Full transcript: Dr. Deborah Birx on Face the Nation, January 24, 2021


The following is an expanded transcript of Dr. Deborah Birx, which aired on CBSN and “Facing Forward” on January 24, 2021.

The extended interview will air on Sunday on CBSN, the 24/7 streaming news service of CBS News, and can be heard as a special edition of the new episode “Looking ahead with Margaret Brennan” Podcast.

MARGARET BRENNAN: I would like to start with some news of the moment we are dealing with this virus. President Biden took a number of measures on the first day: ordering the executive to wear a mask on federal property or on interstate travel, screening everyone on White House grounds, quarantine after international travel, and requiring agencies to Data exchange. What do you think of what he’s done so far?

DR. BIRX: Of course, I fully support all of these elements. I’m a strong advocate of masks and even mask mandates. I think mask mandates are really critical because you need that constant reminder. I mean, we’re talking about our main tools, in addition to the vaccine, behavior change. And when you ask people to change their behavior, you need these constant reminders. And when I was out and about, in the mask mandate states, it was very helpful to be reminded that I had to wear my mask. And so full of me – and everything that has to do with data that I’m excited about. We have some very old databases. We used a lot of modeling instead of improving the way we collect real-time data. I think that’s absolutely crucial. And I think the other innovations to really bring people together have what he didn’t like. One of the directives from the executive concerned the White House coronavirus response coordinator and a deputy. I was an N of 1. So having a team in the White House that can really respond is going to be really very important because the amount of work that has to be done not only in the White House but also in the White House is going to be very important It will be important to really make sure at the state level that we come out of it in some kind of normality by summer.

MARGARET BRENNAN: You said you were only one. You were the coordinator of the task force. What do you mean you were just one?

DR. BIRX: There was only one full-time employee in the White House working on the coronavirus response. There–

MARGARET BRENNAN: How is that possible?

DR. BIRX: Well, that was given to me. So I went to my people, whom I have known in government for the past few years, all 41, and said, can you come and help me? And so I was able to recruit individuals from other agencies. And of course, Irum Zaidi, whom I brought from PEPFAR, was my chief epidemiologist and data developer for the PEPFAR program, where we really revolutionized the data to really get the work done to end the HIV and TB pandemic in sub-Saharan Africa break up. And so I could weave together a group of volunteers who really helped me.

And I had an amazing support person, Tyler Ann McGuffee, who really helped make sure I got to meetings on time and never missed any emails. But there wasn’t a team, a full-time team in the White House working on coronavirus.

MARGARET BRENNAN: Did you ask about employees and were refused?

DR. BIRX: I asked about staff. I think what they do to get an expert in testing, an expert in vaccines, an expert in data and data usage, not just collecting data but how to use it successfully, I think all of these parts will be crucial Hiring a full-time employee in the supply chain is essential for their success. And so all of these individuals existed, but they existed in different government pockets. So, as a team, you have to constantly work outside to get everyone on board and make sure the response is as coordinated as possible.


Regarding vaccines, the president says 100 million doses in 100 days. That’s not 100 million Americans vaccinated. What do you think is actually possible? Is that too limited a goal?

DR. BIRX: Well I know we – we haven’t talked much, but I’m very – I’m very, very hardworking and adamant about where we need to go. And I would be happy if 100 million people were protected in 100 days.

MARGARET BRENNAN: Real gun shots?

DR. BIRX: Actual shots in arms, people in arms. I think it’s really important to get vaccines up as quickly as possible. I understand – and as I told you right after the elections, there is currently not much infrastructure behind many of these initiatives in the federal government. And – and I know that they will provide the infrastructure for it. I think things will speed up, but we shouldn’t hold back. So we really have to make sure that states that are doing well are even better off. Learn from these states, take that to other states. I think learning more on site – that’s why I got involved in the field to really understand what works on site.

MARGARET BRENNAN: So it sounds like you think it’s a little modest as a goal. But

The Biden coronavirus Tsar told reporters for lack of a better term, “When it comes to the vaccine, what we inherit is so much worse than we could have imagined.” Is that a political statement? Is that correct?

DR. BIRX: You know, I’ve been trying to process for the past 11 months because I – it’s really important that we understand what worked and what didn’t. And I think I tried to bring it all together. And I took extensive notes throughout the process because I didn’t want to lose sight of what we need to do to improve our response in the future. One of those critical areas, and you are really getting to this essential point, is this idea of ​​federalism on which the United States was built. But that can go to extremes. And so the mantra was always supported by the federal government and administered by the state, carried out locally.

MARGARET BRENNAN: That was the Trump plan?

DR. BIRX: That was – that was the mantra. But what does support mean? And what does federal support mean? And I really think an understanding of what states need in order to implement guidelines, what states need – states need to interpret data together. You only see your data. But it’s really important that they understand what is happening across their entire region because people have been mobile. When we were out the highways were full of travelers. And so I think that this idea of ​​how the federal government can better support states not only delivers things, but also delivers new ideas and innovations on how these things can work better. And I think your intention – I hope your intention is to do just that. So Arum Zaidi and I took to the streets.

We took to the streets because we wanted to find out which states need federal support, how they interpret these guidelines, and how communities interpret the CDC guidelines.

MARGARET BRENNAN: We have heard again and again from the Trump administration, particularly from Secretary Azar, that they have received this information from the states, that they react, that all of this is only politics when governors complain.

DR. BIRX: So we’ve worked very hard to build a comprehensive database, not without a lot of scars in the past 11 months. For me personally, this was very important because in order to get reliable data, it’s not just the actual number, but also the trend lines around that number. And are there turning points in the slope of the evolution of this number? So we really tried to put all test data, all case data, all hospital data and certainly all death data together in order to be able to constantly triangulate data down to the most detailed level, because I think that’s very important. Here you can see success and you can really see that counties are doing very well, metros doing very well. Then you need to come to them and learn from them because remember, they are about to stop a pandemic. That is why they are working very hard with their citizens to stop a pandemic. If you want to learn from them, you have to physically walk, see what they do, and bring that knowledge back into other states. I think that is the approach they will take. I think the previous administration has been very focused on that when we see a data problem. If we see a problem illustrated by the data as with N95 masks, we send it out with N95 masks. However, when you talk about translating tests more proactively or strategically, you need real examples of how you can do it better. You can’t just send more tests. And I think that’s the kind of learning, the two-way learning between states and the federal government that I hope will increase with the new administration.

A test positive of even 0.1-0.3-0.5% indicates that you have a growing community spread. This is the time to tell this population, this local population, that more community is expanding. You have to do these things. The problem is that we are still late in reacting and that the spread in the community is so widespread that you have two to three to four weeks of really significant hospital stays. And that always concerns me that we don’t stop the virus soon enough.

MARGARET BRENNAN: The CDC director said the health infrastructure was “fragile and poorly maintained”. She seems to be saying this is an issue beyond President Trump. It sounds like she’s saying the infrastructure is rotten. Is that how you describe it

DR. BIRX: Well, that is such a revealing point. It should be–


DR. BIRX: It is a very illuminating point because, after federalism, one of our biggest problems is that we have a complete separation between what we call our clinical data systems, what happens in laboratories and hospitals, and our data systems for have public health. And they don’t interact in any way. When we had to create these databases and data streams, we had to merge public health data with clinical data. And of course that doesn’t exist in the USA and it has to be fixed.

MARGARET BRENNAN: But we are the richest country in the world. What do we call the CDC, which is supposed to be the leading agency, frail?

DR. BIRX: Because we didn’t value prevention. And we didn’t take on the difficult task of prevention early enough to really prevent some of these comorbidities. We are very good at identifying them and the CDC said great it was high blood pressure here. Obesity exists here. There is diabetes here. This is where our overlapping comorbidities exist. But to really tackle this you need to have detailed data, and it needs to be very abundant so that you can see if your interventions are working. So we have serious problems, but we don’t approach them in this deliberate, data-driven way to really make changes. And I think the new CDC director realizes that we really need to bring clinical and preventive responses together in order to really be effective.

Because if you can show a governor why we were also out, if you can show the governor that the Phoenix cases dropped dramatically within two weeks of a mask mandate. Then I can take that to another city and say the mayor of Phoenix did that. Look at the effects. This is the data. You can see that then. And then you can tell your people that the reason we are asking you is that it worked and it worked in Phoenix. We believe it will work here in Tucson. And that’s the kind of information we need about obesity, high blood pressure, and diabetes. We just cannot ignore these comorbidities that put Americans at significant risk.

MARGARET BRENNAN: Some would hear you say that and say it sounds like you are accusing Americans …

DR.BIRX: Oh God, no …

MARGARET BRENNAN: – for her own health problems.

DR. BIRX: Never. Never. These health problems are certainly genetic. But we created a system that was not worth giving Americans clear information and the clear ability to take preventive action. We like to treat diseases. We’re not that good at prevention. And that became very clear in this pandemic. And I would never blame an American for suffering from the same things. And I – I think I should blame myself. I mean, I was on my way. I gained 15 pounds. I mean, I can tell you that if you eat some of our food that is regularly available to us, you will gain weight. If you are immobile and drive around and eat McDonald’s fries all the time, that’s not a good situation. I have a direct experience of what this situation is like. And now I have to work on it. But to encourage people and show that work produces results and impact – people will change their behavior when they know what to do and they will be positively empowered.

MARGARET BRENNAN: You were often at odds with the CDC, I was told. Is that true?

DR. BIRX: I know the CDC well, so it was difficult just to be very clear, it was harder for them because I knew where the gaps were. When I walked in I really asked for those loopholes to be filled. And a lot has to do with real-time data and real-time data collection and data revolution and data modernization to make things better so that the CDC, the leading public health agency, has daily updates on how Americans are doing. Not just in this pandemic, but generally down to the postal code level, so it’s clear what to do. So I was very pushy. I was also very pushy, and the only thing that was completely taken out of context when I talked about not trusting the CDC data was that due to the delay in that reporting, it was early on with ethnicity and race of the people Deaths had to do. So I have used the information from my European colleagues and I am still deeply grateful to them for understanding who is most at risk of serious consequences from this virus, as our delay for death certificates containing all this information may be longer until 30 Days.


DR. BIRX: Well, when you’re in the middle of a pan – and it’s gotten better. So that was the argument. They never talked about what was discussed before and what was discussed after. I really like doing real-time data better. And the way you improve real-time data is by using it.

MARGARET BRENNAN: You said you thought there might be an American strain of this virus floating around and the CDC says they have no evidence of it. Are you wrong?

DR. BIRX: Well, there are two parts to it, to be very clear. So we certainly had what it takes in this country to develop the same kind of what we call more communicable tribes in the UK, Brazil and South Africa. In fact, we had more capacity because we kept having more cases and infections in the United States. So this virus naturally mutates. It’s constantly changing because it’s an RNA virus. Some of it is just a bug and a bug and this virus is no longer able to replicate itself. Other changes can bring a competitive advantage. It’s not like trying to get fit intellectually. It just happens to make these mutations. You will then be fit, better able to spread, and then you will see this escape. So you find them by constantly sequencing the underlying cases so you can look for what we call node escape. Where it’s enriched, where you see more of those sequences in that area. We have always done that in molecular biology. We haven’t had enough of these sequences. So what I was looking at is the fall rate of rise.


DR. BIRX: –and the death rate. So what I said and what I – everything I personally do, I stepped up in October because I could see this rate of increase. So I wanted the governors to know what I was worried about, and I said it might be. Of course, I didn’t say we have one until you have all the sequences you can document them. But certainly the incline of the fall climb was twice as fast and takes longer and critically it was more difficult to moderate. So Texas and Arizona are doing exactly what they did over the summer to control the spread. And it doesn’t have the same effect. You saw the same thing in LA. So I wanted the governors to know we can have it.


DR. BIRX: But we should pretend we have it. On two sides we should sequence more to actually find out if we have it. At the same time, we should improve our mitigation and go to our communities and say that what is happening in the UK could happen here and we just don’t see it yet. So let’s pretend we can …


DR. BIRX: –and let’s tone down more.

MARGARET BRENNAN: I want to talk about when you joined the COVID Task Force. So we are at the end of February. CDC officials give reporters a briefing that fuels the markets when they say a virus may be spreading within the community and it could seriously disrupt daily life. Dr. Fauci goes on TV a few days later and says the risk for Americans remains low. You look at this and what do you think?

DR. BIRX: So I’m in South Africa. We all have our countries from all over the world. We work 24 hours a day, but we take a break at dinner. And we stay in a place where we can cook and I love to cook. So we cook, we eat, we watch CNN. And so we’re shouting at CNN TV these two weeks of February saying this is going to be a pandemic because the Chinese – what I saw from China, if you are overwhelming your hospitals, you must know you are wide – based Spread community before that happens. Still, they didn’t see it. From the moment I saw the hospitals in China, I was concerned that this coronavirus pandemic had a widespread, asymptomatic component. And that really worried me because we were looking for people with symptoms. When people came into the country, we looked for people with symptoms.

MARGARET BRENNAN: When you tell us who do you mean?

DR. BIRX: I mean the United States.


DR. BIRX: Well, the United – I think they were all. I don’t know who was on the task force at the time, but I think there were several agencies represented at that point.

MARGARET BRENNAN: That was Matt Pottinger, –

DR. BIRX: Yes.

MARGARET BRENNAN: – The Deputy National Security Advisor?

DR. BIRX: Because I know him and have known his wife for a long time. We worked on pandemics together. We were both in Asia during SARS. So we understood how serious this could be, and I think I believed that our technology would really save us, that we would be able to find all infections or stop all infections. However, if you have an asymptomatic component, the only way to find it is through proactive testing.

MARGARET BRENNAN: And he asked you, Matt Pottinger is asking you to come to the White House from the State Department.

DR. BIRX: And I’ve said no about 20 times.


DR. BIRX: Well, from the outside, everything in the White House looks very chaotic. I had …


DR. BIRX: – The first three years of this administration tried to stay out of the turmoil and protect the PEPFAR program. We have of course had extraordinary cuts every year.


DR. BIRX: The President’s Emergency Plan for AIDS Aid. It’s what changed the course of the pandemic around the world for both HIV and TB. And I’m very proud of the work that the community and I, the community, the Global Fund, UNAIDS, WHO, PEPFAR are doing along with our HIV advocates and community groups around the world. We did it, but we all worked together. And I’d spent three years protecting the program, keeping my head down, and getting my job done. I wasn’t interested in going into a political space. I am not a political person. I’m an official. I was never a political person. I’ve never worked on a campaign before. I have never advertised any of the candidates. I take the Hatch Act very seriously. I am just not a political person. So it never crossed my mind to go to the White House until I saw we were missing parts that I thought were very important in the answer. After saying no, no, no for many weeks, the president announced the new task force headed by the vice president. They said this was very technical and that I had a very technical position. And because I thought I might be helpful, that’s the only reason I’m doing something. When I think I have something to add, I think that it is my obligation to the American public to do so. An officer should do that.

MARGARET BRENNAN: Do you feel like you’ve made a difference?

DR. BIRX: Yes.


DR. BIRX: I think the biggest difference was in the testing. As soon as I arrived on March 2nd, I spoke to the vice president. I said these are the three loopholes I think we have. You need to be addressed this week. We keep coming back every day. You cannot counter this epidemic by doing small conformational tests in public health labs in the first place, as we do with the flu. As they approached this as a pandemic flu because it was expected in the United States, tests are used to confirm about every thousand or every hundred thousand cases. Flu is diagnosed by symptoms.

MARGARET BRENNAN: But Dr. Fauci, Dr. Redfield from the CDC, they were there.

DR. BIRX: But you know, when you’re in the middle of it and you’ve been very focused on preventing infections from getting into the US. They were very focused on this and looking for these symptomatic cases. Thought what to bring with me, I had a lot of experience with RNA viruses, RNA virus test development, and vaccine development, but mostly trying to get the government to work and the government to work efficiently and effectively and change management in government. And I can tell you, change management in the federal government is very different from change management in the public sector – the private sector. And so I want to – I thought I could bring in some of those skills and focus on being able to read data and spot changes early so people can get alerted early on.

MARGARET BRENNAN: So, as you said, you were an official. You were a colonel in the army?

DR. BIRX: Yes.

MARGARET BRENNAN: As an immunologist, you were appointed by President Obama to, as you mentioned, work in the State Department on AIDS relief. However, her name in the history books is associated with President Donald Trump. How does that sit with you?

DR. BIRX: Well, you know, that’s what worries me. Then when I see how partisan and divided the United States is, it will be played out in the civil service, and if we start to think of technical officials as belonging to a political party, we will lose the ability of highly skilled officials to come and get help . And we have amazingly qualified officials. You’re with the CDC. You’re at HHS. You’re with the FDA. You’re with NIH. And most of the White House staff are officials deployed by their home agencies. If we say if you come in and do this, you will be part of the political apparatus which will be very dangerous for this country.

MARGARET BRENNAN: Do you have the feeling that your work is being misunderstood as political?

DR. BIRX: I don’t – I think pandemics are always political. I’ve worked in 60 countries. Every pandemic is political because you have to make policy changes to address them, and policies are often political.

MARGARET BRENNAN: I mean, you worked on AIDS, which is a highly politicized virus.

DR. BIRX: Right.

MARGARET BRENNAN: – In sub-Saharan Africa. But has anything prepared you for the politics that you witnessed here with this pandemic in this White House?


And I have the feeling – it’s still difficult for me because I pride myself on always finding a way, finding a way or being able to find one. If that doesn’t work, go this route. If that doesn’t work, go this route. You can find a different set of alliances. White houses are quite bureaucratic, and most agencies are very predictable and bureaucratic. However, when you remove the officials’ infrastructure, you get much faster right, left, right, and left turns, and that becomes less predictable and less able to handle and change that type of response.

And so I think that in a way people will say that it is very important to disrupt and change. And yes, disruptions and changes and turning points in American history are important. And it’s important to recognize them and build on them. But even in a pandemic, it can be very, very difficult to keep getting us to the answer we need and to be able to point out where the problems are coming from. Nevertheless, I was allowed to work with a number of political and technical staff from all agencies. CDC has been tremendously helpful. FDA, NIH, and the teams working on vaccines are dedicated officials who gave everything for this pandemic. And so I think the other thing I knew was that this was historical. So I took extensive notes of each meeting, daily reflections, to really understand what I was seeing. I wrote a report every day, over 310 of which were given to senior executives. We created–

MARGARET BRENNAN: Has President Trump read it?

DR. BIRX: I don’t know. I dont know. I sent them to the vice president. I had very little contact with …

MARGARET BRENNAN: But did you briefly brief President Trump?

DR. BIRX: I had very little contact with President Trump.

MARGARET BRENNAN: So you looked at all of this data. Do you think when you were in the room chatting, even if it was to other people, do you think President Trump appreciated the severity of the health crisis you described?

DR. BIRX: I think the President estimated gravity in March. It took me a while to get to the White House to remove any additional data that came in. I mean, a parallel stream of data came into the White House that wasn’t used transparently. And I had to stop where people were …

MARGARET BRENNAN: You mean external consultant?

DR. BIRX: External consultants who come to internal consultants. And to this day I am convinced that there were parallel data streams until I left because I …

MARGARET BRENNAN: Disinformation?

DR. BIRX: I saw the President come up with graphics that I never did. So I know someone – or someone out there or someone in – created a parallel set of data and graphs that were shown to the President. I still don’t know who to this day, but I know what I sent up and I know what was in his hands was different. This worries me because every moment I’ve built my career on data transparency and accountability. It is very important to me that we all agree on how the data is collected and how we use it – use it. We don’t cut it in pieces and say we won’t look at it until these six weeks because it makes us look better. Oder wir werden es uns alle in diesen zwei Wochen ansehen, weil wir in diesen zwei Wochen besser aussehen als Europa. Das kannst du nicht machen. Sie müssen die gesamte Datenbank verwenden.

MARGARET BRENNAN: Wer hat das gemacht?

DR. BIRX: Bis heute weiß ich es nicht. Ich weiß jetzt, warum ich mir einige der Bänder angesehen habe, die Scott Atlas sicherlich in parallelen Datenströmen gebracht hat. Ich weiß nicht, wer noch ein Teil davon war, aber ich denke, wenn die Aufzeichnung zurückgeht und die Leute sehen, was ich täglich schrieb, das an die Führung des Weißen Hauses geschickt wurde, werden sie das sehen – dass ich hoch war spezifisch auf das, was ich sah und was getan werden musste.

MARGARET BRENNAN: Also sagt der Stabschef nicht, Moment mal, das ist unser offizieller Koordinator, der nur auf sie und sie hört? Dir zuhören? Niemand hat das gesagt?

DR. BIRX: Das hat mir niemand gesagt.

MARGARET BRENNAN: Zum Präsidenten?

DR. BIRX: Ich … ich weiß nicht, ob sie es dem Präsidenten gesagt haben.

MARGARET BRENNAN: Glauben Sie, der Präsident war nur von den politischen Implikationen und der Kampagne abgelenkt?

DR. BIRX: Weißt du, ich frage mich immer, und die schlechteste Zeit, in der du eine Pandemie haben kannst, ist ein Präsidentschaftswahljahr. Ich möchte nur ehrlich sein. Es gibt Politik und es gibt Politik und es gibt Pandemien. Aber in einem Wahljahr nimmt alles eine andere Perspektive ein. Ich denke, die Mitarbeiter des Weißen Hauses waren im März und April sehr auf diese Pandemie konzentriert. Ich denke, als sich das Land zu öffnen begann und mir klar war, dass sie nicht meinen wirklich festgelegten Kriterien folgen würden, an denen ich hart gearbeitet hatte. Und der Grund, warum Gating-Kriterien für mich so wichtig waren, ist die Kombination der Erkenntnisse von Tom Frieden mit Zeke Emanuel und Scott Gottlieb. Ich nahm – sie hatten die drei Wachposten, wie man Amerika sicher öffnet –

MARGARET BRENNAN: Wie man Restaurants eröffnet, wie man Leute drinnen speisen lässt …

DR. BIRX: Ich habe all das für diese großartigen Gating-Kriterien kombiniert. Als ich also alles mit der langsamen Wiedereröffnung berechnete, dachte ich nicht, dass irgendjemand bis August in Phase 3 gelangen könnte. Und Sie können in den Staaten sehen, die entweder diesen Kriterien oder ähnlichen Kriterien folgten, wie lange es gedauert hat. Und bis dahin hatten wir die Sturzflut. Ich wollte den Sommer ruhig halten, damit wir Kapazitäten aufbauen können, um zu dem zu gelangen, von dem wir alle wussten, dass es ein viel schwierigerer Herbst werden würde.

MARGARET BRENNAN: Was waren die größten Hindernisse für Sie, dies zu kommunizieren? Ich meine, gab es im Weißen Haus COVID-Leugner?

DR. BIRX: Es gibt Leute im Weißen Haus und ich denke, Leute in diesem Land, weil ich das Privileg hatte, sie zu treffen und ihnen zuzuhören und sie zu hören, weil ich hören wollte, was die Leute sagten. Es gab Leute, die definitiv glaubten, dass dies ein Scherz war.


DR. BIRX: Ich denke, weil die Informationen am Anfang verwirrend waren. Ich denke, weil wir nicht über das Krankheitsspektrum gesprochen haben, weil jeder interpretiert hat, was er wusste. Und so sahen sie, wie Leute COVID bekamen und es ihnen gut ging.

And then they had us talking about how severe the disease is and how it could cause these unbelievable fatalities of our American public. I mean, so every American life lost, I mean, I haven’t slept in 10 months or 11 months because those were the numbers- that’s someone’s parent. That’s someone’s grandparent. My great grandmother was lost in the pandemic flu. I know what that feels like from just listening to my grandmother. To have that others feel that same level of pain and loss when it was preventable or could be preventable was really excruciating. So–

MARGARET BRENNAN: So you don’t blame the president’s own language of calling some of this politically motivated, a hoax? It was a phrase he used at one point.

DR. BIRX: You know, when you have a pandemic where you’re relying on every American to change their behavior, communication is absolutely key. And so every time a- a statement was made by a political leader that wasn’t consistent with public health needs, that derailed our response. It is also why I went out on the road because I wasn’t censored on the road. I was able to speak freely about mask mandates, closing bars when you’re in the middle of a surge, closing indoor spaces where people are going to take off their mask and be inside. We know those are–

MARGARET BRENNAN: You felt censored?

DR. BIRX: –spreading events.

MARGARET BRENNAN: You felt the White House was censoring you?

DR. BIRX: Well, if you noticed, I was not able to do national press. The other thing that was very important to me is I was not going to go outside of the chain of command. And so if our White House comms group did not put me out, I didn’t ask to go out. I- because there was so much leaking and so many parallel stories being leaked to the press that did not have grounding in truth that I didn’t want to ever be part of that slippery slope. I know people started it with good intentions of trying to inform the American people, but then it became a way that they could silence those who didn’t agree with them. And so I knew that every time I had a significant disagreement in the White House that within days a story would be planted.

MARGARET BRENNAN: Who was doing that?

DR. BIRX: I think a lot of people were doing that.

MARGARET BRENNAN: And meanwhile, Americans are dying. Tens of thousands, hundreds of thousands at this point. I mean, there was a long stretch of time right before the election where we didn’t hear from you. We didn’t hear from Dr. Fauci. We didn’t hear in the public space from Dr. Redfield in the midst of this national crisis. Do you think the administration was suppressing vital information to win the election?

DR. BIRX: I don’t know what their motivation was. I know that I was so frustrated by the end of May going into June by the lack of reaction to what I could see in the middle of May coming, that it and that- you combine that with the gating criteria not being utilized, that I realized that the only way, if I could not get a voice internally, that I could get a voice out at the state level because I could see the governors on the governor’s call weekly and I could see how deeply they were concerned about every one of their citizens. Most of them were not in the middle of an election campaign. And so by going out and working with the governors, I- two things happened. One, I got to see amazing things that are best practices and really bring those back. And what I’ve learned from Detroit and Chicago and Arkansas and Alabama and Texas and Arizona and up through Connecticut- I mean, it’s just been amazing to be able to see really great solutions and try to bring those back. But that was the place where people would let me say what needed to be said about the pandemic, both in private with the governors and then in following up, doing press to talk to the people of that state. They also would let me do regional press. And really, I want to thank the comms team who let us go out regionally to speak to people in the States when I could see changes coming and the comms team every week would ask me for a list where were- where were my concerns? And then 10 individuals or so went out that week and did- and just blanketed regional press to really say these are the things you need to do. It was difficult during the- during the run-up to the election. That was the time when one of my daily reports- there was by that time 200 of them. That was when one of them was leaked, right before the election. So clearly there was some intentionality there. And I was talking about how severe the epidemic was in the Northern Plains states and saying if that epidemic gets into our populous states of California, Texas, Florida, New York, that this would be an early surge to what we expected in the winter with the expansion of this virus. And so I was very worried. But others were worried, too. I want to make it clear this was just not Debbie Birx. There was a coalition of- of four of us at the beginning, from Steve Hahn to Bob Redfield to myself to Tony Fauci that- making it clear that we would- we would make sure that we could get the information out to the public in one way or the other. It’s why I sent the information to all of them every morning, because I never knew who would have the ability to do press.

MARGARET BRENNAN: Did you ever consider quitting?

DR. BIRX: Always.

DR. BIRX: I mean, why would you want to put yourself through that, um- every day? Colleagues of mine that I had known for decades- decades in that one experience, because I was in the White House decided that I had become this political person, even though they had known me forever. I had to ask myself every morning is there something that I think I can do that would be helpful in responding to this pandemic? And it’s something I asked myself every night. And when it became a point where I could- I wasn’t getting anywhere and that was like right before the election, I wrote a very detailed communication plan of what needed to happen the day after the election and how that needed to be executed. And there was a lot of promise that that would happen.

MARGARET BRENNAN: Because you knew at that point that the election was a factor in communication about the virus?

DR. BIRX: Yes. Yes.

MARGARET BRENNAN: Did you ever withhold information yourself?


MARGARET BRENNAN: Some people felt you became an apologist for President Trump. They look at that moment in the briefing room, you know the one I’m talking about, when he came out and he talked about injecting bleach and you were sitting there and he looked at you and he asked about ultraviolet light and heat–

DR. BIRX: See, that,–

MARGARET BRENNAN: –and you start talking about fevers. You didn’t say no.

DR. BIRX: No, no. OK, so–


DR. BIRX: –so let’s go back to that, because that’s a really critical moment. He was not speaking to me. He was speaking to the DHS scientist that was two seats over from me that entire time. When he finally turned to me and said, is it a- could this be a treatment, I said, not a treatment. You can look at the transcripts. Not a treatment. That dialogue was between the President of the United States and a DHS scientist. I have always been respectful of offices, and you can see I don’t criticize people specifically in public. I- I don’t think that- I always think that you need to transcend that and you need to find a way to communicate effectively where you’re not criticizing a person in public. So when he did turn to me at the very end of that dialogue, I said, not a treatment.  Now it’s in the transcripts. It never got picked up by the press as that is what actually happened.

MARGARET BRENNAN: Your answer when he said, bleach, you said not a treatment?

DR. BIRX: Not a treatment. When he turned to me and said, what do you think? Could this be a treatment? I said, not a treatment. But that moment was- that was completely lost. And then there’s, you know, skits on Saturday Night Live.

I mean, when you’re a scientist who’s grounded themselves in data and combating epidemics and working with communities and working with governments to change the future of people’s lives for the better and then you get- this is what- when you talked about, was I prepared for that? No, I wasn’t prepared for that. I didn’t even know what to do in that moment. I think, you know, that’s when you’re in that can’t let the floor swallow you up moment. I mean that conversation between two people was going on in front of me.  And I- I to this day don’t know what to do when that happens. I think now- I think there’s some people who thought that I would just stand up and take over the microphone from the President. I don’t know what people’s expectations were in that moment.

MARGARET BRENNAN Well, sometimes people say, well, Tony Fauci, when that happened to- to him, he would sort of gently come back up to the podium and set the record straight if he disagreed with the President.

DR. BIRX: Well, he was given the opportunity to do that, though.

MARGARET BRENNAN: And you don’t feel- you don’t feel you were given the opportunity to respond?

DR. BIRX: Not until he turned to me and said, could this be a treatment? And I said, not a treatment. You know, in that- in that moment, you know, people then want to define you by the moment and I understand- I, look, I understand how perceptions go. And I understand- I understood when Matt Pottinger was- was calling me to go into the White House and try to support a comprehensive coronavirus response by utilizing the strength of the federal government would be a terminal event for my federal career, which is part of the reason why I didn’t want to do it.

MARGARET BRENNAN: A terminal event?

DR. BIRX: A terminal event. I know that I wouldn’t be allowed to really continue successfully within the federal government. You can’t go into something that’s that polarized and not believe that you won’t be tainted by that experience or how people interpret you in that experience. So I knew that part of it. I didn’t want that to happen. But, you know, I had to psychologically prepare myself for that event because- and that was the discussion I was having in South Africa with my colleagues, that if I go and do this, there will be really no option to return to PEPFAR, or to return to my home agency, the CDC. I had always planned on retiring after 40 years. I ended up staying a little bit longer to get through this. Transitions are always very interesting. I actually love transitions because it puts new people’s eyes on your program. It makes you better and makes you better as a program to have to explain the strategy to others and to have others’ insights into your program.  But it’s also sometimes a difficult time and I did want to shepherd the PEPFAR program through that. But that was not a choice now, I- and I knew that in that moment. But I didn’t know- I- I didn’t really know how the White House functioned until you get inside of it and see it.

MARGARET BRENNAN: And this will be the end of your federal career?

DR. BIRX: Yeah, I will need to retire probably within the next four to six weeks from CDC.

MARGARET BRENNAN: And how have you made peace with that, that this pandemic, this once in 100 years pandemic that is projected to kill half a million Americans by the middle of next month that you’re leaving in the midst of this, that you will be associated with it? Have you thought and digested that?

DR. BIRX: Well, what I do know and what was reassuring to me all along is I knew this would be studied. I knew that the emails, the reports that I wrote, the request to expand testing, the how to improve therapeutics, all of that, all of that would eventually come to light. Maybe not in my lifetime.

MARGARET BRENNAN: You feel you’ll be vindicated?

DR. BIRX: I’m not looking to be vindicated. I’m looking to be able- in that moment I think my service was important. I think it was important to make progress in testing. I think it was important in making progress with some of the therapeutics. And I think it was important to really- we had great innovation in vaccines. I also wanted to make sure that we had some of the tried and true vaccines under development. And I think that the history will show my real commitment to ensuring that the subunit vaccines continue to move forward. It’s really important because those subunit vaccines can be made in high volumes and would be very important for a potential booster in the future, but also important to the global community. And so there- there are places where I know I had an impact, but that’s not- I never allowed myself- I was focused solely on the mission, and the mission was to try to save as many American lives during this pandemic as possible. And so I couldn’t get distracted on vindicating myself or getting the information or telling the, you know, coming back to the press and saying that’s not what happened. That would waste my energy in that moment of staying focused completely on that data and ensuring that I was seeing everything that was going on so that I could convey that not only to the federal leadership, but convey it directly down to the states. It’s why we started writing the governors’ report. There were just four of us that wrote that. It took us all weekend, but it was worthwhile because it said to the governor, this is what we’re seeing nationally and this is what we’re seeing specifically in your state. And it was a dialogue that allowed us to come to a common understanding of what we were seeing and what they were seeing of how to work together more effectively.

MARGARET BRENNAN: I read a Washington Post profile of you from back in 2019 before this, and it said, “When she’s working on a vital public health issue, Birx will do whatever is necessary as long as she thinks she can make a difference.”

DR. BIRX: True. And it hurt my family. You know, all of this- I have two daughters in their 30s who had to live through this and watch their mother, these things said about their mother, to become a skit, I mean. I have two grandchildren, daughters. You know, I think, I felt the whole time that I also had to be serious to be taken seriously, and I couldn’t ever let emotion come into this, that no matter how frustrated I got, no matter how beaten down I got, I had to keep pushing as hard as I could. And I think Matt Pottinger knew that I’m very resilient, but this tested my resilience. Because it tested my family and the things that were said that were so untrue, all of that about Thanksgiving.

MARGARET BRENNAN: You were accused of gathering with people outside your household because you went to a beach house with them?

DR. BIRX: Yeah, there- there was no one outside of my household. I have one household. We happen to live between two houses because I had to protect them from me when I was out on the road. I couldn’t let myself because I- when I came back I quarantined. Yes, I relied on testing at day five, six and seven, which eventually CDC came to part of the guidance. But if I had an emergency at that house, I wore a mask the whole time because I had to protect that household at all costs. I have a 92-year-old mother and a 96-year-old father and a- a daughter that’s 38 weeks pregnant. I had to do what was necessary for the country, but I also had to protect my family. And so the implication that I wouldn’t follow CDC guidance- I followed CDC guidance and that’s what protected me. I mean, I was on the road for six and a half months. I was in the White House during the hot- one of the hottest hot spots of viral transmission and I remained negative because I followed the CDC guidelines. That’s why I know they work and that’s why I take it very seriously.

MARGARET BRENNAN: Did any of your children ask you to quit?

DR. BIRX: No, I think they’ve always- they knew what I was trying to do. You know, I’m very lucky to have two daughters that believe their mother can make a difference. And so they would never ask me to do that because they know that I would leave if I felt I was ineffectual.

MARGARET BRENNAN: Well, this summer, you gave an interview. Then you went silent for a while. But you gave an interview on CNN and you said the virus was extraordinarily widespread.

And then President Trump tweeted. He blasted you for saying that. Did you ever speak to him after that?

DR. BIRX: I hadn’t seen him for months before that or months after that, but that was like–

MARGARET BRENNAN: You’re the coordinator of the COVID Task Force.

DR. BIRX: –that was a- that was an extraordinary moment because I also got yelled out by the speaker, who I have tremendous I mean, obviously,–


DR. BIRX: –women have gone through a lot to get in their positions. I have tremendous respect for women and women leadership. I know what they’ve had to go through to get to where they are. I also have now much more respect for women who are involved in journalism because when I was on the road, I could see that dynamic. It’s also why I started calling on all the women first, because, you know, they would be out-shouted sometimes by their male colleagues. I mean it’s difficult out there. Gender is still a very real and very difficult piece. But I wanted women to know that you can work. You can be a scientist. You can hold your head high, and you can help. And I think we do bring a different piece to the puzzle because we’re always concerned about our families and that community piece in a way that sometimes our male colleagues aren’t. And that’s not a criticism. It’s just how fundamentally we function in the American society.

MARGARET BRENNAN: Speaker Pelosi said she didn’t have confidence in you because you were working for President Trump.

DR. BIRX: And so that was very hard because I have known her from the HIV world, and I have tremendous respect for what she brought early on. She was one of the few who stood up along with Barbara Lee and said, this is a problem and America needs to do more. She stood up in San Francisco. She stood up and- and understood that people were at risk and need to be supported and not traumatized and stigmatized. So in my mind, she’s a political hero for what she has done in HIV, which, you know, I’ve spent a lifetime on, along with TB–

MARGARET BRENNAN: So that stung?

DR. BIRX: Oh, that was hard. But she’s not the only one, I think she gave voice to what a lot of people were thinking of, how could you? I think they looked at going into the White House as somehow supporting a political party or a political individual. There are technical people that are brought in for their technical expertise.

MARGARET BRENNAN: But you often were perceived as explaining some of the things President Trump said rather than correcting him.

DR. BIRX: Well, when people asked me a question, I feel like I have to respond with what my perception of that moment was. And so there were three sentinel- or four sentinel events that I think I’m highly criticized for. One of them is the 40,000 ventilator issue. And–

MARGARET BRENNAN: This is a- this was the governor of New York saying he needed 40,000. You said, no, you don’t. You need something like 4,000. So this is in the- in the heat of the moment in the spring.

DR. BIRX: Yeah. But that started the whole cascade of the- in the- that’s when I had to stop looking at Facebook and Instagram, because in that moment they interpreted that as me supporting the president when what I was saying was, you’re using an unmitigated model. And yes, that’s how bad things could be if you weren’t mitigating. But you were mitigating. So your need is going to be significantly less. And the reason that was important in that moment is in that moment we had 12,000 ventilators in the stockpile.


DR. BIRX: We had 16,000. Four of them were in maintenance- 4,000. We had 12,000 ventilators. Now I just want to thank the ana- the head of anaesthesia who called me, who is head of the Association of Anesthesiologists, and called me and said, you know, Dr. Patter- I think it’s Dr. Patterson, we can convert our ventilators. Well, that opened up a potential for 60,000 potential- 40 to 60,000 additional ventilators. But when New York said they needed 40,000, at the same time then governors started calling from all over the country saying, well, I need 10 and I need 20. By the end of that first week with that one Governor Cuomo announcement there was a request for almost 100,000 ventilators.

MARGARET BRENNAN: And we had a fraction of that in the US stockpile.

DR. BIRX: And so what I was worried about is people would start to panic about not having access to the care that they needed, and so it was our job to try to figure out what other options there were from splitting access to ventilators. So two people on one ventilator, utilizing anesthesia ventilators, utilizing high throughput, high volume O2 outside of ventilation. We had- that was a very critical, mad scrambling event for myself and I think many others. And I just want to thank many people who came forward and said, this is- this is a solution, this is a solution, and that is a solution. But we also remodeled what people would absolutely need. And then we realized that we could move ventilators potentially from states that weren’t having an outbreak to states that needed them and backfill them with additional–

MARGARET BRENNAN: Was that the moment, though, that that moment in the spring, is that the moment you looked at the task force and you said we have a serious problem here, this is not going according to plan?

DR. BIRX: I think everyone knew that.

MARGARET BRENNAN: When did that hit you?

DR. BIRX: Everyone knew that. Everyone knew that from, I would say, March- March 8th on.

Because you only had to look at the slopes of the curves in these major metropolitan cities to understand what was happening and understanding if you’re seeing that rate of hospitalization, how much community spread there was.

MARGARET BRENNAN: But you were trying to get Americans just to wear masks. And the president himself was undermining you. He wasn’t wearing one. I mean, you would go out and talk about it can be a fashion statement from the podium. I mean, you were trying to make it light so people would accept it. But all these guidelines are getting undermined by the president himself. Is there ever a way to make that scenario work?

DR. BIRX: Well, you have to, because that’s the president. So you have to figure out how to get that message out when you can’t get it out from the head of the country. And that’s our job. You don’t give up. You don’t say, well that didn’t work so of course you know, everything is going to be terrible. You’ve got to try to make it the least terrible it can be. I mean, you can’t ever in any moment when American lives are at stake, say, well, this is just too hard. I’m giving up.

MARGARET BRENNAN: But where’s the vice president in all of this?

DR. BIRX: The vice president knew what I was doing.

MARGARET BRENNAN: You mean he knew that you were telling the governors privately to do things that the president publicly was making light of? When he was saying you don’t really need to wear a mask, or pushing to reopen the economy faster than your guidelines would allow, Mike Pence knew that?

DR. BIRX: He knew what I was doing because–

MARGARET BRENNAN: And he supported it?

DR. BIRX: –I don’t- I’m not a person who would go out on their own and not do, you know, I wouldn’t go–

MARGARET BRENNAN: Why would you have to be sneaking around? You’re the head of the COVID Task Force and tens of thousands of Americans are dying. Why is that a covert operation?

DR. BIRX: Because if this isn’t working and you’re not going to get that to work, you have to find another solution. I mean, you can’t just say, well the president is saying this so I’m going to give up on the 50 states, the District of Columbia, and the territories that we support. I couldn’t do that. I mean I- and others couldn’t either. I mean, there was a team of people going out and supporting this approach. I felt all along that if we could have put 20 or 30 full-time CDC personnel in every state for long term assignments, six- six months assignments, they could help states get over these barriers and understand and help support states translate their guidance.

MARGARET BRENNAN: But the CDC didn’t do that. They didn’t want to do that?

DR. BIRX: They sent people out for short- short term. And these are the kinds of things because that’s what they’re historically used to doing. I think these are the things we have to work on in the long run of how we really respond to a pandemic, which is part of the reason why I’m going to take time to really reflect on this, organize all my thoughts and put together what really worked, what could be expanded, what kind of legislative fixes do we need? Are we in a- do we accept federalism when a public health- being able to save Americans with a comprehensive national public health response is critical.

MARGARET BRENNAN: Leaving it up to the states, is that the way it should be in a pandemic, is the fundamental question?

DR. BIRX: Yes.

MARGARET BRENNAN: So when you were going out there to the governors, I mean, tell me about some of the restrictions that- some of the resistance from governors, because you’re going out there and you’re telling them to wear a mask, to limit indoor dining. And for some of these Republican governors, that would mean going against the head of their party to do what you’re telling them to do.

DR. BIRX: You know, I don’t know if that was as much as the dynamic as they were dealing with Republican legislatures and legislators that really didn’t- and it’s why I started meeting with the legislature and it’s why I started meeting with county commissioners, because you needed every single level of government then to work together to ensure that, again, we’re talking about behavioral change of American citizens. And everyone then had to endorse it. The governors, the mayors, the county commissioners. I was in states in the middle of this country where the senior public health person, the senior public health person, said to me, why don’t you believe that we should go for herd immunity?

MARGARET BRENNAN: Meaning just let everyone get sick and see how it plays out.

DR. BIRX: Because in the- many of the farmlands, you do that sometimes when you have a really bad swine virus or- you let it run through the herd and rebuild the herd with resistant, um–

MARGARET BRENNAN: And you said we’re dealing with human beings and lives?

DR. BIRX: Yes, but I mean, you have to- you have to let people talk about what they’re thinking. You have to be able to provide an environment where people can honestly say what they are thinking because then you can’t confront it. If we keep pretending that everything is fine and we’re not listening to people and listening for where they’re coming from, we’re not going to make the changes that we need in order to be successful. And so I think, you know, that was the other reason of going out to really understand what governors and mayors and local public health and rural public health individuals and community members were seeing and thinking.

MARGARET BRENNAN: Well, Sturgis, this motorcycle rally in the middle of South Dakota, thousands of people gathered with no mask. How much responsibility lies on the shoulders of the governors running these states like that in South Dakota?

DR. BIRX: A lot. A lot. But let’s recognize what’s happening right here, right now in the District of Columbia. There are National Guard troops here from every state in the Union, probably, young individuals who are most likely to have asymptomatic infection if they do get infected. And they’re congruently living and eating maskless, 25 to 30,000 of them from all over the United States.

MARGARET BRENNAN: Do you think this inaugural gathering is a massive super-spreader event?

DR. BIRX: It could be. When you bring 30,000 people together where you know that they’re most likely to have asymptomatic infections and you haven’t prescreened, pre-tested, and serially tested all of these troops. These are dedicated troops. They’re going to do their mission. I can promise you that they will sacrifice their own health to do their mission, because that’s the- that’s what I came from. You sacrifice for others out of the military. They will do their mission.

MARGARET BRENNAN: But then, I mean, you compare this where people may or may not be tested, but they’re wearing masks. You compare that to the super-spreader event that was held–

DR. BIRX: They are not wearing masks. Did you see the pictures of the National Guard? They can’t wear masks. They’re communally eating and communally sleeping–

MARGARET BRENNAN: When they’re eating and sleeping–

DR. BIRX: Yeah.


DR. BIRX: –so we have to be careful in every single thing. There shouldn’t be it’s okay here and not ok there. We have to be consistent. Sturgis was not okay. Birthday parties, not okay. Bringing together family members indoors, maskless, none of this. We have to be very clear to the community. And yes, we’re going to make mistakes. We all make mistakes, we’re human. If you made a mistake, if you had a gathering, at least get tested, wear a mask around those vulnerable, assume you got exposed and are infected and wear a mask around those vulnerable. So if you went to Sturgis, you should have worn a mask when you came home. If you got exposed potentially here when you go home until you’re 10 days out and you avoid getting with your vulnerable family members. We- that’s what I do to really ensure that you’re protecting each other.

MARGARET BRENNAN: How did the task force, which you led, and those around the president, President Trump, who–

DR. BIRX: I was the coordinator, I didn’t lead the task force.

MARGARET BRENNAN: You were the coordinator. But how did the task force allow the president, who calls himself germaphobe, to get COVID himself? How did this happen?

DR. BIRX: There were only two people who regularly wore a mask in the White House.


DR. BIRX: Myself and Tyler Ann McGuffee.


DR. BIRX: My- the support person that I had from HHS.

MARGARET BRENNAN: So the staff around the president was not wearing a mask?


MARGARET BRENNAN: He’s the commander in chief. This is a national security risk. How is that possible?

DR. BIRX: I think people believed wrongly that testing- testing would be adequate.

MARGARET BRENNAN: So how is that possible?

DR. BIRX: I think they believe that testing is a surrogate for a public health intervention. Testing, I think, is part of your public health arm- armamentarium. And I always want to be clear about that. I think testing is critically important and equal to masking and physical distancing and handwashing, because I think testing allows you to see the silent epidemic and you can’t find them unless you’re proactively testing. So I am a strong proponent of testing, more testing, and testing people who have no symptoms.

MARGARET BRENNAN: But did you say, “The President of The United States needs to wear a mask.” Did you press Mike Pence on that? Did you press Mark Meadows, his chief of staff?

DR. BIRX: There are multiple communications about masking. And this gets into the data issue. Remember when I was talking about the stream of data coming in? People were interpreting the hospital mask data, the difference between an N95, a KN95,  surgical mask and cloth mask, to say that cloth masks don’t work because in this hospital setting, it didn’t work. That was different. Remember, in a hospital setting, you’re trying to protect the nurse or the doctor from what’s out here. We were asking people to wear a mask to protect others from them. So it was a very different context. And so they were mixing data that didn’t have anything to do with the relevance of masking as a public health measure to changing into masking as a personal protective measure.

MARGARET BRENNAN: But did you ever say you’re misunderstanding this? You need to wear a mask. These are close quarters and you’re way too close to the President of the United States? You’re nodding, yes, you had that argument?

DR. BIRX:  Not with the president, I mean, I- I didn’t have that kind of access, but to certainly people around the president. Yes.

MARGARET BRENNAN: And they just didn’t take it seriously?

DR. BIRX: They believed that the testing protocol would be adequate to protect the president. Pe- I just want to make it clear people were concerned about the president and wanted to protect the president. I don’t want to think- have the understanding that there were frivolous people in the White House, that people were very concerned about the president. Mask- they believed that testing would be a reasonable substitution for people masking.

MARGARET BRENNAN: How sick did the president actually get?

DR. BIRX: I don’t know. I don’t know. I don’t know, but I can say that certainly they thought he was sicker than the first lady because they wanted to get him additional therapy.

MARGARET BRENNAN: Do you think his life was in danger?

DR. BIRX: You know what I know- just to be very clear, what we know in the data, for people over 70 even today, about 18 and 19% of people over 70 who get this virus are hospitalized. And of all people over 70 who get this virus, 10% of them succumb to this virus. One in 10. To me, that’s a very, very serious illness. If you knew that your parents had a one in 10 chance of dying from a virus, as I do, you would do everything to protect them. The president was over 70. So, do I believe that adequate, constant public health surveillance and measures were put into place based on his age alone, not even taking into account everything else? No. But they weren’t put in place for the entire country, and that was what my message was.

MARGARET BRENNAN: Did anyone ever say this is a national security risk and we need to nail down who brought this in and who infected the commander in chief?

DR. BIRX: I never heard those conversations.

MARGARET BRENNAN: There was no serious contact tracing that happened after the fact?

DR. BIRX: I don’t know if there was contact tracing or not. I- you know, it’s not something that I was responsible for. The health and welfare of the president falls to the White House medical team. I know many of those individuals. They are very serious individuals. I am sure that they took this seriously. I know they took his care very seriously. I know they took the care of the first lady very seriously. This virus, I think people really just couldn’t wrap their heads around that you could have a virus that caused almost no disease, such mild disease that the person didn’t think they were even infected and they were spreading the virus to others, and such severe disease that it could kill your grandparents. And I think that’s still hard for people to wrap their head around because they have the experience of losing a parent or grandparent, they understand the severity of the disease. If they only see the disease from their college students who got it and there were no consequences in the moment, we still don’t know what kind of chronic, what we would call morbidity could come from this when they are 20 or 30 years older, we don’t know. And we just should be really honest. We don’t know that mild disease might not lead to significant long term health crisis or health consequences. We don’t know that. So we just have to be honest. We don’t know that. But from their perspective, they saw their 18-year-old get infected and it was no big deal. So when you have that experience, being able to effectively communicate that spectrum of disease so that people understand that their behavior impacts the vulnerable individuals in their community at the same time that they themselves may not develop severe disease is really important. And I feel like that communication piece was never really understood at a level to- to really push people to action.

MARGARET BRENNAN: And last question to you, what was your biggest mistake?

DR. BIRX: Well, I’m categorizing- I’m going back through all of my notes from 11 months to really try to understand where I could have been better when. I think there is- I- I always feel like I could have done more, been more outspoken, maybe been more outspoken publicly- publicly. I didn’t know all the consequences of all of these issues. When you’re put into a new situation and you only know one person in the White House, you know, and you don’t understand the culture of the White House, it’s very difficult to get your footing. I’m not making excuses. I’m just saying I didn’t know how far I could push the envelope. I’m known for doing that, particularly in private. But it was very difficult for me at day one to really understand that. And that’s the kind of piece we needed from day one.

MARGARET BRENNAN: You wish you pushed harder?

DR. BIRX: Yes.

MARGARET BRENNAN: On anything in particular?

DR. BIRX: Well, fundamentally testing, I mean, I- I really believe that proactive testing, as we’ve seen happen in universities- universities that tested weekly, at a minimum, of every student, required testing, not voluntary testing, required testing independent of symptoms, had infection rates of about 10% of what the universities that tested the way we do in the United States, focused on people who have symptoms, letting people who want to come in and get a test, get a test, where you’re testing a lot of worried-well that may not even have exposure, but not routinely making sure that young people in the community are repetitively tested so you can find the asymptomatic infections. Young people are responsible, and they will isolate if they know they have the virus. But you cannot expect them to be isolated as young adults if they don’t have the virus. And it’s our job to figure out how to make testing available for them. I think still there’s not enough testing of people under 40. We need to make testing kind of fun and interesting. It’s why I pushed so hard to get those antigen tests out there, because even for all of their faults, if they find 50 or 60% of the asymptomatic individuals who are spreading the virus, that is an enormous public health impact. So sometimes we let the perfect be the enemy of the good. And I think a lot of the issues that we have, in addition to the other public health, behavioral change. And then the final piece is making things too complicated. I went out right before Christmas to six states because I was worried that the- this highly sophisticated tiering of individuals was going to be really difficult for states to execute–

MARGARET BRENNAN: You mean, how states are setting the guidelines on who gets the vaccine when?

DR. BIRX: Yes.

MARGARET BRENNAN: You think it’s overly complicated?

DR. BIRX: I think it’s very complicated.

MARGARET BRENNAN: But that came from federal guidelines.

DR. BIRX: I- it came from the ACIP. I think they had–

MARGARET BRENNAN: Which is part of the CDC.

Dr. BIRX:  I think- well, it’s an independent body, but I think they had- they certainly had the best of Americans at heart. But in a pandemic, you have to simplify things. You have to make it so states have an easy way to do it and document it that the right people are getting the immunizations. And we knew, it’s not that we didn’t know who was at greatest risk for severe disease. We knew that. We know that. We know that today. And I think we were trying to balance the fabric of society with those at greatest risk. But when you’re in the middle of a surge and you know that before Christmas, we had an unbelievable surge across the entire country. Yes, the Northern Plains and the Heartland was improving and the Rocky Mountain states, but the whole rest of the country had rising cases. And then we put out- so the governors, the public health individuals are focused on talking to the hospitals, making sure they have PPE, saving as many lives that they can, and then we put out this very complex guidance. So I went out right before the holidays to talk to governors and say, if you’re willing to think about simplifying this. Think about immunizing everybody over 65. Just do your health care workers. Absolutely. They’re on the front lines. But then everybody else do by age, because we know that that’s the risk of severe disease.

MARGARET BRENNAN: Would you tell governors now, do that, throw out whatever new federal guidelines the Biden administration issues and just go with large portions of the population?

DR. BIRX: Well we see states that are being successful in doing that. One of my first states I went to was West Virginia, because they’re rapid adopters. You know, they really look at their population. The other thing that wasn’t taken into account is every state has a different population of percent of their population that’s over 65, and it ranges from 11% to over 22%  And so not only do you have to like, ensure that they can have access to vaccine, but you need to then redo how you’re putting out vaccines so that the states that have a higher proportion of individuals over 65 get more vaccine than the states by population that have only 11%. I mean you’ve got to really adjust to make sure that there’s equity. And so I think some of the states have figured this out. They’re- they- and the proof will be in the pudding. Did they save more lives? I am very- I am encouraged that our numbers are going in the right direction. It says to me that Americans are trying their best to follow the guidelines. And I- I hope and I believe that they will continue to understand that masks work. And if we have more contagious virus, masking more will have even a greater impact and a critical impact, along with the physical distancing and handwashing. But we need to do more testing and we really need to ensure that we can support the states in their vaccine delivery.

MARGARET BRENNAN: Thank you for- for your time.

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