Dr. Julie Gerberding, former CDC Director on vaccines and preparing for the next pandemic

Dr. Julie Gerberding, former CDC Director on vaccines and preparing for the next pandemic

Dr. Julie Gerberding is Executive Vice President and Chief Patient Officer at Merck.  She is a vaccine and infectious disease expert who served as former CDC Director under President George W. Bush during my tenure in the Senate.  There she led the CDC in responding to HIV/AIDS, SARS, West Nile Virus, and H5N1 avian influenza.  She joins us to share the latest on Merck’s new COVID vaccine announcement, and specifically what we need to do to better prepare for the next pandemic.

Dr. Julie Gerbe…:         There are more than 130 vaccines that are in development right now, and 13 of them are already in clinical trials. So, while people worry that we’re not fast enough, this is incredibly fast in the world of biopharmaceutical innovation, and never have we had vaccines come forward this fast into clinical trials.

Senator Bill Fr…:           You’re listening to A Second Opinion, your trusted source engaging at the intersection of policy, medicine, and innovation, and rethinking American health. Dr. Julie Gerberding is Executive Vice President and Chief Patient Officer at Merck. She is a vaccine and infectious disease expert who served as former CDC Director under President George W. Bush during my tenure in the Senate. There, she led the CDC in responding to HIV/AIDS, SARS, West Nile virus, and H5N1 avian influenza. She joins us to share the latest on Merck’s new COVID vaccine announcement and specifically what we need to do to better prepare for the next pandemic. I’m your host, Senator Bill Frist. Welcome to A Second Opinion.

Dr. Gerberding, we worked together for literally years, starting back to your time, 2002, 2003, ‘4, all the way through 2009 when you were director of the CDC that period, 2002-2009, and I was in the United States Senate up ’til about 2006. During that time, for our listeners, I just want to remind people, it was a period you led the CDC in responding to SARS, another Coronavirus that we’ll talk about, to leading on the West Nile virus, the whole H5N1 avian influenza. During that whole period of time, we saw that rise of multi-drug-resistant bacteria, the whole methicillin-resistant Staph aureus. So, your perspective on steps that we’re taking today, and with that backdrop of so much experience leading the CDC, working in government, and now in the private sector, really will be invaluable, I think, to our listeners as we go forward.

But before getting into that longer history, let’s turn to what I was just reading about in the last few days, in terms of Merck and vaccines and anti-viral, but why don’t we start with that, given your current position there, in terms of the most recent announcement?

Dr. Julie Gerbe…:         Like a lot of the members of our industry, we started working on the Coronavirus very early, as soon as we really recognized there was a new problem and it was likely to be a very serious global challenge, but we were looking for areas to contribute that we thought could potentially be game-changing. So, the first thing we did was work on a partnership with the Institute of Systems Biology to try to get the science of how this virus interacts with the host and how the immune system responds, etc., so that we had a better foundation for predicting what kinds of interventions might be the most successful.

So, we’ve been working on that, and then we’ve been working behind the scenes at our efforts in the vaccine arena, as well as in the anti-viral arena. So, when we announced our two vaccine programs, as well as our anti-viral programs, we walked into that with a high bar for what we were looking for, especially in the vaccine space, where we really wanted to find vaccines that, first of all, were feasible to manufacture and develop, which is a tall order, considering that we need a global market. But, in addition, we were hoping we would find feasible platforms that look like they would be effective with a single dose because that, obviously, is a much better scenario for a pandemic than if you have to give two or more doses to really get good immunity.

And then, finally, we were looking platforms in which we had a lot of experience and could jump-start our effort. So, the two vaccines we landed on, one is the vaccine platform that we’ve used for our already existing and licensed Ebola virus vaccine, which crossed the finish line during a different health emergency, following the West Africa situation with the Ebola outbreak, that’s a platform in conjunction with a non-profit organization called IAVI, that has been in development for exactly these kinds of viruses, and we’re hoping that, together, we can really accelerate what we’ve already learned from using it with Ebola virus and apply that to the Coronavirus situation.

The other vaccine is based on a variation of measles and the measles platform. Of course, measles vaccine has been around a long time, Merck has a measles vaccine and we’re very familiar with that virus, and so by working with Themis, and actually ended up acquiring them as part of this effort to accelerate development, we hope to be able to take what we already know about measles virus platform and, again, accelerate that into what could end up being, we hope, a single-dose vaccine with a very high degree of efficacy and a fairly predictable safety profile.

Senator Bill Fr…:           We’ve been told again and again on the internet and people in Washington that the vaccine is the answer, that that is what the goal standard will be and, once we get it, we’ll be okay. Some people say we’ll get it within a year, but usually people say 18 months. Help paint that picture in terms of what we know today, not what we’ve been told at press conferences. But where did the 18 months come from? Have other vaccines in the past been done that quickly? Why may it be even quicker than that or take longer than that? And then will we have one vaccine, or are we more likely to have three or four or five or six vaccines 18 months from now?

Dr. Julie Gerbe…:         I’ll answer your second question first because I think it’s fantastic that we have so many candidates, so many shots on goal, there are more than 130 vaccines that are in development right now, and 13 of them are already in clinical trials. So, while people worry that we’re not fast enough, this is incredibly fast in the world of biopharmaceutical innovation, and never have we had vaccines come forward this fast into clinical trials. So, it’s a relative comparison: it’s not fast enough to solve the problem as quick as we would like, but it’s very fast by the traditional standards of assessment.

Now, having said that, why can’t we go faster? With vaccines, it’s really important that we not only have a vaccine that works and, as I said, we’re hoping to find one that would work with a single dose, but it’s also imperative that they’re safe because we’re going to be using this product in really healthy people, some very vulnerable people, children, maybe infants, older adults, people with immune conditions, and, therefore, we have to be sure, if we’re going out to the broad, global population, that what we’re putting out there is very, very safe. And we’ve known, throughout history, that sometimes when vaccines are rapidly created for emergency purposes, they’re not as safe as we had hoped they would be originally. So, it takes time to do that safety evaluation.

Senator Bill Fr…:           I think the safety issue is one that you don’t hear very much about. Everybody has this image that we’re going to have one vaccine, we’ll be able to give it to 300 million people, which is a lot less because, truly, it’s going to have to go for the world, but then they don’t talk about the safety. Just remind our listeners where safety in the past has been, not sacrificed, but we’ve made some mistakes in the past with vaccines.

Dr. Julie Gerbe…:         I want to just say, from the beginning, that the vaccines that are currently recommended for broad population use are amazingly safe and I’m very confident in those. But there have been examples in the past where something has gone awry. For example, many years ago, in 1955, I believe, there was a development of a polio vaccine, and some of the doses of the polio vaccine that were created for the oral administration were not completely inactivated.

So, as you may know, the so-called “Cutter incident,” a number of people acquired polio from the vaccine and a few of them were paralyzed and there were also some deaths. So, that’s a worst-case scenario, that was a manufacturing error and probably accelerated because everyone was in such a rush to solve this terrifying epidemic of polio that the inspections and the evaluation of the safety and the manufacturing practices probably weren’t as good as they should be. So, that’s an extreme example, but we certainly wouldn’t want to be facing something like that in this day and age.

Senator Bill Fr…:           No. And I hesitate to even bring it up because people say, “Well, vaccines aren’t safe” and all, I think you’re exactly right: today, things will not come out unless they’ve been demonstrated to prove that they’re safe, and we’ve learned from those past experiences, and vaccine very much is the answer. But it is worth bringing up, only because people say, “Well, if you’ve got a vaccine,” and let’s say Merck or somebody said, “We’ve got a vaccine that works, tomorrow. It’s efficacious, we know that it works,” that’s only about a fourth of the story, probably, because then you have to really check safety, you don’t want to be giving a vaccine that does have some side effects that outweigh the advantages, and that’s why, in part, it takes so long.

Tell me a little bit about science. You’ve followed probably and been involved in six or seven pandemics, personally, so the underlying message there is these pandemics will continue, or the viruses will continue to come back and we don’t want them to become pandemics. What makes this one so unusual, versus the others that you have been involved with?

Dr. Julie Gerbe…:         A good comparison is, of course, SARS that emerged in 2003, which was very frightening, it actually had a much higher mortality rate, about 10%, but it turned out that it was not nearly as transmissible as this virus. So, this new Coronavirus is spread so easily between people, and especially people in large crowds, in close contact with each other, in confined spaces, like ships, or like prisons, or other very large gatherings of people, it can spread like wildfire in those situations.

So, that’s really why it has become a pandemic so fast. They tried containment in China, I think they did about as much as any country could do to try to quench it when they recognized it was happening, but it spilled over fairly quickly. And, to me, sitting where I was sitting, that was the sign that this was going to be the one that we have been worried about, or at least the first one in a long time that we’ve had to worry about and that we were in for a very difficult road ahead.

Senator Bill Fr…:           Well, let’s take it after the vaccine, let’s say we get the vaccine, or we get three or four vaccines, we take it through the safety process, which that just means you have to take it to [inaudible], you don’t know how people are going to respond, at a pretty large level, and then you have to wait for them to either be protected or not be protected in a control trial, and that just takes time. Talk a little bit about the manufacturing.

I was involved, in 2004, 2005, talking a lot, when I was majority leader, that the manufacturing is something and, at that time, we were talking about flu vaccines, we only had two manufacturing plants, and even today, how are we, in the United States, with our current infrastructure, going to be able to manufacture hundreds of millions of vaccines today, and how much of a bottleneck will that vaccine manufacturing be?

Dr. Julie Gerbe…:         Well, there are many things that are converging to address your question. One of them, I think, speaks to the whole speed of the process, and that is we’re working in parallel, not in series. So, even though we haven’t even brought these vaccines into clinical trials with people yet, we’re already planning for their manufacture, at risk, and we expect we’ll be able to make hundreds of millions of doses of these vaccines, as we need them, at the time the vaccine would hopefully be coming out of clinical trials. So, that’s one thing, just start now and scale up as quickly as possible, even before we know we have a product.

Now, if 130 companies did that, it would be impossible, it’s not realistic that we could have that kind of scale up. So, one of the things that’s going on is the NIH is working on coordinating all of the different players who are trying to contribute, and working together with what I like to think of as the wise crowd of scientists from the academic, non-profit, and private sector, all saying, “What are we looking for here? Of these 130 or whatever the number is, what are the vaccines that look the most promising? And let’s place some bets on those and really invest in scaling the manufacturing now, even though we may not ever use it because that particular vaccine might not end up being the one or one of the ones, but, nevertheless, we’re that much further ahead.”

Then I think you have to deal with the broader issue of let’s say we’re lucky enough to find a good vaccine in the United States; well, how do we make sure that people in other places can get it? And that’s where the issue of how do we out-license the intellectual property or transfer the technology so that the vaccine can be made in other countries or by other people and more readily work toward achieving that global scale that we really are going to need. Part of that is how individual manufacturers operate, and part of it is how we each do our part and collectively create a commons of vaccine development that will much better meet the needs of the global community?

Senator Bill Fr…:           The fact that it is a pandemic, and a pandemic, by definition, means a sustainable spread in multiple places, indeed around the world. How would you characterize, A, cooperation among scientists today, globally, and then, B, the industry itself in terms of public/private partnerships, not just in the United States, but around the world? Are people cooperative or not cooperative?

Dr. Julie Gerbe…:         This is such a special moment. I have never seen anything like it, and I go way back to the early days of AIDS, when the world was also really concentrating on trying to develop vaccines and anti-virals as quickly as possibly, but the amount of collaboration, the coming together of the greatest minds to say, “We can’t do this alone, but, together, maybe we can really make a difference.” It’s unprecedented, and I feel so joyous about participating in it because it’s exactly what we need to face a pandemic, but it really brings the best of us to the forefront, it really is our finest moment, as a biopharmaceutical industry, I believe, that this is what we exist for, this is what is in our DNA, and this should be one of the most important things that we can contribute to humankind.

Senator Bill Fr…:           It is really interesting that the pharmaceutical industry takes a beating most of the time, whether it’s in Washington, on the internet, prices, drugs, profits, and all, I think the pandemic puts things in perspective in terms of the importance of research and development and the amount of money and resources that are required, that are plowed back into it, to be prepared for times like this, these teachable moments, where we, literally all of us, our anxiety, our worries, our parents and relatives who may be in the hospital, all depend not on government, not on Washington, D.C. or our government in Tennessee, those are important, but ultimately depend on the pharmaceutical scientists and basic scientists who are working with them today.

So, I think that it is an interesting time for the pharmaceutical industry, and the reason I keep coming back to this global cooperation because there’s a tendency in the populous movements that people come back and say, “The United States have got the smartest people, we can do it on our own. We got this bug here and we can take care of it,” and we can’t, and it does take this cooperative experience that does lie there in an infrastructure, both in terms of pharmaceutical industry, as well as scientists, and as you just expressed, it is a wonderful moment to watch science and deliver it faster than it ever has in history.

Dr. Julie Gerbe…:         It’s interesting, Senator, because, this week, when Merck was making announcements about its new contributions, our head of research, Dr. Roger Perlmutter, said that no one is safe until everyone is safe, and I can’t think of a more succinct argument against vaccine nationalism than the recognition that even if we can protect Americans, we are just one traveler away from the virus being introduced to other people that we care about. So, we have to take a global view.

Senator Bill Fr…:           [inaudible] working together, now 18 years ago, I guess, was the first time that we really met and worked together, I remember, through that period of time, and it was a time, remember, we had the HIV/AIDS, which we successfully came together in the United States with our leadership and the rest of the world, but then we had a whole series of other threatening infectious disease, and it was the same time that anthrax came in and bioterrorism, and security and insecurity around the world, and the hollowing out of societies by infectious disease, making them less stable, less hopeful. And I remember, at the time, you saying, and it was something I strongly believed in, that national defense is our health defense, our health defense becomes a national defense. When you say that, what do you mean by that?

Dr. Julie Gerbe…:         Well, this pandemic is the perfect proof point, I would say, that this event is disrupting not just the lives of people in the frontlines of health and the people who have succumbed to the virus, but it’s affecting all of us in profound ways. It’s affecting our economy, and I believe it’s affecting our national security and all you have to do is think about the naval ship full of soldiers with Coronavirus infection to feel that threat or that vulnerability.

So, we have to really understand that infectious diseases, whether they’re intentional or created by Mother Nature, really do threaten us in foundational ways, and we need to tackle them with the same mindset that we tackle our other strategic national defense imperatives. It’s not about just in case we have a problem, it’s really about making sure that we have what we need just in time to deploy it and hope we never do, but we need to have those capabilities at hand so that when something new arises, we can handle it faster and hopefully more efficiently than we’ve been able to handle this one.

Senator Bill Fr…:           I mentioned that I was speaking a lot about vaccine development back in 2003, 2004, and, at the time, I really felt we needed more public/private partnerships because we can’t really expect private industry to build huge manufacturing plants to make vaccines and then put them in mothballs for 10 years or eight years or 15 or 20 years, and then have them up and running. But it does seem to me that we haven’t made a lot of progress in terms of vaccine development; science, we have, but in terms of working through the logistics of responding, responding quickly. As you said, as bad as the current Coronavirus is, for the case fatality, it’s not as high as something that it could have been, or I would even say we will see something with a much higher case fatality rate coming in the future.

If we just use vaccines as an example, how can we better prepare when this immediacy of the current pandemic and the tragedy and the striking down of vulnerable people today, when that passes, and hopefully that’ll be soon, a year from now, how do we keep the sensitivities up to be better prepared so the next time we have to make a vaccine, we can do it faster, better, more efficiently, more seamlessly than we are today? Because, otherwise, I’m going to be looking, 10 years from now, writing the same sort of thing, that we’re no better than we were 10 or 15 years ago. Now, we’re clearly better today than we were 15 years ago, but, still, it’s not as good as it could be, so how do we prepare for that next pandemic better?

Dr. Julie Gerbe…:         I co-chair a CSIS commission on global health security, and our most recent report was entitled Stopping the Cycle of Crisis and Complacency because I think our pattern, since the time that we were together in government, the pattern has been there is a crisis and we respond, we appropriate, we deploy, we do everything we need to do to try to quench that particular threat, and when it’s gone, we breathe a sigh of relief and then we go about our day jobs, and that is not the doctrine that our national defense system operates under, and I think that doctrine needs to translate over into the health defense mental model.

But in order for that to happen, we need leaders who understand that and remain committed to it, we need structures in our government that perpetuate that process beyond the term of a particular political leader or the political cycle of the Congress, and we need to make sure that we have the kind of budget process that doesn’t go like this, up and down, depending on the crisis of the day, but makes a longitudinal sustained commitment to accountable preparedness that Americans can see and trust and really know that we are prepared for these events.

It’s hard, and it means that we’re going to spend money that hopefully we’ll never use, but if we do need to use it, we will find ourselves in a much better position than we are today. I think if you were an economist, you’d look at the cost of what we’re experiencing right now, from human and economic terms, and you would wish that we had invested a lot more money in preparedness than we have over the past decade or two.

Senator Bill Fr…:           It is going to be groups like the CSIS group, Heritage Foundation, Council on Foreign Relations, all of whom are engaging with taskforces now to look at the current pandemic, but thinking long-term. But I just hope this time around, and pray this time around, that we can come together to do some pretty significant changes, such as that sustained dependable funding over time. It’s not the way our budgeting process is constructed today, and a lot of our listeners aren’t fully aware of that, that it really is, for the most part, annual-to-annual appropriations, year-to-year appropriations, and that we don’t budget for five years, we don’t budget for 10 years, but we budget year-to-year.

So, how we institutionalize that, how our Congress does, which is who we’re talking about in terms of budgeting, not the president, not the Executive Branch, is a real challenge that we need to call up on our leaders to do so that they don’t have budget caps, so that it can’t be cut down just when people don’t have that threat at the moment coming in. So, I think that is an important conversation that we all need to begin. People, such as yourself, and me and listeners on this program need to be thinking long-term like that, and so I really appreciate you mentioning it. And in that linkage to we’re strong, as a nation, in terms of our national defense, only as strong as our public health defense really is, and that’s not just here at home, we have surveillance around the world.

It’s too early now to go back and do after-action reviews, but because you ran the CDC, which is the most trusted scientific public health entity in the world, by far, not going back and being critical or nitpicking, but the CDC has been sidelined to a certain extent, not sidelined because they’re there and I’m on the computer every day going to their guidelines, but the CDC of the future, is there anything in this pandemic that has been introduced that will help policymakers and people at the CDC shape the appropriate role in the future? There’s some people who say there’s been mission creep over the years and that Congressmen and women have thrown in their pet programs that the CDC has to do, but are there any changes, as somebody outside of government now, like you, or me, could suggest in terms of the CDC? Again, the greatest public health organization in the world, but one that can always learn from the current pandemic.

Dr. Julie Gerbe…:         I couldn’t agree with you more. I know the scientists at the CDC, many of whom are very involved in the current pandemic, and I know the caliber of their science and their capabilities, so I wish I saw them more leading the communication because they’re very trustworthy and I know they would give us good, unbiased and non-political advice. So, I think the communication frontline is one that we really do need to understand as imperative in this kind of response capability set.

But I think, beyond that, it’s always hard, and it was hard for me at CDC to do simultaneously the urgent response to the infectious disease threat of the day and, at the same time, manage the broader portfolio of ongoing public health needs because just as we’re experiencing a pandemic of Coronavirus right now, our nation is experiencing a pandemic of diabetes, obesity, and cardiovascular disease, and the CDC is responsible for both. And so you’ve got the urgent and the important and they compete for resources, they compete for people’s time and energy, and I do think some structural assessment of what is the best way for us to support the broad, long-term public health requirements and, at the same time, make sure that this pillar of more urgent response capability is as good as it can be.

Senator Bill Fr…:           I agree entirely. I was just at the CDC, just a few months ago, again, visiting with our leadership before COVID, and have so much respect for what they’re doing, things like communication, much of which is out of their control, but we just need to come back and look at. What about, and again, this is out of your immediate purview, or mine now, but because it’s on people’s minds, the World Health Organization? It’s a pandemic and viruses don’t need visas and borders don’t matter.

We talked earlier in our conversation about the importance of scientists working together, manufacturers working together globally, the World Health Organization seems to me to be the primary conduit through which public health and the global arena flows. Put the World Health Organization in perspective for our listeners. How important is it? Are there other conduits or other places for exchange which can replace it, or is the World Health Organization absolutely necessary in terms of a place to at least convene and exchange and share information?

Dr. Julie Gerbe…:         I believe the World Health Organization is essential. I believe it currently provides some vital functions and that convening and platform of inclusion of all the different countries, large and small, rich and poor, around the world is critical to good decision-making. But I think it does suffer from some foundational structural challenges, and also is woefully underfunded for the scope of the mission that it has. But I also understand why people are reluctant to contribute more until they feel like the organization can rise to the occasion in a more facile manner and provide that true global leadership that’s necessary.

I think one of the structural weaknesses that I experience the most now, from the WHO is that they have a very difficult time engaging in private/public partnerships, and yet this pandemic can’t be solved any other ways, we’ve already been discussing the importance of the biotechnology industry, and so we need to recognize that when you’re dealing with the scale and magnitude of the health challenges that the WHO has on its plate, these are wicked problems and they need people coming together across sectors to concentrate on how to solve them in a collaborative manner, and industry is important in that. Private sector has a lot to contribute, not the only, but a lot, and without including that powerful source of science and resources and innovation, you’re just handicapping yourself, it’s dumb in this day and age to not be broadly inclusive of all the capabilities that could help solve the problems.

So, I hope that part of the after-action that we experience, coming out of this pandemic, we’ll also take a look at that as an opportunity to really rethink is there a way in which the world can provide better global health leadership and still respect the important aspects of the WHO that do matter and are doing a good job?

Senator Bill Fr…:           I agree. The one thing we can’t do is walk away from the WHO, and people can argue that they have made mistakes, there’s too much influence by China at certain points in time, all of which I think we need to address, but the importance, I believe, and from what you just said, I believe you also agree with, is that it is an important organization, let’s fix the things that are broken, but to walk away …

I think we take care of about 15% of their budget, and people say, “Well, that’s way too much,” but I think under your leadership and, in part, my leadership and President Bush’s leadership, with PEPFAR, in a bipartisan way, but the United States did step up with HIV/AIDS and malaria and tuberculosis, and we put in 40% of all the world’s funding for a period of time, but we won, and so I just don’t want people to give up on the WHO.

One last area that I would really appreciate hearing and learning from you is your observations or feelings about the state responsibility and local responsibility and federal responsibility. Most people are not at that point to come back and really address what went wrong, what is going wrong at the federal level as it interacts with the state level as it interacts with the local level, our mayors. We know that public health, for the most part, is local, it’s in our communities, we have a public health department, and it is, yes, water and clean air, and it’s infectious disease, but as you said, it’s now chronic disease.

But at that local level, if I went to a hospital administrator in Nashville, and let’s say there are 12 hospitals there, I’ll bet you none of them, maybe one, could tell me who the public health director is. And I may be exaggerating a little bit, but I think the point is it’s like two different roles, it’s like public health is the stepchild of health and wellbeing. Yet, public health is local, we’re talking about things like contact tracing now, literally picking up a telephone locally and finding somebody who may have been around somebody for 15 minutes, it’s all local.

How do we improve that stature of public health in communities, where these public/private partnerships can be generated and cultivated over time, where health systems and the trillions of dollars being spent in health services, some of that, not just giving it, but working with it, the partnering at the local level? And will this change now? Just talk a little bit about your observations from the past and then where we might go to improve those relationships in the future.

Dr. Julie Gerbe…:         It’s really tough, and there is a budget component to it. What happens in a lot of communities is that providing care, particularly indigent care, takes so much of the discretionary budget that the spillover left for other public health services really get short shrift. That’s an ongoing balancing challenge that most local governments have to contend with. But I also think there is a lack of alignment in terms of what people are trying to accomplish.

And when I’ve seen communities come together, bringing the health care delivery with the public health with the business community and other sectors together, as we actually did when we were doing pandemic influenza planning and exercising a few years ago, you begin to say, “Well, our community has these three health goals. Here’s what public health can do, here’s what the health care system can do, here’s what businesses can do, here’s what schools can do,” and you start aligning the community around the shared agreement about what’s really important in our community.

In a tiny little town in Michigan, a few years ago, I saw exactly this happen, the community came together around infant mortality, really very low budget, hardly any money available, but when they sat down with the various sectors and said, “This is important, let’s tackle this problem,” they performed a miracle. And I think that’s what we really need is to stop dividing our system, budget-wise or agenda-wise, and really rely on mayors and public health officials to try to be the conveners with citizens, especially citizens who are suffering the most health inequities, and really understand what can we do because health is wealth and communities will be better off if they can raise the level of health in their community. So, it sounds utopian, but I’ve seen it work, so I’m an optimist.

Senator Bill Fr…:           Yeah, and I think this teachable moment of who’s affected and how disproportionately by this virus, it’s vulnerable populations. You mentioned the word “inequities” and we all know that they’re there and they are just too often overlooked, but this disproportionately makes them worse, and people will see that. And then people will say, “What are the answers?” And it’ll bring them back to things like social determinants of health care and food and poverty, to a certain extent, and how public health interacts with the acute side of health care and delivery and chronic disease. So, to me there are some hopeful things. So, while we’re on some hopeful things coming out, anything that you would come back and underscore out of all the tragedy that has gone on and the suffering that continues to go on, both in terms of effect of the virus and then the economic loss that’s a product of what was necessary in terms of closing the economy down? What are some of the possible silver linings that are coming out of this?

Dr. Julie Gerbe…:         I hate to use the word “silver lining” because I recognize that it’s not feeling very silver to a lot of people right now. But I do think the way our health care workforce has become the frontline and soldiered through terrible situations is just a tribute to the heroic sense of purpose and commitment that we are so fortunate to have the best health system in America. I think families are learning they interact differently, having meals together and struggling with homeschooling and a lot of things that haven’t been necessarily fun, but have really reframed how people living in the same household interact with each other and get to know each other perhaps a little bit differently.

I think we’ve probably all become a little more cognizant of how precious our social contacts are, our families and our friends and the simple acts that we took for granted three months ago are suddenly things that we crave, like going to a restaurant and having a meal with friends or going to a graduation ceremony, so there are many aspects of life that we will appreciate more, going forward, because we’ve had to miss them during this period of time.

But, in my business hat, I would also say science is on our side. In fact, our science has progressed to the point where we can have this miraculous energy and opportunity to create solutions that, 10 years ago, we couldn’t have imagined. I think that’s an amazing phenomenon and one that will serve us well, going forward, as we think ahead to how we are going to better prepare for these things.

And then what you and I were talking about off and on for a while: how can we make sure that, going forward, we are leading in health defense and that we are truly prepared? And I think, from a standpoint of our government and our world, that’s going to be hopefully a legacy that we can all advocate for and demand as citizens.

Senator Bill Fr…:           Let’s close with just one final question, and it has to do more personally. There are a lot of people who listen to our podcast, who listen to us address issues and problems in a global way, in a scientific way, in a health policy way, looking at creative aspects and solutions. Your career is so interesting, I mean you’re at a point now where clearly the most important thing that we can have today is a vaccine to put this thing to closure, and you’re right in the middle of it, you’re right at the top, in terms of one of the greatest pharmaceutical firms in the world.

I have to be careful, I won’t say “the greatest” because I’ll get in trouble, but the greatest, you’re at that leverage point. 15 years ago, you ran the most respected public health, but much more than that, with surveillance all over the world, organization, the Centers for Disease Control and Prevention, and are a physician and you have that as your background. What moved you to public service? I know we could go on forever, but this public/private career that you’ve made, what first moved you to public service?

Dr. Julie Gerbe…:         I grew up in a small community in South Dakota, Estelline, South Dakota, and dreamed of being a doctor from the time I was four-years-old, so really, no matter what I’m doing in my career, it’s that I’m a doctor, and doctors are meant to try to help people cope with really challenging health conditions and to feel better and do better in their lives, and that’s what I did when I was on the faculty at a public hospital in San Francisco, taking care of those very first AIDS patients. And when I came to government, it wasn’t one patient, it was a lot of people, but the mentality was the same, the purpose is to really help people be healthy and thrive and have the best possible health they can.

In a pharmaceutical company, like Merck, where I went originally to try to help globalize the vaccines that Merck had, it was a privilege to be able to think about how we could take what we knew were health-protecting innovations that were in the resource-rich world and make them available to the girls in Africa who needed them the most, the children in Africa. And so it’s just always that sense of we can do better than this, and that whether I’m taking care of one patient or thinking about a population of patients, it’s just all the same to me, it’s what I do, and it’s what you do, too, right?

Senator Bill Fr…:           Yeah. When young people come along and they say, “Is medicine a good field to go into today, with cutbacks and reimbursement and all the regulations and not enough time with patients?” You come back to that, back to what you just said, you have that privilege.

Dr. Julie Gerbe…:         It’s a privilege.

Senator Bill Fr…:           It’s a privilege. And that opportunity to participate in the lives of individuals with health and with hope and with feeling. Dr. Gerberding, thank you very much for being with us. For our listeners, you and I had the opportunity to have many conversations offline, and I respect so much what you’re doing today on the frontline and everything you have done over the last 20 years that you and I have worked together for the benefit of [inaudible] around the world. So, thank you for being with us.

Dr. Julie Gerbe…:         Well, and thank you for having me, it’s been a pleasure to talk with you, as always, but I also appreciate your energy and your ability to really help people see the bigger picture, so thank you.

Senator Bill Fr…:           Thank you very much.

This episode of A Second Opinion was produced by Todd Schlosser, the Motus Creative Group, and Snapshot Interactive. You can subscribe to A Second Opinion on Apple Podcast, Spotify, or wherever you are listening right now. You can also watch our interviews on YouTube and on our website. And be sure to rate and review A Second Opinion so we can continue to bring you great content. You can get more information about the show, its guest, and sponsors at ASecondOpinionPodcast.com, that’s ASecondOpinionPodcast.com. A Second Opinion broadcasts from Nashville, Tennessee, the nation’s Silicon Valley of health services, where we engage at the intersection of policy, medicine, and innovation.