*Episode published 2/25/2021

Preet Bharara:

From Cafe, welcome to Stay Tuned. I’m Preet Bharara.

Andy Slavitt:

You do know the people that are dying. They’re the people picking your food. They’re the people driving your food to the warehouse. They’re the people packing your food and bringing it to your grocery store. You may not know their names, but believe me, they’re part of your life.

Preet Bharara:

That’s Andy Slavitt. He’s a senior advisor for the Biden administration’s COVID-19 response team and has had a critical role these last couple of months in rolling out the vaccine. This isn’t Andy’s first time working in the white house. He served as the acting administrator of the Centers for Medicare and Medicaid Services or CMS during the final two years of the Obama administration. And before that, he was part of the team that resuscitated the once failing website, healthcare.gov. Last February, just as the first cases of COVID were appearing in the US, Andy launched the #stayhome campaign to encourage people to distance themselves. He came on stage too at about a month later on March 25th, to discuss the impact COVID would have. Almost one year and 500,000 tragic deaths later, here we are. Andy joins me today to talk about the vaccine rollout, Biden’s leadership, and how we got to this tragic point. That’s coming up, stay tuned. Now let’s get to your questions.

This question comes in an email from Emily. Hi, Preet. Love the show. What are your reactions to the recent reporting that New York Governor Cuomo may have misled the public on the number of pandemic deaths in nursing homes? Could he have done anything illegal? This New Yorker would like to know. So Emily you’re referring to the firestorm that has arisen with respect to some of the things that went on in the early part of the pandemic, in the middle part of the pandemic in New York state, as it relates to nursing homes. And there are a couple of things going on. One is there was a rule that has come under some scrutiny and controversy in which the governor basically directed that even if people had been in a hospital and had tested positive for coronavirus, they must be readmitted to nursing homes. And then second, there have been findings that the number of deaths related to nursing home residents has been vastly under counted and understated.

And so to answer your question first, what’s my reaction to some of this reporting. My reaction is pretty negative, and we’ll get to the question of whether or not illegal acts took place. But as an initial matter, as you’ll hear me discuss with Andy Slavitt in the interview, leader should be telling the truth. Leader should not be trying to hide the ball. Leader should not be trying to make things look prettier than they are, especially when life and death is involved, because it always catches up with you later, and maybe, maybe you don’t try to write a book in the middle of a deadly pandemic when we’re not out of the woods yet. And you don’t celebrate and take a victory lap when people are still dying in your state and you know, you know that you probably misled the public and other government offices, perhaps about the extent of deaths in the nursing homes.

So yeah, my reaction is pretty negative. Now, what are the consequences with respect to inquiries and investigations based on these things that have been found out about Andrew Cuomo and his response to the coronavirus? Well, we know that for some months, the DOJ civil division in Washington has been making inquiries. There have been some suggestions on the side of the Cuomo team that that has been politicized. Maybe, maybe not, but New York state’s attorney general, Letitia James who ran on the same ticket is Andrew Cuomo in the last election, made some pretty serious findings in the report about the data that was provided with respect to nursing homes. Let me quote a couple for you. OAG, meaning the office of the attorney general. “OAG is currently conducting investigations into more than 20 nursing homes across the state. OAG found that a larger number of nursing home residents died from COVID-19 than department of health data reflected.

Lack of compliance with infection control protocols put residents at increased risk of harm” AG James’ report also says, “Preliminary data obtained by OAG suggests that many nursing home residents died from COVID-19 in hospitals, after being transferred from their nursing homes, which is not reflected in the department of health’s published total nursing home death data.” And then she puts a figure on the under counting. “In fact, the OAG found that nursing home resident deaths appear to be under counted by the department of health by approximately 50%.” Now, Cuomo and his allies have suggested while the overall counting of deaths in the state was not understated in any way. It’s just that the proportion of people who died in nursing homes versus outside of nursing homes was skewed and that inquiry is ongoing. But then there’s been recent news that the US attorney’s office in the Eastern district of New York and the FBI are also taking a look.

And I’ve asked around and tried to understand whether or not that would be a civil investigation, whether it’s related to what the DOJ has been doing for some months, or if there’s some basis for there to be a criminal investigation. And sometimes even in my own podcast, it’s worthwhile to say I don’t know. I’m not sure exactly what criminal statute would have been violated. Even if these allegations prove to be true, there are certainly requirements for localities and states to give accurate data to the federal government in connection with trying to receive funds and disbursements. Mostly that’s a civil violation. I suppose there’s some argument that depending on the circumstances, it could be criminal, but at this point I don’t see what the criminal violation would be. But that doesn’t mean it’s not serious. That doesn’t mean it shouldn’t be called out. That doesn’t mean there shouldn’t be accountability. And by the way, there’s yet another government entity that’s thinking about looking at this, known as Congress. A number of members of Congress I believe will be taking a look at this as well.

This question comes in an email from Jeffrey who writes, I heard Congressman Bennie Thompson is suing Trump for his role in inciting the riot. Does that lawsuit have any chance of being successful or is it mostly a political statement? Thanks. As Anne Milgram and I had discussed in the Cafe Insider podcast, it’s a very interesting lawsuit. And when you ask the question, does it have any chance of success, it depends on which defendant you’re talking about. So Congressman Bennie Thompson, along with the NAACP sued a number of folks, including Donald Trump, Rudy Giuliani, two white supremacist groups, the Proud Boys and the Oath Keepers under an 1871 law that’s informally as the Ku Klux Klan act. That law by the way, was enacted to prevent white supremacists from engaging in intimidation of federal officials, whether they be federal judges or federal magistrates or federal law enforcement officers, as the case may be.

If you look at the statute itself, it seems to be a pretty good fit for the conduct that we saw. It’s a title 42 US code section 1985, which says straightforwardly, “If two or more persons in any state or territory conspired to prevent by force, intimidation or threat any person holding any office trust or place of confidence under the United States, from discharging any duties thereof, or to induce by light means any officer of the United States to leave any place where his duties as an officer are required to be performed or to molest, interrupt, hinder, or impede him in the discharge of his official duties, that’s a violation.” And you saw that.

You saw members of Congress including Bennie Thompson, who probably will be joined by other members of Congress in the lawsuit in the coming days and weeks, forced to abandon, pursuing their responsibility in counting the votes of the electoral college and also having to abandon their positions within the Capitol, our seat of government. If you believe even the concessions made by Trump’s attorneys at a second impeachment trial, who said, “Well, lots of this stuff was premeditated and intended in the violence was known to be happening.” And by the way, the hearing in the Congress in this past week confirmed a lot of that. The people came to the Capitol intending to engage in this conduct, to intimidate and prevent Congress from acting in its ordinary capacity under its obligations. Those folks seem to make it all the elements here of the Ku Klux Klan act.

The issue when it comes to people like Donald Trump and Rudy Giuliani is a little bit more complicated with Trump, especially. One, it’s one thing to make the argument that Trump incited violence by saying things that he said. It’s another thing to say that he conspired, in other words, had a meeting of the minds, had an agreement with other people, unless you can show probably something more than the statements he made at the ellipse or the reaction he had later. And the second issue is whether or not he will be subject to some form of immunity, if he can make the persuasive argument that the things he did or said in connection with these allegations were done in his official capacity as president, if they’re a part of his official duties, because it’s generally the case that federal officials, if they’re acting in their official capacity and not going beyond their official duties have immunity.

There will also be questions based on the precedent status at the time of what kind of discovery can be taken, what kind of depositions can be taken, what kind of documents can be compelled to be produced because of other issues of executive privilege as well. So in many ways, I think it’s a well-placed suit. I think there are a lot of arguments to be made that in fact, Donald Trump and Rudy Giuliani were of the same mind with the Oath Keepers and the proud boys, but I think there’s a little bit more work to be done. And we’ll see where discovery takes us.

Before we get to the interview, I just want to make one short comment on Merrick Garland’s confirmation hearing to be the next attorney general of the United States, which took place on Monday. And I want to say how refreshing and great and satisfying and gratifying it was to see a person of his experience, integrity, and humility talk about wanting to serve the country. And talking about wanting to serve the country, not as lawyer to the president, but as lawyer for the people. And he made a very simple statement among other simple statements in his opening remarks. One of which was this “The president nominates the attorney general to be the lawyer, not for any individual, but for the people of the United States”

And I’ve often said, sometimes things are not that complicated. Doing justice, doing fairness, doing the right thing, making sure no one is above the law, requires simple commitments. There’s a lot of complexity in the law and he will have a tough job and have to navigate lots of different things in terms of fact specific investigations and complicated legal questions, but some things are basic and simple and need to be stated basically and simply like that. That he doesn’t serve the president, but he serves the people. What a noble concept.

Stay tuned, there’s more coming up after this. My guest this week is Andy Slavitt. He’s a top advisor for the Biden administration’s COVID response team and is responsible for getting all of you a vaccine as soon as possible. After overseeing the Centers for Medicare and Medicaid Services in the Obama administration, Andy is a proven expert in navigating healthcare bureaucracy. As we embark on year two of the COVID pandemic, Andy joins me to reflect on how the last year has panned out and why he has hoped for the future.

THE INTERVIEW:

Preet Bharara:

Andy Slavitt welcome back to the show.

Andy Slavitt:

It’s nice to be here.

Preet Bharara:

So as we were saying before we started taping, you were on the show almost exactly 11 months ago. I don’t even know where to begin with you given how much has changed. How many years have you aged since March 25th of 2020?

Andy Slavitt:

I’m wondering what we both thought would have been different 11 months from then, if we could cast it forward?

Preet Bharara:

I think you were pretty accurate in projecting how bad it was going to be. And that was a period we were in the throws of the lockdown. It had just been a couple of weeks old in many places in the country. There were not a lot of deaths yet, but people were starting to see what was happening in other countries, including Italy and sort of this darkness was beginning to settle upon us.

For me not being a doctor and not having so much foresight, it got far worse than I ever expected. And I want to go back in a minute and talk about how you think things went last year under the prior administration, how you think local officials, governors, and others reacted, what mistakes were made what you would have done differently, but you were not in a position of actual authority then. Now you are as a senior advisor to the COVID-19 response team. But I want to start in the present day first, how do you spend your days? How does president Biden’s COVID-19 team coordinate on a daily basis to deal with what the situation is now?

Andy Slavitt:

Well, it’s interesting. Let’s see a couple things. First of all, as anybody who’s been in the federal government knows, and as you well know, the federal government has some of the best experts on any topic you want to pick. Whether it’s science, whether it’s foreign affairs, whether it’s the law, there’s incredibly deep people. What there’s not, unless you make an effort of it is kind of a horizontal organization that drives to a single mission unless you work at it every day. And what I think that the Trump team got wrong to their detriment and to ours is they didn’t trust the current civil service staff, didn’t believe that anybody but them knew how to do the right work. And what I think we have, the group of us, which Ron Klain, Jeff Zients, Tony Fauci, Rochelle Walensky, [inaudible 00:13:28], people who know each other, people who have a lot of respect for not just the science, but the scientists and the people involved and communicate a lot and are very active.

And we’ve got a few jobs to do. And they’re really pretty focusing, which is, number one, primarily, get the vaccines out bigger, faster, better-

Preet Bharara:

Stronger than before.

Andy Slavitt:

Stronger than before, and do everything possible. And it’s very focusing to know that the faster you do it, the more people will be alive. And so that makes it really easy when you’ve got a decision to make like, should I upset a company or should I do something that might be in another climate, requires some real thought and it allows you to just do it and push as hard as possible.

Preet Bharara:

How involved is the president Biden himself in all of this?

Andy Slavitt:

He’s very involved in a couple of ways, in some ways that I think are expected, in a couple of ways which I think are surprising to the positive. He wants to know the facts and he wants the public to know the facts. The thing that would get you in trouble with the president is if he asks you a question and you said, “Here’s a way that you look really good, Mr. President, and here’s a way to spin the answer.” Which given people in politics are accustomed to doing-

Preet Bharara:

No, really?

Andy Slavitt:

To show this in a favorable light. And he’ll just look at you and he’ll say, “I just want a straight answer. If we don’t know, we don’t know, if it’s yes, I want yes. If it’s no, I want no and I want to be able to explain it to the public.” I want to be able to [inaudible 00:15:14], what did he say, the junior in high school. Any junior in high school can understand what I’m talking about. You didn’t feel the need to dress it up. I think his staff are probably a little more protective, but he just wants to go to the most basic question. When can I get vaccinated? Can you tell me the answer to that? And if you can’t, when can you? So he’s engaged in that regard. Kamala Harris is also deeply engaged, the vice-president. And both of them I think remind us frequently that we have a lot of people in the country that have inequitable access and that we can’t just solve the problem for the country, we have to solve it for the people that are having the greatest challenges.

And I’ll tell you what, and this is true, the last president it’s true this president. You are to take your tone from your boss, right? If the boss is telling you, this is what matters to me, it trickles into everything you do, and if it’s aligned with your own value set it’s a really good feeling. And likewise, I think we had a prior president who I don’t think he was very curious and didn’t want any blame. And I think that colored in even the good people that were working on things, it colored their ability to respond to effectively.

Preet Bharara:

Yeah. So I want to react to a couple of things you said. And one thing that is pleasing to the ear obviously is that you say, Joe Biden doesn’t want to dress things up, he doesn’t want to make things look better than they are. To me, that’s not just an issue of ethics and integrity and morality. It also ends up being good politics. As we’ve seen with respect to the governor of my own state, Andrew Cuomo, who it looks like pretty clearly, tried to do exactly that in the moment, wrote a book that sounds like mission accomplished long before the mission was accomplished. It’s still not accomplished. So in the long run, if you have a time horizon of more than eight nanoseconds dressing up numbers falsely and prettifying things is not even good politics or policy, right?

Andy Slavitt:

Yeah. I mean, you have to operate today under this idea that the public will eventually know. And so if let’s just say we do a great job and we get this thing taken care of, at that point in time, people will start to feel good again. If we don’t, then people will still feel challenged. And so it’s very tempting and we’re getting a lot of push from the press to give people a date certain. To say on X and Y and Z date life will begin to return to normal.

Preet Bharara:

Right. Can I pause on that for a second? And because it’s a very tough thing and in different contexts, it’s not as life and death. Now, I get asked all the time, when do you think there’ll be charges against Donald Trump? When do you think this investigation will come to a close? And that is obviously a completely different cycle of events, but how do you and Tony Fauci and the others balance the need between not over promising, also not under promising and also being accountable to the public and giving people some guidance. It seems to me that sometimes public officials are too restrained. And I’ll give you a particular example in a minute. How do you think about the proper way to answer the question when you’re no longer a private citizen but talking on behalf of the administration?

Andy Slavitt:

Well, I think the first thing is that everybody in the team has to agree and continue to revisit it, because if you have Tony saying one thing and I’m saying another thing, and the president saying another thing that’s not good. So you have to really have that discussion. And Ron Klain as the chief of staff has really led this discussion and I think there’s a couple of things that he thinks are important that I think are important too. One is we just can’t predict the future. So we could do a lot of things well, and surprises will happen. And we’ve learned throughout this pandemic that there are plenty of surprises. There’s things we can control and we should be accountable for and there’s other things we can influence, but we should be very careful about predicting the future.

Number two, and this is something that I deeply believe is part of the reason why we have such a fatigued public is because nobody asked the public to prepare for a bit of a marathon. The ex president kept saying over the last year, “It’s almost over, it’s just around the corner, a miracle’s coming. This is just about to finish.” And a good bit of the public who either believed that or just didn’t hear any different message, even if they didn’t believe it, it was very fatiguing when it was never over, when it kept getting worse and worse and worse.

So I believe the smart thing to do is to tell the public, the following, we are confident we will overcome this and beat this, and we will, and I am confident. But there are more curve balls coming, variants and whatnot. Let’s prepare for them. It will be a matter of months. And if we can beat those times, because we will work every day to do that, not to give the public the, if everything goes right, this is what happens, but this is the current course we’re on. So if I’ll give you an example, the Johnson and Johnson vaccine as we’re recording this is not approved, I would say not yet approved. So all of the dates that we’ve given the public about when things will happen, don’t account for a third vaccine being approved.

Preet Bharara:

That’s not built into sort of a model of predicting that that will at some point be available.

Andy Slavitt:

It’s built into some internal models, but it’s not pretty built into what we’ve told the public. In part, we’ve lived through a year of the white house of bossing around the FDA in a way that just caused people to lose trust and be in question whether they want to take a vaccine. And remember vaccines aren’t what’s important, vaccinations are. So we’re going to let the FDA do their job. And if they do, and well maybe surprise, we’ll have some good news and we’ll report the impact of that good news. But waiting to that takes a certain amount of discipline and probably accusations which we were getting that well, you guys are being too negative. Trump was too positive. You guys are being too negative. That’s kind of some of the flavor of what we’ve thought in recently.

Preet Bharara:

Do you want to share some of those internal models with our podcasting audience?

Andy Slavitt:

Yes, I do, right? I do. If people promise not to tell.

Preet Bharara:

Not to tell, well, obviously that was a joke.

Andy Slavitt:

I know. Yeah.

Preet Bharara:

But this is something that I actually have not focused on and not appreciated. So to the extent public officials like you and others say we’re on a timeline of X number of vaccinations by Y date, if there’s suddenly good news, even if that good news has been reported about, we just don’t know the time certain, I’m going to be very clear about what you’re saying, like the Johnson and Johnson vaccine or some other development. I don’t know what some of those developments might be, you will come out and change the public model and that change could be significant for the better?

Andy Slavitt:

So it’s happened already Preet. When we first got here as hard as this might be for you to believe the country hadn’t yet purchased enough vaccines for every adult in the country. So one of the first things Biden directed us to do is go purchase enough vaccines for every adult in America. And we did that and we asked for a schedule which was consistent with the schedule that they’d given the old team without a lot of the work we had done. And I said, “We will have enough vaccines for the rest of the country by the end of the summer.” And people didn’t like that, but it was the truth.

Now in the intervening three weeks, we did a lot of work with the vaccine manufacturers, a lot of work all up and down the distribution change. We used the defense production act, we did a number of other things. And last week the president came out and said, “We will now have enough vaccines for everybody in the country by the end of July.” And again, that’s without the Johnson and Johnson vaccine. So moving a date up, people generally tend not to be upset with you. And so-

Preet Bharara:

Yeah, it’s the under promise over delivery.

Andy Slavitt:

Right. Getting people to trust again, feels… and I’m curious of what you think. I believe that getting people to trust again, that they’re getting the straight story, that they’re getting straight information, that they’re getting facts good or bad, not tipping the scales either positively or negatively, but being very clear as I’ve said which is the end of July, that doesn’t account for Johnson and Johnson. So we’re very clear. And then should things change, we will say it. And should things get worse, should we have a negative surprise we’re also going to have to do the same thing. I think that public trust piece is so essential to us being able to do this right and get through it as quickly as possible.

Preet Bharara:

Yeah. I think it’s of central importance on a variety of fronts. It’s important so people have faith that their government is helping. And then when you want the public to do particular things, that’s where it’s most important, right? You want them to wear masks, you want them to wear two masks, you want them to wear masks after they’ve been vaccinated, you want them to take the vaccine, you want them to come back for the second. So trust in the information the government is giving. I can’t think of anything more important if we’re actually going to get to the end of the road here.

You said something a few minutes ago that struck me. And you said, something that’s very basic and that I’ve talked about all the time and that people talk about in leadership discussions and that is the tone at the top matters. And there’s a particular tone at the top when the top was occupied by Donald Trump. And as you were saying that I was going to ask you, what does that mean for somebody like Dr. Fauci under the prior administration? And then you anticipated that I guess, and said, I presume you were referring to among other people, Anthony Fauci, and you said it even affected how good people did their jobs. What did you mean by that in the particular case of Dr. Fauci?

Andy Slavitt:

Dr. Fauci should be able to say what he means in as fewer words as possible. And when he has to figure out how to say it in a way that doesn’t upset the president, and one could see him making the effort to bridge this almost impossible divide of saying what he believed the science was telling us and doing it in a way which allowed for the fact that Trump’s statement, whatever it might’ve been at the time, wasn’t some ridiculous false hood. And so as you listened to him, who by definition he’s a team player, he’s believes in the science, he’s served seven presidents now. Generally speaking people let him do his job because they’re too scared that if they don’t listen to him, bad things will happen.

Well, this is the first time I’m thinking, but no this is not something he’s said, but I’m saying it. He worked for president that really didn’t have that fear, that lots of people might die if they got it wrong. And so he kind of was in this very interesting position of having to do both. And I wasn’t really just referring to him, but there’s so many civil servants in the government that we never know, we never heard of. I mean, someone like Nancy Messenier we know of, but she was somebody who basically said the emperor has no clothes when no one else would. She just came out and said, “February, this is going to happen. We’re going to be in a situation where things like schools are going to close and businesses are going to close. It’s not a matter of if but when.” And she got lambasted and when you get lambasted by Trump, it’s not just a one-off event, it’s all pack of people. It is very, very scary.

Preet Bharara:

It can be life changing. Yeah.

Andy Slavitt:

It can be life changing and be very scary. And so it sent a message to a lot of other people who I think at the time were like, I’d love to do my job, but we can’t do this or we’ll be really in jeopardy.

Preet Bharara:

I want to talk about this concept of science and the exaltation of science and the following of science. And I’m in the camp of people who believe in science. And I butter that mantra all the time, but I want to make sure we understand the limitations of that if there are limitations. And to borrow from Tocqueville, science properly understood is something that we should be focusing on. And it sometimes sounds like when people talk about science and follow the science and listen to the science, there is not enough, I think public education on the point that the science is imperfect, particularly when you have an evolving situation. And it worries me because on one day a doctor will say, well, the science says acts and people don’t fully appreciate that that’s kind of a conditional statement being made subject to change based on more science or maybe the intersection of science and policy. Does any of that make sense? Do you think that we’ve caused some problems in how we want people to accept “science” by not talking about it right.

Andy Slavitt:

Well, what’s very weird is that we are in the metaphorical lab with the scientists while they’re doing the experiments. So we’re used to science and thinking of it, if we believe in science as being all knowing and grounded in data and fact and experiments-

Preet Bharara:

Right. After the experiment’s over, you’re saying. And there have been multiple repetitions of that experiment and the same results are found, then you say, now science has spoken, but that’s not what’s happening here. And I don’t know that we’re explaining to people how uncertain it is.

Andy Slavitt:

Right, So we’re in the lab and we’re trying to figure out if you put these two chemicals together, we’ll it fiz up. And so we see three bubbles float to the top and we say, it’s fizzing up. Well, how long will lift is up for you? We don’t know. And so the question of what kind of antibody reaction your body will get to getting the virus and how different that’ll be, if the virus mutates and how different that will be, if you don’t get it from a virus itself, but from a vaccine, those are all great questions that we all feel should be knowable. The problem is they’re not completely knowable yet. They will be, we’ll be able to look back on it and it will look quite obvious to people in the future. But right now, we’re in the lab and so these things are just unknown.

And so my advice to people is if the expert you listen to doesn’t say, “We don’t know” quite frequently, then they’re not the expert you probably ought to be listening to. Now, there are some things that we do know, and I think what’s important about the science is that there are some things that are, you basically do under any circumstances. Wearing a mask and getting a vaccine fall into the category of whatever else turns out to be true, those are really smart things to do. And we know that because the vaccines are very, very effective and incredibly safe. They’re in some ways a gift that we don’t deserve. And I say that in a capacity not of course in a public service capacity, but they really just are completely delivering and likewise masks can do well as a less perfect job can do quite a good job.

And so at some level you say, we know enough science, right? To make some decisions. To make the decision not to go to a raging party with people screaming and spitting and singing on a college campus. You and I know enough, not that you and I are invited to those parties anymore. But were are we to be invited to those parties-

Preet Bharara:

Speak for yourself?

Andy Slavitt:

We’re going to see pictures, but we know enough to know, science tells us enough to know that’s a bad idea. But the science doesn’t tell us is exactly when that will become a good idea again, and we will learn that soon.

Preet Bharara:

I mean, I just want to go back to this idea of public faith, which relies upon a very sort of tricky calibration of predictions that are made, right? And I agree if you’re going to err on the side of not predicting perfectly. You want to under promise and over perform, and then people will forgive you for that. But there is still a risk if you under predict and then good news follows.

Frequently, it can still cause people to say, well, the government is lying to us and they build in the discount. And so, for example, I’m thinking of all these statements that were made by experts. And I just wonder if you have a view as to whether or not there’s any criticism here. Lots and lots of experts said repeatedly, and there were some people that said the opposite, that there was no way a vaccine that would be appropriate and responsibly administered could happen before the end of the calendar year in 2020. Is there any thought in retrospect as to the best way to have talked about the future viability of the vaccine, or is this just in the nature of look Pfizer and Moderna and the others, they just crushed it in a way that was not foreseeable.

Andy Slavitt:

Well. So first of all, of course there is a cost to being too conservative and the best argument against it is mental health and the great anxiety that many people are feeling and the addiction crisis that we had before the pandemic that’s even greater during the pandemic and the sense of hopelessness and despair that many people feel. So I wouldn’t describe ourselves as leaning on the scale to be pessimistic by any means. I don’t think that’s the right approach. I do think the cost of missing is while it is, there’s a cost on either end, the cost of over promising feels quite high. So rather than over promising or under promising, I just try to be descriptive. I lead these Monday, Wednesday, Friday briefings with Dr. Fauci and Dr. Wilensky and I just try to be descriptive and I try to answer every question in plain English clearly and honestly, and to say, I don’t know when we don’t know, but also to be hopeful of what we believe, which is that we will beat this. And it’s a matter of when we’ll do it.

Andy Slavitt:

That probably doesn’t work for everybody, but I think it’s the best approach that I know. In the case of the vaccine, it’s really interesting. I do think it over-performed, look there were a number of people who were saying it could happen quickly and they were right. From the outside I think people said envisioned 12 to 18 months that was kind of the standard go. And it turned out to be pretty close to right. 12 to 18 months for the vaccine, probably a little bit better than that. And that was due to some extraordinary work, not just at Moderna and not just inside the FDA with some guy named Peter Marks, who’s the real hero of this, but actually work that started a decade or more before on this MRNA platform and investments that the government made in 2017 in this MRNA platform for a vaccine for SARS and MERS.

And it’s a really interesting proof point about how basic research, even if you’re not quite sure why you’re doing it turns out to be a really smart thing to do, because by the time we got to January of last year, Tony Fauci and Rick Bright looked around and looked and said, “Oh, we’ve got something on the shelf that’s kind of ready to go.” And so it seems you call that luck, you call that planning, you call that investment, but it’s certainly an argument for science. And in that sense, we got both lucky and lucky to just have such good people who were thinking ahead.

Preet Bharara:

We’ll be right back to my interview with Andy Slavitt after this. So Andy we’re now in sort of this twilight zone where the process of vaccinations is happening, tens of millions, I don’t know the exact number at the moment, you may.

Andy Slavitt:

I know it to the person I think.

Preet Bharara:

So we’re recording this on Tuesday afternoon, February 23rd, what’s the number?

Andy Slavitt:

About 60 million people. 60 million of vaccine shots and about 47 million people. So right now, half of people over 65 have had their first vaccination. Most people in long-term care facilities have been completely vaccinated and about one in eight people have had their first vaccine shot. So we’re making progress, but we’ve got a lot of ways to go.

Preet Bharara:

Yeah. So here’s what I wanted to ask you, so in that universe in which some portion of the population has been vaccinated and others haven’t, questions arise as to what you can do and not do. And going back to what we were saying before, about notes of caution that are offered by professionals at some point people begin to question whether they’re not being overly cautious, and I’ll give you a concrete example. And I saw Dr. Fauci on TV over the last weekend, asked this question and it struck home with me because I have the exact same scenario that I want to present you with. So my parents both elderly living in New Jersey have had both of their vaccination shots and then the requisite period of time thereafter. And so we did something for the first time going back a year and we went and saw them and we saw them inside because I thought it was important for the grandkids to see their grandparents. And we were in close quarters and we did not socially distance and they hugged their grandparents. And we’re generally quite careful and they’re vaccinated, was that irresponsible?

Andy Slavitt:

So I think the way to look at that is there was a substantially lower risk of doing that than there was before they were vaccinated. And there was a high reward for doing that. And so I would say you’re constantly just… while we have imperfect information and not a lot of data, you’re just constantly playing with that. What’s the risk, what’s the reward. So if I went to spend time with two elderly people that I’ve never met before, right? The amount rewards is not that high. So probably not worth it, even if they’ve been vaccinated because the chances are great. And so introducing those sort of personal calculations which are somewhat personal decisions and somewhat circumstantial think it’s something we’re going to have to start to get used to.

Preet Bharara:

Well, I’m glad to hear you say that because it’s really tough on folks to see the light at the end of the tunnel, and to be told in a way that I haven’t heard other people say, when you talk about the high reward for something that’s personal to you, like seeing a family. For some people going to church, if that can be done in a particular way, if enough of the congregation is vaccinated, I feel like a lot of the people in the public don’t think that some of the leaders appreciate the loss of those things that people want to get back. And instead they just keep hearing the same things over and over again. I mean, I haven’t heard too many professionals say, if you have a group of people all over the age of 75 who have had both vaccination shots, can they get together and have a party? The expectation is they’ll say yes. And as part of this, just for people who are speaking publicly and with authority, you just don’t want to give too many blessings to folks because people will abuse it.

Andy Slavitt:

I think it’s that once the CDC says it, and there’ll be the body to say. And they’re working on this by the way. So, but once they say it, it’s different than John Hopkins saying it, or someone with an informed opinion. When they say it, it becomes as close to a blessing in the eyes of the public, as there is. So that probably that they’re 10% to 20% more careful and thoughtful. And therefore, probably not first and not meeting the public with the need as soon as the public wants it. But a little, and I think appropriately a little bit on the slower side to make sure that they’ve thought through all the permutations and I know that’s exactly what’s going on because those subjects and how to answer that question is a really live topic.

Now, from the white house standpoint, we pledged to follow the science. So if the CDC doesn’t say anything, we’re inclined to push them to get an answer. We’re not inclined to push them as to what that answer is. The other thing I’d say is, and this is going to sound a little bit flip, but why do you take an MMR vaccine? Why do you take a polio vaccine? You take them so you don’t die. And at first level, I think people even before we know exactly the permutations of what this can do into your life, which is by definition interdependent, and when everybody else in your community is doing both your family and your community, because going to a restaurant, all those other things there are, you start to get into larger and larger numbers of people. But even before that stuff is completely figured out or advice is rendered, there’s a huge benefit that people feel and understand, I would like to think.

Preet Bharara:

Suppose 10 years from now, I’m going to ask it in this way so it’s not just about the Trump administration. 10 years from now, based on what you’ve learned over the last 10 or 11, 12 months, there is another outbreak of a particular kind of virus that has the same kinds of properties, but it’s a new virus and the then president calls you up and says, “How should we proceed?” Are there things that you would say differently today than you would have said a year ago about how the country should prepare for such a thing or combat such a thing?

Andy Slavitt:

Well, look, I think there’s sort of two levels to this. There’s what I consider to be the traditional first lines of defense, the things that are the objective standard hygiene that is sort of the equivalent in a homeland security context of taking off our shoes and checking our liquids and going through the metal detectors. We will get better at a set of things like that, like surveillance, like making sure we’re stocked up on all of the PPE we need. And then when something comes to be able to contain it as quickly and as systematically and as thoroughly as possible. So we’ll get better at those things, but that’s only half of it. The other half and probably the more interesting half to me in some respects is, do we do more than take the literal lessons, but do we take the other lessons to heart that people with experience do?

And if you go look at this as our starter bug, and you realize how difficult it was once the official response failed. We had another chance to succeed and that chance was with an unofficial response. It was with good collective action. It was with mask wearing. It was with some semblance that our actions affected others. It was with some unity and some discipline, et cetera. And we really just didn’t do very well on those scores. Some of it is our inexperience, some of it is this became a kind of cultural identity piece, but what’s really curious is it’s not guaranteed that the next time, 10 years from now that we’ll get it right with our formal defenses. And then the question is, what will we have learned our lessons from an informal standpoint that we’ll know, hey, like Hong Kong did slap on a mask right away, do some of the things that you can do to minimize the damage that you can do culturally, and I have more faith in our hard sciences than I do in our soft sciences.

Preet Bharara:

Well, I feel the same way. And I had a thought recently. I keep appreciating that you’re not going to want to say doomsday type things for many reasons, maybe because you don’t believe them and also because you speak for the administration now. But I was thinking to myself recently and tell me if this is a crazy thought, thank God for the vaccines, not just for all the ordinary reasons that the vaccines, and of course the vaccinations will help us kill the virus and get back to normal. But boy had the vaccine not come along in multiple forms and we were still, let’s say, hypothetically a year away, I mean, would we have been anything other than doomed given how our response went and how different the responses were in different localities and in States around the country?

Andy Slavitt:

That would be an interesting spin on this. So the Soviets for a long time were developing these biological bugs and have been for years that they planned to either unleash or threatened to unleash against the United States. And if you imagine the most deadly virus you could think of, think of Ebola and the most contagious virus you could think of, think of measles, which is about 17 times more contagious than COVID-19. And Ebola has a 75% death rate. They were creating super bugs that were combining some of these properties.

It really focuses the mind to think about a virus that is 17 times as contagious as this one and also quite deadly. One of the things that is interesting about this virus, and I’ve heard it described by people. Ed Yong of the Atlantic described it this way, it’s almost like the reverse Goldilocks virus. It’s bad enough that it’s killing masses of people, but not so bad that for many people, they don’t think it’s worth disrupting their lives to make a change. In other words, if you have something like the flu or something mild people go, we can live with it, whatever. And if you have something like this super bug, people would respond much more seriously because they had to. But there were enough people in this country, privileged people, people who could isolate, people who weren’t living three generations to an apartment, people who weren’t working in farm labor camps, or in prisons or homeless shelters, et cetera, that have really done just fine. They’ve been inconvenienced, but they share with the other-

Preet Bharara:

It sounds like you are saying, yeah, we would have been doomed.

Andy Slavitt:

I think this trickle would have just, it was getting more and more acceptable to some people, not to the majority of people, but people were living with it. Look, all of us to some extent, have grown numb to this, right? We just passed 500,000 deaths. When I was on your podcast last time, if we would’ve been talking about 500,000 deaths at that point in time, when there were not yet a thousand deaths-

Preet Bharara:

Unthinkable.

Andy Slavitt:

It would have been unthinkable. And now it just passed us by.

Preet Bharara:

Well isn’t part of the reason, a couple of things. And I can’t remember if we talked about this last time, maybe it was too soon. We’re not seeing it on video and other kinds of things like terrorist attacks and other calamities, earthquakes, floods that cause everyone to react in a particular way. You’re not seeing that here. People are dying alone in hospital rooms, in their homes. You are not seeing-

Andy Slavitt:

There’s no 50 mile an hour winds, there’s no flood waters.

Preet Bharara:

Yeah look, imagine everything about this virus is exactly the same. Exactly the same, except that the distribution of cases and deaths is proportional throughout the population regardless of age, so that children would die of COVID to the same degree that they are a portion of the population. Wouldn’t all of this be completely different.

Andy Slavitt:

Yes. And it’s not just age, it’s also race.

Preet Bharara:

Yes, of course. Right.

Andy Slavitt:

I mean, this is an occupational disease. This is a living conditions disease. And so if your occupation is one where you are in constant presence of other people, because you’re bringing up a cash register or you’re working in the meat packing plant, it’s very different. And so a lot of times people look at these numbers on TV and they say 3,000 people are dying a day. That seems impossible because I don’t know any of these people. And someone said that to me once and I still remember my response because it was from the gut and I’ve since used it more times than that. And so now it doesn’t feel like it’s from the gut, it feels like a canned response. But my response was you do know the people that are dying. They’re the people picking your food. They’re the people driving your food to the warehouse. They are the people packing your food and bringing it to your grocery store. You may not know their names, but believe me, they’re part of your life.

Preet Bharara:

Yeah, I think that’s true. Do you have a different view, either more positive or more negative about federalism? A lot of the questions and controversies that have arisen is whose job is it? Should the federal government decide everything? Should they give strong guidance? Should they put incentives at play to get states to do the things that most comport with science and good policy? Should they be hands-off? I mean, the most recent iteration of this is when you talk to people who live in different states and I live in the tri-state area and it’s a very different experience trying to book a vaccination in New York versus Connecticut versus New Jersey, is federalism good or bad for dealing with viruses?

Andy Slavitt:

I think regionalism instead of federalism. What do I mean by that? I mean, you obviously have local differences. You may live in a state or in a part of a state that has a lot of meat packing plants or a lot of nursing homes or a lot of young kids in school and your response should reflect your local conditions. So there should absolutely be a regional approach that is partnered with the federal approach, because the truth is if we have eight territories and 58 states in territory there aren’t 58 best ways of doing everything. Maybe there’s three best ways. Maybe there’s a best way in rural communities, maybe there’s a best way in urban communities, maybe there’s a best way in factory towns. There are different versions, but there aren’t 58 best ways. And so this is a relic of the kind of government we think we have not a relic of what we think is the best approach.

Preet Bharara:

Is it fair to say that the successful creation of multiple really highly effective vaccines is an unmitigated triumph?

Andy Slavitt:

Yes. And lots of people deserve credit. And I think we ought to be generous with credit and not stingy with credit and that for things that have gone well and it went well. I would start by saying, Peter Marks at the FDA is someone you can read about in articles that people listen and haven’t, but someone that I encourage you to read about, but he and Rick Bright, Tony Fauci those career folks did a terrific job. And that they were people in the Trump administration, political appointees who went and got the money for Congress to fund that work and who works successfully with some of the pharma companies, including Moderna and supported that work. And they all deserve they all deserve credit, we should all be grateful and there’s no ifs, ands or buts about that as far as I’m concerned.

Preet Bharara:

I’ve been thinking a lot about, based on my career and based on public perception, about the Big Pharma, about the pharmaceutical companies. And when I was US attorney, we investigated them various things and there has been a lot of reason to criticize particular pharmaceutical companies and the industry as a whole and some people think they get to get away with things, but it is always the case that Big Pharma also has big solutions to things that the country cares about vaccinations and certain treatments. And maybe it’s a complicated thing how the average American should think about Big Pharma. Do you have any reaction to that?

Andy Slavitt:

I think it’s fair to hold two competing thoughts in your head at the same time, which is that we should fund innovation and we should work with public and private partners to fund innovation and that those innovations ought to be affordable to people because the things that I think are appropriate to criticize the pharmaceutical industry for are raising prices on insulin. Something been around for a hundred years, not changed and growing at much more rapidly than inflation in order to meet profits.

Andy Slavitt:

So let’s fund the new innovations, but things that are on the market, they should be going down in price every year, not up in price every year. And even in the middle of all of this, and I’ve worked very closely with the pharmaceutical companies CEOs on this work. And it’s a kind of work you like doing because everybody’s doing something constructive. But we’ve also had very frank conversations about how this is untenable if people can’t afford it. This has happened to be a situation where the government paid for everybody’s vaccine. So we’re not hearing about pricing because government wrote the check, but if the government wasn’t writing the check and everybody had to pay for this vaccine, we wouldn’t be having this debate.

Preet Bharara:

Oh my goodness. During this terrible, terrible period. It’s a lesson you taught me offline and I think it’s very important that it’s still important to laugh and to have pleasure and humor in life. Do you still have time for that?

Andy Slavitt:

I do. I do. And the easiest way for me to laugh is to laugh at myself or make a fool of myself in a tense situation because-

Preet Bharara:

I’ll love to do that here.

Andy Slavitt:

Well, you can make a fool of me after I go to promote… It’s perfectly okay with me. Yeah. I mean, kind of cutting through the tension. I mean, and look, the mistakes that I’ve almost made or caught myself from making and fessed up to how stupid they would have been in the face of very tense work with a lot at stake, helping people see that I’m human. To me, it sends a signal to them. It’s okay for you to be human and to tell me your mistakes and for us to laugh about them and to go, Oh boy, this is kind of a strange situation. I think that’s really important. And some part, because life’s still ticking by, right? And these aren’t years we’re writing off, these are years that have real meaning to them. And I loved the fact that you visited your parents and had an incredibly meaningful experience. And it probably meant more to you than if you and your kids had been visiting your parents every weekend for the last year.

Preet Bharara:

Yeah. No, it was a real special thing and a real joy and we need more of that.

Andy Slavitt:

And I hope everybody decides what their joy is and just enjoys the hell out of it. I mean, just really relishes that.

Preet Bharara:

And if you’re lucky and you do that with your parents your folks will make 10 dishes of steaming hot, wonderful Indian food too.

Andy Slavitt:

I would love that if my mom would do that. I’m going to get Jewish food, but-

Preet Bharara:

Shout out to my mom’s cooking, which was excellent.

Andy Slavitt:

I’m going to angle myself after this thing is over into an invitation because me love some Indian food.

Preet Bharara:

Absolutely. I mean, she made all the kids’ favorites and at once, which I’m not sure we always do that, but it was a special thing. Andy, I know you have a million things going on, thank you for your wisdom, thank you for your service. Andy Slavitt thanks again.

Andy Slavitt:

Thank you, Preet.

Preet Bharara:

My conversation with Andy Slavitt continues for members of the Cafe Insider Community. To try out the membership free for two weeks, head to cafe.com/insider. Again, that’s cafe.com/insider.

So we’ve talked a lot about COVID today, and I want to end the show this week talking about another consequence that is apparently related to COVID-19 and that’s the growing number of violent attacks against the Asian American community and Asian American elders in particular. It’s mind boggling, disgusting and heartbreaking. I’ll give you a few examples. Earlier this month, the Bay area reported a surge in these incidents in one attack captured in a disturbing video circling the internet, an 84 year old man is shoved to the ground while walking in San Francisco. He never regained consciousness after the attack. And he died just days later. These attacks have become jarringly common. A 91 year old man was shoved to the ground in Oakland’s Chinatown. The whole attack caught on camera. A Vietnamese woman was assaulted and robbed of $1,000 in San Jose.

And the Filipino man was attacked with a box cutter across the face on the subway in New York city. And if you saw him tell his story on cable television this past weekend, you would have been moved to tears as I was. And there are so many more. Attacks like these are not recent. In fact, as far back as last March, ABC news obtained a warning from the FBI of an increase in Asian-American hate crimes because of the pandemic. The report said, “The FBI makes this assessment based on the assumption that a portion of the US public will associate COVID-19 with China in Asian American populations.” When a sitting president calls COVID the China virus or the China plague or Kung flu as Trump infamously did, it becomes clear that he’s not looking out for Asian Americans like every other American, or is concerned, ensuring the safety of all people who live in this country. His rhetoric distinctly puts that community at risk.

His language empowered people to act violently on their racist beliefs. We’ve seen a sharp uptick in anti-Asian incidents since the beginning of last year. According to the stop AAPI hate website, a tool used for tracking hate incidents against Asian-American Pacific Islander communities, 2,808 self-reported incidents of anti-Asian discrimination have been documented across the US from its inception on March 19th to December 31st of last year, the spike in hate crimes was so severe in New York city that the NYPD established the Asian hate crimes task force to combat such violence. Cynthia Choi, one of the creators of stop AAPI hate said this about the connection between hate crimes and Trump’s inflammatory rhetoric. “They’re parroting Trump’s language. Animus that’s tied to China being the source and spread of the virus and the pervasive use of orientalist stereotypes and racist demagoguery.” To be clear, this kind of hatred and violence, didn’t start with Trump’s rhetoric and it won’t end with him gone, but it does show how crucial language is, especially when it comes from our highest leaders.

Trump’s language diverted blame away from his administration’s failed response to the pandemic and in a way, put it on the Asian American community. Going to the grocery store or going for a walk should not be life-threatening for anybody. So we need to pay attention to what’s happening in all of our communities, including the Asian American community. And we need to focus on the common enemy of all of us, the Corona virus itself. My deepest condolences to the families of all these victims, and we never forget them and work to create a better, safer future for everyone. Well, that’s it for this episode of Stay Tuned. Thanks again to my guest, Andy Slavitt.

If you like what we do rate and review the show on Apple podcasts or wherever you listen. Every positive review helps new listeners find the show. Send me your questions about news, politics and justice. Tweet them to me at Preet Bharara with the hashtag #askpreet, or you can call and leave me a message at 669-247-7338 that’s 669-24 Preet. Or you can send an email to staytuned@cafe.com. Stay Tuned is presented by Cafe Studios. Your host is Preet Bharara. The executive producer is Tamara Sepper. The senior producer is Adam Waller. The technical director is David Tatasciore and the cafe team is Matthew Billy, David Kurlander, Sam Ozer-Staton, Noa Azulai, Nat Weiner, Jake Kaplan, Geoff Isenman, Chris Boylan, Sean Walsh, and Margot Maley. Our music is by Andrew Dost. I’m Preet Bharara stay tuned.