Coronavirus Report: The Hill's Steve Clemons interviews Robert Redfield

The Hill’s Steve Clemons interviewed Centers for Disease Control and Prevention Director Robert Redfield.

Read excerpts from the interview below.

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Steve Clemons: You have talked about your concern that in the fall we may have the problem of COVID returning and hitting when the flu is here. What is missing that we don't have today to strengthen our public health infrastructure?

CDC Director Robert Redfield: Steve, I think it's really one of the important awakenings for a broad aspect of our society is that the public health infrastructure of this nation has been under-invested in for decades. And so when you really look at it now, there are certain capabilities that we really need to have in place. And we need to have them in place for the fall and winter as we confront both COVID and flu. That's data, data analytics, modernization of our data system. We're using a data system that's decades old, and we don't have an integrated public health system for this nation. We need to get that correct. Laboratory resilience. We need to have multiple laboratory platforms in the public health lab, so there's really remarkable redundancy and surge capacity. We need a public health workforce — and the public health workforce that we're going to need to do the contact tracing and vaccine distribution, both for influenza and for the coronavirus vaccine when it's completed is substantial. And, of course, we need to have a concentration, we’ll come back to later on our global health security, to make sure that we have the capacity around the globe to detect, prevent, respond to new pathogen at their source.

 

Clemons: Many people were worried that a global pandemic was coming this way. So why is public health infrastructure in such antiquated condition?

Redfield: You know, I think a lot of people have discussed it.  And I think I saw some clips the other night about President Obama in 2014. I've seen it go way back. But unfortunately, no one's really gone beyond to do the action required to rebuild our public health infrastructure to where it needs to be. I'm of the point of view, now is the time. If the experience that we just went through so far with the coronavirus can’t awaken all of us, that we can't afford not to be over prepared and over invest. I kind of say it's time for our nation to have the public health infrastructure capacity not only that our nation needs, but that our nation deserves, and it's going to take a sizable investment. But I'm going to say the lack of that public health infrastructure —. Very rapidly this outbreak when it started as that outbreak started in the nursing home in Seattle, one of the best public health departments in this country, King County in the state of Washington. They rapidly were overwhelmed so they could no longer stay in what we call containment mode. Early diagnosis, contact tracing, isolation and quarantine. And I even deployed about 40 people there to help them in those early weeks. And the bottom line is the public health system was overwhelmed, and they went then to full mitigation. And that full mitigation led to the economic shutdown that we've seen. We can't go back there. We need to get the public health infrastructure in this nation that we can operationalize containment. That's early diagnosis. And that means rapidly, readily available testing wherever we need it, and getting timely results. We need to have contact tracing. And that means those contacts have to be all identified and traced and evaluated and tested within a day or so. They need to have capacity to isolate people, and, you know, there are a number of people that are going to need isolation that don't have homes or they live in multigenerational houses. That has to be developed. And then again, this is part of the critical component so we can do this. And then you put on top of it what I said — why I said this fall/winter is going to be difficult. I didn't say it was going to be worse. I didn't say it was going to be more deadly, as some quoted, I said it's going to be more difficult because we're going to be getting the second experience with coronavirus as it expands in the fall and winter at the same time we're getting influenza. This time, we were lucky in one sense that the coronavirus became active after the second wave of influenza A basically went back to baseline. But this fall it's going to be coronavirus and flu. And then when you asked me, what else can we do? What we can do is get the American public to a point that they'll embrace flu vaccine with confidence. Right now, less than 50 percent of the American public take advantage of the flu vaccine, and many people don't realize — sadly were over 90,000 deaths from coronavirus so far this year — but over the last decade, we lost 360,000 people who died in this country from flu. And we have a vaccine that more than half of the people in this country decide not to take. So, we're going to be working hard to get people to accept flu vaccine with confidence. We're going to be working hard to expand testing capabilities all across this country. Congress just appropriated another $11 billion to help states, local territorial travel health departments to get that up to speed. And we're working with them. We're going to expand the contact tracing public health workforce. And when I say expand, I'm talking about increasing it by 30,000 to 100,000 people.

 

Clemons: We don't have those thousands of people in place. We don't have the testing and the contract tracing and the public health infrastructure to the point where you think it should be. Is the nation ready to go through this reopening phase right now?

Redfield: CDC is putting out guidance. We put out a lot over the weekend again about you know how to reopen safely. I want to clarify that the community-based transmission, the community to community transmission that overwhelmed the public health departments in late February, March, April — that's really coming down. Right now, what CDC and the state public health systems are doing is we're fighting outbreaks. We have nursing home outbreaks, and we're going in and containing them. We are having meatpacking plants — containing them. Prison — Homeless — containing them. Certain social events from a wedding or a funeral — containing them. And we're going to continue to do that over the summer. And as we do that, we're going to be expanding what I just told you, but we have the capability and as part of the guidance that we gave — that the president gave — for the states to open up, it was important that they could test people that have flu like illness and or syndromic disease. They could set up surveillance. They had the contact tracers that they needed right now. But in the fall/winter, we're going to need a much more robust workforce because we're going to make the mission that we're going to stay in containment. We can’t get to the point that we have to retreat from containment. I believe we're going to get there. The testing has to be readily available, and it's increasing. I think yesterday there were 400,000 tests done in a day. You know where that exact number needs to be is being defined. But Congress really helped enormously, where they released $11 billion for the states to begin to really concretize that testing and contact tracing and isolation. Clearly from the testing point of view, the states are required to have a plan that CDC and Admiral Giroir at HHS, we're all working together to help them with their plan which will be due at the end of May for at least June and July, and then by middle of June for the rest of the year. So there's going to be a robust plan. In that plan, it's also going to incur aggressive surveillance. One of the complexities about the coronavirus, unlike flu, is that a substantial amount of the human-human transmission is occurring from people who don't even have symptoms. So that makes it harder. How do I know who's infected if there's no symptoms? So, we are establishing really a robust surveillance program, which is going to be very intensive on testing. … We're expanding the nursing home testing so that every individual resident of a nursing home will be tested so we can make sure. We're going to be developing similar surveillances in inner city clinics and homeless populations and meat packing things, that other parts of society to try to figure out what the best way is. But I want to be confident and give — I'm confident that if we make this investment, we're going to get the infrastructure in place, and we have every intent of sustaining containment. The public health capacity of this country is great, but the challenge has been we haven't had a sustained investment in data modernization. We have some health departments that are still using pen and pencil. We've got to get an integrated data system for the whole nation and actually have that data system and its analytics be so effective that it actually can do predictive data analysis so you can predict what's going to happen in the next day or two so you're going to be on top of it. We need that laboratory resilience — and with multiple platforms in these laboratories, we're going to have to make that investment and the workforce. Now I'm just going to say one last thing and I’ll go back to your question. It's going to cost money.

 

Clemons: Is there a gap between what the White House released and what the CDC internal guidelines were?

Redfield: Well, I’m going to say politics didn't push us there, Steve. First and foremost, when this outbreak started, it was a CDC task force within one of my centers — on the 7th of January. And then it became on the 17th an operationalized emergency response center there for all the CDC. And then on January 27th, it became HHS and the task force, and then it became the vice president. So this outbreak has gone from a CDC to an all of government response. As a consequence, there are guidances that we come up that have significant interagency implications and say they go up through an interagency review. And the interagencies make different comments and they come back to us not as mandates, but as comments. And then we have to integrate them. One of the things that became clear at the task force when we put up our initial guidelines is the number of people criticized, and I think, appropriately, that a lot of our guidelines are written in what they called CDC-eze, meaning that they're not easy for the American public to actually get through. And so the decision was, why don't you guys do some decision trees that are simple, one-pagers. You've probably seen them targeting the American public. And we released those six decision trees last week. But behind those decision trees are the regular specific CDC documents that we have for the public health community. They went back through the interagency review — good comments, and they were also all released. In addition, all of our documents on reopening America again related to surveillance, the surveillance in hospitals, our contact tracing guidance, testing, and these specific business issues and opening your business, bars, and restaurants, camps and youth schools, day care centers. All of those now are out on our website

 

Clemons: What is your take on the strengths or weaknesses of our own “global” public health network right now?

Redfield: I think it's a really important and, truthfully, Steve, I think it is the most critical. This nation is going to need a health security capacity as long as we're a nation. And if this didn't remind people, and I'm in the process of restructuring, it's actually one of my top-top priorities. As you know, I spent 23 years in the armed forces. I think I've got a good handle on this to put in place the global health security structure that this nation needs for 2030, 2050 and beyond. And we're in the process of trying to strategically decide where that is. Right now, I have people in over 60 countries with offices in over 45 and around the country. I'm trying to really consolidate it, so I have full capacity, kind of in a regional strategy, maybe eight to 12 regional capacity, they’re full CDC capacity strategically placed around the world. Think of it no different than what the Defense Department does when it sets up its bases. CDC is not a health development organization. We can do health development. We help in it like PEPFAR and the malaria programs, but we have a health development corporation — it's called USAID. I argue that CDC is a health security organization. It's a core responsibility and needs to be built as a core capability of CDC. We’re the tip of the spear so that we can diagnose, prevent and respond to outbreaks at their source, as we're doing right now.

 

Clemons: Share your own insights into the CDC and institution and respond to those who have been public with their criticisms.

Redfield: I would say CDC has never been stronger. We have tens of thousands of the finest dedicated individuals that are data-driven and grounded in science. And the thing that really — I didn't realize how much I missed it after I left the military and went into academia — these men and women are service individuals. They're committed to public service, and CDC as jumped out on this outbreak from the beginning. The first notification from CDC of the unspecified pneumonias that occurred in Wuhan, I had on Dec. 31. All right, the first sitrep [situation report] we did over this was on Jan. 1. We notified the National Security Council on Jan. 2. We activated our emergency incident commander system within the Center for Immunizations and Respiratory Diseases back on Jan. 7. I activated all the CDC. I've only done it, I've only done it two other times since I've been CDC director, one for Ebola and one for EVALI [e-cigarette, or vaping, associated lung injury]. We activated our entire agency for emergency response on Jan. 17. And again, obviously, the secretary called a public health emergency I think on Jan. 27. And so an enormously aggressive response. Dr. Birx and I, we go back a long way. We worked together in the military for over a decade. … She was articulating what I'm articulating. There was no, you know, despite the press, there was no space between us. She was articulating that the data system that we currently rely on is archaic. Well, I've been arguing that before Congress for two years. That's why Congress stepped up to give us originally $50 million for the data modernization. We need to have modernized the data system, and we need to have one public health data system for the whole nation, not every single state having it. So we're actually saying the same thing. The conversation that was going back and forth was we’re in the process of getting that operationalized over the next 12 months or so. And Dr. Birx was making an argument, which I totally agree with. It would benefit this nation for us to get it done soon. ... And Peter Navarro. I don't know where his comments from, they were highly inaccurate, unfortunately. The CDC developed a test for this virus within 10 days of the sequence being published. I don't think anyone's ever developed one that quick in the history of mankind, and we actually were able to use that test to diagnose the original cases Jan. 21. … It's not faulty, it's not flawed, it works perfectly. It's a great test. Many people have developed their test after it, since we've published exactly how to do it. Where the complication and that test was available at CDC then, it's available today. It's never been not available. The only complexity was you had to send the sample to CDC in Atlanta. We, our team tried to then manufacture and scale-up so that we could get that test in all the public health labs in the country. And in that production process, one of the re-agents got contaminated and didn't perform reliably. Nobody was told they were positive or negative incorrectly, but it just didn't work. But we figured out what it was, really within days. … And what I want to emphasize, because this gets lost, is there wasn't a moment in this nation's history with COVID that we didn't have the availability of the public health testing at CDC. … But I will tell you that rather than being criticized, and I go back to something I read every day now from Teddy Roosevelt. Never mind the critic, and I paraphrase, credit goes to the men or women that are in the arena all bloodied and scarred and marred, but at least we’re out there, and failing, failing and going better, failing and going better. And at the end of the day, we either know the triumph of high achievement, or we end up falling short and failing. But at least we failed while daring greatly.