Authors and others who are making things happen. Booknotes of visits is a weekly conversation that feature as they did authors of Nonfiction Books on a wide variety of topics. And the about books podcast takes you behind the scenes of the Nonfiction BookPublishing Industry with insider interviews come industry updates and bestsellers list. Find all of our podcast by downloading the free cspan now apple or wherever you get your podcasts. And on our website cspan. Org podcasts e here. Next to look at decision they the covid19 pandemic and how covid19 impacted health policy. Will hear from Infectious Disease scholars along with fda Principal Deputy commissioner Janet Woodcock and former commissioner mark mcclellan. This event was hosted by the American Enterprise institute. I am tony mills come soon affiliate the American Enterprise institute, i want to looking at all and thank your coming. Particularly those of you who braved the friday before the Holiday Weekend to be with us in person. But also thanks to those who are tuning in virtually. What i thought i would do is, before getting intoo our panel, we have a terrific life today, two excellent panels im really excited about the discussions which will cover a range of important and substantive issues related to the covid19 crisis. I wanted to to start missing a few words about why were having this event here now by way of background. I thinkk it would be uncontroversial to say that the covid19 crisis was, in fact, a crisis. However we think about it, its something well all be grappling with for some time to come. Certainly among the most important events of recent times. Of course it was a Public Health crisis, arguably the worst in 100 years, which resulted in an unspeakable amount of death and illness. But it also has resulted in a set of policy and political decisions which were unprecedented, the effects of which we are still grappling with and trying to understand, and the effects of covid could be measured not only in terms of the massive amount of carnage but also the secondary effects of the crisis, think in terms of learning l loss, Mental Health issues, other sort of medical problems that were exacerbated by the crisis. But also the effect of the crisis at on our social fabric and our political life. If you spend time reading the history of epidemics, which is a demoralizing exercise i dont necessarily recommend, youll find this is a very frequent pattern. One of the worst effects of epidemics and pandemics is to cause social conflict, political conflict and an erosion of social trust. I think we sit today and we will be grappling with that for a long time to come. All of that would be reason enough to have serious reflection on o what happened during theha covid crisis, whate did well, what we did badly, what lessons we can learn but theres another arguably more important reason m which is that covid is not the last Public Health crisis we will face. It is very likely not the last pandemic we will face. In the years to come. And so while recognizing with i think you mentally are certain deep patterns that can recur when crisis like a stasis, we are not helpless and we do have tools we canan use and drawn to think about how to grapple with crisis like this. One thing we could all agree on, regards the politics and blog think about covid is we did not handle covid very well. That response particularly in the United States is not an exemplar of Good Governance or r good policy, and the question that we have to think about today is how we can do better next time what kinds of lessons we can learn for policy, for thinking about how we use evidence for policymaking which is a subject of our first panel but also how we think about institutional reform and building resilience into our federal and other institutions which is what we will talk more about in the second panel. As the crisis recedes, the window which to learn the lessons risks is closing. Its for this reason i think we need have this conversation now. One might have expected a National BlueRibbon Commission to look at the covid crisis and to think about what we did well and family so maybe i can do what happened after the 9 11 attacks in 2001. Demoralizing late we have seen surprisingly little action of that kind here in washington. Relatively little compared to the scale of the crisis and its importance for thinking about thee future. As it happens a group of experts did get together in 2021 with the purpose of trying to create a Commission Like the 9 11 commission, and had inadequate success among policymakers in putting Something Like that together. Fortunately for us they decide to press onward and formed the Covid Crisis Group which was an independent group of experts that triedgr to examine what we did well and badly during the crisis, put together a set of recommendations for how we might move forward. These recommendations came together in a report book called lessons from the covid war that was released this past spring. So part of what we want to do to do is highlight the work of that report and engage with its findings and recommendations, andd so were fortunate to have an member of the Covid Crisis Group on each of our panels today. We hope this will be the beginning of a set of conversations, only the start of more to come, and we are honored here at aei to convene this and contribute to that in a small way. It so without further ado i would like to introduce our first panel so we can hear lesson for me and more from the experts. So join us on a first panel today we have Marc Lipsitch who is a professor of epidemiology at the harvard chance go Public Health and director for senator to medical disease dynamics. During the pandemic he was named the founding codirector of the new center for forecasting and operate analytics within the center for Disease Control and prevention where he now serves as a senior advisor. We also have joined us emily ricotta whose independent Research Scholar in the division of Intramural Research at the National Institute of allergy and Infectious Diseases, one of the divisions within the National Institutes of health were invalid emily leade epidemiology and Data Management unit. Last but not least we have jonathan fuller who has the dubious distinction of being a fellow philosopher like me. Hes currently serving as a visiting scholar at the department of bioethics at the National Institutes of health also a professor and that appropriate to share philosophy of sight of university of pittsburgh as well as a cofounder and Deputy Editor of the excellent journal which recommend philosophy of medicine. So with that i would like to pass it over to mark. Thanks, tony, thanks for the invitation to be here. Im glad this is happening. Its an opportune time to get that it gets less opportunity by the day so the sooner we discuss these things and reach some medicine at how we can move Forward Together the better your i should say that although i do hold a parttime to the cdc come on speaking in my personal and academic capacity, not as a representative of the cdc. I was would have people i was on the Covid Crisis Group which produced this book that many of you may have seen. And lessons from the covid war. And tony sp to set a couple words process of that. As tony mentioned the original idea was toth be the sort of groundwork layers for a fullscale Investigative Commission that might be set up by the government or in some other way. And that begin in 2021 through the efforts of philip who led the 9 11 commission as executive director and who worked with four foundations, the schmidt futures foundation, the rockefeller foundation, the School Foundation and stand together to try to get some diversity of funding and diversity of viewpoints on the planning, what was then thenn Covid Commission planning group. He began assemblingp that group through a snowball process of interviewing people who would been involved in the pandemic in variouss ways, asking some of u, after the interviews, to come and join the group that was doing these interviews. So we sort of assembled in that way. And as tony said the goal had been to put together documents and oral history and some fresh memories for the potential future commission. As we all saw, that was not adopted in more ferries piece of legislation that could have adopted it. And so the book was written really by philip, which is good because hes a great writer and some of us are not all as good writers, most of us are not as good writers as he. I wont go into the details of it. I do recommend one of the things thats good about it is its extremely readable because his ability to write well, even about kind of bureaucratic and institutional history, which weve all read books about those topics that are not well written and its a lot easier to write about personalities and individual stories. But the goal was to write about the systemic issues and what was decided, how it was decided and why it had to be dissent in certain ways that lead to less good outcomes then we wouldve liked. I think thats part of the value of the i book is that it does he individual characters. It does have stories but it really focuses on the structures in on the unfortunate fact that had we had the best leadership possible at that time and all parts of government we stillim wouldve had a really uphill battle. There were some clear failures of leadership, and those are discussed in the book, but the system really was not decide, talks about thee sort of Grover Cleveland area designed for Public Health system and the analogy between the way that we deliver Public Health and the state militias under the articles of confederation. So they keep you a taste of kind of level at which its written. And nonetheless its easily readable. I think i will leave it there. Well come back to l some of the topics that aref in the book during the course of the discussion. I think i will now sort of shift to a few perspectives of my own that iw think are consistent wih but probably not all in the book. Deep, seriously consistent with what the book triesy to lay ou. So the topic of her panel is the of science in pandemic decisionmaking. The perspectives i want to bring our to start i think about the kind of time evolution of that question. So the pandemic at all of its stasis phases was an exercise in Decision Making under uncertainty, and the uncertainty in many ways with greatest at the beginning and narrowed as it went on and as we learned more dirt but it persisted. I think its helpful to think about how you should act in relation to the signs scie science is minimal, when its somewhat more established, and when its more mature, which we could think of is kind of the beginning, the middle, and the later phases of the pandemic. So in the beginning there is a need to be precautionary and use shreds of evidence, even shreds of indirect evidence to make policies that will delay the bad outcome. And i think there was a process of education that happened atas the beginning of the pandemic where people started to understand what it means to have an exponentially growing threat which can be small today and large tomorrow, and where small is easier to l control than lar, and where delay is the name of the game. In the sense as we found in this pandemic, if you got covid in february, sorry, in april of 2020, you faced overloaded hospitals, and review of medical countermeasures, very little evidence about what countermeasures might work and so forth. If you v got it a year later, people knew how to treat the disease. There was not yet an antiviral that was specific and good but there were steroids, there were other procedures in the hospital. You are much better off. If it was, if it wasnt new york at the height of its first wave, you are also less likely to be an overcrowded hospital. So delay is valuable. Flattening the curve as hackneyed as the term became really does mean that fewer people get infected over the course of it, as well as those who do get infected, get infected later. So really you are trying your best as a society to delay the spread. We didnt do that as well as we could have. D that is, that was one of the biggest issues. Its important to mention the issue of the complementarity of following science in that environment. I was one of the few people among my friends who was in favor initially of border restrictions. It was not a popular view among many Public Healthg experts here but in retrospect i made an assumption that was wrong, which was that if we could do late entry by a month, or delay the spread of the virus by a month, we would have time to prepare. In fact, that delay is only useful if your time to prepare, and because we were not doing much preparation in february and march, that delay was not as valuable as it couldve been. So i think i was right on the principle but wrong in the event. As you get, and the precautionary approach means you do a lot of interventions that should be marked very big, with a very big red asterisk as temper and based on our current level of ignorance. And School Closures which is included to later is a good example of that. It was actually the right thing to close schools initially because we didnt know what the role of children would be in spreadingch it, and it made a b, and made a lot of sense given our understanding of how many respiratory viruses are spread. But it should have had an asterisk saying this is based on what wee know, and were going o revisit these decisions. I think thats a general issue that i will mention in a second. As the pandemic wears on, evidence begins to accumulate but it often is not decisive, and so they need to integrate evidence from different sources, from social science, from economics, from biology, from randomized trials of particulard interventions becomes more necessary. As we try to figure out now to live with what turned out to be a very longterm threat. The goal really has to be to make sense of t different kindsf evidence, none of which is completely conclusive by itself, and to treat it as as a multe input decisionmaking problem. Later stages, what struck me s the importance of observational evidence as opposed to the demised trial evidence as opposed to minimized trial evidence. Most of what we know about vaccines are based on observational studies because we did not do trials with this variant. There are a lot of things we cannot do trials on. We have to understand the value of observational evidence and take steps to make it better. I want to finish i wonder finish by saying b a s couple of things we can learn from other responses and how to integrate. One of the most informal processes in major industrializeded countries on Public Health and putting it aside words formalized we have, there was no centralized group of experts filtered evidence to do policy making in the United Kingdom for the criticism, it provides decisionmakers with a sense of what the Scientific Community believes. Another lesson that i think happened informally but no structure, the governor because it was informal, it meant for several hours a week commitment and nobody have the time, we couldnt respond to formal request. Another thing the uk did very well was invest, to put in place structures to gather evidence and it made them understand what was going on at all times across jurisdictional we never had and then putting in place data structures for federal agencies to collect data from the state and structures reported to be more effective. From an epidemiologist of scholars Infectious Diseases. Here to give opinions, im here to talk about data. Having the uncertainty as we move across the pandemic, how we become more certain is gathering data and data is difficult to collect and manage but its more difficult in this situation so in who want to talk about the things we cannot from better during the pandemic in terms of research. There is a difference in why we collect data and where we collected from based on understanding disease spread in the community and would not want to know the questions of how well the vaccine works so we need to separate surveillance and research and data needsec because its not just onesizefitsall so my expertise is clinical studies as well as how and why and how we manage it so i had the opportunity to work at the state Health Departments in academia. I worked on surveillance is a unique opportunity to understand the variety of different areas so during the call pandemic, anybody who has done research, its difficult to collect large amounts of data so your collecting information on health, who is sick, demographic information in the. They have and people have various feelings about the and reasons why they may not like that and we are doing this in a sensitive manner and difficult to do a data systems across the platforms. Having data from three weeks ago to respond to pandemic, how many people are getting tested positive or negative and read this in real time. Understand how we can respond, otherwise where we investigatin