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Andy Slavitt from Inside the White House

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Description

Dr. Bob catches up with Andy ahead of one of his White House COVID-19 press conferences to chat about what he’s been up to since temporarily leaving the show for a role in the Biden administration. They talk about the variants, the vaccines, and the administration’s commitment to equity. Plus, a reflection on the U.S. passing 500,000 deaths, and how that’s pushing Andy to work even harder to bring an end to the pandemic.

 

Follow Dr. Bob on Twitter @Bob_Wachter and check out In the Bubble’s new Twitter account @inthebubblepod.

 

Keep up with Andy in D.C. on Twitter @ASlavitt and Instagram @andyslavitt. And be sure to check out his new Twitter handle @aslavitt46.

 

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To follow along with a transcript and/or take notes for friends and family, go to www.lemonadamedia.com/show/in-the-bubble shortly after the air date.

 

Stay up to date with us on Twitter, Facebook, and Instagram at @LemonadaMedia. For additional resources, information, and a transcript of the episode, visit lemonadamedia.com.

Transcript

SPEAKERS

Andy Slavitt, Dr. Bob Wachter

Dr. Bob Wachter  00:00

In just a few minutes, Jill and I, Kamala and Doug—will hold a moment of silence here in the White House. The people’s house, your house. We asked you to join us, to remember, so we can heal, to find purpose and the work ahead to show that there is light in the darkness. This nation will smile again. This nation will know sunny days again, this nation will know joy again. And as we do, we’ll remember each person we’ve lost the lives they lived, the loved ones are left behind. We will get through this, I promise you. But my heart aches for you, those of you who are going through it right now. May God bless you all, particularly those who have lost someone. God bless you.

Dr. Bob Wachter

Welcome to IN THE BUBBLE. I’m Dr. Bob Wachter. Of course, that was President Joe Biden on Monday night, marking the incalculable loss of 500,000 Americans, just let that sink in for a minute, 500,000 Americans tragic at every level, including the fact that our response was such that some of that did not have to happen. But it’s really wonderful having an administration marked by empathy, that takes the time to talk about the lives of the people that we’ve lost and the lives of the people they left behind. And doing in ways that focuses on truth, on common sense, and on healing. And healing starts with remembering what we’ve lost and these individual lives and all the people that loved them.

Dr. Bob Wachter

It’s a really interesting moment, in a way, because as tragic as it is, it also is a time of some optimism. And the President hinted at that when he talked about light in the darkness, and that we will come through this and we will and most of the signs are pretty positive at this point. And one of the most positive signs is that we now have an exceptional team that the President has put together that is in charge of making it so. And they are sweating, the details, they are telling us the truth, they are telling us what they know and what they don’t know. They are not giving us happy talk. But they are pushing the system to move faster and faster, with an eye not on the politics, but an eye on making sure that no one dies unnecessarily that every life is important and every life that can be saved to save.

Dr. Bob Wachter  02:50

And the person who is really quarterbacking that team and in many ways has become the most public face of that team is someone you may know from this podcast, a guy named Andy Slavitt, who has taken a leave from the podcast to do just that. And of course, we’re grateful that he’s doing that. Andy of course, is now the White House Senior Advisor for the COVID response. under the Obama Administration, he led Medicare and Medicaid. And over the last several years, he’s done a whole lot of things that have been important, probably the most important of which was launching this podcast for which I know, we’re all grateful.

Dr. Bob Wachter 

My interview with Andy covers a lot of issues, you’ll hear that the first probably two thirds is a lot of the issues of the day, we talked a lot about vaccines, we talked about the schools, we talked about getting back to normal and what that looks like and when that might happen. And then toward the end, we get into more personal stuff. We talked about Andy’s experience in the White House, what it’s like bumping into Kamala in the lawn, know what it’s like being called into the Oval for a meeting what dealing with President Biden is like in some of the contrast between his style and that of Barack Obama, it’s really, really interesting stuff.

Dr. Bob Wachter  04:02

And Andy helps us see what’s going on behind the curtain. And through it all, you’ll hear something that won’t surprise you, which is Andy’s extraordinary passion for the issues. And the fact that he understands that what they’re doing is unbelievably important, and ultimately will determine how fast we get through this thing. And how many people live or die. So the stakes couldn’t be higher. I’m thrilled that Andy is in the hot seat doing the hard work and it’s really a wonderful chance to get to catch up with him. So with that, let us ring up Andy Slavitt.

Andy Slavitt 

So I have a, I’ve got to do a press briefing at the top of the hour, whatever time it is.

Dr. Bob Wachter 

Let’s do it.

Andy Slavitt 

Okie dokie.

Dr. Bob Wachter 

The interviews have gotten a lot tougher since things have changed here. Are you ready for it?

Andy Slavitt 

Let’s go. Give it to me straight.

Dr. Bob Wachter 

Andy, thanks for coming on. we’re taping this on the day that we’ve reached 500,000 deaths. So why don’t we start, just tell us what that number means to you?

Andy Slavitt

You know, it’s easy to think about that number, it’s harder to feel that number. I’m finding, feeling, you know, people’s family members and their hopes and their dreams and the missed years. And the sadness of the people who are missing them is really hard to do. I guess from my perspective, there’s a message which says—”Work harder, Slavitt.”—Don’t let this kind of commemoration continue indefinitely, let the public rest and get back to the other worries and joys in their life. You know, the President is gonna be making some remarks tonight with the Vice President and with their spouses. And, you know, it’s kind of a chilling day, I’m sure it is for you too, Bob.

Dr. Bob Wachter

Sure. That’s, yeah, you’re right. I mean, you try to get your arms around the number and you know, the size of the city of Atlanta or five University of Michigan football stadiums that you can kind of get a sense, but trying to put yourself in the place of each person, each family, it’s almost in comprehensive, I think our brains do something to protect us from that. And you have to kind of fight that. So you truly understand the enormity of what’s going on. Is your feeling kind of mirrored by the folks you’re working with? Are people sort of taking stock of the moment and pushing themselves to work even harder based on this milestone?

Andy Slavitt  06:32

Yeah, I mean, I will say something about the team here. I mean, this is a team of people probably in the White House. And well, people team in the White House who come in who are incredibly prepared and have been through things like this before and have a lot of energy for this, and are probably some, you know, […] some of the best people in the world and doing this. And then the people in the agencies to people who you know, and know of, and the CDC and the FDA, and NIH, they’ve always been some of the best people are doing this, they haven’t been always recognized as the people that can do this job.

Andy Slavitt 

And so the easiest part of this job is coming in and telling these folks, we trust you, you know the answers, you are unleashed. Go tell it like it is. And we will wrap a strategy around you tell us what you need to get done. And so I think there’s a lot, I would report that there’s a lot of energy among people who feel like they can finally do their jobs.

Dr. Bob Wachter 

That’s great to hear. So we’ll start with some questions about kind of what’s going on in Washington. And we got we had some listener questions to the lot of interesting questions from listeners. One was from Mimi Segal, who said—”Where do you think you’ve made the biggest progress? What’s been harder than you thought? What’s been easier than you thought?”

Andy Slavitt 

I feel like there is zero declaration of victory or success yet in any way. So I want to avoid that refrain. I rather look back and say—”Boy, look at the things we did well, and look at things we could have done better.”—But we’re in the middle of it now. And I don’t want anybody in this country to have a sense that we’re done. As we know, and as I think I’ve heard you say, on this podcast. The pandemic has had nothing but surprises for us along the way. And so we need to continue to anticipate bad surprises. You know, I think we lived for a long time with an administration that I’ll put it this way, I really wanted it to be over and wanted to keep promising it to be over. And I think that was fatigue, for people. To feel like no one’s preparing for a marathon. So look, I’d rather if we prepare people for a marathon and it only ends up being a 10-mile run a 10K or whatever. What a great analogy I’ve used. See, I’ve still got my game.

Dr. Bob Wachter  08:42

That’s unbelievable. Yeah, you haven’t lost it.

Andy Slavitt 

Pull those things out.

Dr. Bob Wachter 

I worried with shaving and you know, the haircut and all that, that you might have lost your superpowers, but it’s still there.

Andy Slavitt 

The tide chokes off blood supply. So I think we’re being very cautious from a communication standpoint, and not to over promise, not to declare victory, to be very blunt about the challenges and to encourage others to be blunt about the challenges. And then people will feel progress. They won’t hear about progress. They’re gonna feel progress when it feels right to them, and then leave it to you and others and other commentators to tell people what some of this stuff means and avoid interpreting and overselling the results. That’s sort of the ethic I’ve tried to bring in. It’s consistent with the President’s ethic. So it makes it easy. It’s consistent with Ron Klain’s ethic. Jeff Zient’s ethic, Rochelle Walensky, Tony Fauci and so it feels like they’re the cultural focus on do stuff, don’t talk about stuff, but be very transparent along the way, is what we’re trying to hit.

Dr. Bob Wachter

How do you get the balance right between that and some people are talking about not being optimistic enough, sort of too much of a bummer. A million doses day well, we should be aiming for two or 3 million And we’ll have enough vaccines for everybody in July. Well, actually, the month might be May. Yeah. You know, it’s a tricky balance to get right. How do you think about that?

Andy Slavitt  10:07

I’m not sure we do get it right. But I think we have an approach, which is, if we say, July, and it’s May, when it comes to May, people will forgive us, between now and whatever it is—May, June, July, August, September, people are going to be uncomfortable and uneasy. So there’s nothing to do to change that. There’s no words to change that. I mean, I do think like, people are eager for us to say, answer some questions like, “Okay, well, when that was added by a vaccine to your episode on safe or unsafe, what is it safe to do?”

Andy Slavitt 

And we’ve asked the scientific team here to advise on that and think about that and go to work on that. And I’m okay if we’re a little late, if we’re a little later than you and Farzad and others at doing that, because I’d rather be step wise and not have to lock anything back. But when people ask me, What can I do now that I couldn’t do before I get vaccinated? My answer is pretty simple. Live, you can live, you don’t have to worry about dying. And let’s build from that.

Dr. Bob Wachter

Yeah. Let’s talk about the vaccine roll out when you came in, it was a mess. The numbers were a mess. We didn’t know how many doses were out there. The distribution was a mess, sort of what did you, on day one, what did you discover? And how did you set to cleaning it up? And how do you think you’ve done?

Andy Slavitt 

So a couple things. First of all, there’s no upside in kind of having an administration that spends a lot of time blaming the last administration, I don’t think the public wants that, number one. Number two, we’ve got to get out of the trap where Democrats feel one way about a vaccine or mask, and Republicans feel another way. So I think it’s potentially isolating to people who don’t identify with the current administration to kind of continually cast blame. But at the same time, in order to be clear with the public and say, “Look, here’s the facts, here’s what they are.” We’ve had to do some of that. So we’ve had to say, “Look, we didn’t inherit a stockpile of vaccines sitting there ready to go.” We didn’t inherit the amount of manufacturing that had been implied. We were told there’d been 40 million doses done by December 100 million by January, those were very far off.

Andy Slavitt  12:14

So we had the level set. And the level setting probably looked a little bit critical over the past administration. And the truth is, I think we are doing things differently for one, which is working for a different president. A president who is into the details, cares deeply, wants to plain truth spoken, doesn’t really care as much and reflects on him as he does, that we get the job done. That’s the different kind of presidents work for it. So they were very good people in the last administration I know. But they were working for president with different expectations and different kind of communication priorities. Second thing is I think, I think it’s simplified to say that the prior administration was focused on vaccines, and were focused on vaccinations.

Andy Slavitt 

So producing vaccines is one thing, getting them in people’s arms, that last mile is at work, and the whole communication process around should I trust the vaccine, should I not, and all the places locations, having enough vaccinators having enough vaccine sites being located in the right communities, that has equal effort for us because otherwise, you’re just producing vaccines. So when we got here, 46% of vaccines that had been delivered, had been administered, 46%. Today, that number bounces around, but it’s in the 80s. We’ve done a few things; we’ve increased the number of vaccines going out the door by 67%. And a much higher percentage of them are actually getting into people’s arms.

Andy Slavitt

And we’ve purchased all the vaccines needed to take care of the public, not even counting Johnson and Johnson, because we’re not going to take into account facts that are not yet an evidence, even though we’re hopeful, of course, with Johnson and Johnson, which is a very, very good vaccine. And we have created more vaccinators, more community health side, we’re standing up on […] sites. In short, I think we’re treating this like an emergency. And we can’t make vaccines come off the line faster than they physically can, then they physically can safely. And that is a large part of the process. So we’re not going to do that.

Andy Slavitt  14:10

But we are going to do is every single thing else. And you know, again, in terms of how are we doing at it. I want to reserve that judgment for when this thing is all done and I will guarantee you we will have made mistakes. I will guarantee you we will have done some things well, but every step along the way, we are trying to evaluate what lessons we’re learning and try to improve and working really, really hard because I feel like there’s no way to work hard enough given what the public is going through. There’s no way that the public expects us to sleep well at night if they can’t sleep well at night. That’s just my attitude.

Dr. Bob Wachter 

I know that equity has been central to your thinking about this issue from the start. How have you been handling the issue of equity when it comes to vaccinations? What did you think the fundamental challenges were? And how are you and the team addressing them?

Andy Slavitt 

Yeah, it’s such a great point. I mean, I’ve come to believe through all my years in health care, that if you do nothing, if you just ignore the issue, structural disadvantages will rain significantly. Because for some people, it’s just easier to get on computers, it’s easier to get places, it’s easier to take time off work, it’s easier to have people driving someplace easier to get childcare, all of those things add up to a tremendous disadvantage. Unfortunately, though, this is an both an occupational disease, based on what job you’re in, you’re more exposed. It’s also a where you live disease, it’s a color of your skin disease. It’s all of those things. And yet, the people that at the outset, are clamoring for the vaccine are able to easily clamor over other people, not their intent, but not that people, it’s understandable.

Andy Slavitt  16:05

And that’s what happens on the shortage. Point is, you have to do very specific explicit things, or you won’t fix it. So having a certain portion of appointments reserved for people in the community, in your zip code, having morning appointments reserved for people in these locations, having mobile clinics using community health centers, using mobile vans in the clinics. That’s a large part of the challenge. The other part of the challenge is not just the access, but it’s also the conversation where people call vaccine hesitancy or people call vaccine confidence, which is really not about, you know, a message.

Andy Slavitt 

It’s about allowing someone to have a conversation about the reasonable questions. Because I don’t look at everybody who’s a fence sitter and say, well, they’re anti-vaccine or they’re ignorant, far from it. Everybody’s got a question. It’s got a legitimate question, because it’s their question. And if they can get an answer on the internet that misleads them, or is not based on fact, that’s a problem. That’s a loss. But if you can get them to a reliable, trusted source, whether it’s their local doctor, church leader, pharmacist, to the CDC, then you can say, “Yes, your questions are legitimate. And here’s what we know. And if we don’t know.”

Andy Slavitt

and so, you know, you may know that we do these Monday, Wednesday, Friday briefings that I initiated when I got here. And, you know, we have Rochelle Walensky, from CDC, Tony Fauci, from […], who basically speak it completely unscripted, i.e., the White House doesn’t look at what they have to say. They just say like in his reporters come in and ask questions. They give straight answers. They say what they know, they say what they don’t know. We talk about adverse events. And thankfully, the facts are easy, because it’s an incredibly effective and incredibly safe set of vaccines that have been approved. So, we’re fortunate that it’s easy to get the facts out.

Dr. Bob Wachter  18:01

Is there a broad communication strategy rolling out or being developed that says there are some people for whom Fauci and you and others are not the answer? It is the church leader, It is the sports star, it is the Tiktok star? I mean, it’s all, it’s the people that they trust from other parts of their life and kind of what does that look like?

Andy Slavitt 

Yes, it’s 100% Tiktok. No, I’m kidding.

Dr. Bob Wachter  18:23

I didn’t know what Tiktok is.

Andy Slavitt 

A kid on a skateboard, he’s gonna really carry the message for us.

Dr. Bob Wachter 

That’s probably right.

Andy Slavitt 

No, I think it’s a great question. So yes, there’s three stages to this process. And we’ve just finished the first stage and are entering the second stage, the first stage has been getting smart, listening to people, testing messages, understanding what the data, say, understanding who wants vaccines, and what’s getting in their way. And there’s a series of both universal lessons and lessons specific to different communities. And we’ve just finished that stage. And we’ve learned a ton. And it’s been very helpful. And a lot of it is behavioral economists talking about how to break down barriers, and some of it is what people communities are saying and so forth, the second stage, which as I said, begins today, Monday, when is the show airing?

Dr. Bob Wachter 

Wednesday.

Andy Slavitt

When we will have begun, when the show airs is a huge stakeholder engagement effort. So we are meeting with leaders in the African-American community, practitioners from around the country, people in all different communities. And we’re gathering our input and talk to them about what we’ve learned and understanding what they’ve learned. Then, or the third stage is going to be the much more public kind of communication conversation stage, which is going to be timed to be most effective, i.e., when there is enough vaccine for people to get those messages and I think we’re going to spend a lot of money, but it’s not about a message. It’s about conversation. It’s about listening to people and it’s as you say, local people who people trust and have it extensible so that, you know, it can be localized.

Andy Slavitt  20:06

That’s the idea. And it’s really important because sure is today, we’ve got people chasing vaccines, some amount of time, we’re gonna have vaccines chasing people. And when that happens, we need to be ready to go.

Dr. Bob Wachter 

Everybody wants to know that date, you’ve already said you want to sort of not over promise. And the President said July, was that date that vaccines would be available to everybody? Is that the date that you think the right date or you think that’s on the conservative side?

Andy Slavitt 

So I think what he said was, we will have purchased and produced enough vaccines for every American by the end of July. And that only accounts for Moderna, and Pfizer. And so, you know, we will continue to update as we learn more, but I think it’s important. I mean, look, I don’t think there’s anything wrong with people preparing to say, “Look, I’m probably going to get my vaccine some point, this spring.” And some of the answer to this Bob, depends on the previous conversation we just had, which is how many people want the vaccine? Because if that number is lower, then more people get it, we’ll be able to get it. Why don’t we get it more quickly? If that number is higher, which we hope it is, it might take a little bit longer. So you know, I don’t think that it does anybody any good to have any create any false precision.

Andy Slavitt 

I’d rather not have a sense of false precision. And if people whenever date in their mind, I’d rather have them have a date that feels a little bit like an outside date, but knows that we’re working hard to pull that data. In fact, when the President said July 31, it was only two weeks before that, that I had said it was September 30. And it was but we took a series of actions including the Defense Production Act, including contract workers in the scaling up some things that gave us confidence to move that September date to the July date, and we’ll leave it at that July date. Unless and until something changes.

Dr. Bob Wachter 

Stay in vaccines for a couple more minutes, then pivot to a few other things. Carrie […] asked a really good question. This is a toughy. The CDC says that people who’ve been in close contact with someone who has COVID are not required to quarantine if they’ve been fully vaccinated. However, the CDC also says after exposure, people can be infected or carry the virus. So this sort of question that we’re not 100% sure that you’re incapable of carrying it and spreading it. And she asks, how can both of these above statements be true? Tricky issue, you know, this issue where we’re telling people that we don’t know for sure you can’t catch it and spread it. And then the CDC came out and said, you don’t need to quarantine. So I assume the scientists are grappling with that. But how are you thinking about that one?

Andy Slavitt  22:43

Yeah, I think it’s all about relative risk reduction. And that, you know, because there is some chance that people can have some amount of viral load, and can be infectious that they should be wearing masks whenever they’re in public. And that may be like, could turn out that there was an extra layer of protection, but a pretty low cost, kind of public health protection, right? Wearing a mask. So I think that’s why that’s being encouraged. Whereas saying, Hey, you know, you had two vaccinations, you got a very low chance of getting COVID. And we’re still asking you to miss work and stay home for a week, from a relative risk standpoint that feels like no, you know, and so the CDC, I mean, I’m trying to explain CDC decision making, and that’s certainly their role, not mine.

Andy Slavitt 

But when they come to these conclusions, based upon a lot of work, argument, discussion, analysis with a particularly with outside folks. And they know every time they make a decision, it’s subject to questioning and criticism as in, are you going too fast? Are you going too slow? How does that work? What about the point 1% of people that won’t work for? They can’t make decisions in person that suddenly they’ve got to make basically sensible decisions and hopefully explain them well and it’s a very fair question, but that’s how I interpret […]

Dr. Bob Wachter  24:02

Are you, I know one of your worries was that vaccines would get politicized the way masks where do you feel like that is not happening, that that part is going pretty well?

Andy Slavitt 

Well, we’ll start with this. I think the data is say that conservatives have a disproportionate, low disproportionate and lower acceptance of vaccines. But I don’t know that that’s necessarily a political thing. It might be it may be political, and that one of the reasons that people don’t say that they don’t like vaccines, they don’t like the government telling them what to do. And it’s feels heavy handed from government, so they’re more reluctant or more skeptical. That’s not necessarily political. It may be cultural. It may be other things. You know, I was on Hugh Hewitt show last week, and I’ve been talking to a lot of conservative evangelical leaders, and people who are all very pro-vaccine.

Andy Slavitt 

As pro-vaccine as you are, and are thrilled that I want to talk to them and I want to talk to them publicly speak about messaging. And so it’s funny when I was talking to Hugh, who is obviously a big conservative commentator, very well known. He said, We conservatives believe in science, we conservatives, think vaccinations, hugely important. And we think that we can move the needle on this. And so that I said, Okay, let me try to go the next yard and ask you the question, what about masks? And he said, You know what, I wear a mask, I believe in masks. I haven’t changed one mind about masks. And I don’t think you will either. So, it at least today it is telling that is more baked. I’m not quite as pessimistic. Although I would say, you know, a lot of water has gone under the bridge on masks that hasn’t on vaccines. And so I think there’s more opportunity to keep vaccinations from being politicized. That’s an important part of our job.

Dr. Bob Wachter

Israel just enacted what seems like a national program of vaccine or immunity passports and having people show evidence of vaccination when they get into certain places. Do you think that’s in the cards, whether that’s proclaimed by you in the government or just de facto what businesses and airlines and other places do? And if that does begin to happen, what do you think that does to the public debate?

Andy Slavitt  26:15

unlikely that the government is going to have a real active role in that and unlikely that the government should have an active role in that. I think it sort of encroaches on where people’s concerns about taking vaccines are, to some degree, to see that as a government thing. But as it has with the flu, people want to be safe. And whether it’s a school, or a business or an event, you know, they may, in fact, and I want to stop short of this, sounding like a US government endorsed part of the problem I have Bob nowadays is I can’t speak for me any longer. I can’t say it’s picking his axe, because it will be reported as White House advisors, x. So I’m going to tell you that White House has no position on this, that I know a lot of external folks are studying it, and that those things will evolve. And that’s about as much of a cop out as I can provide you.

Dr. Bob Wachter 

That’s pretty good. You’ve learned the lingo. And in a few short weeks, I’ll throw another hot potato at you. So how do you think you guys are doing on the schools and both in messaging and in reality, in terms of the pronouncements that you’ve made so far?

Andy Slavitt 

Schools are not, it’s not an easy issue. Because if all schools could be open, they’d be open. And I do think what the CDC did is incredibly useful. They came out and said, “Look, every school can open safely, if they do the right things.” Even if they’re in a red zone, i.e., with high case guarantee, even if they’re in a low. And it’s a matter of how, not if, but the How is really important. Can you de-densify i.e.? The number of students in the class? Can you require all the kids to wear masks and will they? And they, you know, really pretty good data, which says that if you do this, and you can open schools, and if you don’t do those things, it’s not as safe to do that. And so it’s a line in the sand. But even with that, understand that people are very, very strong feelings on this topic. I mean, if you’re a teacher, and you heard that you say, Hey, I don’t know if I feel safe.

Andy Slavitt  28:22

That’s a very reasonable feeling. Likewise, if you’re a grocery clerk, and you have people come into your store every day, you don’t feel that safe. So this is a real, real issue. And then if you’re a parent, or if you’re an educator, and you see the gap growing, because kids are back in school, it’s an issue that frustrates you. And, you know, I think it’s some degree people want to pick, like, decide that. Is there an enemy in this equation? Should this be cast as parents against teachers? And all that, I think that’s really unhelpful, and unhealthy and unfortunate, and I understand why it happens. But, you know, I think to some extent, everyone’s trying to figure out this puzzle. So the CDC, for the first time, did something other than like, what did their last year which is just open schools, they basically said, here’s how. Those are still local decisions. So the administration can’t go to the schools and do that.

Andy Slavitt

The other thing I have to say, though, is a school very reasonable response from schools is, hey, fine, but we need resources to do that. And that’s where the American rescue plan, which I probably should say about 20, more times on this show, American Rescue Plan, American Rescue Plan, American Rescue Plan has to pass by the Congress. I mean, this cannot be treated like anything other than a full orchestra to solve this. I mean, everybody Americans, business leaders, clinicians, federal government, state governments, Congress, everybody has to do their part and it becomes so much easier, and everything that’s in the American rescue plan. The resources to do vaccinations, the resources for schools, the support for small businesses, the support for people on employment, all of those things have to be done and they have to be done. Quickly. So we will get all the way there without help from Congress.

Dr. Bob Wachter  30:05

The next couple of months were talked a lot about vaccines and the rollout and all of that there’s also issues around the variants and how worried are you about them? So the public health behaviors and testing, there’s a whole lot of, you know, are people going to let their guard down now that they see the case curves plummeting and the test positivity rate plummeting. There’s another kind of messaging that that’s going to be very important to be sure that people don’t completely let their guard down. How are you approaching that?

Andy Slavitt

You just have to be like seven questions at once.

Dr. Bob Wachter 

One question at a time. Is that actually the rule? I had forgotten that?

Andy Slavitt 

Let’s parse the questions out.

Dr. Bob Wachter 

Good idea.

Andy Slavitt 

So you got a question, you know, what people behavior and are they to my concern that they’re going to let the guard down early? You got a question about variants? Well, look, so start with a variance. Yes, it’s worrying. But I think it’s more worrying short term than long term right now, for me. I mean, it’s, I’m worried about another wave, I’m worried about people letting their guard down. You’re exactly right. It’s a real issue. And as the numbers drop, and people start to feel like the breath, that is great news, the numbers are dropping. But it’s not. The signs are always right around the corner with this pandemic. And as you’ve pointed out, countless times that long term, though, I think, getting a strategy, we can beat these variants.

Andy Slavitt 

I feel better and better about both because I think the vaccines are standing well to the UK variant and reasonably well to the other ones. And because as of Monday, i.e., today we’re recording this, the FDA just released the guidance for the monoclonal antibodies, the vaccines and the diagnostics that will allow all of science to keep up and ideally keep ahead on a more rapid basis. With the development of these variants, I have had an opportunity to talk to the CEOs of all of the monoclonal antibody companies, all of the pharmaceutical companies. And while I wouldn’t necessarily take everything they say to the bank, I hear a level of confidence in the early data that they’re seeing that they feel pretty good. Science can beat this. But science with people’s help can beat it a lot faster and a lot better than science and people […]. So you’re exactly right. And come to thinking of it. I completely get why you combine those two questions.

Dr. Bob Wachter  32:19

It was a very good question, I think.

Dr. Bob Wachter 

Andy, tell us a little bit about how your life has been for the past month?

Andy Slavitt 

Surprisingly busy. I’m surprised to hear that.

Dr. Bob Wachter 

Yeah, I am shocked. What are you doing?

Andy Slavitt 

You know, I think in a word, trying to think about the next life that we don’t have to lose, and how to make sure that we lose as few people as possible. That’s what’s taped to my desk in my office. And it’s a pretty guiding principle on how to make decisions, whether it means that that’s how we inform the public more honestly, or whether that is how aggressively we have to upset the applecart if we want to buy more vaccines, you know, nothing else matters as much. And so, you know, it does range at a practical day to day level from making sure we procure an effective vaccines, making sure those vaccines get efficiently and effectively out the system, something you and I talked about Bob, making sure that when they’re distributed, they get to the communities that need them the most, that have suffered the most. And that often get left behind, you know, there’s a fair amount of, you know, trying to do 20 or 30 things to coordinating across the government and make sure you’re doing them well. So every day is got really pretty filled.

Dr. Bob Wachter

How do you filter all the noise? Everybody’s got an opinion about this. There’s no issue more important in the world. You’re hearing from the press, you’re hearing from the political world, you’re hearing from every armchair epidemiologist in the universe, including me. How do you filter that to make sure you’re making the right call and not getting distracted?

Andy Slavitt  34:11

It’s a really great question. Because the easy thing to do would say, filter out the noise. Just do your job focus on that, that much I’m saving people’s lives. But that’s not really truthfully the entire answer. Because that would imply that you think you’re doing everything right. And you’ve got nothing to learn. And you get too locked in to your point of view. So you and I’ve talked and you’ve challenged me on a couple of things. And I give you my reflective answer, I’ve thought about it. But I also then have to deeply consider your point of view. Because particularly if you’re someone credible as long as you are or at least so I believe that people you just can’t get locked in. So if you’re telling me something, or I’m hearing something, or we’re getting some criticism, the easiest thing to do is to reflect and defend yourself against criticism.

Andy Slavitt 

The more challenging and appropriate thing to do is to say, where’s the grain of truth? And what people are experiencing? And how can we resolve that. And so in some cases, you can’t, in some cases, say, look, where the vaccine shortage situation and will be for a little while, people are going to be unhappy, and there’ll be unhappy until it’s resolved, let’s resolve it as quickly as possible, rather than make people feel a sense of resolution when none exists. So in some ways, everybody, whether it’s the Congress, the press, scientific experts, political opposition, they all have very valuable input in terms of what’s going on. It’s not always brought to you the way you want to hear it. But it is, I find it really important to try to listen to do the best job you can, and being willing to be transparent and say when we’re wrong.

Andy Slavitt 

I had a very small example of that in one of my early press conferences, I got asked a question about how we were sending the needles for the Pfizer vaccine, and they gave an answer. I said, I think this is the answer. And I decided to go back and check and I went back and checked. And it turned out, the answer was slightly different. And I said, I’m putting in my script, that I said something wrong. And I’m correcting it. And it was a real interesting test for everybody. Because I felt that level of reflection would be an important signal. And, you know, not to beat myself up over it, but to say, hey, you asked this. I’m accountable for giving you the truth. What I said was, there’s a better way to say it. And here’s what it is.

Dr. Bob Wachter  36:43

That’s how you build trust. That’s how you build trust. It’s really important.

Dr. Bob Wachter 

Yeah, that would operate.

Dr. Bob Wachter 

Let’s talk about life with Joe and Kamala. You’ve gotten a chance to know the President, the Vice President, what do they like? Any stories you can share with us?

Andy Slavitt 

This is funny, he said, it’s like I was walking into the White House grounds with a couple Saturdays ago for a meeting in the Roosevelt Room. And someone’s walking out. And I recognize she’s wearing a mask and a baseball hat. I recognize her face, but I can’t quite place her for the moment. She says, Oh, hi, Andy. You’re doing great on TV. I just saw you something. And I said, Oh, hi. Thank you, Madam Vice President. And because she got really close to me touching my arm, I was like, I think I recognize but very hard, you know, someone throwing a baseball cap in casual clothes. She was going out for a walk with her husband. And trying to say, Mr. Second gentlemen, on the spur of your tongue. […]

Dr. Bob Wachter 

That’s pretty tricky. Yeah.

Andy Slavitt 

But there, she I’m gonna start with her. She’s involved in every meeting. She’s very, very sharp, very inquisitive, very creative reads everything. Very tough. Biden is interesting, because in many ways, the only other president that I’ve had an opportunity to brief is Barack Obama. And there’s a big difference. So I was sitting in my office the other day, and it’s funny, my phone rang. And I was on a call with all the pharma CEOs. They just started Zoom calls, my phone rings, and it said, spam risks. You ever get that on your phone where it’s in spam risk?

Dr. Bob Wachter  38:20

Sure.

Andy Slavitt 

So I clicked it off. And it’s spam risk. Washington, DC. A minute later rings again, spammers, Washington, DC, so I put another call on hold. And it’s the switchboard. And I said, that’s great. What switchboard? Like, […]. And they said, you know, the President’s assistant wants to talk to you. Can you talk to her? I said, Sure. So she comes on, and she says, Can you be in the Oval for a meeting that’s already started, the President wants you to be in. So I like looking at the pharma CEOs. And I’m like, Okay, I think I got what I need, or I gotta go. So I book on over in the Oval and the President’s in the dining room that’s adjacent to the Oval with Ron Klain, and Jeff Zients. And, you know, the President wants to have a conversation about how to talk to the public about what’s going on with the virus or the vaccines, etc.

Andy Slavitt 

And what was really interesting is, he doesn’t want to know what will look good. He wasn’t doesn’t want to know how to spin things. […] the politics, he doesn’t want to know anything fancy. He’s like, I want to give the public straight answers. I want to explain this to people in a way that as he said, a junior in high school will understand it. So if the answer to the straightforward question of when will I get vaccinated is I don’t know. I want to say I don’t know. And then tell people when we’ll know, if the answer to the question of how many vaccines we have is I want to give them the exact answer. I don’t want to spin it. And I think the thing that is not that you could spend Barack Obama. He’s way too smart for that. He was very analytical. President Biden wants to know how to best give the public clear information.

Andy Slavitt  40:09

And he wants us to work hard and solve these problems. But he doesn’t want spin he wants; he wants stuff that connects to people that people want to hear at one I know. And he reminds us constantly that if things are challenging for people there, there are some people that are even more challenging for and ask a lot about health equity. It’s probably the question that they that I’ve seen, the two of them asked the most, is how do we help people who are in the most challenged situations, circumstances. And if you think about it, if you’re a boss of a lot of people, and you’ve had bosses in your career, the thing that you’re interested in, your staff knows, right? Your staff knows Bob cares about blank. So when you’re not in the room, they’ve spent a lot of their time and energy thinking about planning, because they know it’s important.

Andy Slavitt 

And it’s great to have a boss, who is not fixated on the politics is fixated in solving the problem, being very clear and honest with the public and health equity issues. Because you feel pretty strong sense of freedom that when you’re working on this problem, to be inclined that way. And that that’s the culture of the administration. And that’s, I think one of the nicest things about being here is I’ve got the same values as the other people hear. And that’s a great feeling. And people who’ve ever been in environments, whether it’s with your own family or with friends, where you feel like we share the same values. Everything else is easier.

Dr. Bob Wachter 

Yeah, one of the things that strikes me from listening to the podcast over the past year with you, is that you, you managed to keep it light, despite the heaviness. Are there ever light moments that you’ve experienced with in this job? It sounds a heavy and 24/7.

Andy Slavitt 

You know, I mean, you know, me, like, I like to laugh. And I probably like cut tension by allowing people to poke fun of me are poking fun at myself, like recognizing people’s work, and thanking them. And so, you know, it’s serious, and it’s intense. But, you know, there’s funny moments, I mean, there are for sure, funny moments, and most of them are like, a stupid thing that I did or said, or was about to do, or almost did and caught myself, and then say, Oh, my God, you wouldn’t believe what I almost did. Right? There’s a lot of that stuff that just gets you get you through and keep you going and keeps it good people are very real. There’s not a robotic feel to any of this.

Andy Slavitt  42:43

So even the hard work, even the difficult moments, it’s more rewarding, because you feel like you can, you can be yourself and people are themselves and contributing, and not perfect. But more dedicated people are more dedicated to this probably than anything they’ve been in their entire life. So you know, in that sense, I’m appreciated to be part of it. It wasn’t something that is, you know, it wasn’t something I expected to be doing wasn’t something I was looking to do. And it wasn’t something that at first, I was in the in the mode of doing I had a whole year planned out of plenty of other things. But it is a privilege. I do feel very fortunate to be part of it.

Dr. Bob Wachter 

Sounds immensely gratifying.

Andy Slavitt 

I’m going to be walking out to our press briefings, I got a press briefing starting in five minutes, and they will scream like crazy. If I don’t find out they’re like in a minute.

Dr. Bob Wachter 

Maybe last question, then is this pandemic is going to end eventually? What is the future of this podcast?

Andy Slavitt 

Look, I think the audience will decide that, I mean, if the audience wants to hear from somebody, you know, whether it’s you whether you know, I leave this place at the end of May, me and said you know, whether it’s in the bubble, or getting outside of the bubble, or sorting through the challenges that you know, all this has created for us or new challenges. I am hopeful that people feel that it’s a really distinct voice. They want to keep listening to I selfishly frickin loved doing it. So I would you know, I wouldn’t be, I’m not gonna do it for myself, but I wouldn’t be on there talking to no audience. […] I want to hear from you and your guests. And this is what I want to hear. You will pay attention. And as you know, maybe we could spend a lot of time talking about people on Lemonada Media, like they know how to do this stuff. I mean, they are great, great people.

Dr. Bob Wachter  44:56

Very fantastic. Absolutely terrific. We should let you go. Thank you, you’re the best. And this has been amazing opportunity for me and the team is fantastic. And thank you for everything you’re doing. You’re saving lives every single day. And we’re really grateful.

Andy Slavitt 

I really want to tell the audience how much I miss them all. It’s hard to believe that I kind of feel like I know them. So I miss them all.

Dr. Bob Wachter

Yeah, well, they miss you, too. All right, be well stay safe. We’ll look forward to have more stuff out of you and the team there, you’re doing great work. Thanks so much.

Dr. Bob Wachter 

A profound thanks to Andy Slavitt. Partly because this show wouldn’t be here without him partly, because it’s pretty gratifying him that despite the fact that he’s pretty busy, I would think he’s still taking the time to listen to us and, and critique us. But mostly because of the work that he is doing. And you can I mean, those of you who know him from the show, know how passionate he is about the work and getting it right and how much he is driven by all of these deaths and tragedies and doing everything that is humanly possible to have fewer of them as we go forward. So it was great to hear about all the things that they’re doing. So also one of the things I’ve always admired about Andy during the time when he ran Medicare and Medicaid and now is you know, he’s at this point, he’s a government bureaucrat, but he doesn’t talk in bureaucracies.

Andy Slavitt 

Bye, Bye, guys.

Dr. Bob Wachter  46:31

He talks truthy. He’s authentic. He’s, he’s him. He can’t help but be him. And I think that’s what everybody loves about him and why it’s been why it was so nice to have him on the show. You may have heard the audio changing for the last three to five minutes. So the first 45 minutes or so was him sitting in an office. And the last three or five minutes was him running through the halls of what a building that I believe was the White House on his way to one of his three times a week briefings. And I think he may have almost been late because he spent a little too much time with us. That’s our Andy. It was really terrific to have him and to hear about the things that the government is now doing to get things right. And I you know; I think that they’re pretty much doing everything they can do. So it’s partly why I’m much more optimistic about things than I would have been a few months ago.

Dr. Bob Wachter

We have some other great shows coming up. And I think they are clear evidence of the variety we have here on in the bubble. The next will be with Peter Hotez, one of the world’s experts on vaccines. You have seen him on many, many cable news shows he’s the guy with the bow tie. So we’ll talk to him about the vaccines, the new vaccines coming out whether you should skip the second dose, what happens with all of the variants? Should we be worried about the UK one or the South African one, we’ll get into all that it’s really a it’d be a fascinating show. We’ll switch gears for the next one which will be our time with the Platt family. Actually, not all of them, but three members of the Platt family Marc, Jonah and Ben, both Jonah and Ben had COVID. So we’ll hear about their personal experience, but probably spend most of our time talking about the impact of COVID on the Arts.

Dr. Bob Wachter  48:11

And how people have made it through this year in the arts, and many of them have struggled quite a bit, and how the arts have managed to keep producing, for example, producing movies during COVID, which is quite a story some of the things they’ve had to do to get movies out there. And we’ll shift gears again and we’ll talk about Israel. Israel has become the A plus student when it comes to a national vaccination program. You’ve probably heard that where it’s the United States, we’re at about 15% of people vaccinated. Israel is about two thirds of their population now having been vaccinated, and that’s terrific for them. But it’s also given us an early view of what happens when a country gets vaccinated. So lots of great stuff coming up here on in the bubble look forward to having you with us. Until then, please stay safe.

CREDITS

We’re a production of Lemonada Media. Kryssy Pease and Alex McOwen produced our show. Our mix is by Ivan Kuraev. Jessica Cordova Kramer and Stephanie Wittels Wachs executive produced the show. Our theme was composed by Dan Molad and Oliver Hill and additional music by Ivan Kuraev. You can find out more about our show on social media at @InTheBubblePod. Until next time, stay safe and stay sane. Thanks so much for listening.

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