Dr. Scott Gottlieb, physician, former commissioner of the U.S. Food & Drug Administration and frequent contributor on national news programs, including CNBC’s Squawk Box
and CBS’s Face the Nation
, joined WHA President and CEO Eric Borgerding for a moderated discussion, the keynote presentation at WHA’s 2022 Virtual Advocacy Day program. The keynote presentation was sponsored by Quarles & Brady, LLP, and Sarah Coyne, partner with the firm, introduced the segment. Gottlieb and Borgerding discussed various facets of the U.S. response to the COVID-19 global pandemic and lessons learned for future pandemic preparedness.
Borgerding began the conversation on the topic of the collection and sharing of data and information as a fundamental element of pandemic preparedness and response. Gottlieb shared his perspective on the critical breakdown of data and information sharing between the U.S. Centers for Disease Control and Prevention (CDC) and the Department of Health and Human Services (HHS) in the early months of the pandemic and discussed the dynamic between the two agencies.
“The lack of good information and near real-time analysis was at the root cause of a lot of the early problems,” said Gottlieb. “I think a lot of people were surprised at the CDC’s lack of capacity to collect bottom-line data that could inform real-time decision making,” Gottlieb continued.
Gottlieb explained how the CDC’s use of modeling in reporting hospitalization data created a misrepresentation of the situation and led HHS to develop a new reporting system for acquiring real-time data directly from hospitals. Gottlieb provided examples of the CDC’s structural, cultural and operational challenges as justification for the agency’s inability to collect real-time data at the time.
Borgerding asked Gottlieb about the March 2020 directive to hospitals across the country to stop elective and non-emergent procedures. Was it the right decision, given the data available at the time? Gottlieb did not think the directive was the right decision, nationally, although he agreed it was necessary for parts of the nation who were overrun by COVID-19 patients at the time, like New York City.
“Other parts of the country did not have much spread or none. But we did not know where the virus was and wasn’t. We were blind during the first wave,” said Gottlieb. “We did not need to shut hospitals and commercial activity in Montana, and was probably true of Wisconsin. The wave came later,” he continued.
According to Gottlieb, diagnostic testing needed to be more widespread earlier on in the pandemic to better inform where the virus was and where it was not.
Exploring linkages between the health crisis and national security, Borgerding asked Gottlieb about global cooperation in the pandemic response and public health preparedness. Gottlieb compared public health preparedness to national security in the terms of infrastructure investment, such as testing, vaccines and hospital capacity. He reflected on the reluctance to share information between nations, using South Africa’s discovery of the Omicron variant and the global economic isolation that followed as an example of a disincentive to do so. As countries exhibit unwillingness to collaborate, Gottlieb called for the U.S. to do more of its own monitoring and data collection.
“I think we are going to need to do much more active monitoring around the world, and that is going to mean collecting data—looking for indications of outbreaks, trying to intercept data where you can get early information about potential pathogens,” said Gottlieb. “We cannot be solely dependent upon on multi-lateral commitments and the good graces of other nations, especially as we’ve conditioned other nations that if they do the right thing, divulge information early, they’re going to get punished for it,” he added.
Referencing shifting sentiment toward the health care industry following an outpouring of support early in the pandemic, Borgerding asked, “How do we gain trust for our patients, for the public to listen to public health officials, for our staff that have been demoralized and defeated by disinformed patients, and for our health systems, hospitals, doctors, public health officials and institutions in general?” Gottlieb said of regaining public trust, “I think the one missing ingredient from the public health establishment was enough humility to be candid about what we knew and didn’t know and admit when we were wrong.” He recounted how the CDC’s guidance on masking left the public feeling confused and misled. He attributed the confusion to the agency’s reluctance to deliver complex, but accurate messages on “what [masks] will do and what they won’t do.”
Borgerding concluded the 60-minute discussion with a focus on lessons learned from the pandemic and Gottlieb’s thoughts on President Biden’s COVID proposals. Gottlieb said he was encouraged by the plan the Biden administration has laid out. “Conceptually, they are looking at public health preparedness through that national security lens,” he related. “They are looking at trying to build core capacities and invest, rather than just put out individual fires.”
As for lessons learned, Gottlieb called for “an honest after-action report,” but recognized that the current environment is too polarized and “emotions are still raw” for that to happen just yet.
A full recording of the discussion between Borgerding and Gottlieb is available for viewing for registered Advocacy Day attendees through the LeaderPass
event platform until April 7.