Additional funding is provided Corporate Funding provided by. Welcome to firing line, dr. Scott gottlieb. You are the former fda commissioner in the trump administration, a resident fellow at t American Enterprise institute, and on the board of pfizer, a drug company, and illumina, a diagnostics company, bothf which are involved in aspects of the response to covid19. A i think ito important for our viewers to know that you are a Trained Medical doctor who worked in new york city. D you have managed to receive eraise from both republicans and democrats al because of your time at the fda and also because of your early response and voice to the covid19 crisis. And were delighted to have you here to delve into your roadmap and your view of how we should tackle this crisis next. Thanks. You tweeted back on january 6th about a mystery disease less than a week afteric china had pu acknowledged its first novel corona case. How did this get on ur radar from the very beginning . Probably started tracking it late december, early january, when these cases first started to emerge. And what was concerning about id was it it s very sarslike, but it seemed more transmissible. Th e were some early reports from some physicians in china that this was highly contagious. And we always feared tha sort of perfect pathogen, one that would have a lethalityl that it cause a lot of death and disease, but be contagious enough that it could spread around the world. You wroten opinion jthe wall streenal on january 28th. You said. Now, at the time, your focus in that piece was not on mitigation, not on social distanci, but on increased testing and on medical supply availability. You know, you cant help but wonder when you readth piece now that if your advice had been heeded, we may not be in the situatione thate now of mitigation of the crisis of tndemic. Whats your response to that . Well, my concern early on was that we dont have enough surveillance in theed untates, didnt have enough testing in place to be able to detect this if this came to the u. S. I knew from working at fda that it took time tget that kind of Testing Capacity in place. So i think the real Inflection Point for a lot of us was on january 18th, en a report came out that the cases in china had quadrupled,ha ne from about 50 cases that they were reporting in wuhan to about 200. W and th a real wakeup call. I think that was a day that a lot of people got very concerned abouthis. It was the day after your piece came out that the white house coronaviruf task formed. And, you know, it was reported that you were in the running to lead it before Vice President pence was announced as the leader of the Coronavirus Task force. And youve been called by media reports, politico in particular, as the shadow coronavirus czar, which i know is a title r,u eschew and say isnt f but you are currently serving as an informal adviser to the white house Coronavirus Task force, are you not . Al ito them quite regularly. I mean, i talk to the white house folks, you know, almost every day, n a couple of you know, every other day. And im also talking torn a number of gos, congressional staff. And so im trying to provide perspecte to a lot of different people who are involved in this. There are now eight states that still havent told residents to stay home. Now, you served in two republican administrations. Youre advising republican governors right now. Do you have any advice for those eight states, all of whom, coincidentally, have republican governors, about how to handle this virus as it approaches higher levels in their states . I dont think every sta has to have the same response. I do think most states yould be implementing pre strict measures at this point. Well, thats my question for you. A i mean, ublichealth official, is it advisable for any state to not have stayathome orders right now . Is it okay for iowa not to he a stayathome order . Do you think thats advisable from a plichealth perspective . I think a state like iowa should, given the fact that they have dense urban environments. But i think s advisable that most states be ndntemplating these things implementing them at this point, because the problem is we dont have enough testing and surveillance in ace to really identify where the risk is. So a lot of states may think they have lolevels of spread and low levels of risk mt be underestimating it. Yeah. But lete ask you about a headline that was at National Review this week, and it was about sweden and w sweden is handling this crisis. The authors of the piece wroteden has kept schools, bars, restaurants, parks, shops open and only isolated the most vulnerable citizens, the elderly, those with underlying the headline of the piece is, has sweden found the ght solution to coronavirus . Is that approach, while very different from the United Statess approach, one that is viable from a publicheah perspective . And the United Kingdom contemplate this kind of an approach, too. The theory is that tple who are most affected by this virus are older, older individual and if you can just isolate individuals with preexisting Health Conditions who are older and more likely to suffer bad outcomes from this virus, you can allow it spread in the general population and developer what we callimmunity. Basically, enough people get it that it stops spreading. Th k theres a lot of problems with that theory. First of all, it isnt just Older Americans that are having bad outcomes with this virus. Theres a lot of younger americans, 40, 50, who are succumbing to the virus but also having prolonged hospitalizations with prolonged stays in the icu and intubation in order to survive this virus. The other issue is that we dont know that we can achieve herd immunity here. Right now, when you talk to peop whove modeled spread of this virus in the United States, they predict anyere between 1 to 5 of americans have probably been exposed to ts at this point and developed some level of immunity to it. Thats a very small percentage. N look at all the death and disease we have with just 1 or 2 the population having been exposed to this. If we allowed this to run through the population and infect 40 or 50 of the population, which is what it might take to develop herd immunity, probably a little more than that, there would be a lot of morbidity and a lot of Death Associated with this virus. All right. So, to that pointd i want to o the audience something you wrote this week in pahe wall street journal editorial opinios. You said. What do you say to people who are really hoping d aspiring that, you know, we can start getting back to normal by the end of april . Were going to make a transition in may where were going and people are goistartcountry to resume aspects of their normal lives. I think that transition will accelerate in june. And by july and august,re it may btively quiescent in this country. We may see cases really drop off as we get into the depthe summer. Im very worried about september. This is a viruthats probably going to infect the southern hemisphere. Theres probably a seasonality were going to see epidemics in the southern hemisphere. But its going to want to come back in september. s going to want to beco epidemic. This is a virus, the characteristics of which suggest that it wants to infect 40 or 50 of the population. And the question is, are we going to have the tools in place in september to prevent thafrom happening . And im concerned that we dont yet have those tools in place t really have a very clear path to how were going to oain them. And while we may never we may not he an outbreak like we have now, an epidemic like we have now, i do worry that weree going to hzable outbreaks, and this is going to continue to be a drag on normal activities. Y ve recently written a publication through the American Enterprise institute called a roadmap to reopen. And it deals with this series of phases that you say need to happen in order to reopen. I want to break those down, but first, i want to listen to what president trumpro said about youmap. Lets take a look. Scott gottlieb, your former fda commissioner, wrote a roadmap for recovery after the coronavirus. Yh, very interesting. I saw it. Hes somebody he was with me for a long time. He did a gat job at fda. So, were going to take a look. I just i just received it a little while ago. He sent it over. So your roadmap calls for the continuing of slowing the spread, developing the ability to treat the virus, either through vaccines or thapeutics, and, also, you recommend for widespread surveillance. And i want to get to all of those, but first, you know, according to your roadmap, social distancing is going to need to stay inlace for some time until two things are achieved, you write. Be declining for 1ecutiveed to days in a certain jurisdiction, and that jurisdiction will need to have the ability to implement widesead testing. Right. You need to have the capacity to test in the community. So, you know, several companies are working on these rapid tests. And i want you to listen to what new York Governor Andrew Cuomo had to say about it. Also, Rapid Testing to determine whether or not s. U have the virus now exi they have 15minute tests that are commercially available. But again, they have to be brought to scale. No private company has the capacity to bring those to scale. So, dr. Gottlieb, how long do you believe it will take for us to get Rapid Testing widely available . Well, its already deployed. So one of the systems is by a Company Called abbott thats currently deployed in 18,000 doctors offices across the country. Op and they dev a kit that goes on their existing platform. Its the platform that doctors use to test for flu or strep that. So its deployed. Needs to be expanded. So how long before, you know, you and i can walk out just ordinary people, right . But ordinary people can walk out and really get a rapid test. I mean, is that a matter of weeks or mohs . Yeah, unfortunately, probably months. Its not going to be in place in time. And thats what im concerned about, that if you dont have this in place, certainly when you transition away from these populationbased basically asking people to stay at home and not work, you want to have that testing wideldeployed, and were not going to have that in place in a month. We could have it in place by september, by august and september, and we have to make that a goal right now. But were going to be flying without all the tools that we want once we start lifting these measures come may. Is that wise . Its a concern. I mean, thats what im y ask me what im most concerned about with respect to transitiong the country as cases fall off, its the facthat the Healthcare System is still gonna be overburdened because there is a delay in hospitalizations and deaths. And thats one concern. But the other big concern is the fact that were not going to have the diagnostic capacity in place that we need. We started late, and so were going to finish this jobr laan we should. It is clear. I think we all understand now that we had a series of fumbs at the beginning of this testing. The Washington Post has written about these testing failures and their quote is. In your estimation, does that fairly characterize the governments failure . Well, i dont know all the details of what went on. Ive read the same articles. St the cdc clearly had challenges associated with it and was delayed in getting out to the publichealth labs. But what i would say is that even if everything haworked perfectly, even if that system had worked just as it was supposed to, cdc had gotten a test out in a very timely fashion, it worked, and the publichealtt labs were abstand up those tests, wed still be in a very difficult situation and maybe precisely where we are right now. Why . Because what needed to happen was someone needed to decide at some point, probab in january, that this pathogen could become an epidemic here and start standing up the Clinical Labs and the academic labs. What ifou had been at fda in january and february . What would you have done differently . Well, look, its easy hindsights easy and its easy to opine sitting outside the agency. But what i was feeling outside the agency and what i wasbo tweeting was doing exactly what i said getting the Clinical Labs in the game andin gethe academic labs in the game. So those are the kinds of things i was advocating from the outside. And i probably wouldve been working the same kin of issues from the inside. Do you think that the fda made a mistake by not aowing private labs to stand up testing earlier, to be ableng to scale tesarli . Yeah, i dont know where those decisions were made. My hunch is that the professional staff at the fdaan the career staff at the fda very much wanted to get these labs in the game. I know how they operate. Ow i ow they think. And im hardpressed to believe that the scientific staff didnt want to find way to get the academic labs and the Clinical Labs stood up earlier and y to develop a pointofcare diagnostic earlier. Now, why that didnt happen, i donknow. Look, i mean, there are some who speculate that it wasnt the professional staff at allul thats to but its some of the political staff, and that there are some reports that the president , not wanting to hear how dire some of the prognostications could be, made individuals who are in positions of power, political leaders, hesitant to make him aware of some of the real threats because they didnt want to risk being fully honest with the president ,g know didnt think it was in his political advantage to have a pandemic. Do you thi theres anything to that . I just dont know. I mean, you know, i wasnte. Th i havent asked these questions. I try to look forward, not back. The thin thai thought we should be doing in january and february, i said in january and february. Now, come april, im sing what i think we should be doing in august and september. We need to be looki forward, i agree with you. But there is a certain degree of learning from our mistakes,at e dont make the same mistakes again, and thats all im trying to y. Right. And i think i think the lesson is, weat didnt do e needed to do in january to prepare for april. We shouldnt we should make sure we do in april what we need to do to prepare for august. And im not sure were doing that. And so absent a lucky breakthrough with a drug, me this fall, were goin to be at a lot of risk for big outbreaks, potentially. Well, so lets move on to therapeutics, treatments, vaines. I want to point you to something dr. Anthony fauci said just this week. Lets take a look. I dont think that youre ing to have to say that the country cannot get back to a real degree of cy and effective vaccine. Ave a safe d gottlieb, is it the community that, as youve said, our best nearterm hope is a therapeutic drug if not a vaccine . A vaccines our best longterm hope . I think if you want to be conservative, you have to figure that a vaccines a couple years away. The platforms being used to develop the vaccinesre highly novel. Weve never developed a vaccine against a coronavirus, so to think that we going to do that in some superaccelerated the entire populatth acinate highly novel vaccine against a highly novel pathogen, i think need to budget two years, and we need to understand what it looks like living with this pathogen for two years. There is a potential that you can have a drug by the fall of more than one drug. I think the subs of medicinesul that both be available and could be impactful enough to actually affect the morbidity, the death and disease from this pathogen is a very small subset. All right. So, lets talk about what some of those drugs are. Theres currently noov fdaap treatment for covid19, but several of the drugs are being tested in clinical trials. And while i want to get into the various options, the drug the president has continued to tout is hydroxychloroquine, which is an antimalarial drug. It is also used to mitigate symptoms of autoimmune disorders. Lets take a look at what then presjust said this week. And the other thing that of is the hydroxychloroquine t hydroxychloroquine which i think is, you know, s a great malaria drug. Its worked unbelievably. Its a powerful drug on malaria. And there are signs that it works. So you have said previously that you are not an optimist about this tatment. But just last week, the fda did authorize the emergencyof usydroxychloroquine in certain cases where paents are hospitalized. Do you support that move byhe fda . Look, the datas very early and very mixed on this drug. D ile we understand the safety profile of the drug, i think the important thing to keep in mind is this drugs widely available, and its being widely used. A lot of doctors were taking it as a prophylaxis, off label. N a lot of doctorsaly were doing the same thing. Werent on some other protocol, they werent receiving some other experimental therapy that were hospitalized, were receiving this drug. Ve sked physicians informally if theyre prescribing it, and theyre prescribing ity fairly widre in United States and have been from the outset. So if this was having a robust trtment effect and was goi to help mitigate the impact of an epidemic, itd beoing it. This treatment is being tested. When are we going to know for certain whether this treatment will beffective . Ive asked people this question. I get different answers. K most people that theres trials that should read out within a month that are goingti to be not defi trials but more informative than whats been done. Theres been a couple of trialse one ha retracted. And that was the initial trial that people pinned a lot of hopes on. It only involved six patients in the active arm. One was 30patient trial that showed activity, some potential benefit, anda another waial of similar size that showed no benefit. So the publicly ailable datasets are very limited. Now, again, i suspect that therm isprivate data that they have because its being so widely prescribed in the u. S. , theyre probably extracting data from clinical records th just hasnt been published yet. More enthusiastic about a different antiviral drug which is currently in its trial phase, remdesir. Is that right . The aspects of how this virus replicates, weve drug before. Weve developed successful drugs to interfere with those aspects of how this virus goes about making copies of itself. So we should