How the U.S. could address confusing, shifting COVID-19 health directives

Hari Sreenivasan:

Joshua, on the one hand, you've got a regulatory agency, and on the other hand, you've got one whose primary mission is public health. Give me an example how during the pandemic these agencies that should have been kind in lockstep because their services were all called for didn't work together as efficiently as they could have?

Joshua Sharfstein:

Well, I think people know that there was a big challenge with testing at the beginning of the pandemic that we didn't have enough tests. But behind that is the intersection of, well, how big a problem is this going to be? What does the nation need and the actual technology of the tests? It was a big disconnect between the CDC and the FDA between the approach of what the country needed to fight the pandemic and the tools that we might have to use. So FDA was approaching testing in a certain way based on some historical precedents thinking about what might be needed for diagnosis with the state public health labs needed. And CDC was really thinking about the entire pandemic, but they never really came together. The idea that we needed many, many tests very quickly, that could have emerged if CDC and FDA had gotten together and said, Well, what does the country need to fight COVID? And I think that would have led to changes both at the CDC and FDA. Instead, they kind of went about it in their own way. And only later when it became clear this was such a crisis, both of them had to scramble.

Hari Sreenivasan:

You also point out that the different type of messaging from these different agencies has led to confusion from us, the consumers.

Joshua Sharfstein:

Right? Well, there's certain products, certain situations when both FDA and CDC are communicating to the public, for example, on booster shots. FDA is assessing whether booster shots are safe and effective, and CDC is kind of deciding well, where and when are they needed? And those are slightly different questions. And the system that's been set up is for FDA to make its announcement and CDC to have a discussion and make its announcement. But the net effect for the public is on Monday, Tuesday, Wednesday and Thursday there can be different headlines about booster shots, and it seems very confusing. I think it's important for the agencies to work together to consider both safety and effectiveness on the one hand and need on the other together. Get input, have discussions. People can disagree. But then when they come forward with this is what's going to happen. It can be a coherent explanation across both of their agencies jurisdictions.

Hari Sreenivasan:

If this does not happen, if these agencies don't inspire trust, I mean, is there the inverse possibility that we start losing trust in these institutions?

Joshua Sharfstein:

An important point for me is that I think both the agencies have done a lot of really important work during the pandemic and have saved hundreds of thousands, if not millions, of lives in this country, because this could have, believe it or not, been much, much worse without safe and effective vaccines, without really good advice on how people can protect themselves. What I'm trying to say is that by working together, you can get hopefully to a stronger level of understanding of what needs to be done and a stronger level of action for people to do things that make sense to protect themselves. Otherwise, we're stuck where we may feel like we're watching a little bit of a ping pong game and really have this sense of, you know, uncertainty, you know, when there's scary news out there about hospitals filling up, we want to hear what the tools are that we have to protect ourselves and how to use them to do that as well as possible. It requires these two agencies and their great scientists to come together.

Hari Sreenivasan:

Josh Sharfstein, vice dean at the Johns Hopkins Bloomberg School of Public Health and also a former deputy commissioner of the Food and Drug Administration thanks so much.

Joshua Sharfstein:

Thanks so much for having me.