The following is a transcript of an interview with former FDA Commissioner Scott Gottlieb that aired Sunday, September 6, 2020, on “Face the Nation.”
JOHN DICKERSON: We now turn to former FDA commissioner Dr. Scott Gottlieb. He’s in Westport, Connecticut. Good morning, Scott. I want to jump right in. Give us an update on where things stand now here on Labor Day.
DR. SCOTT GOTTLIEB: Well, if you look at where we are heading into Labor Day, relative to where we were heading into Memorial Day, we have an equivalent amount, if not more infection heading into Labor Day right now. And we’re heading into a more difficult season. We’re heading into the fall in the winter when we would expect a respiratory pathogen like a coronavirus to start spreading more aggressively than it would in the summertime. Looking at Memorial Day, we had about 40,000 people hospitalized. We were diagnosing about 21,000 new cases a day and had about 1,100 deaths. Now, notwithstanding the fact that we’ve made really significant gains in reducing in-hospital mortality and reducing length of stay in the hospitals for patients who are hospitalized for COVID right now, as of yesterday, we had about 35,000 people hospitalized. We’re diagnosing about 40,000 infections a day. And on a seven-day moving average, we have about 850 tragic deaths a day. So that’s a lot of infection to be taking into a season when we know a respiratory pathogen is going to want to spread more aggressively. And the other backdrop here is that people are exhausted. People have been social distancing and wearing masks and staying home for a long period of time right now. Small businesses are hurting. So I think that people’s willingness to comply with the simple things that we know can reduce spread is going to start to fray as we head into the fall in the winter. And that’s another challenge, trying to keep up our vigilance at a time when we know that this can spread more aggressively.
JOHN DICKERSON: So, Dr. Gottlieb, just to remind us all why the fall and winter are considered worse than the summer, why is it that we wanted to be in a better position going into the fall than, say, some other season?
DR. GOTTLIEB: Epidemiology of spread for a respiratory pathogen, changes in the wintertime, in the fall and the winter. Typically in the summer you see viruses spread that are spread through food, things that are ingested. In the wintertime, you see respiratory pathogens spread more aggressively, in part because people are indoors more. They’re in congregate settings where respiratory pathogens can spread more efficiently, in part because there is some impact of the cold weather on your ability to protect your upper airway from respiratory pathogens. But we know that the epidemiology of spread changes, and that’s when you see these respiratory pathogens like coronavirus or respiratory syncytial virus or flu, that’s when you see these pathogens start to spread. Typically, a coronavirus isn’t a summer pathogen. It’s a seasonal pathogen that really manifests itself in the fall or the winter. There’s a lot of circulating strains of coronavirus that cause nothing more than the common cold. And typically they only circulate in the fall and the wintertime.
JOHN DICKERSON: I want to pick up on that point you made about people just being fatigued and tired. Listening to public health officials, trying to sound the alarm yet again about Labor Day, you really felt for them. So I want to ask you about vaccines in this context, which is we are hearing more about vaccines. Certainly the administration is talking about it. Is- is there a way in which talk about vaccines, which is a little bit of a ways away, obscures what needs to be done today to stay on top of this?
DR. GOTTLIEB: I think- I think in terms of thinking about the vaccine, at least as far as this year is concerned, 2020, the fall and the winter, I think that if there is a vaccine made available, it’s likely to be a very staged introduction of the vaccine under an emergency use authorization, where there’s going to be a lot of data collection around the use of that vaccine. And it’s just going to be for very select groups of people who are either at very high risk of contracting a coronavirus because of what they do, for example, health care workers or very high risk of a bad outcome. Think of people, for example, in a nursing home. So you can almost think of the vaccine being used in a therapeutic sense to try to protect very high risk populations and not in the way we traditionally think about a vaccine in terms of trying to provide broad based immunity in a population and really quell an epidemic. I think the likelihood that we’re going to have a vaccine for widespread use in 2020 is extremely low. I think we need to think of that as largely a 2021 event. And if we do have a vaccine available in 2020 it is likely to be used in a much more targeted fashion, almost in a therapeutic sense, to protect very high-risk populations. You know, the reality is that if we continue to see spread at the rate that we’re seeing it now or something higher than what we’re seeing it now, by the end of the year, upwards of 20% of the population in the US could have been exposed to this coronavirus. And we’re likely to see the virus itself start to slow down just because of the natural progression of the epidemic and the fact that we’re heading out of the winter into this- into the spring and the summertime as we enter 2021. And so this could run its course in 2020. And as we get into 2021 start to slow down. I think the tragic consequence of that is that there’s going to be a lot of death and disease along the way. But I think by the end of this year we’re likely to be through at least the most acute phase of this epidemic, in part because it’s going to end up infecting a lot more people between now and then.
JOHN DICKERSON: So it sounds like what you’re saying is that all of the things everybody’s heard of one hundred times about masks and social distancing and not gathering in large groups, everybody has to stay vigilant because a vaccine isn’t coming racing to the rescue. If a vaccine does get this emergency use authorization, people are worried about politics. The CDC this week told states to be ready by the first of November. Help people understand how much politics could get in the way of speeding up the vaccine distribution.
DR. GOTTLIEB: Well, I don’t think politics should get in the way at all, and I don’t think it will. There is a very rigorous process around the development and approval of a vaccine. And I’m on the board of Pfizer, which is one of the companies developing a vaccine, which is pretty far along. First there’s a data safety monitoring board overseeing that trial. And the data doesn’t get unmasked to the drug developer and to the FDA until the data safety monitoring board is comfortable with the conduct of the trial in terms of letting it continue. Then the company needs to file that data with the agency and ask for permission, either for an authorization or approval. And then you have a very rigorous process inside the FDA. And I led that institution and worked there in three different iterations during both the Bush administration and the Trump administration, and I have absolute confidence in the scientific staff that’s going to review this application. It’s a very rigorous process. There’s multiple layers of review among people who are expert in these areas. And so I don’t think those people are going to be pushed around to make a decision that they’re not absolutely confident in. In terms of the distribution of a vaccine, the government has said that they’re going to take over the distribution of the vaccine. I think at least initially, the distribution is likely to be very limited because if there is a sort of authorization or an approval of the vaccine sometime this fall or winter, again, it’s likely to be a very targeted populations of people where it will be relatively easy to distribute to sites where those individuals can get access to the vaccine. So, for example, if you think of distributing the vaccine to nursing homes, well we know where the nursing homes are, we know who is there. The federal government and the state governments oversee those institutions and regulate them. So that should be a relatively straightforward exercise. Same with trying to vaccinate doctors, frontline health care workers. In 2009, we- we vaccinated frontline health care workers first. And we were able to do that very efficiently with the swine flu.
JOHN DICKERSON: All right. Dr. Scott Gottlieb, as always, we really, really appreciate it. Thanks so much. And we’ll be right back with a look at the economy from Allianz chief economic adviser Mohamed El-Erian. Stay with us.