“Culture Wars Are Killing People”: NIH Director Dr. Francis Collins on Politics and Harm to Pandemic Science

Francis Collins

[Music]

Female : Welcome to Conversations on Health C are 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 healthcare of the f u ture.

This week Mark and Margaret speak with Dr. Francis Collins, Director
of the National Institutes of Health, the largest biomedical research
agency in the world , a nd the guy who led the Human Genome Project
mapping the human genome. Dr. Collins talks about the acceleration
of global research around the pandemic, the mRNA vaccine boosters,
D elta and Mu variants and where the NIH research is headed next.

Lorri Robertson also checks in, Managing Editor of F actcheck.org . She
looks at misstatement spoken ab out health policy in the public
domain, separating the fa ke from the facts. And we end with a bright
idea that's improving health and well - being in everyday lives.

If you have comments, please email us at CHC R adio @ chc 1 .com o r
find us on Facebook, Twitter, Spotify or wherever you listen to
podcasts. And you can also hear us by asking Alexa to play the
program. Now stay tuned for our interview with NIH Director Dr.
Francis Collins, here on Conversations on Health Care .

Mark Masselli: We're speaking today with Dr. Francis Collins, Director of the National
Institute of Health the largest biomedical and public health research
agency in the world. He's been leading the agency since 2009.

Margaret Flinter: Before that Dr. Collins was D irector of the National Genomi c Research
Institute where he oversaw one of the most significant biomedical
accomplishments of modern times the Mapping of the Human
Genome . Dr. Collins, w elcome back to Conversations on Health Care .

Dr. Francis Collins: I'm glad to join you at this propi tious time as we continue to struggle
with COVID - 19.

Mark Masselli: Yeah and speaking of that, you know, millions of parents are taking
their children back to school and many of the children are under the
age of 12, without the benefit of a vaccine. And no w you've said that
the vaccine approval for younger kids may not come until late fall at
the earliest. But just recently, the American Academy of Pediatrics ,
issued a request to speed up emergency use authorization for
younger kids, because of the risk to their health has increased
significantly with the Delta variant. What's the likelihood we'll see the
vaccine authorization for younger children sooner than you would
expect it? And really, why don't we have better fix on date certain for
approval?

Dr. Fran cis Collins: That’s a good question. First of all, let's be clear that kids from 12 Up

Francis Collins

can be immuni z ed that has been approved for a while and
unfortunately, only about half of them so far have been vaccinated
and those kids are going back to school to . I had hoped we'd be in a
better position th a n in terms of having that group of students less
likely to be the source of outbreaks.

So we have a broader problem here just in terms of public acceptance
of vaccines, both for adults and kids. But I get it that p articularly
parents who have kids under the age of 12, concerned about schools
opening up again, wish that there was a way that those kids could
have also been immuni z ed. The challenge, of course, is you don't
really want to begin to advocate for any kind of medical intervention
for children under 12. Unless you're really sure you got it right. You
can't consider kids as just being a little miniature humans, they have
different physiology and different metabolism. So the data has to be
generated by doing ve ry carefully conducted clinical trials on kids of
that age. That has been done. But it's not quite complete a s far as the
follow up for any kind of safety signals.

As I understand it, that data will be submitted by Pfizer to FDA later
this month, near the end of September. And then FDA will need to
look at the data. Now if everything looks perfect and there's no
surprises and the efficacy and the safety are all beautiful, then you
could imagine FDA granting approval in maybe just a month or so. But
if there 's any tricky thing there where they need to ask more
questions, get some additional details, it could take a little longer.

So I think we all got to be careful here better not to over promise. I
guess previously I've said w ell, I think by the end of the y ear, I would
love it if that happened to be October. But it could certainly linger a
little longer than that. And I totally get it why everybody's impatient. I
am too.

Margaret Flinter: Well, right up there in the news, of course, is the issue of a booster for
all the folks who have been vaccinated FDA now recommending a
third booster for those fully vaccinated and especially if they're
medically compromised. I think you've said in the past that maybe
rather than rolling out the third dose of vaccine, you'd rather see the
unvaccinated getting their first dose of vaccine. What are your
feelings now around the booster and how important this is, as we
worry about protection waning over time and the new coming
variants Lamda and now Mu , possibly evading our vacc ine protection
even further what's your thought about boosters at this point?

Dr. Francis Collins: First of all, I would say the number one priority is to get those who
have not yet been vaccinated , haven't even gotten their first dose to
do . S o those are the people at the greatest risk right now, especially
with D elta, which is so incredibly contagious and may also be more
severe than its predecessor virus variants. And so those 85 million

Francis Collins

people are sitting ducks right now. And everything we can do, to tr y to
convince them to look at the evidence and make a choice to roll up
their sleeve is got to be number one priority.

But I don't think we ought to make this an either or when it comes to
boosters. Since I made the statement you quoted, we've got more
dat a now looking to see what's really happening as far as the
effectiveness of the vaccines, and providing protection over time. A
lot of this data actually comes from Israel, they've had a very
complete ascertainment of what's happening, and they're relative ly
small country, and they have a single vaccine, the Pfizer vaccine, so
we can really look and see what's going on. And it's pretty clear that
the people who got immuni z ed first back in January, are now showing
more breakthrough infections, including some that are not just mild,
but some that seem more severe. That's not too surprising. But now
we can actually see the evidence for it. We're seeing some of that also
now in the U . S . and data collected by CDC.

So it makes sense to begin to prepare for booster s, so that people
who have been immuni z ed can really give their immune system
another jolt of reminder about what to watch out for, especially
against Delta.

The good news is the vaccines work against Delta. But as they wane
over time, they just need anoth er kick. And that's what the boosters
are supposed to do. That FDA right now is looking at that data, they
will then decide . T here'll be a meeting on September 17, where they
publicly discuss the evidence for boosters . CDC and their advisory
committee will then make a recommendation and as soon as
September 20 t hat week, we might then see a recommendation
coming forward f or boosters , beginning with the people who got
immuni z ed first, which are mostly elderly people and healthcare
providers, they were first in line and they should have been.

So it's based upon science. There's nothing arbitrary about this. The
people who should get boosters right now, or maybe we should just
call them third doses are the people who are immunocompromised,
we know that they don 't always get a full response to the standard
vaccines, the two doses of Pfizer or M oderna or the one dose of J & J .
Those folks as of a month ago were encouraged to go ahead and get
another dose to try to be sure that their immune system, which is a
little sleepy from chemotherapy, or immunosuppressive therapy for
organ transplant patients, gets just one more chance to give them
that kind of immunity.

Margaret Flinter: Oh, that's a great reminder for those that are immune compromised.
You know, Dr. Collins y ou oversaw the Mapping of the Human
Genome , really a remarkable feat. But surviving three Presidential
administrations in the current political climate is also a remarkable

Francis Collins

achievement . A nd I wonder if you could talk about your experience
leading the world 's largest Biomedical Research Institute, under
President Obama, Trump and Biden. And how do we lessen the sting
of politics which can have such a negative effect on the world of
research?

Dr. Francis Collins: Well, it has been an interesting ride and I fe el really privileged to have
been given the opportunity to play this role. Fortunately, in most
situations, medical research is not quite as politici z ed as everything
else. Although there have certainly been exceptions with COVID - 19.
Regardless of your pol itical party, or other persuasions, most people
are really concerned about health issues, want to see advances made
that would help prevent terrible diseases like cancer and heart
disease and diabetes. And so that's what we do. And so we've been
fortunate to be able to make that case a nd to get support from the
administrations and from the Congress.

The problem that has really become much more severe though now
relates to COVID - 19 a nd how the current polari z ation of our country
about almost everything has p layed out in a circumstance where it
really has been destructive. Your political party really shouldn't be the
main reason for you to have a view about vaccines or mask mandates.
But that's turned out to be the case.

And so things that really should be bas ed upon evidence and the truth
of what we actually know, get colored over and that is further made
complex by social media and the way in which misinformation spreads
often times more quickly than the truth. I do worry about that, not
just about what it's done to COVID - 1 9, but about the future of our
country, if we're in a circumstance where truth has somehow stopped
having the same purchase that it should, on our decision making, and
other things like politics, conspiracies, and just random opinions seem
c apable often times of pushing truth aside, that is not a good place for
the most technological nation on the planet to be.

And I hope we can begin somehow to learn the lessons, because the
culture wars that are now so much affecting COVID - 19 are killing
pe ople . W e've lost 600,000 people, most would estimate that if we'd
had a better management of our public health, circumstances, based
on evidence 10s of 1000s, maybe hundreds of 1000s of those lives
could have been spared. This is really serious.

Margaret F linter: Well, it is so heartbreaking to have lost people after we had the
vaccine. You know, in those early months when we had no vaccine,
we just longed for the vaccine , to have lost people afterwards is truly
heartbreaking. And I wonder if I can ask you, Dr. Collins, to comment
on certainly an issue that many organi z ations struggle with, in which
people have expressed that their faith is a reason to issue the vaccine.
And I know your own faith journey has informed your approach to

Francis Collins

science. And I wonder wh at your thoughts are, as you see people put
forth their religion or their faith a s the reason that they are refusing
or if they're in an employment situation sometimes seeking an
exemption to accept the vaccine. How do you answer that in terms of
the scien ce as we continue to navigate this pandemic?

Dr. Francis Collins: Well, thanks for that question. I am a person of faith as well as a
scientist and I have not seen a conflict between those worldviews
since I became a Christian at age 27. But many people do perceive
such a conflict. And it may mean that people of faith sometimes are
more suspicious of scientific developments , because they think they
are secular or maybe even atheist, in their perspective . A ctually, 40%
of working scientists believe in God. S o it's not as if there is this big
divide, but sometimes it looks that way from the outside.

So I would argue that this is another place where we really have some
work to do to try to help understand that science for the perspective
of a believer is actual ly a way of understanding God's creation. And
it's a gift to be able to do so and then to use that information to try to
alleviate suffering. When people pray for deliverance from a medical
disaster, what are they actually praying for? Well, perhaps some
m iraculous intervention, but oftentimes, I think the intervention
comes about through the way in which science provides answers. And
that's where we are with COVID.

So many people of faith have been praying that this epidemic could
be managed that it wouldn 't threaten the lives of themselves and
their families. And we have an answer to that prayer. It's called the
vaccines which are remarkably safe and effective. And i t puzzles me
that people of faith would look at those at somehow not consistent
with what t hey've been praying for when in fact, it seems like it's right
in the middle of that.

But I don't want to generali z e every person of faith who has concerns
about the vaccine generally has a series of questions about it, and
they're not all the same. There' s a lot of misinformation about
whether this is something that is going to be dangerous, causing
infertility, maybe it actually will give you the disease itself, which it
won't. Maybe there's a chip in that vaccine needle that's going to
allow people to tr ack you a round. No, that is not happening. There's
so much noise out there.

And again, I think people have faith, maybe trying to find w here i s a
credible place to look to get those answers. Just one place, I would
say Curtis Chang who's a Pastor has done a whole series of videos on
Christians and the vaccine . P eople really ought to have a look at that.
They're very well done. They're based on the facts. He deals with a lot
of the information that's out there that are scaring people and tries to
really put the truth into the picture. And as a Pastor , somebody who

Francis Collins

believes in the truth , the truth will set you free t hat's what Jesus said,
I hope that will be something that people can look at if they're
confused about what's going on. And listen to a credible s ource who's
a Pastor not like me, some federal employee who runs a government
agency, but somebody with that kind of credibility because Pastors
have a lot they can do right now.

Mark Masselli: Well, and you do as well as a person of faith, and thanks so m uch. And
we're speaking today with Dr. Francis Collins, Director of the National
Institute of Health. You know, Dr. Collins, millions of deaths have
occurred worldwide from COVID - 19. And we're seeing really troubling
phenomena long COVID is an increasingly prevalent outcome, even
amongst those who have mild cases, and I'm wondering how you're
directing Research at the National Institute of Health to help us
understand the complex nature of long COVID. And can you describe
the syndrome of long term COVID a nd its impact?

Dr. Francis Collins: It is one more reason we're really concerned about this virus. And it
was unexpected that this respiratory virus would have this ability and
as many as a third of the people who have the acute illness, to have
that illness linger on for weeks, or even months, with a variety of
symptoms that are very troubling and puzzling. And that includes
fatigue, palpitations, brain fog, where people really have difficulties
maintaining concentration that interferes with work or school. And
we don't really understand the mechanism that is causing this virus to
have that kind of lingering consequence.

Is it that the virus is somehow still in the body hidden away in some
reservoir that we can't find? We don't see it there . Is it the immune
system has been activated in a way that it can't reset itself? And is
causing these symptoms? Is it some sort of effect on blood vessels?
Because we know this virus does bad things to blood vessels? We
don't know, we aim to find out.

So at NIH, we have one of the largest cohort studies we've ever
mounted to track 10s of 1000s of COVID - 19 survivors, figure out who
it is who gets long COVID? Who doesn't? And what is the specific
metabolism and immunology that we could learn about that would
teach us what's go ing on and what to do about it. But we're still
looking for those answers.

By the way, and this is one more reason for people who are skeptical
about vaccines to really think about do you want to pass up the
chance to be immuni z ed , b ecause if you think tha t, okay, COVID - 19
maybe doesn't sound that bad , I 'm a young person, young people get
long COVID, too. And they may then spend months and we don't
know how long this can go on i n a very impaired state. The vaccines
prevent that another reason to roll up you r sleeves.

Francis Collins

Margaret Flinter: Dr. Collins, looking back over our shoulders, to the first months of the
pandemic, it was testing, testing, testing, right . W e were so concerned
about testing. And there were a lot of critiques that as a country,
maybe we dropp ed the ball on standing up a testing infrastructure all
across the country. But we find ourselves at this point a nd I wonder,
particularly in the United States, what's the role of testing now and
maybe particularly rapid testing? What should that infrastru cture look
like in communities all across the country?

Dr. Francis Collins: Yeah, we did get off to a rocky start. NIH was asked by the Congress to
jump in here back in April of 2020. And they gave us additional
resources to try to develop new technologie s, especially those that
could give a rapid response at the point of care. So you didn't have to
wait a day or two, to get a result back from a central lab. That includes
now home tests, which you can get at the drugstore, a direct result of
the program we founded called R ADx rapid acceleration of
diagnostics.

So we're doing pretty well now in terms of being able to get rapid
answers for people who have symptoms where you're worried about
is this COVID. And we need to worry about that because you want
that person immediately isolated, so they don't infect other people.
What we haven't done so well is to figure out how to really put in
place asymptomatic testing in places like schools and businesses,
because that is a really important part of ending this pand emic.

One of the more diabolical aspects of this SARS - CoV - 2 is its ability to
infect people at high viral loads, who have no symptoms, and they
then are infectious for others around them. Unless you do that kind of
asymptomatic testing, especially in areas where you have a lot of
people packed together like schools, you're going to miss that. Now,
we do have the technologies now to start to do that. But we haven't
really quite figured out how to distribute them. And many
organi z ations, be they businesses or schools are looking for advice.

Let me just mention a website that can help with that in terms of
choosing amongst the options that are out there about what kind of
testing you might want to put in place. And this is just called
whentotest.org in an effor t put together by NIH and MIT that I think a
lot of places have found valuable. But you have to have the resources
of course, testing i s not free. The federal government has distributed
a lot of money to the states for this much of which hasn't been spent
yet. People are still trying to figure out how best to apply the
technology. But boy here it's the fall and schools are starting up and
D elta is out there. This would be a great time to really pull that
together.

Mark Masselli: Dr. Collins, I want to pull the thread on Margaret's comment about
infrastructure and talk really about vaccine distribution. You know, in

Francis Collins

America, we don't have an adult vaccine distribution system like we
have with children, and we're seeing i n Israel the COVID Czar said we
may nee d a fourth shot. We know already that it may not be like the
flu, it may be not 12 months, it may be eight months. We don't know
all of the data yet. And the healthcare system is really strange health
cente r s, our hospitals are strained in terms of just de livering regular
care, do you think we need a Vaccine Corps or some group that's like
the Peace Corps VISTA that really sets in place an infrastructure, so
every community has access to that, where education could happen
and the like, because relying on th e current health system seems to
be straining it . Are we really prepared on our distribution model?

Dr. Francis Collins: Well, I think all of us who've looked at the U . S . healthcare system over
the years would agree that it's far from ideal, and that COVI D - 19 has
pointed out, for instance, the health disparities that are very much
part of our system where people really don't have equal access to
healthcare, depending on your resources . A nd this needs to be
addressed, not just for COVID, but for lots of oth er things.

In terms of your question about a vaccine cor ps , that's really the
CDC ’s role. The problem is CDC has been hampered by having had
their resources cut over the years, and they depend on the states and
the State Health Departments have been really working on fumes, as
those budgets have also been severely constrained. We need to beef
that system up. That's the place this needs to happen.

I think we've got the ability to deliver vaccines, because pharmacies
have stepped into that 75,000 of them. And so right now, 95% of the
country is within five miles of a site that can give you a vaccine. The
trick is the o rgani z ing of it, the delivery of the doses and the database
to keep track of where we are with all of this, which is important to
do, but also c oncerns people who are worried about privacy and
tracking of medical information.

I think this ought to be the wake up call to get there. Unfortunately,
there's some politics in that one too. So we're not quite there. But
one of the things we have to do, a s far as lessons learned from this
pandemic, is to recogni z e that our public health system in the United
States has been allowed to atrophy and it needs a big infusion of
resources to get back into a place that would be ready for something
like this the ne xt time.

Mark Masselli: We've been speaking today with Dr. Francis Collins, Director of the
NIH and former leader of the team that Mapped the Human Genome .
You can learn more about his groundbreaking work by going to
www.n ih.gov , y ou can follow his blog at www.directorsblog.nih.gov .
You can follow him on Twitter @ NIHDirector . Dr. Collins, thank you
for your lifelong dedication for advancing biomedical research, seeking clues to some of the most confounding diseases and

Francis Collins

conditions plaguing humanity and for your tenacity in addressing the
mysteries of genomics and of this pandemic a nd for joining us today
on Conversations on Health Care .

Dr. Francis Collins: I'm glad to have ta lked with you. We're all in this together. We're
going to get through this , but we'll get through it faster if we really
depend on the best science and we have got a lot of that to offer.

Margaret Flinter: Absolutely. Thank you so much Dr. Collins.

Mark Ma sselli: Thank you so much. 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 non partisan,
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: The seven day average of COVID - 19 hospitalizations in the U . S .
increased by 322% f rom mid - June to mid - August, stripping the ability
of medical staff in some states to care for patients. The seven day
average of hospitalizations was more than 80,000 on August 15 .
H ospitalizations tend to be higher in states with low vaccination rates,
including Florida, Alabama, Mississippi and Louisiana.

Despite the rising numbers an Instagram post questioned whether
COVID - 19 is quote, “T ruly a pandemic that was overwhelming
hospitals ” if the post claimed “H ospitals are firing nurses who refuse
to be vaccinated . ” Some hospital staff have been fired for refusing to
get the vaccine. But Colin Milligan a spokesman for the American
Hospital Association told us the overall number fired for that reason is
likely to be very small. About a quarter of all hospitals in th e U . S . have
some sort of vaccine mandate, but there isn't evidence they are
shedding employees due to the mandate policies.

Earlier in the pandemic some healthcare providers were forced to
tighten their budgets and reduce staff due to lower overall patient
volume , cancelled elective procedures and higher expenses tied to
the pandemic and the pandemic continues to put a severe financial
strain on hospitals. But the Bureau of Labor S tatistics data show
hospital employment has actually increased slightly by 11 ,000 jobs
from January to July . A nd hospital employment was up by 45,000 jobs
in July compared with a year ago. But staffing is still below the pre -
pandemic high in February 2020.

In mid August, the President of the Florida Hospital Association said
that m any hospitals in that state are quote “S tretched to their
absolute limits. ” And that’s my fact check 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

Francis Collins

ma jor political players and is a project of the Annenberg Public Policy
Center at the University of Pennsylvania. If you have a fact that you'd
like checked e - mail us at www.chcradio.com , we'll have
FactCheck.org's Lo ri Robertson check it out for you here on
Conversations on Health Care.

[ Music ]

Mark Masselli: Each week C onversations highlights a bright idea about how to make
wellness a part of our communities and everyday lives. Over the past few decades, kids have be en getting less and less physical activity
throughout the school day and as budgets have been tightened Phys Ed has become less prevalent in many schools . University of Michigan
researchers wanted to find a creative and effective solution that
would increa se kid ’ s movement and increasing sedentary lifestyles
without disrupting the school day

Dr. Rebecca Hasson: W e looked at the scientific literature in terms of prolonged sitting.
And they have demonstrated that if you just do two minutes of
activity, a smal l burst, get up do some movements, activity in that
small of a dose can have dramatic improvements on health on
cognition on learning. So we decided to develop an intervention a
program that would allow children to get these small bursts of activity
throug hout the day.

Mark Masselli: Dr. Rebecca Hasson is Principal Investigator for i nPACT Interruption of
Prolonged Sitting with Activity . She wanted to find out if just two to
three minutes short bursts of physical activity , five times a day would
impact the k ids cumulative movement. The research showed that kids
of all shapes and body types found the program easy to participate in .

Dr. Rebecca Hasson: W e typically see in PE or recess lower participation in girls compared
to boys. But in classroom activity brea ks you actually see similar rates
of participation, if not higher rates of participation in girls compared
to boys. We also saw that for children who are carrying a few extra
pounds that those children also were exercising at a high intensity,
even childre n with asthma , t hey were even able to do the activity
breaks at a higher extent than their children without asthma.

Mark Masselli: Dr. Hasson a Kinesiologist said they wanted to design the intervention
that would be easy for teachers to adopt and manage. S o they
created videos designed to get kids moving quickly then allow them to
quickly ease back into their learning mode,

Dr. Rebecca Hasson: W e created a compendium of 200 activity breaks that are just three
minutes long. So the teachers had a variety of d ifferent types of
activities, whether it was Jumping Jacks, Leap Frogs, something that
will get their heart rate in the target heart zones, we got a lot of
positive responses, particularly for the videos from the teachers,

Francis Collins

because it was really easy to imp lement.

Mark Masselli: Kids burned on average, about 150 more calories per day, and at the
end of the week, had accrued a significant amount of physical activity.

Dr. Rebecca Hasson: The kids when they left the laboratory, when they went home, they
still c ontinued to be physically active. We had these little
accelerometers. They measure movement at the hip. And so it tells us
how many calories were they kids burning away from the laboratory
and how much physical activity were they getting .

Mark Masselli: A low cost easily adoptable fitness intervention for kids, allowing
short bursts of physical activity throughout the school day, enhancing
fitness, empowering kids to move more positively impacting the
learning experience. Now that's a bright idea.

[ Music ]

M ark 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

[Music]

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
[email protected] or find us on Facebook or Twitter. We love
hearing from you. This show is brought to you by the Community Health Center .

[ Music ]