Additional funding is provided by. Corporate funding provided by. Welcome to firing line, dr. Scott gottlieb. Thanks for having me. You are the former fda commissioner in the administration, a resident fellow at the American Enterprise institute, and on the board of pfizer, a drug company, and illumina, a diagnostics company,ar both of whicinvolved in aspects of the response i think its also important for our viewers to know that you are a Trained Medical doctor who worked in new york city. And you have managed to receive praise from both republicans and democrats aliketi because of you at the fda and also because of your early response and voice to the covid19 crisis. And were delighted to have you here to delve into your roadmap and your view of how we should tackle this crisis next. Thanks. You tweeted back on january 6th about a mystery disease lesshan a week after china had publicly acknowledged s first novel corona cas how did this get on your radar from the very beginning . Probably started tracking it late december,arly january, when these cases first started to emerge. And what was concerning about it s it it sounded very sarslike, but it seemed more trsmissible. There were some early reports from some physicians in china that this was highly contagious. And we always feared that sort of perfect pathogen, one that would have a lethality, that it could cause a lot of death and disease, but be contagious enough that it could spread around the world. You wrote an opinion editoria at e wall street journal on january 28th. You said. Now, at the time, your focus in that piece was not on mitigation, not social distancing, but on increased testing and on medical supply availability. You know, you cant help but wonder when you read that piece now that if your advice had been heeded, we may not be in the situation that we are now of mitigation and the throes of the crisis of this pandemic. Whats your response to that . Well, my concern early on was that we dont have enough surveiance in the United States, didnt have enough testing in place to be able to detect this this came to the u. S. I knew from working at fda that it took time to get thd of Testing Capacity in place. So i think the real Inflection Point for a lot of us was on january 18th, when a report came out that the cases in china had quad, had gone from about 50 cases that they were reporting in and that was a real wakeup call. I think that was a day that a lot of people got very concerned about this. It was the day after your piece came out that the White House Coronavirus task force was formed. And, you know, it was reported that you were in the running to lead it before Vice President penceun was and as the leader of the Coronavirus Task force. And youve been called by media reports, politico in particular, as the shadow coronavirus czar, which i know is a title a you esch say isnt fair, but you are currently servingfo as an al adviser to the White House Coronavirus task force, are you not . I talk to them quite regularly. I mean, i talk to the white house folks, you know, almost every day, if not a couple of you know, every oty. And im also talking to a number of governors, congressionastaff. And so im trying to provide perspective to a lot of different people who are involved in this. There are now eight states that still havent told residents to stay home. Now, you served in two republican administrations. Youre advising publican governors right now. Do you have any advice for those eight states, all of whom, coincidentally, have republican governors, about how to handle this virus as it approaches higher levels in their states . T i donnk every state has have the same response. I do think most statesim should bementing pretty strict measures at this point. Well, thats my question i mean, as a publichealth official, is it advisable for any state to not haverd stayathomes right now . Is it okay for iowa not to have a stayathome order do you think thats advisable from a publichealth perspective . Think a state like iowa should, given the fact that they have dense urban environments. But i think its advisable that most states bein contemplthese things and implementing them at this point, because the problem is we dont have enough testing ansurveillance in place to really identify where the risk is. So a lot of states may think they have low levelsread and low levels of risk but be underestimating it. Yeah. But let me ask you about a headline that was at National Review this week, and it wasbout sweden and how sweden is handling this crisis. The authors of the piece wrote, sweden has kept schools, bars, restaurants, parks, shops open and only isolated the most elderly, those with underlying conditions. The headline of the piece is,de has sfound the right solution to coronavirus . Is that approach, while very different from the United Statess approach, publichealth perse . Rom a and the United Kingdom contemplate this kind of an approach, too. Th thry is that the people who are most affected by this virus are older, older individual and if you can just isolate individuals with preexisting Health Conditions who are older and more likely to suffer bad outcomes from this virus,ca yoallow it spread in the general population and develop what we call herd immunity. Isically, enough people g that it stops spreading. I think theres a lot of problems with that theory. First of all, it isnt just Older Americans that are having bad outcomes with this virus. Theres lot of younger americans,0, 50, who are succumbing to the virus but also having prolonged hospitalizations with prolonged stays in the icu and intubation in order to survive this virus. The other issue is that we dont know that can achieve herd immunity here. Right now, when you talk to people whove modeled spread of this virus in the United States, eethey predict anywhere be 1 to 5 of americans have probably been exposeds to this at tint and developed some level of immunity to it. Thats a very small percenge. And look at all the death and disease we have with just 1 or 2 the population having been exposed s. If we allowed this to run through the population and infect 40 or 50 of population, which is what it might take to develop herdob immunity, ly a little more than that, there would be a lot of morbidity and a lot of Death Associated with this virus. I want to read to the audience something you wrote this week in the wall street journaed orial opinion pages. You said. What do you say to people who are really hoping and aspiring that, you know, we can start getting back to normal by the end of april . Ell, look, i think were going to make a transition in may where were going to start to reopen the countryd ople are going to start to resume aspects of their normal lives. I think that transition wi accelerate in june. And by july and august, it may be relatively quiescent we may see cases really drop off as we get into the depth of the summer. Im very worried about september. This is a viruthatsbly going to infect the southern hemisphere. Theres probably a seasonality to this. Were going to see epidemics in the southern hemisphere. But its going to want to come back in september. T its goiwant to become epidemic. This is a virus, the characteristics of which suggest that it to infect 40 or 50 of the population. And the question is, are we going to have tls in place in september to prevent that from happening . And im concerned that we dont yet have those tools in place and dont really have a very clear path to how were going to obtain them. And while we may never we may not have an ok like we have now, an epidemic like we have now, going to have sizable outbreaks, and this is going to continue to be a drag on normal activities. Youve recently written a publication through the American Enterprise institute called a roadmap to reopen. And it deals with this series of pses that you say need to happen in order to reopen. First, i want to listenown, but to what President Trump said about your roadmap. Lets take a look. Scott gottlieb, your foer fda commissioner, wrote a roadmap for recovery after the coronavirus. In yeah, verresting. I saw it. Hes somebody he was with me for a long time. He did a great joba. So, were going to take a look. Just i just received a little while ago. He sent it over. So your roadmap calls for the continuing of slowing the spread, developing the ability to treat the virus, either through vaccines or therapeuti and, also, you recommend technology that willllow for widespread surveillance. And i want to get to all of those, but first, you know, according to your roadmap, social distancing in place for some o stay until two things are achieved, you write. First, that cases wi need to be declining for 14 consecutive days in a certain jurisdiction, and that jurisdiction will need to have the ability in implement widespread te right. You need to have the capacity to test in the community. So, you know, several compans are working on these rapid tests. And i want you to listen to what new york governor andrewuomo had to say about it. Also, Rapid Testing to determine whether or not you have the virus now exists. They have 15minute tests that are commercially available. But again,hey have to be brought to scale. No private cpany has the capacity to bring those to scale. O, r. Gottlieb, how long do you believe it will take for us to get Rapid Testing widely available . Well, its already deployed. So one of the systems is by a Company Called abbott thats currently deployed in 18,000 doctors offices across the coury. And they developed a kit that goes on their existing platform. Its the platforthat doctors use to test for flu or strep throat. So its deployed. O it needs expanded. So how long before, you know, you and i can walk out st ordinary people, right . Youre not ordinary, but ordinary people can walk out and reallyet a rapid test. I mean, is that a matter of weeks or months . Ea unfortunately, probably months. Its not going to be in place in time. And thats what im concerned about, that if you dont he this in place, certainly when you transition away from these populationbased mitigation tactics, basically asking people to stay at home and not work, you want to have ,at testing widely deploy and were not going to have that in place in a month. We could have itn place by september, by august and september, and we have to make thata al right now. But were going to be flying without all the tools that wee want o start lifting these measures come may. Is that wise . Its a concern. I mean, thats what im if you ask me what im most transitioning the y asespect to cases fall off, its the fact that the Healthcare System istill gonna be overburdened because there is a del in hospitalizations and deaths. And thats one concern. But the other g concern is the fact that were not going to have the diagnostic capacity in place that we need. We started late, and s were going to finish this job later than we should. It islear. I think we all understand now that we haa series of fumbles at the beginning ofhis testing. The Washington Post has written about these testing failures and their quote is. In your estimation, does that fairly cracterize the governments failure . Well, i dont know all the details of what we on. Ive read the same articles. The cdc tests clearly hades challessociated with it and was delayed in getting out to the publichealth labs. At but would say is that even if everything had worked perfectly, even if that system had worked just as it was supposed to, cdc had gotten a test out in a very timely fashion, it worked, and the publichealth labs were able to stand up those tests, wed still be in a very difficult situation and maybe precisely ere we are right now. Why . Because what needed to happen was someone needed to at some point, probably in january, that this pathogen could become an epidemic here and start standing up the Clinical Labs what if you hadat fda in january and february . What would you have done differently . Well, look, its easy hindsights easy and its easy to one sitting outside the agency. But what i was feeling outside the agency and what i was tweeting about was doing exactly at i said getting the Clinical Labs in the game and getting the academic labs in the game. So hose are the kinds of things i was advocating from the outside. And i probably wouldve been woesing the same kinds of is from the inside. Do you think that the fda ivde a mistake by not allowing e labs to stand up testing earlier, to be able to scale testing earlier . Yeah, i dont know where those decisions were made. Myunch is that the professional staff at the fda and the career staff at to get these labs in the game. I know how they operate. I know how they think. Anim hardpressed to believe that the scientific staff didnt want to find a way to get the academic labs and the Clinical Labs stood up earlier and try to d a pointofcare diagnostic earlier. Now, why that didnt happen, i dont know. Look, i mean, there are some who speculate that it wasnt thats to fault but its some of the political staff, and that there are some reports that the president , not wanting to hear how dire some of the prognostations could be, made individuals who are in positions of power, political leaders, hesitant to make him aware of some of the real threats because they didnt want to risk being fully honest sident,e p knowing he didnt think it was in his political advantagend to have a ic. Do you think theres anything to that . I just dont know. I mean, you know, i wasnt there. I havent asked these questions. I try to look forward, not back. The things thai thought we should be doing in january and february, i said in january and february. Now,ome april, im saying wh i think we should be doing in august and september. Ne w to be looking forward, i agree with you. But there is a certain degree of learning from our mistakes, that we dont make the same mistakes again, and thats all im trying to y. I think the lesson is, we didnt do what we needed to do in january to prepe for april. We shouldnt we should make sure we do ine april whated to do to prepare for august. And im not sure were doing that. And so absent a lucky breakthrough with a drug,fa come thi, were going to be at a lot of risk for big outbreaks, potentially. Well, so lets move on to therapeutics, treatments, vaccines. I want to point you to something dr. Anthony fauci said just this week. Lets take a look. I dont think that youre that the country cannot get back to a real degree of normalcy until you absolutely have a safe and effective vaccine. D gottlieb, is it the consensus of theedical community that, as youve said, our best nearterm hope is a therapeutic drug if not vaccine . A vaccines our best longterm hope . I think if you want to be nservative, you have to figure that a vaccines a couple years away. The platforms being used to develop the vaccines are highly novel. Weve never developed a vaccine against a coronavirus, so to think that were going that in some superaccelerated timeframe and mass vaccinatee tire population with a highly novel vaccine against bhighly novel pathogen, i think we need get two years, and we need to understand what it looks like living with this pathogen for two years. There is a potential that you can have a drug by the fall of more than one drug. I think the subs of medicines that both could be availablemp and could betful enough to actually affect the morbidity, the death and disease from this pathogen is a verybs small. All right. So, lets talk about what some of those drugs are. Fdaapproved treatment for covid19, but several of the drugs are beintested in clinical trials. And while i wantth to get intvarious options, the drug the president hasnt ued to tout is hydroxychloroquine, which is an antimalarial drug it is also used to mitigate symptoms of autoimmune disorders. Look at what the president just said this week. And the other thing that weve bought a tremendous ount of is the Hydroxychloroquine Hydroxychloroquine which i think is, you know, its a great malaria drug. Ke its wunbelievably. Its a powerful drug on malaria. And there are signst thatrks. So you have said previously that you are not an optimist about this treatment but just last week, the fda did authorize the emergency use of hydroxychloroquine in certain cases where patients are hospitalized. Do you support that move by the fda . Ar look, the datas very and very mixed on this drug. And while we understand the safety profile othe drug, i think the important thing to keep in mind is this drugs widely available, and its being widely used. If you tk to physicians, a lot of doctors were taking it as a prophylaxis, off label. A t of doctors in italy were doing the same thing. Most patients that werent on some other protocol, they werent receiving some other experimental therapy that were hospitalized, were receiving this drug. Ive asked physicians informalle if therescribing it, and theyre prescribing it fairly widely here in United States and have been frou thet. So if this was having a robust treatment effect and was going to help mitigate the impact of anpidemic, itd be doing i this treatment is being tested. When are we going to know for certain whether this e . Treatment will be effect ive asked people this question. I get different answers. St people think that theres trials that should read out within a month that are going be not definitive trials but more informative than whats been done. Aleres been a couple of t and that was the initial trial that people pinned a lot of hopes on. It only involved six patients in the active arm. One was a 30patient trial that showed activity, another was a trial of similar size that showed no benefit. So the publicly availabl datasets are very limited. Now, again, i suspect that there is some private data that they have because its being so theyre probably extracting data from clinical records that just hasnt been published yet. You seem to be more enthusiastic about a different antiviral drug which is currently in its trial phase, remdesivir. Is that right . The aspects of how this virut repl, weve drugged before. Weve developed successful drugs to interfere with those aspects of how this virus goes about making copies of itself. So we should bable to do it here. Remdesivir, we have a lot of experience with it in other settings. It does appear, based on limited datasets, to be active against the rus. Probably the place where a drug like remdesivir will have its biggest impact is if youar prescribe it in the course of the disease to try to break offlly get sick viral replication, before the virus has a chance to do more harm to the person. Youve also written about antibody treatments. Right. Do you think that an antibody treatment holds more promise than an antiviral treatment . Probably in the longterm, no, but what im focusing on are drugs that could bela ave by august. And if you look at the subset of drugs that could be availae by august, really, this is it. And the antibody drugstr are tive because its a fairly simple approach. Other viruses, inc ebola. Nst and the virtue of an antibody is it can be used as a tatment in early disease. Probably when patients are very sick, its not going to be effective. But it can also be used as a prophylaxis to prevent infection in peoplwho are exposed. And so it could be a bridge to a vaccine. So you wrote in your ed last week in the wall street journal that and this is a quote that a therapeutic drug would be transformative, and its plausible as soon as this summer, but the process will have to move faster. So as the former commissioner of the fda, what needs to be done in order for the process to move faster . I think we need to have a differt mindset about how we pull these drugs through. We need to be able to say, these are t drugs we really need in the next four, five months. And were going to make a very delirate effort to try to bring these products to development and to work in a way that we h before. S whats it gonna take for that to happen . I mean, youve been the yommissioner of the fda, s understand why regulatory process rks the way it does now. What will it take for it to be expedited in the way youve just suggested . Well, i think the most important thing is for professional staff,e the center directors, who are exceptional, that thats what you want, and do whatever you need to doa what resources you need to take to make sure that weve done everything we canex to try tdite the development of these products. That should be the charge and the mission, and that shoule beirection, because we need these therapies. If we dont have them by the ll, were in a challenge does that direction come from Political Leadership . Yes. Youve called in your roadmap to reopen for a National Surveillance system forco ainment. Could you just describe to us what a National Surveillance systemould look like . Yeah, i think, in retrospec we shouldnt have used the word surveillance, because it has the ong connotation. Really, what were talking about is Health Monitoring and having in place very itwidespread testing capab so people could get diagnosed with the virus. C th go to their doctor. Theres a pointofcare system there. They can get swabbed in the office, in the convenience ofth doctors office, and find out if they have it in a rapid fashion, not have to wait days to find out if they have this virus, especially if tyre presenti with signs and symptoms of coronavirus. So thats the key to a nional testing system or a National Surveillance system. We use the word surveillance in medicine, but its not the kind of surveillance i think you typically think of in other mantexts. This week, thr story about the coronavirus is how it is disproportionately tting communities of color. To what do you attribute this . Well, i think that the virus disproportionately impacts people from lower socioeconomic grps. And theres a lot of reasons for that. And i dont know that we understand all of them and i bedont know that im gonn able to explain all of them. But first of all, its harder to social distance en youre living in tight quarters, when youre living in public housing. You cant separate from sick family members. You can separate from other people. I ink a lot of lowerincome americans are forced to work you know, if youreckout person on a grocery line in a store, youre coming into contact with many people. What are the Public Policy soluti in terms of simply, you know, the healthcare responsean the publichealth response for those who are more economically disadvantaged . I think a lot of the Public Policy solutions are going to be on the back end of this, unfortunately, w that the way this has ensued and trying to make sure that we suppt those communities that have been hardest hit by this virus and help people get back to work. But, you know, theres things that we could think about, in terms of how we implement poli,. One of the places where ere probably is a lot of spread of the virus is on public transport. S now therreason why new york city and others have maintained the subway systems. They have to for peo to be able to get to work, essential employees and people who just ct afford to travel other ways. But recognizing that and recognizing that af lowerincome new yorkers are now gonna be forced to continue to take public transport, whiccould become a vehicle for spread of this virus, we should try to fus more resources into those systems to do cleanings of those syste. You know, you predict, based on what you know and virus and how it replicates, that there is a likelihood that it comes back in the fall. How do you think that then plays into impacting our elections, our national elections, in november . Yeah, i think we need to start thinking about this right now whether or not wre gonna be able to crowd people into voting booths and into long lines in the middle of the cold in november. Do we shift to mailin elections or early voting in most states to allow people, to allow the voting to be spread out over number of days where you dont have to have big crowds . Those are things we probably should be contemplating right now because there is aeal risk. I dont think this just goes away. This now recedes into our lives, and its become something that we ed to deal with on an ongoing basis, again, until we can vanquish it with a vaccine. Tell me, do youhink that handshakes should go away, like dr. Anthony fauci just suggested . Well, i was never a big fan of the handshake, long before it was fashionable and would purell after i shook peoples hands. And i think sometimes people saw me do that and thought it wasof nsive. But now youre prudent. Now that i have an excu not to shake peoples hands, im gonna take advantage of that. Tl dr. Gb, ever the canary in the coal mine. Thank you so much for coming to firne and for sharing your insights. Firing line with margaret hoer is made possible by. Additional funding is provided Corporate Funding provided by. Youre watching pbs. Hello, everyone. Welcome to amanpour co. Heres whats coming up. 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