The FRONTLINE Interviews
J. Stephen Morrison
Senior Vice President and Director, Global Health Policy Center, CSIS
J. Stephen Morrison is senior vice president and director of the Global Health Policy Center at the Center for Strategic and International Studies.
Following is the transcript of an interview conducted via Skype by FRONTLINE filmmaker Martin Smith on March 31, 2020. It has been edited for clarity and length.
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Hi doctor.
Hi there Martin.How are you doing? …
We're trying to make an art form out of Skype.So it's a bit of a challenge.So how are you sir?
I'm doing just fine…
So I want to go back.You've spent a lot of time thinking about the possibility or the inevitability really of some kind of pandemic hitting us all.You worked all through last year on a report about it.But without the benefit of any hindsight now, what was going through your mind when you saw the news out of Wuhan?Can you remember that first time you saw it?
Well, my first reaction was that this looked like the option that we feared the most, a fast-moving respiratory pathogen that we had never seen before, that was moderately lethal.And then as we began to learn more about its transmissibility, the fact that it could be spread very clandestinely by people who are infected but asymptomatic or only with mild disease, I began to realize that this was a truly extraordinary threat that we faced.
So immediately you felt that this is what you feared the most?
And I was not alone.I was not alone.This was being voiced by many of the experts who were watching this closely.Tom Frieden, Scott Gottlieb, Scott Dowell, many of the people, and including those at [the Centers for Disease Control and Prevention] CDC that I was in touch with.
Do you remember what the first thing you did was?Who you called?What you did?
Well, we began to chat among ourselves.I mean we had put out the commission report in late November.We were heading into a commission meeting at the end of January, and we were preparing for that.And so we knew that the coronavirus was going to figure very prominently in the commission meeting that was held in the Senate in the last week of January.And we knew that the dinner that was that same evening, which was held down at the [Center for Strategic and International Studies] CSIS, was going to feature many of the same personalities, many of the same leaders from the administration on these matters.
So you were, it's fair to say, very worried at this point?
Yes.I was quite worried and watching very carefully to figure out the true gravity of this and figure out how quickly were we going to see a test developed because the Chinese, they made their declaration to WHO December 31st.They began to share the genetic details, the genetic sequencing data around January 10th.So a race began right away on developing vaccines, developing antivirals, and developing tests.So the race was on, and there was a big question of what do the Chinese know and what are they willing to share and are they open to cooperating?
Inside the White House—you were in touch with the White House throughout this period of time.What was the reaction inside the White House early on?
Well, the reaction inside the White House, after Dr. [Robert] Redfield, the head of CDC, had called Secretary [of Health and Human Services Alex] Azar, which was January 3rd, almost immediately then folks from the National Security Council began sitting down with experts from the other executive agencies in order to begin to track what do we know and what do we not know and begin to ping the Chinese to try and have greater sharing of data and specimens.So we knew that was ongoing.The problem that they faced of course was that the directorate at the White House responsible for this had been dissolved in May of 2018, and we had a president that was in the midst of the most brutal and toxic impeachment process and totally consumed with that.
And we did not have any senior figure within the White House structure with authority and gravitas on these matters.So the team swung into action in the bowels of the White House immediately, but it had a hard time connecting to higher levels.
In other words, those people that were on the team that were looking at this closely and that had some expertise were not able to reach the president?
The president was not reached by secretary Azar until January 18th, so there was quite the long delay.Secretary Azar was the designated lead under the national biodefense strategy on this matter.And so he took it up and he began pressing to get in to see the president.But it wasn't until January 18th that he did that.And the president's first concern at that time was to talk about e-cigarettes.And as I said, the impeachment process was an overwhelming distraction and preoccupation in this period.And Secretary Azar was having a hard time conveying the gravity of the situation to the president.
So this is more than two weeks.This is 18 days after the Chinese government has recognized that they are seeing deaths from this, and it takes 18 days for Azar to get in to see the president.
Correct.
Was that the president's first true briefing on this?
As far as I know, it was the first serious high level discussion.I expect there was some data in the intelligence briefs that would have gone, the daily intelligence briefs.So I wouldn't say that it was the very first occasion when anything was brought to his attention.
What you're saying is Secretary Azar began asking to see him and it took two weeks or more for him to get in and have a meeting.
Correct. Correct.… I wanted to make the point that in this same period, of course, the administration had just signed the phase one trade agreement with the Chinese, and so president Trump was feeling quite proud and positive about what had happened there.And that was very much top of mind in this period, along with getting through the final phases of the impeachment process.
He had other things on his plate, but, of course, this was alarming to you and the other people that had studied the potential of something like this happening.
Correct.
So the alarm bells are ringing, but he's not responding.
Correct.I think also, at the different agency levels, there was simply a weakness.A weakness of leadership.The secretary [Robert Redfield] could not get through.Later on, the testing debacle.Steven Hahn head of the [Food and Drug Administration] FDA, he had only been on point in that job for six weeks.At the key agency level, you didn't have strong leadership.
At the level of the White House, you didn't have a directorate.You didn't have a senior personality with gravitas dedicated to leading on this issue, who could have pulled the parties together and gotten the president's attention more readily.There were multiple problems.There were multiple problems across our government and the system of government, structurally, in which you had the alarm bells going off, but you did not have concerted action happening with speed and coherence connecting to the president in the way that it should.
Once Azar did get in to see the president, and once they got through their preliminary discussion about e-cigarettes, how did that conversation go?Do we know?
Well, out of that conversation and subsequent conversations led to what we saw unfold on January 31st, which was the declaration of a public health emergency, and the announcement of the formation of the White House Task Force led by Secretary Azar at that time, and the announcement that they would be imposing a travel ban on anyone coming from China, and that there would be quarantining of those Americans coming from China back to the United States, temporary quarantine.
Right.I want to go back to your report… Let me just ask you, what was your top or first recommendation in that report?
The very top recommendation, which was a very strong consensus recommendation of everyone on the commission was just restore strong leadership at the White House.
What had happened that the White House did not have a pandemic team inside the National Security Council?
Well, when John Bolton came in as the National Security Advisor, one of his early actions was to begin a review of the overall structure of the [National Security Council] NSC, which is a prerogative of each president and each national security advisor.It's not uncommon to go through major restructurings in order to try and adjust to the realities and demands and style of this presidency and what's happening in the world.As part of that effort of rationalizing and streamlining the National Security Council, he ordered the dissolution of the Senior Directorate for Global Health Security and Biodefense.
You say it's the prerogative of the national security advisor, in this case, John Bolton to reorganize, but you had concluded that this was a mistake.
Yes, indeed.This was a serious mistake.We raised it in the report that we put out, and we raised it in many other fora in that period.We were not alone in voicing discontent and alarm that such a step would be taken.The argument that I think was most powerful was to say, "This is an area of exceptional vulnerability, low probability events that can have enormous and gargantuan impacts."That's what we're talking about.
We live in an era in which we're seeing increasing rapidity, and increasing velocity, and increasing impacts of these new pathogens coming at us.This is the condition of our microbial universe today.That reality cannot be denied.The idea that you would disband your capacity willfully at the White House, aware of the developments of the last two decades, which were convincingly that we needed to be prepared and far better prepared on a consistent and sustained and coherent basis.
I'm not sure that Bolton is going to want to speak to us, but if he were to defend this decision, what was the rationale?What's the explanation that would be given?
Well, I can't speak for John Bolton.I presume that his argument would be that the issue set could be folded into weapons of mass destruction, the senior directorate for that area, and handled properly and coherently. And more to the point that they had developed a national biodefense strategy that tried to elevate the significance and the role of the Secretary of Health and Human Services.They wanted to see that responsibility moved over out of the White House, the lead responsibility moved over to the Secretary of HHS and to those who worked underneath him like Bob Kadlec as the Assistant Secretary of Preparedness and [Response].
…What's wrong with that idea to reorganize and move things over to HHS?
The mistake there is to assume that the Secretary of HHS is able to see the full picture and be able to command the different elements of our government to respond in a coordinated and coherent and integrated way.That can only happen through an empowered entity at the White House.
Secretary Azar is a very competent and dedicated and experienced person with lots of experience in dealing with pandemic outbreaks and other dangerous outbreaks, but he's got a busy agenda.He's a secretary, and he can't command DoD. He can't command our intelligence community.It's very, very hard to imagine that he would be able to be effective.So by definition, we set ourselves up for a slow and sluggish response.A slow, sluggish, and halting response.
Secretary Azar was not in good favor with the White House in January when this all unfolded.His reputation was on the line among several critics in the inner circle in the White House that had to do with other matters having to do with reform of our healthcare system, and pricing controls, and the like.His star was not up at that time.His access was limited, and the whole conversation that he had was colored by all of these realities.That's why it's so important that you have someone who's trusted and dedicated within the White House itself with the authority to command the executive agencies to follow a common strategy and to be able to have access in a quick and timely way to the president, and who's not going to get distracted or sidelined by virtue of a bunch of other unrelated issues.
… Another point that you make, it's in the executive summary of your report and dealt with at length inside, we had or have a public health communications' crisis?
Yes.
What is that?What do you mean?
Well, we live in an era of weaponized social media that spread disinformation and misinformation deliberately that interferes with the public understanding of what behavior is necessary in the midst of a health security crisis.We've seen the evidence of this with the rather amazingly swift reversal of progress in the control of measles.We've seen this with special and acute experiences around a range of vaccines, that the public trust, public confidence in vaccines, in public health authorities, in science has been weakened dramatically.We live in this era of great paranoia and skepticism.It's fed from multiple directions, but it all has emerged simultaneously with the emergence of global social media in the last 20 years…
This problem of collapse of public trust and confidence in science, in vaccines, in public health authorities, in industry is very pronounced and it's manifest in multiple ways.We did not start our work at the commission thinking that this was going to be one of our primary focal areas, but it became apparent over the course of the two years of our effort, that it had raced to the fore as a major problem and it required a special spotlight and a special focus on what can and should be done…
I think that was a very important sign of how important this is.During the coronavirus pandemic that's unfolded in these last few months, WHO has focused attention very early on to the “infodemic,” to the communications crisis that is faced by all of these forces spreading disinformation at a time when WHO and major governments are attempting to transmit reliable and effective scientific information to guide populations on where are we in this outbreak and what kind of behavior is essential.
This gets blended in with Russian efforts to create disorder and lower confidence in government in the United States and in Europe.It blends in with some of the old anti-vaccine movements that have gained more traction in recent years.
It's also driven by the president's own statements that don't comport with best science… We've heard [Dr. Anthony] Fauci say, "Well, it's a matter of style."He's tried hard to kind of not directly confront or offend the president, but it's become very difficult for him with his repetition of things that are just clearly false.
Well, Tony Fauci is a hero and has shown remarkable resilience and valor in this very, very difficult period.The president's behavior, the president's resort to repeated falsehoods is a function of the way he is approaching this crisis.He's approaching this crisis about how it affects his own political survivability and re-electability.It's in that context that if he can grab on to some half-truth or full falsehood and spread it because he thinks it will calm people down and reassure them and build their support, and he's prepared to do that.
Look at all of the repeated comments made all the way up to, very recently, in mid-March by this president to say to people, this is temporary, this is going to go away soon, this is not serious at different points, this is a hoax, the vaccine will come soon — knowing full well it won't — antivirals like the chloroquine and hydroxychloroquine are safe and effective and people should begin using them, when he's been advised that if you say that to people, they will go out and buy those treatments...
When you released that report, did you get responses out of the White House?You're directly criticizing the White House for having disbanded the pandemic team.Did you hear directly from them?
We've maintained an open dialogue with the Trump administration throughout the preparation and release of the commission's report, and that included folks at the NSC as well as those at the major executive agencies, [National Institutes of Health] NIH, CDC, Health and Human Service secretary's office and his major leaders in other agencies, [Department of Defense] DOD, the National Intelligence Council and the like.When the report came out, we did a pre-brief for the executive agencies, including the White House.So we gave them the pre-brief before it was released.The White House officials who were present at the pre-brief were very polite and cordial but did not comment.The others that were engaged from the executive agencies were very supportive of us but had to be cautious about how they expressed that.I emphasized also that in the course of doing the commission's work, we made it a point that the commission operated always on a bipartisan basis…
So when we came forward with a set of recommendations that were quite critical of the way the White House had acted, it was no surprise, I think, to them.And they didn't, the White House itself did not respond, which was no surprise to us.
What did that make you think?The fact that you debriefed them, you gave them a pre-briefing before the report was released and they made no comment.
Well, I think silence speaks for itself.I think that they didn't want to get into an argument where they couldn't easily win, and they didn't want to admit the veracity of this conclusion.They didn't want to get into a fight, an open fight with us, when it was not going to be productive, it was not going to be productive for them.And so we just cordially agreed to move on.
That's pretty disappointing and frustrating for you?
Of course.But we also were looking, keep in mind Martin, we were looking to build very strong support within Congress around this agenda.And we knew that this was a White House that wasn't likely to reverse course and take in recommendation like this and move on it. So we put a big focus on getting letters and communications coming out of Republican and Democratic offices associated with our commission, and other offices on the Hill, communicating, let's do this, let's reconstitute this entity.And there was very strong resistance within the White House to taking that step, and there were claims made that this went beyond the constitutional limits of Congress and Congress should back off.
What's the highest level official that's called you after the outbreak of Coronavirus and said, "Steve, you were right"?
None.
Nobody?
No, no.
No calls like that, no contrition?
No.And I'm not surprised by that.
Right. Okay.I just had to ask.
The point here is at each point the object is not to get trapped in the blame game, but try to get the parties that are in a position to do something, to do something different and effective.And so, as this crisis has unfolded over January, February, March, and now heading into April, each step along the way has been a false start in a series of incoherent actions and falsehoods.And we have continued to press for corrective actions in a spirit that we think is constructive.Condemnation and confrontation is not necessarily going to be very effective in the midst of this mayhem in this urgent crisis.
…Had these recommendations been adopted, especially the top recommendation that a unit be maintained inside the White House that would be there and close to the centers of power and could coordinate across all agencies a response, where would we be today do you think?I know it's a hypothetical, but I'm sure you've thought about it.
Well, the recommendations came out in November, they were no surprise…So, if there had been immediate action to reconstitute the group and to put the right people in the right positions, they would have been poised to respond on December 31 when the word came forward from the Chinese to WHO alerting them to this outbreak.
Presumably thousands upon thousands of lives would have been saved.Fair?
Potentially.Potentially, obviously.There have been catastrophic mistakes made all along the way by many, many governments in this, starting with the Chinese covering up and allowing it to race out of control, and extending to the actions taken by the United States as well as virtually every government in Europe with a few exceptions.And there's only a small handful of countries that have handled this correctly that you can point to today.
South Korea.
South Korea, Taiwan, Singapore.Hong Kong.
Right.Given the course that the Chinese chose to take initially, to cover this up for a matter of weeks, it raises the question of whether or not we would have really been able to stop it from becoming a pandemic, doesn't it?
Well, yes.It had been ongoing for six weeks before the notification on December 31.We had no knowledge or leverage over that.And so, you can't hold the United States or anyone else responsible for what developed internally within President Xi's regime, and that is the starting point.That's the first catastrophic mistake that was made.
Let me just ask you generally, what had happened inside China with the CDC, with Americans that were working inside China?
The unit, the CDC office in Beijing was reduced in scale, and its access became very, very problematic prior to this outbreak.And that was part of a broader freeze in the relationship between the United States and China in the scientific and health domains.And that freeze in cooperation, which went back many months, was a part of the larger breakdown of the U.S.-China relationship as the trade war intensified and as we moved to a national security doctrine designating China as our greatest strategic threat…
But that reduction in the office of the CDC in Beijing is just another way in which we were set up for failure here?
It was another reflection of the United States lowering its commitments and its influence in critically important places around the world on these matters of pandemic preparedness, health security and partnership, partnership that builds trust and exchange of information and best practices and insulates the technical and the professional expertise from political interference.
I have to think that this is something that's hard for some people in government to get their heads around because it's not like you can just commission some defense contractors to build hardware that can go to war and defeat an enemy or to seize a capital somewhere.But this is an amorphous, invisible, as the president has said, an invisible enemy.And I would wonder if that contributes to why our health security is not prioritized in the same fashion that our defense budget is forever seemingly larger and larger?
Health security as a concept has always had a hard time getting respect and getting elevated permanently into security doctrine.There's oftentimes a lot of rhetorical commitments made, but when you're out of a period of crisis and you're into the quiet zone, there's a tendency to forget, and there's a tendency to see this field as one that really does not merit status as a full security concern, but rather as something that is more technocratic and strictly health oriented and should be the responsibility of those health authorities.And it's that logic that got us into this particular straight.
You talk in your report about a cycle of crisis and then complacency.
Yes.That cycle of crisis and complacency, crisis and neglect, boom and bust, it bedevils this field and has bedeviled this field for decades.And we wrote this piece, the commission's report, with the thought that we needed to finally try to come to terms with how to break that cycle and convince policymakers that the time had arrived, that our microbial universe is sufficiently dangerous that people will recognize that and convert to something that's more coherent and sustained over time.That's a tough argument to make.I do, however, believe that this pandemic that we are facing today is the best chance we will ever see for breaking that cycle by virtue of the fact that it's creating such a pervasive nightmare.
It wasn't unknown to you that this was a true threat.That there was inevitably going to be a pandemic somewhere in the future.It was also known after the breakout and Wuhan by the intelligence agencies that this was going to present a huge problem for the United States and it had their attention, and then what happened there?
Well, that's another instance of a broken system.It's another instance of the fact that our government is not functioning in this period.That you had intelligence community focused on what was coming at us, but unable to connect that knowledge effectively with the leadership level at the White House.
…Why did we fail so miserably on testing?
The testing fiasco is a complicated story in some respects.CDC is the gold standard globally for developing tests against new pathogens.And CDC took up the task, but it ran into some technical difficulties, and things were delayed.And in the meantime, the virus was moving ahead at rocket speed, far faster than anyone had anticipated.That was the first blunder that happened.
The other blunder was the Food and Drug Administration, which is responsible for commissioning the private sector actors to get out and begin developing tests.It was very bureaucratic and not proactive, at the same time that CDC, which is preparing tests that can be disseminated to the public labs, was stumbling.
And then the third failure was at the level of the secretary at HHS, not recognizing the gravity of all of these delays, of losing a month or six weeks at this particular moment in time.
And of course above that, you had a White House that didn't really feel that testing was necessary in that first phase.The view was, "It's not going to come here.We're going to throw up the barriers to entry if the Chinese and we will contain it." …
As you watch the numbers rise, the number of cases, the number of deaths, and you see these horrendous scenes of frontline hospital workers giving their lives, shortages of equipment, how do you feel?
I feel like everyone else.I feel anguished.These are gut-wrenching tragedies.These are courageous people who were putting their lives on the line.These are patients who predictably are in terrible, terrible circumstances and their lives hang in the balance, and we're ill equipped to protect them and preserve their lives.There will be thousands upon thousands of people in America who will die needlessly.They will experience preventable deaths, and there will be thousands of health workers whose lives will be imperiled and many of them will become sick and some of them will die because of our lack of preparedness.
Have you been hit with this personally?Do you have friends or family?
I have my 87-year-old mother here living with me for indefinite period because that's the best option to protect her.She and my wife were producing masks from fabric that I purchased in Sierra Leone during the Ebola outbreak in January of 2015, which is somewhat ironic…
Well, I thank you for the work you've done.
Thank you.
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