been raised, which is, should we delay a second dose of a vaccine the

• 28:17Speaker 01

  way the UK did for theirs, delaying it to 12 weeks instead of, for example, with the Pfizer Moderna vaccines, where we have a 21 and 28 day time until the second dose. But in both of those cases, I understand the arguments that are being made for pursuing the aggressive approach, extending second dose timeline or half dosing. But this is where you have to make a judgment, and there's enough data based, you know, from other vaccines that tells us that it is a very real possibility that if you give somebody an insufficient dose of vaccine, or don't boost them in enough time, then you will lose the robustness of the immune response. And if you do that, you'll have to re vaccinate them, which means ultimately using more vaccine. So if we were

• 28:59Speaker 01

  in a scenario where we were so vaccine constrained, that we knew that we were stuck with a small supply for the foreseeable future, then I could imagine a scenario where one might want to consider those options. But what we know right now is that we have a strong possibility of bringing in substantially more supply in the weeks and months ahead. Right? Now, what this means Ezra, is that if we can hold on for just a little bit longer, we can get that supply in, we can deliver this vaccine. In the way it was meant to be delivered and in which it is proven to generate the kind of lasting protection that's required.

• 29:41Speaker 01

  But that also means that this is, conversation has to be a much bigger than about the vaccine. It's going to be about how do we make sure we're still masking, that we are still avoiding small indoor gatherings, that we're still washing our hands and distancing and doing the other public health measures, which seem simple, but which are powerful in reducing the spread of this vaccine until we have enough supply available for everyone.

• 30:03Ezra Klein?

  So here's what's in my head on this, and I know it's in yours too, so I'd like to draw it out. In the current situation we're in, which has gotten very, very bad, I mean, we're routinely seeing days of 3,000 to 4,000 people dying. There's one set of trade offs that that might make sense, and I take your point that if you start going onto new dosing regimens, you can have a loss of immunity, or you have to re-dose, there's all kinds of problems that can emerge. But we know these new variants are around. The B117 variant from the UK, I think some, what even more concerningly, the 501 YV2, I guess it is variant from South Africa, they're 30 to 70% more contagious. There's some reason, I think, to worry about the South African variant and vaccines.

• 30:45Ezra Klein?

  It seems likely to me, and you can tell me if you think this is not true, that six weeks from now, when these variants have taken hold, we're going to see much more transmission. And so we're going to be in a much more dangerous spot. And people are not doing a great job on lockdown already. People are tired, it's been a long time. With these new variants coming online, does this require us to think about doing things differently? Does this change the trade offs that make sense? I mean, how are you thinking about preparing for a world that really could be worse in six weeks if we're looking at the UK example as a possible future?

• 31:16Speaker 01

  It's a really good question, Ezra, and I am worried about these variants. They are more transmissible, like you said, the UK variant, South African variant, and likely the Brazilian P1 variant as well. You know, we're still trying to understand the full impacts of these viruses in terms of, do they affect people more in terms of severity of disease? It seems the answer is no at this point, but we've got to keep studying that. It also seems like the vaccine should still protect us from these variants, but look, the variants will continue to develop. There will be more variants over time, because this is what coronaviruses do. More broadly, this is what viruses do. They change over time. And the question is going to be, is there going to be a variant down the line?

• 31:59Speaker 01

  That is, in fact, not just more transmissible, but causes more severe disease and that may not be susceptible to our vaccine. So we've got to be prepared for that. Here's what the variants make me think about. Number one, they make me think that we've got to have much better genomic surveillance here in the country. We rank 43rd in the world in terms of our ability to, not our ability, our practice, I should say, in surveilling and looking for variants. And we can do better. It's a question of sequencing more of the positive cases that develop in our country and making sure we know when a variant may be surfacing. But there are other things that we've got to do because of these variants. It emphasizes just how critical it is to double down on the public health measures to prevent spread.

• 32:41Speaker 01

  It emphasizes how we've got to do more to strengthen our healthcare systems, which are really on the brink right now. And many of them are struggling, not just for space and supplies, but for people. They're running out of nurses and doctors and respiratory therapists because, keep in mind, these health professionals have been battling this pandemic for a year. Many of them are burned out. A number have dropped out of the workforce. It's also emphasized, one other thing, Ezra, which we don't talk about nearly enough, which is that we have under-invested in our country when it comes to developing treatments for COVID, not a vaccine, but treatments that can be used to address the illness once it arrives. Yes, we have monoclonal antibodies, but we've already seen that the monoclonal therapies

• 33:25Speaker 01

  may be less useful with some of the variants than they are with the more common form of the virus that we've been dealing with in the United States. We need as aggressive an investment in treatment as we had in the development of vaccines. But with all of this said, your fundamental question, this started with supply, and should we think about the supply differently? And what I would say, Ezra, is that we have still a substantial amount of supply that is sitting in freezers in states across the country. And what we need to do first, before we change doses or contemplate delaying a second dose, is we've got to liberate that supply and get it to people. And part of that means that we've got to build more channels and hire more vaccinators

• 34:10Speaker 01

  so we can deliver that vaccine more efficiently into people's arms. And as we do that, supply will increase. But last thing I'll say about this is we're not just taking it on faith that the supply is going to increase based on what the companies are saying. The team already during transition and certainly will continue to do this during the administration is in very close touch, working with the companies that are making these vaccines to see if there are any additional levers we can pull to increase their production. We're also using the, the president rather will be using the Defense Production Act to also increase the production of components that are needed for the vaccines as well as the types of low dead space syringes that can extract more vaccine from each bottle, often getting six doses instead of five.

• 34:54Speaker 01

  These are some of the steps that we'll be taking to increase supply, but keep in mind, there is supply right now that is sitting around. We've just got to liberate that and I would much rather we did that and pull other levers to increase supply than changing the dosing regimen because I just don't think that we have enough science or confidence frankly from the scientific community to support that.

• 35:30Ezra Klein?

  Why hasn't the FDA approved the AstraZeneca vaccine, given that the UK and a number of other countries have?

• 35:36Speaker 01

  So I don't fully know the answer to that as well because I, you know, being on the private citizen at the moment, I have not had direct conversations with the FDA. I do know they're going to want to see the data from the United States trial, they're going to want to evaluate that aggressively. There were some open questions from the earlier discussion and data that the company had released about an unusual, unexpected response it saw after one dose, but a lesser response after two doses. And so there are these open questions that the FDA is going to want to assess, but I don't have insight on to the, as to their timeline.

• 36:08Ezra Klein?

  Are there things that can be done to bring the Johnson and Johnson or Novavax vaccines to market more quickly? Are there things that be done to increase capacity for production when they do? And I'm asking this in part, I take your point, I want to note that we have more supply right now than we have distribution. I take that fully, but this is going to come online quickly. Hopefully, distribution is going to come online quickly. And then there's also a global issue, the quicker we get America vaccinated, the quicker Quicker developing countries are going to be able to get vaccines because we're buying up a lot of that supply. So part of what is in my head when I want to accelerate this so much isn't just for us. It's also that we exist almost as a bit of a roadblock to the rest of the world because we have these great contracts for Americans. And so getting our

• 36:53Ezra Klein?

  vaccination program done quickly also means that a lot of other countries that need this help will then have it and will have done the capacity building that it can come online really quickly there.

• 37:02Speaker 01

  I'm hopeful, as I know many of us are, that the Johnson and Johnson vaccine, that we'll get the data from it soon and that it'll be promising. I'm hopeful. I don't know that. I haven't seen the data. But that would really be a game changer for us, not only because it's a one-shot regimen, but because it can also be stored with refrigeration temperatures as opposed to needing either a freezer or the kind of deep freezing that the Pfizer vaccine requires. There are several ways in which this really helps us. We can, for example, more readily get primary care doctors across the country involved in distribution if we don't have these kind of storage challenges and get them vaccinating their patients. And we've got to certainly work to do everything we can to ramp up supply, just like the other

• 37:47Speaker 01

  two companies, Moderna and Pfizer. Johnson and Johnson is projecting that they will have some vaccine in the beginning and that will ramp up over the coming months. What we've got to do in the short term is work closely with them to see, is there any other manufacturing space and capacity that we can utilize, even if it's not owned by Johnson and Johnson, that would help us create this vaccine more quickly. And the second thing we've got to think about in the longer term, Ezra, is that we are going to run into this same exact problem again with the next pandemic when it comes to supply, which is that we will have a vaccine and will be limited by this supply capacity of one company. And that's why one idea some of us have thought about and then have discussed, which hasn't

• 38:28Speaker 01

  been certainly implemented or taken on officially yet by the administration, but is an idea that we need to think about building bioreactor farms where we have a large-scale capacity that the government can build and finance, license out in between pandemics, but then utilize to rapidly scale up our production of a vaccine, of therapeutics like monoclonal antibodies or other treatments, once the science tells us that we've found something that's effective.

• 38:56Ezra Klein?

  Ooh, this, there's this other whole track I want to talk to you about, about this exact question about how we build this response in a way that creates infrastructure for the future, in a way that lets us create all kinds of other new vaccines. I want to hold that for a little bit, but it's an exciting way to think about this, right? What if this spending can create a much more effective public health spillover and infrastructure for the future? I don't hear people talk about that, but, but there are ways this could really, could really benefit us and, and save us from worse things going forward. I want to ask you though, about something on the other side of this question. Still, 30% of people in polls say they simply will not take one of the vaccines. Before I ask you what you think can be done on that, I want to ask you to put yourself in

• 39:38Ezra Klein?

  the shoes of those skeptics. Why might someone, or why do you hear from people that they're scared of getting the vaccine or skeptical of getting the vaccine? Like, what is the kernel of fear?

• 39:50Speaker 01

  Well, Ezra, I worry about this, about the vaccine hesitancy that we still have. I think the numbers overall have been improving since the fall, but they're still too high. Here are the reasons I hear. I hear from some people that they worry this vaccine was developed too quickly. And to them, that means that maybe corners were cut and maybe some of those corners were around safety. I hear from others that they had relatives or friends who got the vaccine and they had a side effect, like they got a fever afterward or their arm hurt and they're worried about what that means for how safe the vaccine may be. And I hear from, so others who, you know, are from communities that have had

• 40:30Speaker 01

  a very difficult relationship with the medical community because of racist practices and the development of clinical trials, Tuskegee, and even the racism that they feel right now and how the healthcare and public health system treat them, which make them skeptical about why they should take a vaccine like this. And also frankly, make them skeptical about why, to use the words of a group that I was just talking to, of young black men who are influencers in their community. They said, you know, all of a sudden, we see that white folks are coming to us and telling us to take this vaccine and we're wondering, how come they're all of a sudden concerned about young black men? Maybe there's something that should give us pause here. These are some of the things that I hear from the public.

• 41:13Speaker 01

  But I think that there's a lot we have to do to address this. And it starts frankly with listening. I think so much of addressing hesitancies is always focused on what information to be pushed out there. When it comes to trust, though, you build trust first by showing up and by listening to people. It was something I was taught early in medical school. It was something I saw my mom and dad do when they were building a medical practice in Miami, is that before they tried to distribute information to people or tell them what they thought, they sat back and they listened to where they were, what their concerns were. So that's one thing I think we've got to do from the outset. I think the second thing we have to do is make sure that we are engaging the right people in the conversations as messengers. You know, there's some populations for whom I might be the right messenger, or you might

• 41:56Speaker 01

  be the right messenger, Ezra, and there are others for whom we may not be as effective. And so what we have to do, I think, is also engage with trusted voices in communities, whether those are nurses and doctors, whether those are local faith leaders or other community leaders. And it's often more effective when they go out and speak directly to communities. And lastly, Ezra, I think we've got to make sure that the information people has is actually as clear as possible. And that involves not only putting out very clear, digestible, understandable information to the public and in the hands of messengers, but it also, Ezra, involves fighting back against disinformation campaigns. And the difference, as you know, between myths and disinformation is disinformation is willfully put out there and propagated.

• 42:37Speaker 01

  And whether it's myths or disinformation, we find that too much incorrect information is being spread on social media sites and other, through other avenues. And we've got to work closely with those companies to make sure that whatever the platform may be, that they are doing everything they can to root out that misinformation and the disinformation campaigns, because they literally cost lives.

• 43:01Ezra Klein?

  I love what you said, by the way, just about listening there. And I think that's an important point in not just this exact space, but basically everything.

• 43:08Speaker 01

  Yeah.

• 43:09Ezra Klein?

  It's very, very, very hard to get people to Believe your counter arguments if they don't think you've listened to their actual arguments and they don't think you empathize. And I think it's something we forget in politics way too often.

• 43:22Speaker 01

  I think that just bears underscoring because of the kind of society that we live in, which is a very quote unquote, action oriented society. I remember being in the intensive care unit as a young medical resident and thinking about, you know, all the patients who were ill and trying to think about all the different things that we could do for them. And I remember the attending, the supervising physician got all of us together at one point. And he said, he said, look, when people are really sick, when there's a crisis, your immediate response is going to be to ask the question, what can I do? But he said, sometimes the most important thing you can do is nothing. And nothing doesn't mean that you're not actually helping. Sometimes you're giving people time. Sometimes you're listening. Sometimes

• 44:05Speaker 01

  you're pausing before you do something which may have side effects to someone else. In our society today, we think we are so focused on action that things like pausing to listen feel like, almost like dereliction of duty. It feels like, gosh, when the fire is burning, how can we pause and listen? But I want to make the case that listening is a form of action. And that even though we may think that we're not quote unquote, doing anything, the act of listening, it communicates something very powerful to someone else. It tells them, I see you, you matter, your life has worth and value. Those are very powerful things to be able to convey to somebody. Those are the foundations of trust. And it's on that

• 44:48Speaker 01

  foundation that we build partnership, that we get people to understand the truth, you know, about information that's out there, whether it's a vaccine or something else that we're working on. And that's why this process has to start with listening, not just addressing vaccine hesitancy, but the broader challenge we have of how to bring our country together in the face of this pandemic and how to build the kind of cohesion we will need to take on future pandemics.

• 45:14Ezra Klein?

  I try to keep up a pretty regular meditation practice. And there's a line you'll sometimes hear in meditation circles. Don't just do something, sit there. Which I always like because it's actually a lot harder to sit there. It's harder to listen oftentimes than it is to talk, particularly when somebody is telling you something that you disagree with or that you're upset by. That idea that listening is not doing something or sitting there and bearing witness or holding space is not doing something. It's so belied by the experience of actually trying to do it in adverse circumstances, where it is much easier to take back the floor and tell everybody what you want them to do or why you were right in the first place than to hear what people are trying to say.

• 45:57Ezra Klein?

  But in cases like this, it doesn't work that well. It's actually a reason why I had tapped into that line about we should listen to the science earlier, because I do think that there is a destructive tendency, particularly on the left, to try to overwhelm people's concerns with authority. We're listening to the science. And then, well, science doesn't always speak with a clear voice or know what it's saying, or sometimes these are not actually scientific questions or questions that bear on social values or communities' past experiences. And that if you're just telling people what authority says and you're not able to listen, on the one hand, that's easier and it feels like more action, but it can actually be quite counterproductive.

• 46:38Speaker 01

  Yeah, no, it's a really good word of caution, Ezra, that you state, because I think what's more accurate is we should be saying we're listening to science and to communities, recognizing that science has some of the answers, not all of the answers. Communities are an important part of that as well. And that I love the lesson that you brought from your meditation practice about don't just do something, sit there. Because if you think, Ezra, and this is huge, actually, political consequences as well and cultural consequences. If you think about how we define leaders in society, our picture of leaders is the people who are speaking up in meetings, who are speaking up loudly and forcefully and emphatically, the people who know all the answers and are willing to fight for them.

• 47:21Speaker 01

  That's the picture of leaders that modern society typically has, whether that's in the boardroom in a meeting at work or whether that's in the political arena. But what about the person who takes time to listen? To draw out people's ideas, to give them space to talk, to build consensus, to nurture partnership on the team. We don't value that nearly as much, and that has consequences for the kind of leaders we select in our organizations, in our cities and states, and for our country. And so I think that one of the many, many, many lessons that COVID-19 has for us, I think, is around leadership.

• 48:01Speaker 01

  And it's certainly pushed me to ask the question, what truly does constitute strong leadership? And how am I, as an individual, like all of us who have some sphere of influence, whether it's my family or my friends, how am I being an effective leader in my own life? Am I truly listening? Am I pausing to understand? Am I drawing other people out and giving them space? Or am I seeking inadvertently or intentionally, am I falling into that model of leadership that I think we have perpetuated for too long in society of the loud vocal leader who takes up all the space and has all the answers? I don't think that model has worked out well for us, but I think this is an opportunity for us to rethink what true leadership is.

• 48:45Ezra Klein?

  Something that relates to the vaccine that my colleague David Leonhardt wrote a great newsletter about the other day is that I think scientists and epidemiologists have been trying very hard not to make the mistakes they made early in the crisis and not be too certain and not be too optimistic. And so there's been a tremendous amount of hesitant vaccine communication emphasizing that you'll get the vaccine, but nothing really can change. We don't know if you're still contagious. We don't know what its long-term immune effects are. There's been, David argued, an underselling of the vaccine, or the vaccines, when given what we know about them so far, they really are likely to change people's lives dramatically.

• 49:29Ezra Klein?

  And so I guess I wanted to put this in a very direct way. If my, let's say, I'll use my family as an example. If my parents, who are both over 65 and have comorbidities, if they get vaccinated, what can they safely do in their lives? Can they come and see their grandchild? Can they start going about as normal? How contagious should they think they are? Like, what, what, what does the vaccine mean for somebody when they get it? At this point in your judgment, in a daily way?

• 49:58Speaker 01

  Asher, I love your questions because you're getting at the heart, I think, of some really critical issues here. And I do think that there are many people in science who have felt a backlash, if you will, and about how certain they are when they convey recommendations. Because science changes. You know, science is about a process of discovery. Science itself doesn't change, but the answers it tells us evolve over time as we get more information and data. And I think in this world in particular, where we often don't give people room to change their view, whether it's on health or other issues. I think there are scientists who worry that if they're too definitive and then they change their mind, that they'll be looked at as uninformed or willfully misleading.

• 50:42Speaker 01

  But I do think that we, we have more that we can say about the vaccine than we're probably conveying as a larger scientific community. And to use the exact example that you brought up, which is a common question that I get, does this vaccine prevent an individual from spreading COVID to someone else? Or does it just reduce the likelihood of you developing symptoms and potentially passing away from the virus? Both of which are obviously of huge value. And I think if you ask most clinicians about this, most scientists, what they would say is their general understanding, an assumption if they had to bet on it, is that this vaccine does reduce the likelihood that you're going to transmit an asymptomatic infection to someone else.

• 51:26Speaker 01

  But does it reduce it to zero? Well, we don't exactly have the data to say it, but it most likely does reduce the risk. And it's in that form that I think we should think about how this vaccine changes our life, which is that, number one, the science tells us clearly that it reduces the risk of our getting sick if we get this vaccine and getting consequentially sick, which means having symptoms and certainly being hospitalized or passing away from this virus. Second, it probably reduces the chances that we spread it to other people. And what this means for us on a practical day to day basis is that, number one, in the occasions that we do need to go out and interact with the world, whether it's getting our groceries or if we're a frontline worker and are having to interact with others, if you're a nurse in the hospital

• 52:11Speaker 01

  and are caring for patients who might be sick, that it gives you greater confidence and reduces your anxiety that you will get sick because you've got more protection. And that is really, really important, that reduction in anxiety. But the second thing is in circumstances where you do see people in your life, if you're going to, for example, get together with your grandkids and see them, you still want to do that. You still want to wear masks. You still want to be distanced because, again, we've got no ways to go to get enough people vaccinated where we've dramatically reduced the number of infections. And we still do not know 100% how much this reduces your risk of transmitting to others. But it can give you greater confidence that if you take those precautions, that things are even more safe, that you're even less likely

• 52:56Speaker 01

  to create a risk to people around you because you've gotten vaccinated. I'd love to be able to say that because you get vaccinated means that we can just throw caution to the wind and then go back to pre-pandemic living. No mask, see and embrace and hug and kiss the people you love, get together in large gatherings. We can't quite do that yet. But if you think about how much anxiety and worry this vaccine, this pandemic, rather, has generated in our lives, I can tell you that for the people getting vaccinated and the people who love them, getting a vaccine, knowing that you're significantly protected against infection, can make a huge difference in your quality of life. Ezra, my dad and my sister got their second dose two days ago.

• 53:40Speaker 01

  My mother and my grandmother got their first dose of the vaccine two weeks ago. And as a child and a grandchild and a brother who has watched my sister and father go to see patients in their clinic every day, knowing that they could potentially, that could be the day that they get exposed and they can get sick. The amount of comfort that I now feel is I can't put a price tag on it. Similarly with my 90-year-old grandmother and my mother, knowing that they are on their way to protection gives me huge relief and a sense and a peace of mind that I have not had for the last year. So I don't want to undersell the importance of that. I think we will get to the place where we can put away our masks and when we can embrace each other with without reservation.

• 54:25Speaker 01

  But I think getting there will require many more of us to get vaccinated to the point where we're starting to approach herd immunity levels and where we're also seeing frankly, the number of cases come down and the number of deaths and hospitalization come down.

• 54:40Ezra Klein?

  That answer is both. I take your point on the anxiety. I feel that myself. If I could know my family is safe, it would mean everything to me. It's also disappointing to be blunt, right? As a human being, I hoped that when people got the vaccine, they could at least move through the world more freely. So let me actually ask the other side of this because you understand this data better than I ever will. Putting aside the question of whether or not you can transmit the virus, if my parents get the vaccine, should I be pretty confident they're safe? They can go to the grocery store, you know, wearing the mask and the level of protection is sufficient that they are out of danger?

• 55:17Speaker 01

  So I think you can feel much more confident that they are protected if they get both doses of the vaccine. Yes. And you're right, they should still wear masks, they should still wash their hands and keep their distance from folks outside their household. But I think you can, and I certainly do, feel more comfortable that our family can engage in those kind of activities without putting themselves at significant risk.

• 55:54Ezra Klein?

  Okay, let's go to the things that are not vaccines because they take up a lot of energy. I've obviously focused our conversation here, but if I look at the Biden administration's plan, of that $1.9 trillion, only $20 billion goes to vaccinations. $50 billion goes to setting up a national testing structure that is another one of these things that I think we should have had some time ago. But tell me about that. What is that $50 billion buying us? What do we not have that we should? And assuming that we're only six or eight or nine months away from having a reasonably well vaccinated population, is it really worth spending $50 billion to create testing right now?

• 56:34Speaker 01

  Well, so I'm really glad you asked, Ezra, because I do think that in the conversation about vaccines, that testing and, as we may talk about later, contact tracing has also fallen by the wayside. Both are still critically important. And the $50 billion of funding that the Biden team put together in their larger package is aimed at doing a couple of things. At number one, scaling up dramatically our production of existing tests, but also investing in the production of better tests, of more accurate, more mobile, if you will, tests that could be performed at home, where we can both get samples and deliver results, ideally in the home setting. We made a massive investment in vaccine development. We need

• 57:19Speaker 01

  to make that same kind of investment, if you will, in treatment as well as in testing. And here's why this matters right now. Because one might ask, you know, if we're getting to the point where everyone may be vaccinated this year, do we really need this testing? And the answer is yes.

• 57:36Ezra Klein?

  Indeed, I just asked that.

• 57:38Speaker 01

  Yeah. And here's, here's why. Because when it comes to knowing whether the illness is cropping up again, like in our communities, we need to have testing available to do that. And it's got to be easy to do. It's got to be accessible. It's got to be affordable, and it has to be accurate. Right now, the problem we have is that some parts of our country have abundant supply, but many others do not. And that's one of the reasons we have to dramatically increase our supply. But here's the other reason, though. Like, if we want to ensure that we are also tracking new variants, you know, we're going to want to make sure that we're regularly doing surveillance testing and that we're also then plucking a portion of those positive tests and sequencing them.

• 58:23Speaker 01

  And doing that surveillance testing, again, requires capacity. I think that we've been doing some surveillance testing in nursing home facilities, which has been great. But there are many other places which are potentially higher risk, where we need to be doing that proactive surveillance testing. Think about universities, think about prison systems, any other setting, especially like workplaces, like meatpacking plants, where people are going to be in close proximity to one another. These are the kind of places where you're going to want to do surveillance testing. So this is why testing still matters. And more broadly, Ezra, if we think beyond COVID-19, we need to have a better system in place for developing testing for the next pandemic. We need to know that we can both develop the right test quickly, produce them at the right scale, distribute them rapidly,

• 59:08Speaker 01

  and collect data, build the right data system so that we know the results and can target our resources where cases are starting to emerge. This is our chance to build those systems now. And coming to the larger point that you had raised about how do we not only build for COVID-19, but build for the future? This is one of the ways in which we do that. It's like, we can come out of this pandemic with a way of approaching testing, with a capacity for manufacturing treatments, vaccines, and testing supplies, with a public health apparatus that is both well-funded and well-coordinated, and with a mechanism for communicating and cooperating with the public as well as with state and local officials

• 59:50Speaker 01

  as quickly as possible during the first signs of a pandemic. Then we will have come out stronger from COVID-19 than before the pandemic began.

• 59:59Ezra Klein?

  So I think the obvious liberal perspective on testing, which I'm a liberal, so I hold it, is that we have not spent nearly enough money on it, and we should. And I would say that is 100% correct, and I'm glad to see the administration proposing spending on it. We need to build this. But this is another place where one of the other threads of our conversation comes in, where I'm pushing a little bit on this question of, is our regulatory structure being too conservative? So Harvard's Michael Mina, who's a great health expert, has been arguing for at-home rapid testing. There are people who want to create and sell me at-home rapid testing apparatus. And the FDA has been pretty resistant to that. They've wanted it to clear a very high bar when maybe something that is somewhat better than nothing is actually pretty good at scale.

• 1:00:44Ezra Klein?

  It's an argument that the Nobel Prize-winning economist Paul Romer has made as well. Have we been too conservative on just allowing testing innovation? Allowing people to have things at home that are maybe not as good as what you get at the doctor's office, but could create that kind of national constant testing structure?

• 1:01:01Speaker 01

  I do think we've been too conservative. Part of what COVID has revealed to us is that there are different types of testing that we didn't really, I think, fully appreciate in the sense that there's a difference between public health surveillance testing and diagnostic testing. Diagnostic testing is what you get when you think you're sick or you think you may have been exposed and you want to get a test. Public health surveillance testing is the kind of broad testing we do to see if there are cases popping up in people who don't necessarily think that they may be infected or may not be showing symptoms. And the fact that companies that potentially make public health diagnostic tests did not feel that there was, for example, a pathway to get those approved at the FDA.

• 1:01:44Speaker 01

  The fact that many of those companies then figured maybe it wasn't worth investing in those tests because there wasn't a pathway at the FDA, that to me speaks to our failure to think broadly enough about the kind of testing that we needed. I think Michael Mina has done great work in accelerating this conversation and saying that we should be thinking more broadly about the kind of tests we need. And that if you really want to empower people in a moment like this, Creating the kind of tests that people can utilize in their own homes would be a wonderful way to do that. It would also allow us to identify infection much more readily than what we're doing right now. We know there's a lot of asymptomatic infection that is floating around in the community. We're just not able to capture it because we're not providing

• 1:02:29Speaker 01

  the kind of testing that people can use to detect that infection and ultimately keep it at bay.

• 1:02:35Ezra Klein?

  That's hugely encouraging to hear. You mentioned contact tracing a couple of minutes ago. The Biden plan envisions hiring more than 100,000 new public health workers, many of them, though not all, for contact tracing. I've been genuinely surprised that no state on its own, with the maybe exception of Massachusetts, has set up strong contact tracing, or at least that is my understanding of the situation. Why has this been so hard? And then I guess the secondary question is, why do we still need it with testing and with vaccination coming online?

• 1:03:05Speaker 01

  Contact tracing is is still important because it's how we detect whether there are people at increased risk of getting infected once we have a positive case. So, you know, I think of it sort of this way, that testing is a light that goes off that tells us when somebody has infection. Contact tracing is like the net that we drop over that light to contain infection so it doesn't spread further. In theory, if we had such a scale of testing in our country, that people were regularly testing themselves throughout the country, then, you know, there's a circumstance where you could maybe make the argument that contact tracing would be less important at that point. But the reality is that until

• 1:03:48Speaker 01

  we achieve such a massive scale of testing, and frankly, the willingness of people to do that testing on a regular basis, contact tracing will still be important. And this is a place where I think technology could potentially be really helpful, as long as it obeys a lot of the safeguards that we need around privacy and security of information. But the bottom line is, until the technology evolves to that's to that place where it can be a useful adjunct, we've got to make sure that we are training people to do That contact tracing and contact tracing is a proven way to contain infection. We've used it. We use it in TB. We use it in all kinds of infectious, you know, circumstances in the United States and around the world.

• 1:04:29Speaker 01

  But we don't have right now nearly sufficient workforce to serve as contact tracers. It's one of the places where President Biden has asked for a greater investment. But I worry that it will be a need that will fall under the radar. That we get left behind, just like testing, frankly, in the all the focus that's been given to a vaccine. And if that happens, then I worry that we will continue to experience, frankly, spikes and surges of infection and pockets here and there because we haven't built up the testing and tracing that needs to go along with broad, widespread vaccination.

• 1:05:05Ezra Klein?

  Let me add into this set of what I call the the lower tech answers, although some of the the testing may not fit that. But the sociologist and writer who's been great on coronavirus issues, Zainab Tufekci, has been writing a bit about masking. And some of the things that she's been arguing is that we finally got widespread adoption of masking, and then we just stopped. We didn't start giving people information on what kinds of masks are better. The federal government is not sending out N95 masks to everybody. So we're a lot of people just using cloth, including oftentimes me. There's no government agency testing and providing simple ratings for masks. So when I go to buy them, it isn't easy for me to use just simple market signals

• 1:05:46Ezra Klein?

  or some kind of certification to know, am I buying a good mask from a public health perspective or or not that good mask? Is there just more we could do here to give people information about what kinds of masks to buy or even to get it to them directly as we're doing in some in some other countries?

• 1:06:03Speaker 01

  Absolutely. And masks are so important. If we've learned anything over this pandemic, it's the fact that Masks work not only to help prevent us from spreading infection, but to some extent, they seem to help the wearer of the mask as well. And we know that from other countries that when people do wear masks, that it does help to prevent and contain spread. So we've got to do that. And I think with the variants in particular, Ezra, the UK, South Africa, Brazilian variant, and the potential for others that are more transmissible. This makes the quality of the masks that we use all the more important. We have data that tells us that there is a hierarchy here that, you know, single ply face masks don't work nearly as well as surgical masks. They don't work as well as some N95 masks.

• 1:06:48Speaker 01

  I think we should have more clear standards around masks. I think we should be working to produce these masks in sufficient quantity that people can use them. And I think it's important for us to do everything we can to get these masks to people as well. Because the bottom line is that masks save lives. And in a circumstance where we didn't have the capacity, supply, et cetera, to ensure that everyone had access to a high-quality surgical mask, it's understandable for us to give people instructions on how to make good cloth masks, et cetera. But this is a place where I think a little investment will go a long way. Making these masks is relatively cheap. The costs are manageable. But the benefits in terms of lives saved and anxiety deferred

• 1:07:32Speaker 01

  is absolutely extraordinary. And I want to make sure that masks are a topic of focus and conversation for us going forward.

• 1:07:40Ezra Klein?

  President Biden has talked about trying to push as much mandate as he can through the federal government, which can only do so much, certainly trying to ask people to really mask up. Should the government be sending everybody out masks? I mentioned something we've seen in some other countries. We now, I think, probably have the production capacity to do something like that. Is that an idea worth considering?

• 1:08:00Speaker 01

  Well, you know, and again, all of these are just my, my personal beliefs, but I think so. I think that it is, again, a relatively low cost investment for the government to send good quality masks to people. It doesn't mean it's cheap, but it means it's the cost of it is far less than what we are incurring in terms of the cost when people get sick, most of all the lives lost, but also the healthcare costs, the economic costs and the disruption to society more broadly. And so, yeah, I think it's an idea worth considering. I think it's an investment that would be worth making.

• 1:08:36Ezra Klein?

  I want to now move, as we come to the, the end of this, towards some more human questions. Before all this, you wrote a book about loneliness, something you were known for as a surgeon general was trying to elevate loneliness as a public health issue. We talked early on in this crisis about the social recession it was creating. Some of the stories are really, really profoundly sad out of it. I mean, not just people dying alone, but just people being alone. I mean, in every family has stories like this, but what's even worse is where there isn't a family to have the story, where it's just somebody who's in isolation in a nursing home. As somebody who has thought a lot about loneliness and isolation, what do you think this has done to us and our social bonds?

• 1:09:16Speaker 01

  Such a good question, Ezra. I think we'll only understand the full answer to that question in the months and years to come, because I think we are all still processing how this pandemic has affected us. But I do think that for many people, COVID-19 has pushed them to reevaluate, frankly, the importance of relationships in their lives. And they often say that you don't realize how valuable or important something or someone is until it or they are taken away from you. And for many of us, COVID-19 has taken away our ability to be with friends in the way

• 1:09:57Speaker 01

  that we're used to, to, to hug our families and to be present for special moments. And so I think there's a reevaluation in many people's lives that's happening. And it's not just a reevaluation of our relationships, really important to me, but there's a prioritization, I think, that is being reexamined of, quite simply put, are we putting Our work above our relationships in our life. And if we are, should we start flipping that paradigm? And should we start putting people first? And what does that look like in terms of the decisions we make about where we work? About how often we seek to work from home? About how we show up in the lives of our kids and our spouse and our extended family and friends at times of need in particular?

• 1:10:41Speaker 01

  And so this reevaluation is happening. But there's something else that's happening in parallel, Ezra, which is that for many people, COVID-19 has felt like and looked like a very divisive experience in terms of the larger national response. Things like masks have become politicized. Even the evaluation of the response to the pandemic has taken on a very political flavor. And I think that that has led to more division. I think it's deepened our fissures. And so I think coming out of this, what we have to contend with is these dual realities that in some way we have become more divided

• 1:11:25Speaker 01

  as this pandemic has been politicized. But in other ways, we've also started to recognize that the relationships in our lives are perhaps even more important and more critical for our well-being than we had perhaps thought. And the question is, where do we go from here? And I think that's the most important question. And when I think about it on a very practical level, I'll just speak about it from my personal context. I want to come out of this pandemic truly putting people first, truly building a life that's centered around relationships. And that means making time for the people I love. It means being fully present and having quality conversations with people as opposed to being distracted by technology,

• 1:12:09Speaker 01

  as I often had been during conversation. It means reaching out to people in my, in my life, whether it's family and friends, or frankly, neighbors or strangers I may cross paths with, recognizing that all of us are hurting and suffering in some way. And if we can be of service to one another, whether that's simply in saying hello or in listening to how someone is doing, that that itself is a powerful act of service that can help strengthen our connection with one another. You know, if you are somebody who runs a workplace, if you manage a group of people, if you're a teacher in a school or an administrator in a university. I think there's a lot we can do now to create spaces where students and work colleagues

• 1:12:52Speaker 01

  can actually truly listen to one another and learn how to dialogue respectively. I think we've lost that art and the lack of listening, the lack of true respectful dialogue is, as I think of it, a health risk. It's a national security risk and it's a risk to our fulfillment and happiness because no family can function without dialogue. And similarly, no community, no country can prosper and thrive without an ability to dialogue respectfully and productively with one another. And it is now all of our responsibility to figure out how we rebuild that kind of dialogue, how we listen to people who we love, but also those who we don't know.

• 1:13:35Speaker 01

  And if we can start taking steps to create that dialogue, then we can start rebuilding, I think, the country, not just that we had pre-pandemic, but frankly, the country that we needed even before COVID came, which is a country where people do value their relationships, where they invest in each other, where they take the time to see one another for who they really are and where they are truly partners in one another's healing.

• 1:13:58Ezra Klein?

  I think it's a lovely sentiment to begin to close on. So the final section of the show now, you've been on in the past when I've asked about book recommendations, this is a little bit of an expanded version of that. So I'm going to ask you for some recommendations across a couple of different areas. You ready?

• 1:14:14Speaker 01

  Sure. I feel like I never have good recommendations, but I'm happy to.

• 1:14:17Ezra Klein?

  And you can always say skip.

• 1:14:20Speaker 01

  Okay, okay.

• 1:14:21Ezra Klein?

  What movie or book best understands what loneliness is actually like?

• 1:14:26Speaker 01

  So I would say Cast Away, the movie with Tom Hanks where he's stranded alone on an island after, after an accident. And as unusual as that scenario may seem, to a lot of people, that's what it feels like when you're lonely, even if you're surrounded by a lot of people, that you're stranded on an island.

• 1:14:45Ezra Klein?

  What's the book every surgeon general should read? If you had a successor coming into the job and they asked for a recommendation, what would you give them?

• 1:14:51Speaker 01

  So the book I would recommend every surgeon general reads is called Plagues and Politics by Fitzhugh Mullen. It's about the history of the United States Public Health Service Commission Corps and the role that they played in fighting pandemics, outbreaks, and other public health crises.

• 1:15:08Ezra Klein?

  What show or movie do you think best gets at what it's like to be a doctor?

• 1:15:15Speaker 01

  Wow.

• 1:15:16Ezra Klein?

  I can't believe you're not just saying scrubs here.

• 1:15:19Speaker 01

  You know, I almost did, but the thing about scrubs is scrubs gets at the crazy irrational elements of being a doctor in training. But what scrubs like doesn't fully capture are these like extraordinary, like unexpected, like human moments that you have with patients, with colleagues, with their families and how being a doctor just changes also how you think about your life and about your relationships. So I've struggled, you know, I find a lot of the doctor shows like highly entertaining. I haven't quite found one that really reflects the true full experience.

• 1:15:58Ezra Klein?

  Yeah, fair enough. It's a ineffable quality being a doctor. Then let me ask you the easier version of this. What book or movie or show or just anything do you find yourself going to as a way to recharge from the work you actually do as a doctor and public health official? Like, what do you use to relax and turn off?

• 1:16:16Speaker 01

  Hmm, this is gonna expose a bit of my geeky side, but I'm a speech buff in that I love to catalog and then to re-listen to speeches that I find to be inspiring. And it's what fuels me up. So at times when I was surgeon general, when I would feel drained after a day or feel disillusioned about the work that we were doing and our ability to actually execute, I would turn to some of these inspiring speeches just to remind me of what truly mattered and to give me inspiration. And those, the speakers, you know, the people who were the sources of inspiration were varied. Some of the speeches I've listened to were speeches from Martin Luther King, others, you

• 1:17:00Speaker 01

  know, I've found President Obama and some of his speeches, especially in, during his campaign and in the early part of his presidency, really served as powerful reminders to me of our values that matter. There are certain speeches that John McCain gave that I've found to be powerful reminders of, again, what matters most in life, our relationships, our devotion to cause and to country. So that's what I do when I'm feeling drained.

• 1:17:28Ezra Klein?

  Is there a book of speeches you turn to or are you just collecting them from random internet archives?

• 1:17:32Speaker 01

  Just collect them from random internet archives. Maybe if somebody like you Ezra wrote such a book and compiled the most inspirational speeches, I would buy that, but I haven't found it yet.

• 1:17:41Ezra Klein?

  Is there any particular thinker you go back to to find sort of comfort in difficult times?

• 1:17:47Speaker 01

  There are a couple of people who I think of as teachers. Some of them I've met, some of them I haven't, but I look to them, their words, you know, for wisdom and for direction during hard times. You know, one of them is Jack Kornfield, a wonderful meditation teacher who I'm grateful to count as a friend. But I also look at the writings of Mahatma Gandhi, who, as many know, was seen as the father of the freedom movement in India and somebody who was also a powerful proponent of nonviolent resistance for greater ideals. I look to his teaching a lot as well. And the third person is the person I was named after.

• 1:18:30Speaker 01

  I was named after a Hindu monk named Vivekananda. And he was a man who believed in the power of all faiths to bring us greater strength and clarity. And he was an extraordinary teacher, but he also lived by example. And he found most powerful of all that spirituality, when delivered through service, was one of the greatest forces for improving and strengthening the world. And I read his biography when I was young, when I was eight or nine years old, to understand why it was that my parents named me after him. And I find his words and teachings a continued source, you know, of direction.

• 1:19:05Ezra Klein?

  That's lovely. And then let me end on this one. If you could look weirdly like any New York Times columnist, who would it be?

• 1:19:16Speaker 01

  Oh, my gosh. Maybe David Brooks. He always looks like he's deep in thought. I don't know.

• 1:19:22Ezra Klein?

  There you go. Well, unfortunately, you're stuck with me. Vivek Murthy, thank you very, very much. I really appreciate you spending the time and good luck on a very, very difficult job ahead.

• 1:19:31Speaker 01

  Well, thank you so much, Ezra. I really appreciate it. It's always good to talk to you.

• 1:19:41Ezra Klein?

  Thank you to Vivek Murthy for being here. Thank you to all of you for being here. We're just getting restarted, so if you have a moment to go into your podcast app and give us a rating or a review or send a recommendation to your friend, that would be great. The Ezra Klein Show is a production of New York Times Opinion. It is produced by Raji Karma and Jeff Geld, fact checking by Michelle Harris, original music by Isaac Jones and mixing by Jeff Geld. See you on Friday.