White House COVID Advisor Andy Slavitt on “Preventable”: His Book Chronicling America’s Failed Coronavirus Response

Andy Slavitt

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M oderator : Welcome to Conversations on Health Care with Mark Masselli and
Margaret Flinter, a show where we speak to the top thought leaders
in health innovation, health policy, care delivery, and the great minds
who are shaping the hea lthcare of t he future.

This week Mark and Margaret speak with Andy Slavitt, recent Senior
Advisor to President Biden’s White House COVID Response Team,
Former Acting Administrator for the Centers for Disease Control and
Prevention. And the guy accredited with stating the Affordable Care
Act signature effort, the launch of the Insurance Exchange portal,
www.healthcare.gov . He is author of Preventable: The Inside Story
About of How Leadership Failures, Politics and Selfishness Do omed
the U.S. Coronavirus Response.

FactCheck.org, Lori Robertson checks in the Managing Editor look ing
at misstatements spoken about health policy in the public domain,
separating the fake from the facts . And we end with a bright idea
that's improving hea lth and well being in everyday lives.

If you have comments, please e - mail us at [email protected] or find
us on Facebook , Twitter , or wherever you listen to podcast. And you
can also hear us by asking Alexa to play the program. Now stay tuned
for our interview with Andy Slavitt here on Conversations on Health
Care.

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Mark Masselli: We’re speaking today with Andy Slavitt , recent White House Senior
Advisor for President Biden’s COVID Response Team. He previously
oversaw the deployment of www.healthcare.gov under the
Affordable Care Act and was Acting Administrator for the Centers for
Medicare and Medicaid Services under President Obama.

Margaret Flinter: Mr. Slavitt is ho st of the podcast I n the Bubble . And he is the author of
a new book, Preventable: The Inside Story of How Leadership Failures,
Politics, and Selfishness Doomed the U.S. Coronavirus Response. Andy
welcome back to Conversations on Health C are .

Andy Slavitt : It’s great to be back.

Mark Masselli: You know Andy, before we get to your book, I want to hear your
thoughts about the Supreme Court ’ s most recent ruling which upheld
the ACA for the third time. And obviously had it gone the other way, it
would have jeopa rdized health coverage for millions of Americans. I
wonder if you could talk about the significance of the Supreme Court
decision on the law that you've been so intimately connected with,
and what does the latest development pave the way for ward in terms
f health policy.

Andy Slavitt

Andy Slavitt: Well, the ACA has become kind of integral to life for many Americans
and many American families. Not just the 30 billion people that g et
insurance through ACA, but the now many, many protections that
most all of us in the U.S. take for granted, protect us against pre -
existing condition , discrimination etc. And for a lot of people you
know sort of in the sword hanging over their head that someday you
know even though they have got a chronically ill child that someday
someone ma y be able to take away their insurance. A nd so and the
most important thing is that I think that s word is gone. I think the
lengthy threats around from the executive bran ch of Donald Trump,
the House and the Senate trying to repeal the Bill , court cases, y ou
know we should now move on and be able to talk about, how to give
Americans more security and have a more affordable and better
operating healthcare system.

Y ou know it’s worth pondering, you know the Court basically said
[inaudible 00:03:17] that the p laintiff didn’t even have standing,
which means that they weren’t being harmed by the law. It’s worth
pondering why people w ould sue to takeaway other people’s
healthcare and rights , w hen they themselves were not even being
harmed. So I think it , that’s ma ybe another story, but it’s something
that it would be really good for us as a country to come to grips with .

Margaret Flinter: Well I, for one am very glad to have this third one behind us. C ertainly
remember the first two. So this is a good day in health care, but you
certainly have racked up quite a bit of experienc e stepping into help in
times of crisis . Y ou help ed rescue the Online Insurance portal back in
the early days, the ACA was successful, I think we remember the
website kind of crashing and burni ng, as people tr ied to get on and
take advantage of trying to get healthcare.

But in your book, you talk about your reluctance, perhaps to step into
the fray, once again to do it. Maybe share with us a little bit about
that decision to go back in, how you pull ed the team together to
confront the crisis. I think there is a lot to be learned from how that
happens in a moment of crisis, the war room conversations, if you
will, that helped ultimately shift the pandemic strategy in this country
to a much better place.

Andy Slavitt: Well for me it started even earlier, it sort of started when the
pandemic beg a n and the book Preventable really outlines what
happened . A nd from beginning of my conversations with Jared
Kushner who I spent the better part of the year t alking to, and
Deborah Birx , Anthony Fauci, as well as people from all across the
country that were impacted, doctors, nurses. So th is really la ys out
kind of in a narrative from what I saw and how that all work ed and it
culminated, didn’t know that when I was writing the book. But at the
end of this, it culminated in the election of Joe Biden, and a real

Andy Slavitt

commitment on his part, to really taking accountability for this crisis
and ending it once and for all.

So he was, you know in doing that, it is sort of h ard to resist the call,
no matter what you do in your life, when so much is at stake. I mean
think back to the time, it wasn’t long, thousands of people a day were
dying, we had really no inventory of vaccines, not enough vaccinators,
not enough places for people to get vaccinated. Only 40% of people,
said they even want ed to get vaccinated , b ut so much at stake, new
variants coming in .

A nd so for me and for all of us, who had the privilege of being working
inside of the White House, it was incredibly criti cal mission that and I
worked with great people to do it and get it done and then try to
demonstrate to this country that when we , on our best days, we can
accomplish anything we want to.

Mark Masselli: You know Andy in war and in pandemic leadership matte rs. And I
think we've a tail of two responses and we watched in 2020, the
country go from this runaway pandemic, killing thousands of
Americans per day as of the other day, 600,000. But 2021, we saw an
enormous shift in terms of the reduction in deaths . O b viously the
President announced today 300 million vaccines delivered. And you
say that previous administration committed several deadly sins, tell us
what they were and describe how the Biden strategy has alter ed that
and change d trajectory?

Andy Slavitt: So first of managing a pandemic is hard, you know sadly you're going
to lose people. And I think we should be careful about being too
critical about people for making well - meaning mistakes in the fog of
war. Those are not the kinds of things that I think I found fa ult with or
we find fault with in the book. But there were three when I call deadly
sins that come out of this book that I think you can see up close . O ne
is beginning with the President’s willingness to deny the pandemic for
too long. We now know that he knew in January that people were
going to be dying in large numbers. And he went to bed every night,
presumably soundly a nd it wasn’t until the NBA called it s season off at
March and the stock market went down, that forced him to even
publicly ack nowledge the pandemic. I f he would have simply said,
“H ey we've a problem, and we're going to have to get through this
together ” , would have saved so many lives, if he would have done
that in January. The fact that he didn’t and then continue d to
downplay the virus, is I think, the very deadly sin.

Second is the quashing of dissent. There is a scene in book where Alex
Azar is about to go on Fox & Friends, and it script says, the things are
going well , b ut could change rapidly. Now first of all things were n ot
going well , b ut it was that phrase, “but could change rapidly”, the
White House saw that script, pulled him from Fox & Friends, and then

Andy Slavitt

forbade him from talking to the media for 45 days.

So imagine this, here we're in a global pandemic and our own
Depa rtment of Health and Human Services , h e isn't allowed to talk to
the press or the public. And that became a pattern throughout the
administration that whole year, where anytime somebody spoke up
against the narrative th at Trump wanted which was basically t hat this
whole thing is just overblown. Whether it was Deborah Birx or Tony
Fauci, or Nancy Messonnier, he would silence them and ostracize
them.

So because it’s a novel coronavirus and no one has the monopoly and
the answer, you need dissenting voices, yo u need experts, you need
scientist s , you need people to say what they think. But he view ed that
as a reflection on him in his reelection, and s o that was the problem.

And the third deadly sin which is almost for extra credit, was you
kn ow the pandemic is h ard enough, but he saw in it an opportunity to
take advantage of the divisions in our country and turn ed the
pandemic into something political. You know I talk ed to world leaders
who said, you know no one, not everyone loves mas ks you know we
have plenty o f debate about whether to wear them , we've got a
plenty of debate about social distancing and lockdowns etc. those are
all very legitimate conversations. B ut w hat the President did is, he
took this a step further and said, basically, this is in a matter of
identity. And once you saw that his supporters were at one side of
this, he as a populist, he played into that. And so he basically
undermined the ability of the country to respond.

Mark Masselli: And it seems like that’s stuck, right, I mean that’s still with us today,
that third sin is.

Andy Slavitt: We're living with the legacy.

Mark Masselli: Yes, we're going to live with that legacy for a long time, the other
ones you know, administration are always silence d –

Andy Slavitt: Because if you c ould deal w ith this on it’s merits, you get a real
conversations with people about mas ks yes or no, you know the
tradeoff between economic and health issues, all of which are very
legitimate conversations to have. But he took this out of the realm of
legitimate conve rsation and into the realm of something quite
different.

Margaret Flinter: Well, I think Andy, one of those that we look back on, was the issue
of, should it have been to state - by - state response or a national
response. And what we seem ed to see was, a lot of competition and
really on almost competition being promoted between the states,
competing for PPE, competing for the vaccines, competing for the
supplies to go with the vaccines.

Andy Slavitt

You warned against a state based approach especially in a pandemic.
And on the theory that we're always going to have national challenges
that come out as I hope for the next pandemic and so I'll save it for
the next lifetime maybe, but we know that these things will happen
again, wh at should have happened ? A nd how you know what flaws
did it reveal in our system that maybe if we can do better th e next
time on?

Andy Slavitt: Look, it’s a big country and th ere is no question s that we need to
allow people who are regional and local leaders to be very involved,
but that’s not what we 're talking about here . What we're talking
about here, and I had th is very conversation with Jared Kushner which
I outlined in the book, is that, they made a very deliberant , specific
decision that their strategy, their political strategy not their pandemi c
strategy but their political strategy was to allow Trump to get credit
for opening the country a nd then shift responsibility to the states .
And what they call ed the State Responsibility Handoff; it was literally
the name of it. And when things went wrong as they inevitably would,
he could blame the Governors and blame the states and for any bad
moves if they had to shut things down again, he wouldn’t have to be
the one to do it.

And that, you know I talked about it in the book there is this
expression th at Barrack Obama used to use, which was something to
the effect that it was a basketball expression, it was some people like
to have the ball in their hands at the fourth quarter. And Donald
Trump wanted no part o f the ball . Donald Trump wanted the ball as
far away from him as possible. And there is really no way to manage
yourself and your country through a pandemic, without taking
responsibility. And the interesting thing is, my political calculation is
that he would have been politically rewarded, if he would have said,
“Y ou know I'm doing the best I can, I'm working on this, I'm trying to
protect every life ” emphasize d a degree of empathy at a loss which he
never did for the people we were losing. And he went the other
direction and I don’t think it work ed out.

Mark Masselli: We're speaking today with Andy Slavitt, recent Senior Advisor for the
White House COVID Response Team. He is author of a new book,
Preventable: The Inside Story on How Leadership Failures, Politics and
Selfishness, Doomed the U.S. Co ronavirus Response. Congratulations
it’s already a best seller. And you know just diving into the book, you
outlined some of the heroes and you talked about how some people
were muzzled in the administration and you know we certainly have
had both Dr. Fauc i and Rick Bright on the show, who both were
clarion voices during the pandemic. Rick certainly paid for it with his
dismissal for publicly speaking the truth. And I'm wondering if you
could just tell some of the other outstanding heroes, there were
millio ns on the frontline doing it, but inside the b ubble, people who

Andy Slavitt

were standing tall.

Andy Slavitt: Well l ook, you got it exactly right. I mean two decades ago, Tony Fauci
and his team and the people at BARDA which Rick Bright ended up
overseeing, created th is platform that’s mRNA platform over the last
two decades. And many people were involved and the people from
the private sector , people from the public sector, people from
Republican administration, and Democratic administrations, it’s truly
an American s uccess story that many people should be proud of and
take credit for. You know when it came to early January, a few people
sprung in action, one was Fauci and Barney Graham who worked o n
th
his team, getting the sequence over to Moderna and on January 13 ,
M oderna started working on the vaccine.

The other person who is a complete unsung hero is a career civil
servant name Peter Marks. So Peter is in the FDA. Peter came up with
this idea that he called Operation Warp Speed, this was an earlier
inclination of O peration Warp Speed and it was very interesting idea.
Now he is a Star Wars fan, so that’s where he gets the Operation
Warp Speed from. And he says, and this idea rather than waiting for,
we know who all th ese vaccine companies are, rather than having
them all do a bunch of work and submit it to the FDA and having us
evaluate it, w hy don’t we send people from the FDA in BARDA and
NIH out to do the work with the companies, so that we can make the
observations as they are making them, and we don’t have to do this
back and forth . And that cut down tremendously the amount of time
th an it was going to take.

What makes him an even greater hero is they then went to the Trump
Administration to Alex Azar and said, “T his is our idea, what do you
think? ” And Azar liked it . And ultimately Congress funded it. But then
what happened is that , the White House saw this as the political
opportunity. And so they invited Peter Marks into the White House
and said, we're going to run Operation Warp Speed out of the White
House. An d then it became something very, very different, and it
became, the President’s way of demonstrating that he had this virus
beat . And so he use d that to then say ing , we're going to get vaccine
even necessarily before it was ready.

And so what Peter Marks did was he did something that was almost
never done in the history of politics. Is he said, “ I'm leaving the White
House and going back to the FDA, because we need people with
sound judgment to evaluate when these vaccines are ready. ” And
then when the Pre sident Trump said, later that he was going to force
these drugs to be approved, he had a meeting the next day with a
bunch of people, who they knew would get out. And he said, “I f these
drugs are approved, and they are not safe or effective, I'm going to
p ublicly resign. ” So he was not only the creator of this approach, but

Andy Slavitt

then when the approach started get abuse, he went to navigate it and
it’s really a terrific story.

Margaret Flinter: Well that is a name we want to remember and a wonderful story,
thank you for sharing it. You know we seem to be well - passed the
days when we're s ee ing thousands of cars ro ll through our mass
vaccination sites, vaccines were falling off, precipitously. But we still
have population, significant numbers of people outside the
m ainstream, maybe underserved, hard to reach , vaccine hesitant ,
however you want to think of it, the Biden team ha s got the
C ommunity Corps for u m to address the needs of vulnerable
populations, our health departments are working with people to get
help out there. But there is a real urgency with this variant in our
probably not distant future and it’s spreading rapidly. What do you
think about the next phase of vaccinations? How are we going to get
back to that sense of urgency, to get that last larger group of people
vaccinated ? A nd why are those people so vital to stopping this
pandemic?

Andy Slavitt: Well s o I think we have some people and I would put myself in this
category to whom a vaccine was not a very difficult decision. I knew
right away that it was something I would do. And I wanted to do it as
quickly as possible. And that describes a lot of people in this country.
There is another set of people, there is probably another couple
categories of people to be fair, one of whom says, you know what, I
ne ed to think about it more, I need more data . I t’s a more considered
decision, it’s something I'm putting in my body, and I want to make
sure it’s safe and what do I know about it. And I think we need to take
a step back and really respect that process, res pect the fact that for
some people this is the decision I wanted more information about.

Now the best thing we can do for those people is get them that
information in a trustworthy, reliable way. Fortunately the vaccines
are so effective, we're so blessed and so well tolerated, that I think
when people do their homework, they will end up doing what many
people who have been on the fence have done, and they will come
over and take the vaccine. I think th ere are couple of -- moments,
when the FDA gives final approval, for the Pfizer and Moderna drugs, I
think those will be similar moments where we'll see more people.

So that’s one set, and then there is another set of people who I would
just describe as frankly where the vaccines is not that higher priority.
And for both of those groups, they are not anti - vaccine, they have
taken the rest of their vaccines. But for this group, they are generally
speaking under 40. So people over 40, 75% have started the
vaccination process, for people under 40 is less than hal f. People
under 30 i t’ s e ven lower. And for those people you know if they
walked into some place they were going anyway and someone had a

Andy Slavitt

needle out and sa id , “H ey would you like to get vaccinated? ” They
would very likely do it. But it would have to be eas y. And so I think
we're going to have to continue to make it easier and easier and
increase access.

Mark Masselli: Andy, the President just returned from a successful meeting with the
allies of the G7 also the Putin Summit , but I liked how he struck the
ch ord as he was departing to announce that he was donating 500
million vaccines to the world’s most vulnerable countries. It’s called
the global pandemic and I think the only way America is going to get
out of it, is if there was a global solution. And so it ’s great that the
new administration is taking this lead. Talk to us about the U.S. role in
global health, we're back with the WHO, and working with COVAX,
and you know it’s so important. But how can we leverage the global
health defenses for future pandem ics a nd what role should we be
playing?

Andy Slavitt: So I was really pleased , th at on my last day in the White House was
the day that we made the announcement of the half a billion doses.
You know it felt to me like one of several things that was where I had
hoped you know quite honestly well in advanced where our hope
would be when I left, because I had planned on only coming in and
serving 130 days. And there is no question that we can’t vaccinate the
globe with out cooperation from all the wealthy countr ies in the
world, the pharmaceutical manufacturers and many, many other
things. You know we need about 11 billion doses to vaccinate the
world and it’s going to take us a long time, it’s not going to take us
until you know we won’t get it all done in 2021, it’s going to take us
likely till 2022 . A nd that’s with increasing manufacturing capacity,
increasing global cooperation through COVAX a nd quite frankly a lot
of money, ten s to billions of dollars. And then we'll still run into
problems of distribution an d vaccine hesitancy and all the things that
we've run into here.

So it’s going to take a lot of work. The U.S. will play a leading role, I
think making the commitment that we've to basically buy and donate
half a billion vaccines to poor er countries and mi ddle income
countries, is the right way to think about it. But the longer term, you
can imagine the U.S. becoming kind of the world’s arsenal for
vaccines. And you can imagine the development of capabilities and
capacity here in the U.S. that will make us a global leader . And I think
that’s part of the vision that the President has.

Mark Masselli: Well, and I think the President just announce d the $3.2 billion for the
antiviral program for pandemics which really is starting to some of
those building blocks, because it not only a humanitarian site, purely
economics for the country, and we're a global power, a global
commerce is going on. And so we really need to make sure that we

Andy Slavitt

meet what you're laying out here.

Margaret Flinter: We've been speaking today wi th Any Slavitt, he is the recent Senior
Advisor to President Biden’s COVID Response team, the author of a
new book, Preventable: The Inside Story of How Leadership Failures,
Politics and Selfishness Doomed the U.S. Coronavirus Response. Learn
more about hi s latest endeavors by following him on Twitter @aslavitt
and Andy, we want to thank you, after your dedication to stepping in
when there is a need for real leadership, helping to fix some of our
healthcare systems biggest challenges over the years a nd for joining
us again today on Conversations on Health C are.

Andy Slavitt: Well, thank you both. It’s a pleasure to be on and an honor to serve .

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Mark Masselli: At Conversations on Health Care we want our audience to be truly in
the know when it comes to the facts about healthcare reform and
policy. Lori Robertson is an award winning journalist and Managing
Editor of FactCheck.org, a nonpartisan, nonprofit consumer advocate
for voters that aim to reduce the level of deception in U.S. Politics.
Lori, what have you got for us this week?

Lori Robertson: A new study found there was no negative e ffect on sperm levels in
man after receiving the COVID - 19 vaccines, undercutting suggestions,
that the shots affect male fertility. But social media post have made
the baseless claim that vaccinated man “are e ffectively sterile.”
Expert s say, there is no evidence that the vaccines cause infertility in
man. And there are new data that’s further rebut the online claims.
th
In a study published on June 17 in the Journal of t he American
Medical Association, researchers at the University of Miami reported
that they found no significant decreases in sperm measurements
among a group of healthy m e n before and after receive of a COVID - 19
vaccine. The team collected semen samples of 45 m e n, 18 and older
before receiving either the Pfizer - BioNTech or Moderna vaccines a nd
again more than 70 days after receiving their second dose.

Daniel C. Gonzalez, a medical student at the university and one of the
study’s author said in his statement that 70 days is enough time to see
if a vaccine impacts semen. The researchers measured volume,
concentration and the total amount of moving sperm and found no
declines post - vaccination. Researchers at a hospital in Israel have
reported similar findings i n a stud y that has not yet been peer
reviewed. That study evaluated the sperm production in 43 m e n
before and after receiving the Pfizer vaccine.

The Society for Male Reproduction and Urology, and the Society for
the Study of Male Reproduction issued a joi nt statement in January,
saying “COVID - 19 vaccines should be offered to m a n desiring fertility,

Andy Slavitt

similar to m a n not desiring fertility, when they meet criteria for
vaccination.” The statement notes that some m e n could experience a
fever as a side effects fo llowing vaccination, which can cause a
temporary declined in sperm production. Expert s say, a fever could
a ffect a man’s fertility for upward of three months. But that’s any
fever, not something unique to a fever following vaccination. And
that’s my fact c heck for this week. I'm Lori Robertson, Managing
Editor of FactCheck.org.

Margaret Flinter: FactCheck.org is committed to factual accuracy from the country's
major political players and is a project of the Annenberg Public Policy
Center at the University o f Pennsylvania. If you have a fact that you'd
like checked e - mail us at www.chcradio.com , we'll have
FactCheck.org's Lori Robertson check it out for you here on
Conversations on Health Care.

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Mar k Masselli : E ach week Conversations highlights a bright idea about how to make
wellness a part of our communities and everyday lives. Anxiety
disorders a re on the rise among the nation’s youth and experts in the
field of child psychology, feel the conditions start much earlier in
childhood and is far more common than previously thought. With an
estimated one in five children being affected , b ut too often th ese so
called internalizing disorders go undiagnosed.

Unlike children with more expressive conditions, such as ADHD or
Autism Spectrum Disorder, young kids struggling with anxiety or
depression, often internalize their symptoms and may just seem like
an introvert to the casual observer. U niversity of Vermont, Child
Psychologist, Ellen McGinnis says the process of diagn osis for younger
children is often painstaking and it can take months to confirm. Dr.
McGinnis says th e traditional method of diagnosis involves creating
scenarios that induce anxiety, followed by behavioral observation by
clinicians and the results can be inexact. So she teamed up with her
husband and fellow researcher biomedical engineer, Ryan McGinnis,
to create a wearable sensor that can pick up on physical cues that
suggest the presence of anxiety, using Accelerometers and simple
algorithms to compare normal stress responses.

Ellen McGinnis: The device is called Inertial Measurement Unit and it’s about this size
of the business card. And so we strap that through belt on each child,
and when they did the mood induction task that has an
Accelerometer in i t. And so we're able to pickup you know angular
velocity speed of how much the child have been bending forward and
backward and tu r ning side to side. And it actually pick s up 100
samples per second, so much more than the, you know the eye can
see. So we're able to see if kids with anxiety and depression move
differently in response to a potential threatening information. And

Andy Slavitt

they do, so kids with disorders turn further away from the potential
threat than kids without a disorder.

Mark Masselli: The research paper shows the device was nearly 85% accurate in
making a correct diagnosis. And she says early diagnosis is the key to
avoiding more damaging manifestations of anxiety disorder, later on.
A simple , wearable tool that can assist parents and clinicians in
determin ing if a child is suffering from anxiety disorder, leading to less
guesswork and more rapid diagnosis and treatment , n ow that’s a
bright idea.

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Mark Masselli: You've been listening to Conversations on Health Care. I'm Mark
Masselli.

Margaret Flinter: And I'm Margaret Flinter.

Mark Masselli: Peace and Health

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M oderator : Conversations on Health Care is recorded at WESU at Wesleyan
University, streaming live at www.chcradio.com , iTunes, or wherever
you listen to podcasts. If you have comments, please e - mail us at
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