WHAT WENT WRONG — The Trump book boom is about to enter its next phase: the pandemic memoir. And a big name looks to be first to print. Scott Gottlieb, FDA commissioner under the Trump administration from 2017 to 2019, tweeted this week that his book, “Uncontrolled Spread: Why Covid-19 Crushed Us and How We Can Defeat the Next Pandemic,” slated for publication on Sept. 21, is open for pre-orders. Nightly called Gottlieb to talk about the current state of the pandemic, where we went wrong in 2020 and what new details his book may reveal. This conversation has been edited. What are you most worried about right now? We’ve seen how difficult it is to deploy the vaccine here in the U.S. and in parts of Europe where there’s hesitancy about taking it. That’s going to be equivalent, if not deeper, in a lot of parts of the world where there might be concerns around taking a Western vaccine. So I think we’re going to have real challenges deploying vaccines well beyond supply. We’re focusing, frankly, on the wrong challenge. There’s going to be ample supply. What would you say we got the most wrong in 2020? The near-term thing we got wrong is that we applied a flu model to a coronavirus. We used the tools that we had developed to try to mitigate a pandemic flu and then we made assumptions about how this virus was spread and how it would behave that were predicated on our assumptions about flu, without recognizing how the coronavirus would behave differently. We wrongly assumed that asymptomatic spread wouldn’t be a significant contributor to the epidemic. We wrongly assumed that it was spread primarily through droplet transmission. We wrongly assumed that diagnostic testing wouldn’t be that important to containing the epidemic because we thought the incubation period was short, like flu, and patients were only contagious once they became symptomatic and early testing wouldn’t be that important to containing spread. Could we have done anything to investigate the lab-leak theory sooner? Well, not if China wasn’t cooperative. But I think the critical piece of information that we could have identified earlier, with more certainty, was the scope of the asymptomatic spread — if we had been on the ground in China, if we had been able to investigate and work side by side with the Chinese CDC. Is there something you didn’t fully understand about the pandemic until you sat down to write? What this reinforced for me is the CDC is a largely academic type of institution that has a lot of independent silos that don’t necessarily collaborate, and isn’t really capable of mounting a large and rapid response to any kind of event of this scale. It’s much more focused on doing investigations of early outbreaks and things that are contained. And we really lacked that operational capacity. There’s no agency overseeing the different components that would be relevant. Are we going to learn any lessons from the pandemic? I think we’ll definitely be doing things differently. The question is whether we derive the right lesson. That’s what the book is really about. We need to look at capacity building. We need to look at public health preparedness through the lens of national security. That means our foreign intelligence services. We need to be doing better proactive surveillance for risks. The old notion was that this was a mission that was handled by public health agencies, and that we would get the information we needed to protect ourselves through multilateral engagement like the International Health Regulations, then WHO. But we’ve seen that those conventions fail, and fail repeatedly, and we can’t rely on them solely anymore. And this clearly wasn’t a bioterrorist weapon. But rogue regimes and terrorist groups, now looking at how this hurt us more than it hurt a lot of other nations — I think we need to reassess the calculus of how we guard against biological threats. Are you still wearing a mask? I’m not wearing a mask outdoors. But I wear a mask in certain indoor settings where there are crowds. And it’s not necessarily because I feel vulnerable. I’m fully vaccinated. I feel like it’s etiquette. When I go into a pharmacy or grocery store, there’s enough people wearing masks, that I feel like by wearing the mask, I make other people feel less uncomfortable. That’s why I’ve been wearing a mask. Welcome to POLITICO Nightly. Reach out with news, tips and ideas for us at mward@politico.com, or on Twitter at @MyahWard.
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