The following is a transcript of an interview with former FDA Commissioner Scott Gottlieb that aired December 13, 2020, on “Face the Nation.”
MARGARET BRENNAN: We want to go now to former FDA commissioner Dr. Scott Gottlieb. He is also on the board of Pfizer, and he joins us from Westport, Connecticut. Good morning to you.
DOCTOR SCOTT GOTTLIEB: Good morning.
MARGARET BRENNAN: I want to start on the big picture. You forecasted last week that we’re not going to see peak hospitalisations for at least six weeks. The CDC director put an even more dire timeline on that, saying 60 to 90 days we’re going to have more deaths per day than on 9/11, than on Pearl Harbor. He was talking about on each day. How do you save lives at this point?
DR. GOTTLIEB: Look, the pressure is going to be on the healthcare system, and we need to keep the healthcare system from getting maxed out. They’re not going to see peak burden on hospital resources probably until mid January, late January. You are seeing some hopeful signs around the nation in terms of a slowing of new cases in the Midwest and the West in particular. But, you’re seeing an acceleration in cases in the East Coast and the West Coast. So, the entire country isn’t going through this pandemic at the same time. New York, California, were a little later to have an acceleration in cases. So, they’re going to be later to peak. We are seeing some signs that there is a slowing of new cases in the parts of the country that were hit hardest the first, which is particularly the Midwest and the West. So, cases are likely to continue to increase through the end of December into early January. We’re likely to see a peak at some point in January, but the burden on the hospital system is going to continue for another three weeks past that.
MARGARET BRENNAN: You heard Mr. Garrett say there that the nursing homes he operates have been told by CVS that they can’t begin vaccinations until December 21st. CVS says that’s also what they were told by the Trump administration. Health and Human Services secretary says they’re wrong. Does it make any sense to you as to why they would be asked to delay vaccinating the most vulnerable?
DR. GOTTLIEB: Well, the current guidance by CDC to the two pharmacies that are going to be going to the nursing homes, Walgreens and CVS, is that they can’t begin until 12/21, giving those vaccinations. They’re going to spend this week getting the consents in place. Now, it’s possible that they tried to get into some nursing homes this week. But the bulk of those vaccinations right now, according to the CDC guidance to the states and the pharmacies, is that they can’t begin until 12/21. They’ll work through getting the consents in place from the individual patients and their family members this week. Those weren’t put in place in advance. Once they start, they’re going to start with the skilled nursing facilities first, but it’s going to take them three weeks to work through all the pharmacies. They’ll get the SNFs done, the skilled nursing facilities, which are the highest acuity, probably in the first week, but it’ll take three weeks total to get through those- those nursing homes. There’s about 45,000 in the country. So this is a big undertaking.
MARGARET BRENNAN: I understand it’s a big undertaking, but there- there are vaccine doses being made available before then. Why? I mean, this seems like a costly delay since the elderly are so vulnerable.
DR. GOTTLIEB: Look, it’s a very costly delay, there is 50,000 new infections in nursing homes every week right now, probably more than that. And we know 20% of people in the nursing homes who are infected will succumb to the infection. So, there’s a lot of death happening in these nursing homes. I think the critical issue is that the consents weren’t in place. You have to consent the patients. They want —
MARGARET BRENNAN: Why?
DR. GOTTLEIB: — to get all the consents in place before they go into the nursing homes. Why? Because they didn’t do it in advance. I think they could have. They could have provided a fact sheet. They could have cleared a fact sheet with the FDA, maybe provided a limited emergency use authorization just for the nursing homes to get that information cleared so they could have properly consented patients. That wasn’t done. We are where we are right now, but that needs to be done this week. They need the consent those patients. And in some cases, they’ll have to go to family members because they’ll be dealing with patients, unfortunately, who don’t have capacity to give consent for themselves. So not an easy task —
MARGARET BRENNAN: No.
DR. GOTTLEIB: — but probably something that should have been done in advance.
MARGARET BRENNAN: Yeah, I mean, and don’t get me wrong, it is good news the vaccine’s out there. But now getting it out to the people is the really complicated part and that’s being left up to the states to figure out. I know you talk to governors. What are the biggest choke points?
DR. GOTTLIEB: Well, the last mile problem is really the complexity here. People talk about the cold-chain, but the logistics in this country are very good. Pfizer, which I’m on the board of, is shipping in a box that can keep these vaccines properly stored for up to 10 days and can be refilled with- with dry ice and kept even longer. You can keep it up to 30 days by refilling it with dry ice. The issue is the last mile, dealing with trying to get into the community to get these vaccines distributed. And initially they’re going to be distributing to hospitals for health care workers and nursing homes. So, that’s a little bit of an easier challenge. You know where those institutions are. You can get to those individuals. Once they go into the community and start trying to vaccinate, for example, elderly individuals who might not be able to leave their home, they’re going to have a challenge getting into those parts of the country, especially in- in disadvantaged communities. If you look at what’s happening with the antibody drugs right now, some states aren’t distributing those very evenly. I’m told some states really aren’t making use of them. They haven’t distributed their available supply because they’ve had challenges getting those systems up and running. I think that’s a- a- a concerning harbinger for the challenges they’re going to face with the vaccine in that last mile challenge.
MARGARET BRENNAN: The Health and Human Services secretary said those criticisms from governors were all just a matter of politics. But you’re describing real problems.
DR. GOTTLIEB: Well, look, I- this is happening on a bipartisan basis. I talk to and- and advise Republican governors and I’ve talked to Democratic governors. They have challenges on the ground, especially once they get past this month. This month is a little bit of an easier task for them. And I don’t mean to trivialize it. It’s still a challenge. But going into the hospitals and the nursing homes, they have big institutions they can work with, the big pharmacies and the hospitals themselves. Once they try to go into the community, that’s going to be where the challenge is. I’m not sure the country is prepared to do that right now. The governors have about a month to get ready because they’re not going to be doing that until January.
MARGARET BRENNAN: You’ve already been on the record earlier in the week on CNBC saying Pfizer did indeed offer Operation Warp Speed the option to buy more vaccine after they knew it was effective, after they’d seen the data. And the Trump administration continues to dispute those details. But I wonder what you think of the- the overall supply question right now and whether there is adequate supply to meet that target that you heard the HHS secretary say, a hundred million people vaccinated by February.
DR. GOTTLIEB: Look, I can’t speak for the supply beyond- beyond Pfizer. Pfizer has manufactured most of the doses that they’re going to deliver in December, so they said they’ll deliver 25 million doses to the United States. Twenty-five million outside the United States. Most of those doses have been manufactured at this point. They’ve committed to deliver up to a hundred million doses by the end of the first quarter of next year. And I believe they’ll hit that target. I’m pretty confident the company is going to hit that target.
MARGARET BRENNAN: Right.
DR. GOTTLIEB: Beyond that, you know, Pfizer hasn’t secured an agreement with the U.S. and I can’t speak to the other manufacturers.
MARGARET BRENNAN: Right. And I know that the secretary has said they’re- they’ve been talking since October about buying the supply that still exists on Pfizer’s shelves, so to speak, or on- in terms of what they could do this year. Do you understand what the secretary was talking about in regard to exports and supplying the vaccine outside the U.S.? The president continues to say Americans need to get it first.
DR. GOTTLIEB: Well, look, the federal government has all kinds of authorities they can try to invoke. I’m not sure what they’re prepared to do. This is a global supply chain. There’s vaccines being shipped into the U.S. and is vaccines being shipped out of the U.S. and there’s ingredients being shipped into the U.S. globally. So, I’m not sure that they want to step in and try to disrupt the global supply chain where we’re dependent upon other nations as well. But it remains to be seen what they’re willing to do. They have an opportunity- they had an opportunity and they have an opportunity, at least with respect to Pfizer, to contract for more. This is an American company. I’m sure we’d like to work with the federal government, the U.S. government.
MARGARET BRENNAN: Right.
DR. GOTTLIEB: So, the company stands ready and I’m sure the other companies do as well.
MARGARET BRENNAN: Alright, Dr. Gottlieb, good to talk to you again today. We’ll be right back.