Science Journalism

Transcript

President Ron Liebowitz speaks through Zoom from his home office with his wife, Jessica.

Good afternoon. My name is Ron Liebowitz, President of Brandeis University.

My wife Jessica and I are delighted to welcome you to today's program. The past year, living through COVID-19 has underscored, among many things, the importance of scientific research in fighting the pandemic.

In fact, at Brandeis, we recently granted the Lewis S. Rosenstiel Award for distinguished work in basic medical research to two scientists; Katalin Kariko and Drew Weissman, the latter a Brandeis alumnus for pioneering much of the science underlying two of the COVID-19 vaccines now being given across the globe.

But the focus of today's forum is not on the research being conducted by so many scientists and physicians to fight threats to public health. But on the urgent challenge of explaining science to the public and the role of the news media in the fight against the pandemic.
 
The discussion will be moderated today by Neil Swidey, Director of the Brandeis Journalism Program and editor at large of the Boston Globe Magazine.

Neil will introduce our panelists momentarily, but first, I'd like to extend a warm Brandeis welcome to Dr. Atul Gawande and Dr. Elisabeth Rosenthal, as well as a warm welcome back to Dr. Anthony Fauci, who participated in the recent Rosenstiel Award ceremony.

Now let me turn the program over to Neil.

Neil Swidey speaks.

- Thanks so much,

Ron, and welcome to everyone. I came to Brandeis in the fall with the goal of working with a small team to re-imagine the journalism program. We've added some great new courses in people. But we see a big part of our role as convening really smart people to try to tackle some of the urgent problems facing the news media and our democracy.

I can think of no better collection of talent and brainpower to kick off this effort than the panel we have convened for you here today. I'll keep the introductions brief.

Our panelists are so accomplished that reading all of their accomplishments would eat up the whole hour.

But I'll just start with Dr. Anthony Fauci. Fauci isDirector of the National Institute of Allergy and Infectious Diseases and Chief Medical Advisor on COVID-19 to President Biden.

He's also of course, widely trusted and now incredibly popular and has the singular distinction of having been portrayed on Saturday Night Live by both Kate McKinnon and Brad Pitt.

Welcome, Dr. Fauci. Dr. Atul Gawande is a surgeon at Brigham and Women's Hospital, a Harvard professor at both the med and public health schools, a New Yorker staff writer and a best-selling author. He's also the founder of Ariadne Labs and co-founder of CIC Health, which is a major player in the mass vaccination sites going on now. For all your researchers out there who are doing those studies showing how lousy we human beings really are at multitasking. You've got to deal with the one man rebuttal and a tool.

Dr. Elisabeth Rosenthal is the Editor-in-Chief of Kaiser Health News and a contributing Op-Ed columnist to The New York Times. During her years as a reporter for The Times, she was in the Beijing Bureau where she covered SARS and Avian flu. She's also the best-selling author of a really important book, American Sickness. She began her career as an emergency room physician, which prepared her perfectly for a life in a frantic, coffee fueled, sleep-deprived newsroom.

Welcome to all of you. I'm enormously grateful for you for sharing your insights and time today.

Like everyone else in the audience, I'm eager to hear you talk. Once we get things started, I'm going to try to stay out of the way as much as possible.

Just one word to the audience about questions.We have the Q&A function open. If you have questions, please add those, we'll be monitoring that during our time. We also got a ton of great questions when people register.

We have very limited time here today, particularly for Dr. Fauci who is going to need to leave a few minutes early.

We'll do our best to get to a representative sampling of the questions. But please bear with us on that. Now let's get started.

Dr. Fauci, we're a year into this pandemic and I'm just wondering what you feel are the most important lessons that you've drawn from our response, both from the public health officials and the journalism side that could help us do better the next time around or do better to get out of this more quickly?

Dr. Fauci speaks:
Well, there are several lessons, they're the other one that I think is the most cogent that I've had to experience up close and difficult is that if ever you want to have a historic pandemic, don't have it at a time when there's intense divisiveness in society, which is what we really went through, where as difficult as much as a response to a historic pandemic is, it becomes extraordinarily problematic when you try to guide the country through difficult public health measures that have implications well beyond health, namely on the economy and on indirect effects on people's lives.

At the same time, you're trying to blunt the insurgents of what is clearly already shown to be historic in its dimensions with 515,000 deaths already.

At the same time that you're almost fighting a political battle with half the country about trying to get public health measures implemented. To me, that's a lesson that if you're going to fight a pandemic, it's got to be the entire country pulling together. You have to respect differences in states and differences in readings. That's one of the beauties of our country.

The diversity that we have geographically, demographically, e-t cetera. But when you have a situation where there are individual elements of a doing things that are directly contrary to public health measures, that becomes very, very difficult.

The other thing just to be brief is that don't ever underestimate a microbe that is emerged. One underestimated early on, HIV.

In the very early, early years, few gay men getting infected. Probably a fluke, probably something that's going to just be in a barren situ. One of the most extraordinary outbreaks of infectious disease we've had, we're still in the middle of it and the beginning of the outbreak here, fearing but never really wanting to believe that it could turn into such an explosive outbreak as it did right now.

There are many other lessons, but those are two of the ones that stick very much with me.

- That's great. Dr. Gawande, how about you?

•  
• Dr. Gawande speaks:
• 
  I think I'd add to that.
  
  One of the things that taught,
  
  especially thinking about my hat as a journalist,
  
  is about the limitations of science journalism.
  
  We've been impotent, I think,
  
  in addressing the strengthening forces of
  
  pseudoscience and anti-science and most of our approaches to it,
  
  which amounts to thinking that fact-checking will prevail, have not succeeded.
  
  It's been made more dangerous by the force that Antony mentions,
  
  which is the alliance between political power in
  
  an election year and pseudoscience in the midst of a pandemic.
  
  I was really struck just this week by the conservative, by CPAC,
  
  the conservative meeting of the major Republican figures,
  
  that the most celebrated political figures for the next president,
  
  beyond President Trump, [inaudible].
  
  all are there because they've made a point of
  
  defining the public health scientists and that they have made a point of
  
  specifically attacking Antony and
  
  the reaction after that to
  
  immediately follow it by the governor of Texas and Mississippi,
  
  jumping to make sure they're recognized to be seizing
  
  the same banner of 100 percent reopening,
  
  ending mask requirements and saying that we will defy the public health scientists,
  
  really as a quandary for what science journalism is.
  
  How it addresses the issue other than throwing a hand up in the air and saying,
  
  how can it be, of course, science is science.
  
  I think it's exposed our impotence,
  
  I think, against a major force.
  
  - Dr. Rosenthal.
  
  - [inaudible] to stand up for journalism a little bit on this one
  
  [OVERLAPPING] [LAUGHTER] It's really hard to
  
  do good journalism when the information coming from the government,
  
  the CDC, the FDA,
  
  is so limited and constrained.
  
  We were constantly over the past year digging to find things where I was saying,
  
  why is it our job to figure out how many healthcare workers
  
  have died of COVID after on-the-job exposure?
  
  Doesn't the CDC or OSHA collect that?
  
  But now, we did a fabulous series called Lost on the Frontline.
  
  That has certainly gotten better with the new administration.
  
  We're starting to get a much better flow of information to
  
  help guide or contribute to the science journalism.
  
  It's very hard to do journalism when frankly,
  
  the President is the one spreading misinformation.
  
  I'm sure no one knows that quandary better than Dr. Fauci.
  
  Beyond that, I would say one thing we've really learned from where I sit is
  
  that many of us journalists are, how do I put this?
  
  We're snobs like, all my reporters,
  
  they want to write for the New York Times and The Washington Post
  
  and the PBS, The New Yorker.
  
  We do a lot of things.
  
  We've really shifted our strategy to go to small newspapers in small markets,
  
  talk radio because that's where people are getting their information.
  
  I think part of this is thinking about the function of journalism differently.
  
  If you want to counteract misinformation,
  
  you got to go to where the misinformation is coming from.
  
  Like I do, write op-eds in the New York Times.
  
  Yeah, that's fine, but most of the people who read
  
  the New York Times already know that COVID is real and that we have to wear masks.
  
  I like to point out things that I think we don't all know in those opinion columns.
  
  But I think part of the problem was the
  
  coming together of pandemic at a time when local journalism,
  
  there are news deserts all over the country where
  
  the only thing to fill those deserts was often social media.
  
  That was a disaster as a combination in terms of
  
  getting good information about how to respond to COVID out there.
  
  - I wanted to dig into that.
  
  These are great insights, a little bit more.
  
  Dr. Fauci, this is the first major public health crisis that we've had
  
  to fight when more than half of Americans are getting their news from social media.
  
  As Dr. Rosenthal said,
  
  in many cases, solely through social media.
  
  I'm wondering how you had to pivot
  
  and adjust and if you think we did from the public health side,
  
  enough adjustment to deal with that new reality.
  
  I also want to ask just one more thing.
  
  A good friend of mine
  
  said our biggest issue right now is
  
  we have a problem of under believers and over believers.
  
  We know about the under believers these are the people
  
  who dismiss science for political reasons,
  
  as Dr. Gawande was saying.
  
  Or because they don't want
  
  more inconvenience in their life and it's a good excuse for that.
  
  But the over believers has to do with science journalists in some cases like that.
  
  That's people who treat information coming from scientist
  
  or from medical officials as certainty when we all know
  
  that it's always changing and I think we saw that play out last year with
  
  the face mask issue with the Surgeon General saying don't buy face masks,
  
  they're not going to stop the fight of COVID.
  
  Now the Number 1 reason that science deniers use to support
  
  conspiracy theories about the government
  
  is the early flip-flop from the government on face masks.
  
  How do you see that over believer under believer issue?
  
  If so, what do we do about it?
  
  - Well, I'm not so sure.
  
  I mean, when Atul was talking about the importance of journalism.
  
  I was going to say join the club Atul.
  
  [LAUGHTER] Evidence of trying to communicate when you have the under believers,
  
  it's a false equivalency.
  
  That's one of the real issues that's a problem.
  
  When you have one group saying one thing,
  
  the other group saying the other thing there's no judge or editorialization there is
  
  no shame in being wrong and it really becomes just almost a circus.
  
  It becomes very, very difficult.
  
  I mean, you're absolutely right.
  
  You point out that issue with masks.
  
  At the time that we were saying that we really shouldn't be using masks.
  
  The circumstances had three aspects to it that were important.
  
  One, it was felt that there was a shortage of
  
  masks and that if you did go out and everybody start buying masks,
  
  they wouldn't be enough masks because we were at the time of
  
  acute shortage of PPEs and we didn't want our health care providers,
  
  of which I am one,
  
  and of which Elisabeth was one,
  
  and of which Atul does every day you didn't want them to be essentially out of PPEs.
  
  The next thing is that there was no good meta-analysis showing that they actually worked
  
  on the outside of the operating room or outside of a healthcare setting.
  
  Number 3, we didn't have a really good idea that
  
  a substantial proportion of the infections was spread by people who had no symptoms.
  
  That was when the Surgeon General was
  
  saying and we were echoing his words about don't get so excited about wearing a mask.
  
  Then what happened? It became clear that cloth mask works and
  
  you can make them by the billions. That took care of that.
  
  Number 2, meta-analysis studies started to show that in fact,
  
  they do work both in preventing you from infecting others and
  
  others from affecting you and probably the most important thing,
  
  we found out that between 50-60 percent of
  
  the infections are transmitted by someone who has no symptoms.
  
  You can have somebody walking around thinking they're
  
  fine spreading infection yet you're absolutely right.
  
  That became the calling card of don't listen
  
  to anything any of them say because they're wrong.
  
  I mean, that was the governor of South Dakota's mantra this weekend saying they're wrong,
  
  therefore, I'm going to do all these things.
  
  It becomes an almost impossible thing to counter.
  
  Which is why I thought of it immediately when Atul said the importance of journalism.
  
  I mean, the importance of the scientific community to
  
  count as something when they throw something like that in your face.
  
  It is one of the most painful things that I've gone through over this past year.
  
  - Dr. Rosenthal you were in China as you said when SARS was happening,
  
  we know Asia, that was the centerpiece of their response to respiratory viruses.
  
  Do you think science journalist,
  
  enough of them called to question that when that first guidance was coming out?
  
  - About the masks, you mean?
  
  - Yeah.
  
  - No. I hated being called a flip-flop when it's in fact,
  
  as Dr. Fauci said,
  
  it's a product of learning.
  
  It's not a flip-flop, it's progress.
  
  We understand something more now.
  
  SARS was a very different illness,
  
  partly because there was no transparency on what was going on.
  
  You would just see ambulances and be told that there
  
  were very few people dying when you knew hospitals were
  
  filled and you knew people who were quite sick and it
  
  was somewhat less transmissible we know now,
  
  but not a whole lot less transmissible.
  
  But it wasn't transmitted by asymptomatic people,
  
  I think because the feeling is that the people who
  
  got it and the real doctors here can probably correct this.
  
  They were really sick.
  
  A very high percent of people who got SARS died.
  
  I felt like, and I've written about this,
  
  that I've lived through this lockdown experience with my kids,
  
  but it was quite different.
  
  But it does annoy me when my friends from New York always say,
  
  "Oh, well SARS isn't like COVID,
  
  this is different, this is way worse here."
  
  I'm like, well, yes and no.
  
  SARS didn't come to New York because at that time it was very hard for Chinese to
  
  get visas to come to the US and
  
  because most people who had SARS were too sick to get on a plane.
  
  I think it was just different virus,
  
  different characteristics and you learn about those things as you go along.
  
  In one of my early columns,
  
  I too wrote something about,
  
  because I listen to what Dr. Fauci and the experts say,
  
  you don't really have to do this mask thing.
  
  But then we learned very quickly that we did and shifted and that's appropriate.
  
  I think one of the things that I applaud,
  
  the new administration for and Dr. Walensky and Dr. Fauci
  
  and President Biden is for saying we're going to tell you what we don't know,
  
  which the previous administration was loath to do.
  
  There was a false confidence about things that we really didn't know.
  
  - Dr. Gawande what do we do about this impedance that you described?
  
  - Well, first of all to dive a little deeper into it,
  
  part of the interesting thing is that,
  
  I think science journalism at the same time I described it as impotent save lives,
  
  and did because there was a large portion of the world that was listening.
  
  Maybe it was 50 percent, maybe it was 60 percent,
  
  maybe was 70 percent who took in the information and changed their behavior accordingly.
  
  It was very interestingly early in the pandemic,
  
  you had states like Massachusetts that restricted spaces and suggested people wear masks,
  
  and that in Florida where that didn't happen,
  
  you had the same rate of uptake among the especially the older population.
  
  They stopped going out to the movies,
  
  they stopped going to restaurants and bars at
  
  the same rate that [NOISE] in Massachusetts did without the rules and the government.
  
  The reason why is because the information got around.
  
  Where the impotence comes up is in the 30 or 40 percent where early on,
  
  it's not just in the United States.
  
  I think that part of the issue here lies in two things.
  
  One is that the asymptomatic transmission you
  
  don't feel anything and yet you are passing it along.
  
  That compounded the fact that
  
  75 percent of the transmission is from people between the ages of 20-49,
  
  and 93 percent of the deaths are in people over 55.
  
  The folks over 55 have been the ones to
  
  listen to the advice and that's why I think it's save lives.
  
  Yet it didn't stop transmission
  
  because in many countries there have been leaders who can exploit,
  
  those who you can say,
  
  it's no big deal and those people are not feeling
  
  anything and they're not the ones to necessarily get sick.
  
  But their lives are being curtailed in significant ways and
  
  their pain isn't necessarily being
  
  acknowledged by everybody that their lives have changed,
  
  their kids aren't in school, those kinds of things.
  
  How do we overcome it?
  
  I've had a theory, I don't know how it'll play out,
  
  but that we can do a better job in science journalism and as public health leaders in
  
  pointing out how you come to
  
  recognize the difference between good science and pseudoscience.
  
  There's a pattern that people have pointed out.
  
  The hallmark moves of pseudoscience is declaring that
  
  there is a conspiracy to suppress dissenting views,
  
  putting on fake experts with contrary views,
  
  but no credible scientific track record in the field.
  
  Cherry picking data to create discredit field,
  
  and deploying logical fallacies.
  
  Some of those things,
  
  there are occasionally conspiracies we had to [inaudible].
  
  There are experts out of left field who can make discoveries,
  
  but when you put them together,
  
  when you see that pattern,
  
  that's when you know you're being fed the goods.
  
  I wonder whether by learning how
  
  to indicate to people this is when you know whether it's from the left,
  
  whether it's from the right, whether it's a politician you like,
  
  whether politician you don't like.
  
  Whether they're actually using science as a way of making claims.
  
  I think it's possible to say, look,
  
  this is how you know you're getting snookered
  
  and have a debate about that as part of the discussion.
  
  May still not be strong enough. [LAUGHTER]
  
  - Yeah. [NOISE] Dr. Fauci,
  
  we also have this other issue that we're grappling with right now this week,
  
  when we seeing what's happening in Texas,
  
  in Mississippi and that is maybe
  
  an American tendency to want to celebrate and
  
  exhale to easily when we start to see signs improving,
  
  maybe others exploiting for the reason,
  
  what do we do with that and what role can journalism play in that progress of not
  
  letting us undercut when we're starting to move the stats in the right direction?
  
  - Yeah.
  
  I want to link that to something that Atul just said
  
  about the contrast between what happened in
  
  Massachusetts and in Florida where
  
  the elderly individuals really understood that they really needed to be careful.
  
  I think that right now the pressure really come out strong about how,
  
  I don't want to be too strong a word,
  
  but how ill-advised it is right now.
  
  If you look at the curve that was steeply coming down,
  
  the last week, the seven-day average, it's done this.
  
  That's exactly what happened last summer when we tried to so-called open up the economy
  
  again and several of the states did
  
  a version of what Texas and Mississippi are doing now,
  
  and we had it go right back up.
  
  The baseline that we're at right now,
  
  between 60,000 and 70,000 cases a day,
  
  is unacceptably high for any significant pulling back on mitigation,
  
  and I think we just need to state that.
  
  You have a tendency,
  
  you don't want to directly contradict someone in such a position as the governor,
  
  but the fact is, that is ill-advised.
  
  When we say that hopefully,
  
  the people who are the most vulnerable in Texas and in
  
  Mississippi can essentially shield themselves to the extent that they can,
  
  but as a Atul said,
  
  it's the younger people who are not getting sick that are spreading it.
  
  It's a very unusual infection where you have
  
  the people who spread it are the ones who are least likely to be impacted by it.
  
  I've never quite seen an infection like that.
  
  - Dr. Rosenthal?
  
  - Yeah. I wanted to ask,
  
  because this is the journalist dilemma as running a newsroom on a daily basis,
  
  we have written numerous articles now stating several things.
  
  One, that even if you've been vaccinated,
  
  you still need to wear a mask because you could still potentially spread it.
  
  Then even if the rates are going down,
  
  you still need to wear a mask even more because it's premature to open.
  
  I think Dr. Walensky is very powerful and how emotional she gets about this on camera.
  
  But our dilemma is you can't run the same story every day.
  
  It becomes like, "Yeah,
  
  there they go again."
  
  How to make it real to people,
  
  and one of the things that we found very effective and for the audience is
  
  always to put this in human terms because
  
  one thing I think we've seen across the country is initially like it was in New York,
  
  it was in the Pacific Northwest,
  
  and people thought, "Yeah, that's in New York,
  
  that will never come here."
  
  Of course, viruses don't respect those boundaries and they go everywhere.
  
  We've tried to make sure that we're featuring the stories of
  
  people that a reader in that demographic can relate to.
  
  I think one of the most powerful things I've heard,
  
  and I'm going to toot our own horn here,
  
  but we did a podcast with Reveal over the weekend following a young Latina intern
  
  at a critical access hospital in
  
  the Central Valley through her first seven months of internship during COVID.
  
  Her parents got COVID,
  
  all of her patients had COVID,
  
  many of them couldn't speak English,
  
  many of them couldn't see their family.
  
  She was the last person to hear their dying words.
  
  She was an amazing young woman.
  
  At the end of it, the reporter says,
  
  "Well, do you consider yourself a hero?"
  
  She was like, "No, I'm not a hero.
  
  I'm just doing my job,
  
  but that's why it's so important for everyone in
  
  these communities to put on a mask and that's their version of being a hero,
  
  or not go into a restaurant even if you really are dying to right now."
  
  I can give you statistics about the number of black and brown people,
  
  how it disproportionately affect certain communities and certain essential workers.
  
  Because what people respond to in
  
  journalism is hearing a story about someone like them who got sick,
  
  or when they came to community,
  
  they could be their uncle or their cousin.
  
  I think that's where journalism has fallen short in some areas because at a high level,
  
  we think people will respond to these alarming statistics.
  
  Numbers are numbers to most people.
  
  They don't feel personal.
  
  - Dr. Gawande, do you have questions you want to dive into?
  
  - Yeah.
  
  I'm curious to ask Tony,
  
  some of the people that are most heroic to
  
  me are the public health officials in the counties
  
  and cities where the pull backs are happening and they are fighting the fight,
  
  they're trying to bring facts,
  
  they're the ones getting on Facebook and countering the Facebook memes, etc.
  
  Are there ways for the government as well as journalists,
  
  but I think in particularly the government,
  
  to arm those local public health officials?
  
  Also, it's city councils and state senators and others who
  
  are every day engaged in these debates and trying to come forward.
  
  It's hard work and they're in the fray.
  
  I was struck by the impact that Debby Birx had by going around the country,
  
  visiting, calling out places where masks are way too low,
  
  and the impact that had by actually going and
  
  not doing it from afar and connecting to those places,
  
  that was some of the most effective engagement I saw with
  
  these discussions and it got places.
  
  Even in South Dakota, mass squaring got above 84, 85 percent.
  
  Wearing a mass most or all of the time,
  
  and was a big part of the reason I think that their hospitalizations and cases fell.
  
  Do you have a sense of how those folks can be helped to be more effective?
  
  - Yeah. I think you pointed out
  
  a really good example because when it became clear at the White House
  
  that they had pivoted away from focusing on
  
  the outbreak and became more interested in political issues like re-election,
  
  Deb made the decision that she was going to just go out and spend
  
  most of her time out in the field visiting people doing exactly what you said.
  
  Yeah, I think we can do more of that.
  
  I've actually done it,
  
  but I'm only one person.
  
  I get on the phone every other week with health officials from New York,
  
  from New Orleans, from Chicago,
  
  from LA, and from Seattle,
  
  doing the same thing that you're suggesting.
  
  But we've got to do more than that.
  
  I'm only one person, I'm not having a real noticeable impact.
  
  But it's really very interesting to see when you support them in what they do,
  
  the idea that they're getting someone that's an official from Washington,
  
  getting on the phone and talking
  
  down in the trenches type-talk with them about
  
  how to help in getting information for them.
  
  I actually find that it's more helpful for
  
  me [LAUGHTER] than it may be for them because I really get
  
  a feel for what they're going through and
  
  then maybe I could bring it back and make what we
  
  do in our own exalted places a little bit
  
  more connected with what's going on in the ground.
  
  So it's a two-way street.
  
  - Can I turn [OVERLAPPING]
  
  the question around a little bit [OVERLAPPING] and ask Dr. Fauci.
  
  How do you think the press did in this past year?
  
  We always get to ask you the questions about how you did or what you were able to do.
  
  Now that there's a new administration,
  
  what is the role of the press?
  
  We're going through this vaccination campaign,
  
  which is from a journalist's point of view,
  
  looks pretty chaotic despite
  
  an administration that is trying very hard to make it work better.
  
  - Elisabeth, I actually think that the press has done a really very good job, I must say.
  
  I'm not saying that because [LAUGHTER] I'm talking to a journalist.
  
  - We're far away, there's nothing we can do to you from here.
  
  [LAUGHTER]
  
  - I really do.
  
  I mean, for the most part,
  
  they have really pushed back and not allowed a lot of that false equivalency to happen.
  
  Even though it does happen when you have
  
  one person say one thing and the other person say another.
  
  You know, we went through that with the AIDS denialism,
  
  you might remember with Peter Duesberg back then,
  
  it was Peter Duesberg says this,
  
  Tony Fauci he says this.
  
  Two people who are scientists, who are you going to believe?
  
  [LAUGHTER] You know what I mean?
  
  That was really a difficult experience,
  
  but right now I think they've done a really good job,
  
  and they've shown something over
  
  the last couple of weeks that I think really gives them a good degree of credibility.
  
  They are not hesitant to be critical or to put the feet to the fire,
  
  even of the current administration when they think that
  
  something is not being done as well as they feel it should be.
  
  I mean, obviously, the relationship is different
  
  because we're not spouting 2,000 untruths a day.
  
  But I think for the most part it's been really, really quite good.
  
  The thing that I always say is the same way with any field,
  
  is that the press is in a monolithic organization,
  
  there's the majority when you're talking about the press I think.
  
  The press that you mentioned,
  
  the people who are really professionals and really take their job very seriously
  
  versus the kinds of things where anything gets done with no editorializing at all.
  
  I think that that's obviously a problem.
  
  - Can I jump in?
  
  Since we have the chance to ask the questions,
  
  [LAUGHTER] I'll add another one.
  
  One of the things I've been thrilled to see that's changed in
  
  the pandemic is the speed of science communication.
  
  The creation of pre-prints,
  
  basically the disappearance of most embargo systems.
  
  I think those are actually good things.
  
  But what I find disturbing,
  
  especially as vaccines and therapeutics come out,
  
  has been the science by press release.
  
  Which is where you can't access the information to
  
  make any considered judgment even as a scientist,
  
  let alone from the righter side.
  
  Those releases, whether it's vaccines and therapeutics,
  
  are often coordinated with the government.
  
  What's the reason not to make them put
  
  their information out in pre-print as if it's going into a journal.
  
  Before Johnson and Johnson puts out results.
  
  For example, I'm dying to see Johnson and Johnson put out in
  
  the vaccine press release results about their 49-day findings.
  
  But they were never once,
  
  they're still not coming to print.
  
  They didn't turn up in the FDA briefing guide.
  
  But it's suggested that after 49 days,
  
  the effectiveness is extremely high.
  
  You may well have seen some of that data privately.
  
  How can we get more access to that information rather
  
  than have it serving shareholder price concerns? [LAUGHTER]
  
  - That's a great question Atul,
  
  and I think there are two aspects of it
  
  that I'm going to try and condense pretty quickly because we can
  
  have a long conversation about this and we want to give
  
  it the amount of time that it doesn't overdo it.
  
  First of all, when the pre-print service came out,
  
  the first thing I thought is, "Oh my goodness,
  
  there's going to be a whole bunch of junk out there."
  
  Well, I was wrong because most of those ultimately,
  
  when you get put into a peer-review journal,
  
  it may be tweaked maybe a little bit,
  
  calming down of what the claim is or getting an extra controlling or what have you.
  
  But for the most part,
  
  it's really been very, very valuable.
  
  I mean, particularly now the work that's coming out on the variance,
  
  it's very helpful in our policy.
  
  I mean, in New York, David Ho came out yesterday with something
  
  about the work that he did on the variance of the P1 in Brazil.
  
  It was very helpful in the discussions I had in the White House today.
  
  If I didn't have that, I wouldn't have done it.
  
  I'm sure when it comes out in a peer-review journal,
  
  it's not going to be substantially different.
  
  That's the first point you made.
  
  The second point you make is really interesting and it has to do
  
  a lot when the data and safety monitoring board says,
  
  we've got to end the study.
  
  Because then what they need to do is that they need to let
  
  the people in the control group know that the study is done.
  
  You got to let the investigators know.
  
  What has happened when you do that is that everybody starts asking,
  
  "Well, why did you make that decision?"
  
  So the company says, "Well,
  
  we've got to show you some of the data."
  
  They show the data by press release,
  
  we get involved, the government,
  
  because most of the time we sponsor the study,
  
  and I can tell you personally I'm very uncomfortable
  
  about talking about things that haven't been peer-reviewed.
  
  But it's almost an ethical consideration that if you're going to stop a study,
  
  you've got to tell the investigators and you've got to tell
  
  the people in the control group and you got to explain to them why.
  
  Once you do that,
  
  it's a little bit of a slippery slope of,
  
  you're going to tell them that their data that's not peer reviewed.
  
  Maybe we can figure out some way that when they're getting ready to do that.
  
  I mean, you and I have written parts of paper overnight.
  
  I know [LAUGHTER] I have, you have.
  
  Why not see if we can do that and make it into a pre-print situation.
  
  Your point is very well taken because it
  
  adds a degree of skepticism on the part of the public.
  
  When you have data coming out in a press release. [OVERLAPPING]
  
  - We can look at the tables themselves to understand the methods and things.
  
  It would be great to push that along.
  
  - A quick follow-up to that.
  
  Dr. Fauci, you mentioned you used that information today at the White House.
  
  Can you tell us what the context of it was?
  
  - No, we were talking about what kind of an approach we need to take to variance.
  
  It became very clear the point that David was
  
  making was that when you diminish the effect of vaccine-induced antibodies,
  
  a couple of fold.
  
  If you have a vaccine-induced antibodies that's
  
  ten-fold over where you really is the cutoff point when you come down to a three-fold,
  
  you still have protection from the vaccine.
  
  If your level of antibody is marginal and you come down two-fold,
  
  then you're lost, you've lost protection.
  
  Knowing exactly what the impact is of the variants on what vaccines can do
  
  to protect allows you to really get a good feel of
  
  is the vaccine going to be able to protect against that variant,
  
  and you've got to make that decision long before a paper comes out.
  
  - Can I ask a question?
  
  It's about the vaccine roll-out and about,
  
  I see and worry slightly about politics runs by slogans and science runs by the opposite.
  
  First there was the 100 million doses in a 100 days,
  
  which sounds great, but it's actually not
  
  far away from where we were at that point anyway.
  
  Now I hear over and again,
  
  the slogan that really bothers me is it's important to just get shots into arms.
  
  You hear it repeated by governors all over,
  
  and you hear it in places where as self-justification because
  
  the categories in many states of people who were
  
  eligible now are so broad to make everyone,
  
  every college kid who sometimes babysits a caregiver,
  
  everyone with an albuterol inhaler and asthmatic.
  
  Meanwhile, we're the ones who get the letters,
  
  heartfelt e-mails from like 70 five-year olds with heart disease who can't get a vaccine.
  
  What do you feel about this?
  
  The important thing is just to get shots into arms.
  
  It seems like that phrase sounds good,
  
  but it's being misused to jump the line as it's called often [OVERLAPPING] in many places
  
  - Yeah. I think that's an unintended and you make a reasonable point, Elisabeth.
  
  I think it's an unintended consequence of trying to say to
  
  counter a bit vaccine hesitancy and say it's really important to get vaccinated,
  
  and that gets translated into,
  
  we've got to get shots in the arms of people because the
  
  quicker you get vaccine distributed,
  
  the better off we are,
  
  particularly when you have the emergence of variance.
  
  But I could understand how that can be taken out of context.
  
  - Now we have to be conscious of your time,
  
  Dr. Fauci we're about to lose you.
  
  So just any message that you can have.
  
  To, either the Science Journalism Community or
  
  the Public Health Community about this next phase, what we should be doing?
  
  - I have to tell you,
  
  I'm not saying this to make you feel good.
  
  I said that about a minute ago and I mean it,
  
  that I think you all are doing a really good job
  
  and keep reporting it honestly and keep pointing
  
  out some of the things that Elisabeth just pointed
  
  out right now about some of the weaknesses of what's going on.
  
  Because people tend to self-correct,
  
  sometimes you don't realize you're going down a path.
  
  You read it in the newspaper and you say,
  
  "That's a reasonable point there,
  
  maybe I should relook at it."
  
  Just do the same honest reporting that you've done this far.
  
  I think we are getting into the next phase.
  
  We're in a very critical phase right now because we're in a very nice deflection.
  
  It's starting to plateau,
  
  we're seeing what might happen that the danger of
  
  people pulling back and yet at the same time,
  
  we have vaccines being rolled out.
  
  It's like a tug of war,
  
  who's going to win that tug of war?
  
  I think it needs to be reported accurately with the data as it comes out.
  
  - Great. Dr. Fauci,
  
  thank you so much for all your time and insights.
  
  It's a pleasure having you here.
  
  We'll stick with Atul and Elisabeth,
  
  but we want to let you go now to your next appointment, but thanks so much again.
  
  - Thank you, thanks guys.
  
  - Bye.
  
  - Atul, you have this terrific piece in
  
  The New Yorker recently about Minot, North Dakota.
  
  When you describe the aldermen who fought hard against
  
  the mask mandate and there's just this incredible lovely details
  
  about going at a public meeting and saying you've talked to his position friend in
  
  Texas and he said the best thing to do is
  
  to take a bunch of zinc and Gazelle diets seltzer,
  
  not regular seltzer but diets seltzer.
  
  He told the citizens that.
  
  Then of course he gets COVID.
  
  The most heartbreaking thing is,
  
  at one point he says he feels as though he might not make it out of COVID.
  
  He really gets hit hard,
  
  worries desperately about that and then he comes back
  
  and continues to oppose the mask mandate.
  
  What do we do with people like that?
  
  I think honestly, you withheld judgment and just paint a portrait of
  
  how this really is getting fought out in
  
  small towns around the country that are under siege.
  
  What do we do? What do you come away thinking we can do what is possible?
  
  - A couple of things about that.
  
  Thanks for talking about that piece about Minot, North Dakota.
  
  It was partly reflecting on growing
  
  up in a town in rural Ohio that's not very different from Minot, North Dakota,
  
  where people I know and grew up with and I'm friends with really have
  
  extremely different political views or even a take on what's happening in this pandemic.
  
  We all are listening to different sources of information.
  
  What I came away with was,
  
  Tom Ross, that alderman, for example,
  
  he is a lot like a lot of people I grew up with in terms of just who he is. I liked him.
  
  I think he's a good man.
  
  More to the point I wanted people to understand and respect that
  
  these were not people who have been oblivious to the losses.
  
  He knew the first person who died of COVID in Minot, it was a friend of his.
  
  He got COVID and watched his own [NOISE] level drop to
  
  below 85 percent in his basement and feared for
  
  his own life and didn't want his mother to get sick, stayed away from her.
  
  But at the same time,
  
  he was speaking to real suffering and pain as a middle aged person
  
  with younger kids who haven't gotten to be in school,
  
  have had difficulties with employment,
  
  seeing people lose their jobs and
  
  not feeling like the public health people always talking about deaths,
  
  deaths, deaths, deaths, deaths without talking about what is the mental health costs?
  
  What is the suicide risk?
  
  What is the effects on everybody's lives?
  
  What are we feeling that we in public health aren't speaking to that?
  
  I wanted to push back and say, wait a minute.
  
  [LAUGHTER] Fighting the virus is how you help get jobs back.
  
  It's taking the foot off the pedal at this moment,
  
  prolongs the agony into the summer and into the spring.
  
  But there is some basic way in which you have both politicians exploiting those gaps and
  
  doubts and just genuine feeling that they don't believe all of the data that's out there.
  
  Some of these folks like Tom is also someone who
  
  still wonders whether the election was stolen.
  
  The place I came to though was I walked away, hardened.
  
  It's a thin sense of hardening,
  
  which is that they have had this battle in North Dakota.
  
  They ultimately voted and got in place a mask mandate.
  
  Even before the mandate,
  
  mask wearing was up to 85 percent and with the mandate got to 90 percent.
  
  There was a slight bump upwards and they got their pandemic under control.
  
  It was very late in the game,
  
  they lost a lot of lives,
  
  still not as many lives as we lost in Massachusetts per capita and New York per capita,
  
  New Jersey per capita,
  
  and Connecticut per capita.
  
  There's a human element of we're late to addressing this until it's right in front of us.
  
  They are also very humanly taking the foot off the pedal too fast.
  
  My bottom line that I came away with was,
  
  can a democracy function in a crisis like this and address it?
  
  Yes. Is it going to be too late?
  
  Are we going to take the foot off the pedal too early?
  
  Yes. That's going to be the way that's going to go.
  
  We're not going to get to consensus,
  
  but we are going to have this battle and out of it,
  
  humans change and evolve.
  
  My sense of how this will go is,
  
  I do think we'll get this pandemic under control,
  
  the vaccination will move out.
  
  There'll be pockets that resist.
  
  We'll get hospitalizations below, I believe,
  
  under 100 deaths a day,
  
  which is about the flu levels and we won't get it to zero.
  
  We will then have a messy process in the next several months of,
  
  are we taking the mask off and are we still allowing it to spread?
  
  That's going to be the way it is.
  
  It will be an unsatisfactory,
  
  but largely successful way forward out of it. That's what I came with.
  
  - I would agree with you,
  
  Atul, that it will end and it will be messy.
  
  But the question I wake up with every morning as a journalist is looking at
  
  the statistic that there have been a total of 1,300 deaths in South Korea,
  
  a nation of 51 million people.
  
  That now yes, the cat is long out of the bag.
  
  We blew it at so many levels that we're stuck with this.
  
  But why is the nation don't we have?
  
  I'm not saying we need Medicare for all,
  
  but we do need a national functioning public health system.
  
  Whether that's in parallel with
  
  a market-based thickness care system and we just didn't have that.
  
  My mom was one of the people who died of COVID and she was old, she was 96.
  
  - But if this country had
  
  a public health system and politicians who are
  
  willing to address this early on and honestly,
  
  we wouldn't be so desperate to jump the line for vaccines.
  
  It would just be an illness that was scary and was there in the background.
  
  But it's just shown to me this huge gaping hole in how we approach healthcare.
  
  - I'd love to pull that apart a little bit because I completely agree with you.
  
  There is one aspect that I don't think is necessarily the case,
  
  which is the central thing that cost us unnecessary hundreds of thousands of lives,
  
  was simply having a political figure who
  
  decided in an election year that it was against his interest
  
  to speak publicly about what we know
  
  he believed some of the public health science coming his way,
  
  but that it wasn't viable politically.
  
  When you go internationally,
  
  whether it's Bolsonaro in Brazil,
  
  whether it's in Sweden where ironically was the public health establishment that was
  
  driving the differences in opinion where there
  
  was not alignment in acknowledging the reality of what people were seeing,
  
  that just was deadly even with good health systems in place or bad health systems.
  
  But what made it worse here was the lack
  
  of having a health system that
  
  was true system which could account for people falling between the gaps,
  
  meant that we continued to have places where there isn't deployment of testing.
  
  Where there isn't deployment of vaccines,
  
  where the therapeutics weren't getting to,
  
  where basic missing elements like
  
  inadequate supply of masks and inadequate supply of ventilators.
  
  This is a system where a third of our counties don't have an obstetrician and even more,
  
  don't have an in-patient psychiatric bed access.
  
  We can't even map and name that.
  
  Let alone solve it because we're not committed to it.
  
  It's no surprise that given an infection that's a
  
  lot easier to deploy than making sure that childbirth works.
  
  That we couldn't get this working for all of our citizens and
  
  continue to be unable to while Israel and the UK are.
  
  US is in the top five for deployment of vaccines.
  
  But we still have UK and Israel have got 90 plus percent coverage of their over 75 rolls.
  
  It's 97 percent coverage in the UK.
  
  It would be worried about 70 percent.
  
  I'm not sure we'll ever get to 95 percent coverage
  
  in our population even with
  
  Medicare because we don't have that system you're talking about.
  
  - Our deployment is on the top five,
  
  but it's messy.
  
  It's so messy.
  
  One of my editors said to me,
  
  "How come AARP knows when I turn 65,
  
  but our government can't figure out that it's my turn to get a vaccine?"
  
  I've been perpetually shocked as a journalist about the lack,
  
  especially given that we spent eight billion dollars doing digital medical records.
  
  I see people get vaccines and I hold up these cards and they say,
  
  "It's in my epic chart" That's even side loaded in your hospital.
  
  Why don't we have a national response to this?
  
  Why doesn't the CDC have a portal where every vaccine that's given gets registered?
  
  [OVERLAPPING] We don't even know who's getting vaccines now very well.
  
  - We're running out of time here.
  
  But I just want to just get through a couple of quick questions that have come in.
  
  One is, as you both know,
  
  the CDC used to be around the world as the gold standard,
  
  people from other countries would turn to the CDC for guidance and something like this.
  
  How irreparably harmed was the reputation of the CDC
  
  during the pandemic under the Trump administration and how do we get that back?
  
  Just quickly, if you have thoughts, Atul?
  
  - I'll take and I'll be real quick.
  
  I think it was severely damaged.
  
  I don't think irreparably,
  
  it will take some time.
  
  I think Rochelle Walensky is doing a great job of being a consistent voice.
  
  The test will be where she has to put pushed back on the President.
  
  There will be times when she will have to and that the staff they
  
  are no longer being muzzled and are able to respond.
  
  The second part about the CDC,
  
  was they failed a testing that was held on the CDC phase.
  
  I do think that there is a sense of bureaucracy and the
  
  slowness of response at times that has to be changed and accelerated.
  
  I know that there'll be something that Rochelle,
  
  who is a friend and from the Mass General system will be taking on,
  
  but it's going to take supplying consistent,
  
  honest information and then moving fast and
  
  moving accurately and I think there are still issues,
  
  the school opening responses,
  
  the guidelines there are still not supporting the ability to get the schools open
  
  when 96 percent of districts wouldn't qualify to meet the guidelines for opening.
  
  - Okay. Just quickly,
  
  Atul, as I alluded to in your introduction among your many hats,
  
  you've been with mass vaccination kits,
  
  what did you learn from that that you wouldn't have
  
  been otherwise either as a clinician or as a journalist?
  
  - To try to do in 30 seconds.
  
  I help stand up and I'm doing this without taking income myself.
  
  I should point out but a company called CIC Health to
  
  enable vaccination in Gillette Stadium, Fenway Park,
  
  and at Reggie Lewis Track and field in Roxbury,
  
  Massachusetts and which is a majority-minority population.
  
  I'd say the thing that I've learned that we're now
  
  demonstrating I feel this week is that speed and
  
  size has been thought to be the opposite of achieving
  
  equity and there's no reason you can't do equity at mass scale.
  
  But it takes really being thoughtful and we're doing
  
  things like reserving 50 [NOISE] percent of the slots for
  
  local people and deploying in nine different languages and
  
  not requiring being signing up online in the Internet to get a place in the line.
  
  There's a lot of things you have to do that we're still learning how to deliver on.
  
  - Great. Well, thank you both so much for
  
  all your great insights and
  
  participation today on behalf of Ryan and the entire Brandeis team,
  
  we're really grateful for you and all of you who joined us.
  
  We'll be in touch soon.
  
  Thanks again, everyone. Stay safe.
  
  - Thank you.
  
  -Thank you, everybody.