- [Announcer] Support for "Overheard with Evan Smith" comes from HillCo Partners, a Texas government affairs consultancy, Claire and Carl Stuart, Christine and Philip Dial, and the Eller Group, specializing in crisis management, litigation, and public affairs communication, ellergroup.com.

- I'm Evan Smith.

She's an infectious disease specialist and CBS News medical correspondent who knows as much about the state of public health as anybody on Earth.

And that makes her the hero we need right now.

She's Dr. Celine Gounder.

This is "Overheard."

(stately music) A platform and a voice is a powerful thing.

(audience applauding) You've really turned the conversation around about what leadership should be about.

Are we blowing this?

Are we doing the thing we shouldn't be doing by giving in to the attention junkie?

As an industry, we have an obligation to hold ourselves to the same standards that we hold everybody else.

- [Director] Three, two.

- This is "Overheard."

(audience applauding) Celine, welcome.

It's good to see you.

- Great to be here.

- Thank you very much for being here.

If I had told you six months ago that we would be sitting here today talking about measles, would you have believed me?

- Actually, I might have believed you.

- Why?

- Well, we've seen vaccination rates declining across the country even before the pandemic.

We had seen a rise in vaccine skepticism.

However, over the course of the pandemic, I think this is really a political backlash in many ways, trust backlash.

And we've seen vaccination rates among kids entering school for the first time, really much lower than they had been before.

- Right, but measles specifically?

I mean, to me it's like, what's next, rubella?

I mean, like, these are all things that I thought a generation ago maybe we sort of kind of put a lid on.

And now all of a sudden, I mean, we've just had the first death in a decade or more in this country for measles.

And the the outbreak is spreading.

It's not getting less bad.

It's getting more bad.

What about measles specifically, if you have a thought about that.

- Well, and by the way, we might start to see some rubella too, because it's the measles, mumps, rubella, varicella.

I didn't mean it, I jinxed it, oh no!

Oh no!

So it's a four-in-one now.

- All right, well, I should've kept my mouth shut.

- And rubella causes what's known as congenital rubella syndrome, where mothers, if they get rubella when they're pregnant, can end up with a child who has congenital heart defects, hearing loss, deafness.

So there's a reason we vaccinate for these things.

- I'm not gonna mention any more disease.

(Celine laughing) - I'll be bringing more bad news.

- Okay.

- But yeah, with measles in particular, measles is known as the most infectious disease to man, most contagious.

Because you can actually spend some time in a room, leave, having had measles, leave, and somebody who comes into that room, even two hours later can contract measles from you having been there.

- Right, and well, and some of the alerts in Texas where we are today, where the first death occurred and where there has been this outbreak, not all of it has been in Texas.

There've been the kind of alerts that have been like very broad about like, there was this person in this place and if you were in this place.

And I thought, is that really how this works?

- Apparently it is how this works.

- Well, especially in rural areas, it can be very easy to identify who that person might have been.

So you have to be very careful about how you communicate that somebody might have been exposed.

'Cause you don't wanna say, you know, Tom or Kelly or whomever is the one who exposed you.

- Right.

Specifically on this question of what happened, I mean, you've just basically told us what happened.

I mean I love that I have one of the great epidemiologists in the world here, but it seems as obvious as this, the lower vaccination rates in some of these communities have been a precipitating factor.

There was an "Atlantic" magazine story just today where they interviewed the father of the young person who was the first victim of measles, the first death in west Texas, Gaines County.

And the story said that the vaccination rate among kindergartners in Gaines County was 82%, which was well below what you needed to have herd immunity, which was 95%.

- Yeah.

- Right?

I mean that, that pretty much, you don't have to be an expert, that tells you everything you need to know.

- Well, and by the way, there are some counties in the state that have much lower vaccination rates than that.

There was a pastor in northern Texas who was boasting that their school had a vaccination rate of just over 14%.

(audience gasping) - Right, that was seen as a positive.

- That, well yeah.

He was basically bragging about that.

And you know, I do think that is very concerning.

Because measles is so infectious, you really do have to have very high vaccination rates to prevent spread in a population.

So 95% or more.

And we've seen a lot of places across the country that have dropped to 92, 93%.

That might not sound like a big deal, but it really does leave you exposed to these kinds of outbreaks.

- Would you characterize to the best of your ability, the response of government?

I don't necessarily mean the White House or the public health apparatus in Washington, but I mean, generally speaking, we have gotten into the habit of turning to government, broadly defined, in moments like this, to tell us what to do, what not to do.

Everything is political, as you pointed it out earlier.

And we're gonna talk more about that.

But how has government done in responding to this latest public health crisis?

- Well, one thing people don't appreciate is a lot of public health is actually at the state and local level.

And CDC largely acts as a funnel of federal funding down to the state and local level.

But a lot of the work, most of the work, is being done locally.

CDC might offer some technical expertise, help with investigating an outbreak.

But again, it's really led by state and local health officials.

And frankly, I would say they're doing the best they can, you know, given the resources they have.

You're dealing with hospitals, for example, that don't have, and we should have learned this during COVID, that you actually need to have ways to isolate people who are sick, who might be contagious to others.

Something that still was not invested in, unfortunately in many parts of the state.

And you also had a pullback, a clawing back of funding, that had been sent to state and local health departments.

They've had to lay off staff.

So when you don't have the staff to do the, you know, house-to-house screening of people, offering testing.

Especially, you know, where it's rural and hard to get to testing, it can be very challenging.

- So if you're in a rural community, where in many states, Texas and others, in rural communities, the number of hospitals and other health providers have declined over time, right?

Like people have- - Well, hospitals have closed, yeah.

- Closed, like the economics of this for the medical profession aren't in favor of keeping a lot of these places open, that's gonna exacerbate an already bad problem.

- Yeah, that's right.

So we've seen a lot of rural hospitals closing over the last decade or two.

Some of that is because their patients, many of them are on Medicaid.

And so it's very contingent on how much Medicaid funding they get.

You have- - Well, in place like Texas, where the legislature sets the, they get narrowed out on this stuff for a second.

Where they set the reimbursement rate for doctors to receive, you know, if you take Medicaid patients, Texas has one of the lower reimbursement rates in the country.

- Well, and then you have, you know, doctors who don't wanna practice there because they're being paid less.

And it's not necessarily easy to live in a rural community.

You might have to send your kids off somewhere for private school or, you know, whatever.

The distances are far.

So for a whole bunch of reasons, the economics, the desirability, you know, that's unfortunately left a lot of these communities under prepared.

- Yeah.

So you mentioned not having enough staff at the state and local level.

Let me actually talk about the, let's talk about the public health moment right now at the national level.

Boy, oh boy.

Right?

What are we seeing?

We're seeing reductions in the workforce, right?

Through the- - Massive.

- Whether it's DOGE or it's just generally speaking, new administration, new sheriff in town, we're gonna have more efficiencies.

We've seen a reduction in, in workforce at many of the agencies that are responsible for public health.

We've seen the scrubbing of data from some websites.

And that may continue.

And we have Robert F. Kennedy, Jr.

In a moment when we have an outbreak of measles.

And you've said, and you're the expert, that vaccination is the thing.

We have a guy who has been publicly opposed to vaccination.

- Yeah.

- I mean that this is a perfect storm, is it not?

- Well, you have a few other things that are happening at the same time.

So you have what he's saying in terms of messaging around this outbreak.

He has conceded that vaccination might play a role here, but he's really pushing three other therapies.

Vitamin A, which is in cod liver oil.

Budesonide, which is a steroid.

And then finally clarithromycin, which is an antibiotic.

Now, is there data for some of these things?

Yeah, if you develop a severe case of measles, there is a role for some of these things, but you don't wanna develop that severe case of measles.

You don't wanna end up in the ICU.

And these things will not cure you.

They can maybe mitigate a little bit.

- Yeah, this is not like drinking bleach.

- It's not, okay.

It's not that harmful.

- Right.

- And there is some data, for example, vitamin A in highly malnourished kids in low-income countries, these were studies that were done back in the eighties in places like Indonesia, which was very underdeveloped at that time.

Yes, vitamin A helped to reduce blindness in kids who had very severe cases of measles.

Clarithromycin, if you develop a bacterial infection on top of your measles infection, something we often see with COVID or flu or measles, you get bacteria on top of it.

Yeah, then you might treat it with that.

And you know, steroids may also have a role if somebody's immune system has really gone out of control and you need to tamp it down.

But again, these are all situations in which the initial infection with measles has gotten so severe that you're having these complications.

- Right, you're assuming that you've already jumped to the stage where you need the treatment.

So you have the things I mentioned.

But then there's also this continuing turn against science, like the message, leaving aside the question of the public health apparatus, you have the continuing turn against science.

You have a decline in the faith and confidence people have in institutions like medicine.

I mean, there was a story in the "Wall Street Journal" last week.

The headline was one of those, open my laptop, read the story, close my laptop moments, where the headline of the story was, "Why We Don't Trust Doctors Anymore."

I mean, we're really at a point where our confidence in this thing that is there to help us, to save us, has also declined.

And that is making matters worse.

- Well, I think part of the problem here is government health agencies and the private sector are often confused.

So people confuse public health and healthcare.

A lot of people don't even know what public health is.

They confuse NIH, the FDA, and pharmaceutical industries.

They, you know, you have RFK who's basically blaming the FDA saying, the people working there are making tons of money, which I can tell you (chuckling) they're not.

- They're not.

- And so when you have people who think it's all one big pharma-industrial complex, and they don't feel like they can afford the very products of, say, the years of NIH investment and certain research that leads to certain therapies, if then, you cannot afford to access those things, you as the taxpayer sort of like, well, what was the point of all of that?

You know, it's not helping me.

And you have this privatization, frankly, of public health that happened during the pandemic because public health departments had been under invested in for years.

So of course, you know, they were, and actually still reliant on fax systems for transmitting information and so on.

And so then they could not move with the speed for things like surveillance, for example.

And then you did have private sector actors who stepped in, and then you have the public saying, well see, public health doesn't work.

Well, it doesn't work if you don't put money into it.

And so it's this vicious cycle of, oh, well then we need to give more and more to the private sector, which also means you have companies that are profit motivated.

Which means they're not necessarily aligned with your best interest.

And it creates this cycle of mistrust.

- Well, and the fact is that in a case like that, where we have to rely on the private market almost entirely to solve these problems that government wants solved, class becomes an issue.

People who can afford to get the kind of care get it and the people who can't don't.

And also there are racial disparities in healthcare outcomes.

And that kind of a situation that you described, doesn't make that better, it makes it worse.

- It makes it worse.

You know, at the same time, I think there's another reason we're seeing a loss of trust, which is really a backlash against elites, and scientists are seen as elites, right?

This has also been a couple decades in the making.

And we're seeing, you know, for an administration that was very anti-censorship before being elected, we are seeing very real censorship now happening.

You mentioned, you know, some of the sites that are being taken down, restrictions on research.

Just yesterday there was an announcement that all research on vaccine skepticism was gonna be terminated.

You know, we heard a lot during the pandemic about the need for social sciences and people understanding, you know, how people think about these things.

Yeah, all of that is gone.

Halted in one day.

And so at the, and then you have RFK, who has asked the CDC to conduct another study on vaccines and autism.

So, I mean, I think it is kind of unprecedented to see government interfering with science in the way that it is in this country.

- Yeah.

And then on top of everything else, you have, and here's another case of, you know, institutions or elites, we don't trust the media, right?

You have this mechanism for spreading misinformation unchecked.

We'll talk about the pandemic in a second.

But that really was, for me, surfaced in a kind of glaring way during the pandemic.

But you have this problem of not being able to distinguish between real information and unreal information.

You have an inability of many people in the country to be able to distinguish real sources from fake sources.

Truth is not truth.

Facts are not facts.

Reality is subjective.

Like that's a whole other other layer of this that probably is not making things better in this moment.

- It's not.

And more information is not necessarily leaving you better informed.

And I think this has been an important lesson of the last several years of the pandemic.

And I think what does concern me in that space is we are also at a certain tipping point with consumer's access, patient's access to medical information, their own information, broader information.

And so that's gonna be a whole other fire hose of this.

And how are they gonna cope with that?

I have some real concerns.

- Yeah.

The pandemic, which we've alluded to or mentioned a couple different times, but haven't really gotten into, that was really an inflection point in this entire conversation about public health, right?

I mean, as we look back now, we're, what are we, we're five years?

- Five years, this week.

- Five years this week from the country shutting down.

In so many ways, it was terrible.

In so many ways, it could have been worse.

In every way, it could have been better.

- Yeah.

- Do you think that we have enough distance from it now, enough perspective, to understand why it was as bad as it was?

What we could have done differently and what we should do differently the next time?

- No, I don't think so.

I think if anything, you're seeing revisionist history now.

- Say, say more about that.

- So for example, people claiming that schools were shut down for two plus years.

There are very specific places where schools were in hybrid mode for two years.

For example, New York City, where you had communities of color that were very distrustful of their kids being sent back to the classroom.

This was really being dictated by parents as well as to some degree teachers.

It was not coming down from the CDC or departments of health.

But most of the country, kids were back in school by the spring.

So this is not, it is one form of revisionist history.

You know, some of what's happened around, did masks work, the vaccinations, do vaccines work, et cetera.

It's really unfortunate that here you had a vaccine that was developed in record time, in part because NIH had invested in these basic, basic research, basic technologies that we had the building blocks on the shelf that we could tailor to have a vaccine come out by the end of 2020.

That is amazing.

And what's also amazing to me is Watson and Crick, when did they discover DNA?

It was over 70 years ago.

And people still think have this idea, "Oh, mRNA, it's gonna change my DNA."

That is how unfortunately uneducated people are about science.

And this is over 70 years later.

- Yeah, to your point about revisionist history, what many people today are saying five years out is what the pandemic was really about, was liberty.

It was not about public health.

It was about mandates against, you know, vaccine, you know, requiring people to take vaccines or mask mandates.

And we, you know, we shouldn't have those.

And again, I come back to this, it became more of a political conversation than a public health conversation.

And that actually sort of leads me to ask you what you're worried about going forward.

One of the things that I'm worried about, as a barely educated person in this space, you are supremely educated in this space, is if we have another public health emergency, that the lessons we took away from the last one won't necessarily prepare us or position us to do any better the next time.

That's my anxiety.

Is that your anxiety?

- It is.

So bird flu is probably the thing- - Bird flu, right.

- That is top of our list of concerns right now.

It's been really spreading unchecked among poultry, where the only solution to that is to cull birds.

Because once you have bird flu on a farm, among poultry, they're all gonna die.

And it's really painful for the farmers to watch them sort of die one by one.

And you also, by the way, cannot repopulate your farm until you've gotten rid of all the sick birds.

So for economic reasons, it's actually in their interest to do that, and they get compensation from the government.

But you have, not even public health officials, economists in the current administration who are saying, "Oh, well that's not really a way to control this."

And they're saying things that on the surface, if you don't know the details might sound like they make common sense.

But I think that's part of the problem is we have a lot of common sense that is not grounded in fact.

Some of the other issues, well, towards the end of the last Biden, or the end of the Biden administration, they had contracted with Moderna to develop mRNA vaccines for bird flu.

The current administration is pulling back on that.

They have a anti-mRNA stance right now, including research on mRNA vaccines at NIH, one of the leading vaccine researchers on NIH was barred from giving a science talk at Hopkins and University of Maryland, you know, an hour away, north of DC, because it was a vaccine talk.

You know, the kind of shutting down of research.

How on earth are we gonna have a bird flu vaccine in time if there's an outbreak of that?

You know, that's very concerning, - Man, you are a Debbie Downer, aren't you?

(Celine laughing) - It's funny you mentioned that.

One of my producers at CBS sent me their, with the SNL50, there was a Debbie Downer skit, and she sent it to me and she's like, "This is you."

- This is you.

Oh my God.

(Celine laughing) I wanna talk about you in just a couple minutes we have left.

So we were talking backstage about why you became a doctor.

Your dad had a significant amount to do with that.

You were kind of born in, you were born and raised kind of all over, right?

- Mm hmm.

Mm hmm.

- Educated at Princeton, at Hopkins, University of Washington ultimately, did your residency at Mass General, you know, have this extraordinary background that prepared you for the work that you do now, but at the end of the day, everybody has an origin story, and your origin story goes back to your dad.

Talk about him and talk about that.

- Yeah, so my dad was from a rural rice and sugar farming village in India.

They only had up through the fifth grade in the village.

And so then he was sent to Jesuit boarding schools where, you know, they pay all the expenses.

It was nothing to the family other than room and board.

And then he went on to the equivalent of MIT in India at that time, in the Indian Institute of Science, and then came to the US for graduate school.

And, you know, me having been to the village, having seen what my life would've been like if I had been born there, especially as a woman, but in general, what the access to education, healthcare, et cetera, would've been.

It's something that me and my sisters were all very conscious of.

I went into health, they went into education.

And it's completely because we saw, you know, what it took for my dad to come here to the US and have the success he did.

- Yeah.

I wonder if, as you look at young people who are considering their career choices right now, people who were you back then, are you seeing the same commitment to serving their communities, to serving the public?

Are the incentives structures in place to get people to be the next you?

I mean, I worry a little bit that what we've done across all areas of public life, is we have talked badly about community service, public service in a way that is creating almost a hole generationally.

And that when we all pass on, there's not really gonna be a generation of people to replace us doing the work that we did.

And that's gonna be bad for society.

- Well, I've actually been asked if I would run for various offices.

I would not run for office.

I think the downsides in terms of the personal attacks, you have to worry about having your own private security now, whether you're AOC or Francis Collins or- - Or Anthony Fauci.

- Anthony Fauci.

- Anthony Fauci, right?

- Yep, and so that, they're very real costs and it's frankly unaffordable in so many ways.

You know, it's interesting, that question also.

So I was of the generation of people going into global health.

I worked on PEPFAR and USAID and CDC programs all over Southern Africa.

- Everything they're killing now, basically, right?

- Yeah, yeah.

It's very painful to watch, actually.

And so my whole generation was very much influenced by that.

Not that everybody went into that, but that was really formative for many of us.

And then I think you had a period of time where it became a lot more about, I don't wanna say shift work exactly, but I'm on, I'm on, I'm off, I'm off.

Less of a commitment to patients and you know, in the interim, more financially driven.

And now, it's interesting, speaking to some of my colleagues, it's changing again.

Because the earnings you can get as a doctor versus going into finance or tech or something, it's so disparate, it's such a big gap, that the people who go into medicine now are actually more mission driven again, which has been, you know, a perverse.

- I mean, I guess that's a hopeful- - Yeah, yeah, yeah.

- Silver lining.

What are you gonna do next?

You, you know, you've been on our televisions through the work you've done with CBS and, you know, we kind of see you and hear you and read you.

You're continuing to do this work.

What's in your kind of viewfinder looking ahead?

- Well, I'm very concerned about where things are headed with the media.

And part of the reason I went into journalism over a decade ago now was because I was concerned that people were not going to invest in public health if they did not understand what it was.

Now you can decide whether you wanna invest in it, but at least understand what it is and what value it has or not.

And unfortunately, I think that problem has only gotten worse.

In the meantime, we've seen the decline of media.

Something I know, you know, intimately.

Lots of local newspapers shutting down.

Even the cable news and network news television, I think their average, the age of their average viewer is well into their sixties, if not seventies.

- So by comparison to PBS, young.

- Yes.

(laughing) - Yes.

I get to make that joke, I get to make that joke.

- See, with wisdom.

(laughing) - Right?

Okay, yeah.

- But no, but it is a concern, because then you basically have this age cliff where, where are these younger people getting their news?

- And the quality is terrible, and so- - And the ownership structure of a lot of media, we know what the story is, is creating this kind of question about the independence of the work being produced.

Like it's really, it's its own version of the public health story.

Like we, there's a perfect storm of its own.

- You've had over consolidation.

You have, yeah.

You have these, for CBS where I work, for example, the Trump administration has threatened to pull their broadcast license.

You know, what do you do?

And they're in the middle of a sale.

- Totally normal, totally normal.

- Yeah, business as usual, right?

- Totally normal, yeah.

- So I, and so as I see legacy media dying, I mean, I think we maybe have 10 years left of that kind of news.

I mean that's, yeah, I don't know.

- Serious, should I get my affairs in order?

(Celine laughing) Like what does that mean?

Yeah.

- So, you know, I am definitely thinking about what is the future of news?

And where should we be?

Where should I be positioning myself, where I can actually continue to have an impact on the conversation?

You wanna be in the middle of that conversation?

- Yeah.

- Yeah, yeah.

- Yeah.

- Well, we need you.

- Yeah.

- Great, even if you're depressing.

(Celine laughing) We need you, all right.

Dr. Celine Gounder, thank you so much for helping us think clearly and intelligently and grasp reality on this very important subject.

- I tell it like it is.

- I appreciate that.

Give her a big hand, Dr. Celine Gounder.

(audience applauding) Thank you very much.

Good.

All right.

(stately music) We'd love to have you join us in the studio.

Visit our website at AUSTINPBS.ORG/OVERHEARD to find invitations to interviews, Q and As with our audience and guests, and an archive of past episodes.

- [Announcer] Support for "Overheard with Evan Smith" comes from HillCo Partners, a Texas government affairs consultancy, Claire and Carl Stuart, Christine and Philip Dial, and the Eller Group, specializing in crisis management, litigation, and public affairs communication, ellergroup.com.

(bright flute music)