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Fighting back the virus with Andy Slavitt: podcast and transcript

Chris Hayes speaks with former White House senior advisor Andy Slavitt about how the Biden Administration tackled the vaccine distribution campaign.

Here in the United States, things are closer to normal than they have in a long time. Businesses have reopened, gatherings have started to resume, and Covid-19 cases and deaths continue to fall to levels that we have not seen since the very beginning of the pandemic. But even three months ago, it was not clear that this would be the point we are at. So how did the government ramp up its vaccine campaign to get us to a closer normal? This week former White House senior advisor to the Covid-19 response, Andy Slavitt, joins to talk about how the Biden Administration tackled the vaccine distribution problem as well as his new book about the U.S. Covid-19 response, "Preventable."

Note: This is a rough transcript — please excuse any typos.

ANDY SLAVITT: There was one decision we made, which is we're going to take accountability for whatever happens. We're going to own it, we're going to publish goals. If we meet those goals, we're going to publish new goals. We're not going to blame governors, we're not going to get into fights with states, we're going to say the buck stops with us, and we're going to deliver.

And on the one hand, that obviously made things intense, but on the other hand, you don't sleep at night when you're on the hook for something so very visible and so very public. And that allowed us to say, let's do everything we can to overwhelm the problem.

CHRIS HAYES: Hello and welcome to "Why Is This Happening?" with me, your host, Chris Hayes. It's vaccinated summer here in the United States, not for everyone, of course. There's millions and millions of Americans who have not been vaccinated. The administration has set a goal of trying to get 70% of adults with at least one shot by July 4th. It’s going to be close whether they get that or not. In fact, we’ve seen a decline in daily vaccinations. That said, the U.S. remains the best large country in the world, I think it's fair to say, in terms of its vaccination deployment. And at least in places with high levels of vaccination and in social circles with high levels of vaccination, there is this incredible sense of normalcy returning. My brother's wedding was a few weeks ago with essentially 100% vaccinated. It was amazing and joyous and exuberant, and people hugged each other. They got on the dance floor.

My dad and brother went to a Brooklyn Nets playoff game and we've been hanging out with friends without stressing out about who's six feet away from where or whether we're wearing masks. And all of that has been the accomplishment of a Biden administration that came in and said, “Look: we are going to set these targets, hit these targets, surpass these targets on mass vaccination.” I think it's very easy to take for granted, but it was not at all foreordained in January of this year that we would have hundreds of millions of shots out into arms, that we would have 13,000 cases a day, which is what we're running at right now, that we would have a situation where, by my brother's wedding in late May, that everyone be vaccinated for it.

When he announced that wedding, that they were going to do the date in May back in January, I was like, "Oh, buddy. That's going to be a tough one." But it is a tremendous testament to the Biden Administration. A lot of hardworking folks at all levels of government, red state and blue, governors and local county officials and nonprofits, and the folks that have been doling those vaccines that we are where we're at. And I think it's a good time to talk about what's gone right, what's gone wrong, and where we go from here because the world is not vaccinated and that is going to produce increasing levels of misery unless we get to it.

I thought the best person to talk about that with is someone who was instrumental in all this. You probably know him from our program. His name is Andy Slavitt. He's a former White House Senior Advisor to the COVID response. I'm speaking to him on his last day in the White House. He served there for the first six months of the Administration. He's the host of the podcast “In the Bubble”. He's the author of a new book called “Preventable: The Inside Story of How Leadership Failures, Politics, and Selfishness Doomed the U.S. Coronavirus Response.”

And he is now just picking his head up to come above ground after being, I think, probably working 20-hour days for the last month. Andy, great to have you on the podcast.

ANDY SLAVITT: Well, thanks for having me, and congratulations to you and your family on the wedding.

CHRIS HAYES: Yeah, it was so special and to me this really definitive… You know, your brother getting married is going to be an intense, emotional and joyous occasion, but it was tenfold that because of the conditions. I think for everyone involved, it was the thing that marked that we are back, that we're out of it. First, just tell me what your role was inside the White House for the last six months.

ANDY SLAVITT: I was what Washington calls a Senior Advisor, which means that when you have a crisis they can ask you to do just about anything. I had a little bit of a history at fighting crises at the federal level. I was taking the lead on rescuing after it crashed. So between the fact that I knew my way around government, knew my way around crises, had been in healthcare for my whole career, both in and out of government, I got a call, it was probably the third call I received, but it was after Christmas, saying, "This situation on turning this vaccine distribution around looks really bad and really tough. Can you come in and spend 130 days of intense work and help us get this done?" And ultimately, I said yes. And among other things, I was responsible for the public communication effort out of the White House on the COVID response, but pretty much anything that was needed to get vaccines moving, get manufacturers moving, get people vaccinated, get people informed about getting vaccinated, those were all things I was deeply involved in.

CHRIS HAYES: I think everyone probably was in crisis mode, right? When you talk about turning it around, let me give you this version of the story. If you look at the graph of vaccines and vaccine deployment, there's not a noticeable inflection point around the Biden take over. It grows at a fairly steady and linear pace. And someone could make the argument that, "Oh, it was all there ready to go when you guys got in there and pressed the button." Is that true, and if so, why not? What did you have to do?

ANDY SLAVITT: Well, if we want to have that "credit conversation," we can have that conversation. Ultimately, I think one of the things I loved about serving President Biden is that's not where he was principally focused. But I will say this, when we got there... Put yourself back in the shoes of where we were January 20th, thousands of people dying every day, most people unable to get vaccines because of a very complex system set up, no inventory and a commitment from the prior administration that, by January, 100 million people would be vaccinated. We were nowhere close, but the public had been misled with all sorts of expectations. And then when you dug under the covers, Chris, what you found was that only about 45% of the vaccines that were actually even sent out to states were making its way into people's arms. There were no vaccines really to speak of in pharmacies, there were no federal retail sites, there weren't enough pharmacists.

And the manufacturers were all having difficulty with their manufacturing, and of course didn’t have a great relationship with the Trump administration for a variety of reasons. So, we came in and I think the first thing we felt was that yes, people were inevitably going to get a little bit better, but we were in a race to get a lot better a lot more quickly. And so we took a number of critical actions including getting 90,000 sites, including standing up 36 federal sites, deploying 7,000 people from the U.S. military, FEMA… And we really just turned it into how you would run a logistical war effort. As opposed to kind of a “best efforts, let’s just send this out and hope for the best,” which is sort of what it felt like when we got there.

CHRIS HAYES: Yeah, and I should say, I want to be clearer about this, it's an incredible thing. I mean, on January 20th, you're doing a daily average of 900,000 doses a day and by April 20th, so that's February, March, April, right, three months, you're doing four million, three and a half million a day. It's an unbelievable scale-up. What were the hardest parts of getting that? You just ticked through a bunch of things. I saw this first-person. We all did, I think. People like myself were anxious to get the vaccine as soon as they were eligible. We saw the supply come online, right?

I'm now at the point where there's a chalkboard outside my local pharmacy that says, "Come in. We have Moderna and J&J. Literally walk into our door." That was not the case three months ago. What was the hardest part? What were the biggest bottlenecks in getting from 900,000 a day to 3.5 million a day?

ANDY SLAVITT: Well, manufacturing a vaccine and distributing a vaccine, particularly these vaccines which have to be kept in such cold storage, none of these things are simple, but on the other hand, and I say this carefully, they're just execution. They're paying attention to details, they're experienced people taking accountability. And I will tell you that there was one decision we made, which is, we're going to take accountability for whatever happens. We're going to own it, we're going to publish goals. If we meet those goals, we're going to publish new goals. We're not going to blame governors, we're not going to get into fights with states, we're going to say the buck stops with us, and we're going to deliver.

And on the one hand, that obviously made things intense, but on the other hand, you don't sleep at night when you're on the hook for something so very visible and so very public. And that allowed us to say, let's do everything we can to overwhelm the problem. For example, we didn't have enough vaccines purchased, so we purchased enough vaccines for all adults. We used the Defense Production Act to get that. There are a lot of stories that never became stories because we began to anticipate them. We started running sites and the factories 24 hours, we started enlisting the country and volunteers to get engaged. I would say the overwhelming amount of things that we did to basically say something will go wrong – and in fact things did go wrong – and we have to be in a position where that doesn’t knock us off our course because if we do, we will get punished by these coming variants and we will be coming down to a matter of weeks or, at best, a month. And if we can’t accelerate quickly, we are going to potentially have significant issues, as the rest of the world has shown.

CHRIS HAYES: Yeah, that's an interesting answer, right? Because the question I said was, "How do you do this?" And your answer was, and this is an interesting organizational and institutional answer, the short version is we set public goals and we held ourselves accountable to hitting those goals, which is the answer that a field director will give you on a campaign or a sales manager will give you on a sales team. This is our goal and every day we're going to be transparent about what the numbers are, and you're going to wake up every morning and go to bed every night thinking about those numbers. And then everything downstream of that will be geared towards hitting those targets.

ANDY SLAVITT: I had made the observation, and I think you agree with me based on the conversations we've had in the past, that one of the reasons why the public was so fatigued was because they felt like they were never dealt the truth. That no one had ever said, "Hey, this is how long it's going to take, we're in for a marathon." And the public felt that the Trump administration – or I should say large amounts of the public, not all – that the president wasn’t taking accountability. For all of those reasons, something like 40% of people said they would even take the vaccine if offered to them. We had to turn around not just the supply situation, but the trust situation. And I was given a large share of the responsibility for that. And I think you’re exactly right. Feeling like, as the president so often said to us, we give people straight answers to simple questions as much as possible. He actually said, “Don’t worry about making me look good. Just worry about giving the public the information they need.” I think that was probably in some measure why he was elected because we had gone through such a different experience with this crisis, and this approach that he had – which I think was colored by what he believed needed to be done – made our jobs very very easy.

CHRIS HAYES: There's also something interesting about this first three months that I marveled at too, which is that as challenging a task as it was – and it was – it was also so clearly the priority and so clearly a pass/fail test. Usually governing, and you know this because you've been in prior administrations, is a battle between competing priorities. It's a question about who's going to do what, and what's the most important thing to do, and then there's a question of what counts as success and what doesn't. It's very rare in governance to get basically a pass/fail exam like this, like, "You are going to vaccinate the country and stop another outbreak or you're not."

That is clearly the priority and everyone understands, I imagine, everyone in the administration just understood that from day one as the priority.

ANDY SLAVITT: I think that is exactly true for the Biden Administration. I think it probably would have been true for something like a Romney administration, certainly an Obama administration, but it was not true for the Trump administration. And this is what you mentioned, the book that's coming out, “Preventable.” My experience in the first year of pandemic was very much working with the Trump administration and Jared Kushner and Deborah Birx – all these things are detailed in the book. And they spent an incredible amount of effort just to avoid accountability, ultimately, I don't believe successfully. But it was fascinating how just that very simple thing you said had been violated, and I think to the real detriment of people's lives.

CHRIS HAYES: So, let's talk about chapter two in the vaccination story, because I'm looking at this. It's this huge peak. We do four million doses on April 16th and then it starts to come down, and it's come down. Now we're back to basically, we're doing a daily average of about a million, which is about where we were around back in early February. Now, something changed, right? In the beginning, it's a supply bottleneck. There's a huge amount of demand and people can't get shots.

Then we get to this peak point in April where we're matching supply and demand at this incredible pace – three and a half, four million doses a day. Now, there's tons of supply and the demand is the problem. It just strikes me that those are such different questions because when you're talking about the first half, which is attention to detail and logistics, the second half is culture, media messaging, sociology, human behavior – in some ways a more complicated problem to solve.

ANDY SLAVITT: So the thing that I would say is, yes, that's true, but you also have to treat every execution problem as an execution problem and not leave it to the dark arts of the mystery of the moment that somehow we can't reach people. And in fact, you have to have a mental model of how people are thinking about whether to get vaccinated. And this model that people use that says people are either vaccine acceptant, or vaccine hesitant, or anti-vax, or so forth, leaves you pretty limited.

The way I chose to look at it is that the vast majority of people believe in vaccines in this country, vast majority. But that in the case of a new vaccine, we were going to have some people that required very little homework in order to decide whether to take the vaccine, larger numbers of people that would require more homework – they would have questions they would want answered – and then yet another segment of people to whom it just, frankly, isn't that high priority and, therefore, they're going to be in no rush to get the vaccine. And for each of those groups, you have to kind of take a deep breath and decide to respect each of their needs and each of their concerns and try to get them addressed. That does mean that you won’t vaccinate everybody as quickly as you want to, but it also means that you are eventually going to have a better shot at getting everybody to take the vaccine because you take their needs seriously. You allow them to get their questions answered, in which I really hope they don’t end up on Facebook and some guy on Facebook supplying them the information, in which case they can be lost.

CHRIS HAYES: Well, it also strikes me too, one part, and I've seen a lot of reporting to indicate this, I'm sitting here right now. I'm actually pulling up ... I keep a little to-do list. There's items I've had on my to-do list: one, my glasses are slightly crooked and I should get them straightened out. That's not a matter of life and death, but I am on television every night, so I probably should have straight glasses. I don't know, that's been on there for 11 weeks or somethingand I haven't gotten around to it.

It does seem that a big chunk of it, there's people's hesitancy, but it's a thing you have to do in a maybe chaotic life and trying to run around work and kids and all those things, that it just can fall through the cracks. It seems like there's a non-trivial chunk of the question is that.

ANDY SLAVITT: No question about it. And so we could be accused of doing what people might look at as silly things over the last month to get people interested in getting vaccinated. We've got Uber and Lyft to donate rides to and from vaccination centers. We have put out a very explicit set of resources – you know, you can text your zip code to places to get vaccinated. We are accumulating a bunch of free stuff that companies are giving out to people. And people that, “Oh, these lotteries and things, they're silly, why should you have to do that?” But a guy with a 23 year old son – and, by the way, maybe this is some helpful context: people over 40, 73% of them have gotten their first shot. People under 40, fewer than 50%. Right? It's sort of like me, I'm 55. If I haven’t gotten my shingles shot yet, will I get it on my birthday? I don't know.

I'll get it, I know I'll get it, but I'm not in a rush. So what motivates my son, who's 23? Largely speaking, it has to be easy. And then, interestingly enough, free stuff. My 23 year old would walk two miles to save $2 on a Subway sandwich, and he’d eat dinner at like three in the afternoon to save those $2. Young people are motivated by that kind of stuff. So we've had to do things like that and work with the dating apps to speak to them, and all kinds of things like that. But the truth is, not everybody thinks about these things the same way. And if you sit back and kind of wag your finger and say, "Gosh, these people aren't taking the vaccine as seriously as they should," you'll just never reach them.

CHRIS HAYES: I want to talk about the hesitancy questions. There's the to-do list people. There’s the, “Is it easy? Can you get a day off work if you're feeling sick?” And then there are tens of millions of people, I think, who really do think, "No, this thing is bad,” or “This thing is dangerous,” or “This thing is a threat to me,” or “This thing is a plot,” or “It's going to install a microchip,” yada yada. So I want to talk a bit about that aspect right after we take this quick break.

All right, so there's all kinds of reasons that people may or may not get vaccinated earlier or later. I think sometimes, too much of the conversation focuses on the most hardcore disinformation that has been circulated in people's conspiracy theories, paranoid conspiracy theories about the vaccine. But that is part of it, too. Did you guys feel like you were in a battle with someone on the other side pushing against you in terms of the messaging?

ANDY SLAVITT: I think, without a doubt, misinformation and disinformation is a public health hazard. There are only a small number of people that are truly anti-vax. The problem is, those small number of people will spend inordinate influence on places like Facebook and WhatsApp to try to dissuade people from taking a vaccine, for whatever reason or for whatever agenda they have. And so it is absolutely essential that we ask the question, "Who do you trust?" because it turns out people don't trust the government either, and they don't trust the big pharma companies either. So, who do they trust? They trust their own doctor, they may trust a clergy person, they may trust a pharmacist. And so, our entire effort has not been about big national campaigns saying, "Get vaccinated." It's been about a ground game of what we call the community corps of thousands of people and communities around the country, doctors, nurses, et cetera, and getting them the information so they could provide reliable straight answers to people. Here's the interesting thing: if this was a vaccine that had, like, 50% efficacy and 20% of people got really sick, and therewere hundreds of people dying, it would be a tough product to sell.

But this is a product that has 90%-plus efficacy rate. It has been in hundreds of millions of people with very, very tolerable... Because the data is so good, my view is, all we need to do is let people see the real information, allow people to do the homework for themselves, not get distorted information, and, as a result, that will get us to a place where more people over time choose to get vaccinated. But you have to be conscious of the fact that, at the same time you’re doing that, there are tens of thousands of people that get their information from someone on Facebook that has got an agenda.

CHRIS HAYES: Well, but it's more than that too. There's been this concerted effort by Fox, particularly Tucker Carlson, to do this, "Well, I'm not saying vaccines are bad, but do we know about pregnant women?" This trolling, just asking questions, which has a real effect.

ANDY SLAVITT: By the way, that is the most effective type of disinformation, is what they call the borderline doubt raising, because you're talking about people who are on the edge. All you have to do is say, "Boy, they didn't think asbestos was bad in the ‘70s." You get people's heads whirring. That’s very deliberate. That approach where people can say, “Hey, I’m not anti-vax. I got vaccinated. I'm not anti-vax." But then they can say that with a straight face and, at the same time, they're plowing these doubts into people and they’re lifting up stories out of context and out of proportion. Yes, Tucker Carlson knows exactly what he’s doing.

CHRIS HAYES: So, let's talk now about ... I think we're in a pretty good place right now. Although, I've got to say what's happening in the U.K. is freaking me out slightly, where you're seeing this new Delta variant. And the part of the U.K. where the Delta variant is spreading most quickly, which I think is mostly among people under 40 who haven't been vaxxed yet, but hospitalizations are going up. That's really worrying to me, because the U.K. has had a very successful vaccination implementation program.

It's the first time that we've seen what looks like something appearing to be a real outbreak in a fairly vaccinated country.

ANDY SLAVITT : Well the threat is not gone. And if you’re not vaccinated and you think that you’re safe… You’re safer now than you were because fewer people around you have the virus, but that can change very rapidly, as we know, and as England is showing, as you said.

I think it also drives home the message that two vaccine shots, in the case of Pfizer and Moderna, are far more effective and more important than just one shot, where you don’t get nearly the immune response. So that’s important. And look: there will be people who, in communities where there are low levels of vaccination, particularly in the Southeast, will continue to be hot spots. If your brother's wedding was in Arkansas and nobody was vaccinated, there is a good chance that it could have sparked an outbreak. We will be seeing those stories and they will be different kinds of stories, hopefully, than the stories we’ve seen in 2020, but when they reappear in the fall, they’re going to be in a context which says this stuff is all controllable, we have the ability to get our arms around it, but we have communities that, until they get vaccinated, are going to be at some significant risk.

CHRIS HAYES : Let's talk about the global context here. I've been pretty tough on the administration on the global aspects of this. There's been good talk and commitments about sharing vaccines, but in terms of the numbers thus far, I think on the domestic side, you guys have been transparent and accountable. We know how many shots are going into arms and talk doesn't do it. Like, you've got to get shots in arms and you have. I have been on the show extremely complimentary and admiring, honestly, of that effort.

On the global side, we got our first shipment out the door the other day with South Korea, I think. There's an amazing announcement today about buying as many as 500 million doses. But we haven't gotten doses out the door into countries at the rate that feels to me like we should be. I understand that from an outsider perspective, this stuff looks simpler than it is from an insider perspective. I wonder if you can just talk a bit about what that looks like from your perspective in terms of the logistics of all this.

ANDY SLAVITT: Well, I think that, much like the domestic side, my prediction is, within ... Let's say by the end of the year, I think the story will be very different. The work that has been getting done behind the scenes will be more and more apparent. The announcements at the G7 are but one example. If we were doing this interview before that news became public you would have said, “Andy, how come we’re talking in the tens of millions?” Now you can say we're talking in the hundreds of millions. What I don’t want people to get the impression of is that there are a bunch of doses that are sitting around that could have been sent out to the globe that haven’t been. By and large, that’s not the case in any meaningful way.

There certainly will be doses that have been sent to states, that states ordered, that they didn’t use and that expired. That will happen. And I think part of that is because we have chosen to prioritize speed and health equity and broad distribution over not wasting a single dose. So that will happen, but that will be inconsequential and modest compared to the very significant work that’ll be done to get doses shipped overseas. So, there is a massive effort needed, more than 10 billion doses needed across the globe, and Tens of billions of dollars. And I will tell you that that will have to be a joint venture by the rich countries, by the G7, and, quite frankly, by the G20. We’re going to have to think about what role the Chinese vaccine and the Russian vaccine play. We’re going to have to think about where the money is going to come from, not just to manufacture the drugs, but to distribute them. The U.S. has put out a marker which has saidthat we are not going to allow the intellectual property of the pharmaceutical companies to get in the way of this. And the truth of the matter is that, for the middle income and poor countries, this all needs to be done at cost. This cannot be done with profit. Now, if the pharmaceutical companies want to make a profit, they should make the profit with the wealthy countries. But that’s where it ought to stop, and I think that’s a fair deal.

CHRIS HAYES: Well, I guess I would say part of what is so harrowing about all of this is that one of the things that I've learned – and again, I'm just a reporter who talks to people and tries to learn, so I have no expertise here – but one of the awful realities of this pandemic is it's only a matter of time. We've seen places ... India was quite aggressive. I have all kinds of very intense critiques and reservations about Narendra Modi, which I've actually talked about on this program. The early Indian response was pretty proactive.

They took it pretty seriously pretty early on. Then fatigue sets in and then it's like, we've got to open up businessesand then it’s hit really hard. We're seeing Haiti now, a place that had largely been spared the worst ravages, is now having a really bad outbreak. It's one of the poorest countries in the world. The first phase of this really hit the developed and rich world, the U.S. and E.U. particularly, quite hard, and then hit more middle-income countries, like Brazil and Ecuador in South America, really hard.

But some of the poorest countries in the world were spared and it just seems like a matter of time, which is why the clock ticking on this seems so urgent to me.

ANDY SLAVITT: You couldn't be more correct about that. The last year, if what happened in the U.S. had happened in Sub-Saharan Africa, or in Haiti and in India, it would have been even more horrific than it was. The fact is, there are reasons why that didn't happen, some of which I go into in my book. And in particular, I think things that we did here in the U.S. were almost inviting the virus to come here, whereas people who had a little more experience with pandemics and a little more willingness to think about the collective good, even if they didn't have much, much better leadership and then had far fewer resources, fared a lot better. But where you're right is there's an irony now in thatthe nations that have very little blanket of immunity and have not had access to the vaccines are the most vulnerable. I think COVAX, the concept on COVAX is to really get the vaccines to the places that need it the most. The U.S. has announced that three-quarters of our vaccine distribution are going to go through COVAX. 25% will be bilateral to countries that need them because we can move more quickly and work in our hemisphere, but still be leading the global effort.

CHRIS HAYES: Well, this brings me to a larger conceptual topic that I've been wanting to discuss with you, which is, we've done all these comparative studies. I've been covering this obviously since the beginning. You compare South Korea to Italy and then us, and then you compare the Vietnamese response, Japan, right? These countries, particularly in Asia that had had experience with SARS, which was really the crucial ... That was their version of a vaccine almost.

SARS was kind of a societal vaccine, where having dealt with a very severe and acute and scary respiratory infectious disease had created systems in those places that could be activated in the event of COVID-19 and I think that helped those countries in the world. It's an interesting thing to look at places with as different institutions and governments as, say, Vietnam, Singapore, Taiwan, China, Japan, New Zealand, Australia, South Korea, all of which have different governments and different institutions and all do a really pretty good job of containing COVID.

That said, the other thing we've seen is, as time goes on, the kind of stochastic nature of the outbreaks feels more and more apparent, which is to say there's one way of viewing this as, "Look, strong public health measures implemented correctly, and particularly proactively, are prophylactic against the worst of this." That's one way of looking at this, and it's the way I tend to think.

But there's another counter argument, which is, this is all just rolls of the dice. These outbreaks are extremely stochastic. They're like forest fires and they start in certain places and then others. And yes, there's things you can do as risk mitigation, but ultimately, it's just going to be your time when the time is up. I wonder how you think about those two models of thinking about what we've seen.

ANDY SLAVITT: Let me offer a third model, which isn't necessarily inconsistent, but it's actually I think, after spending a lot of time on this, I find the most useful way to look at it, which is that ... Take things here in the U.S., and put aside the Trump presidency even for a second, although I don't think it's fair to do that. I think a lot of the sins visited on us were visited on us from the top, but not all. The thing to remember about the pandemic, Chris, is many, many people suffered and continue to suffer. But many people did quite well during the pandemic.

There's a chapter in my book which I call “The Room Service Pandemic,” and it shows that there are a lot of people who’ve lived on the side of the line where they have been getting Amazon deliveries and groceries, been working from home on Zoom, and they've been relatively untouched, they've been very safe. But 50% of the country, and that varies by state, have been labeled essential workers, so that Big Mac can show up on time and piping hot, and everybody from the person who's taking the food out of the ground, to the person who's driving the truck, to the people in the meat distribution center, to the people in the grocery counter, all have to basically show up every day and do that. And so, part of what I think is happening, at least very distinctively in this country, is the divide is so wide. And it's so easy to be on, if you're on the good side of the room service equation, to protect yourself that there was very little incentive, very little incentive for people to sacrifice even modestly.

Because many of the people that were dying, and have been dying, are people that they don't know and they don't know personally. Now, they're the people that serve them, but they don't know them. If a modest amount of sacrifice – you talk about a modest amount of sacrifice, wearing a mask or being careful not to breathe around other people or have large enough events so that things spread. It's something we're not in practice in this country. Other parts of the world I think don't feel immune to the world's problems as much as we do here in the U.S. today.

CHRIS HAYES: I think it's a great, important way to think about this, right? In my first book, “Twilight of the Elites,” I talk about this concept which I called social distance, which is, the more unequal America gets and the more social distance there is, the more that people are removed from the effects of the maybe policies they implement and you've got this class stratification. And so, the more that people are insulated from what's happening to one certain subsection – you even saw this early on.

I remember it was a state supreme court. It might have been in Wisconsin. It said, "Well, right, but if you take out the people in the meat packing plants, this is the level of community transmission in the state." And it was this perfect example. It's like, "Well, the meat packing plant is in the state." You can't just say, "Well, if you take out the meat packing plants..." That's where the outbreak is.

ANDY SLAVITT: Sure. Take out the tribes in South Dakota. If you take out the tribes at the meatpacking plants, and why all the fuss?

CHRIS HAYES: Right, but that's my point. In South Dakota is a great example. South and North Dakota. It started in indigenous territories and meat packing plants, but it didn't stop there, and it ran pretty roughshod in those two states, even outside of those populations. And yet, still, I mean that was what was remarkable for me, because those are real laboratory experiments of precisely this, because it was clearly the case in those states. It started at the margins and worked its way to the core in a social sense. But even as it came closer and closer to the core, it was amazing to me how chill everyone seemed to be about it.

ANDY SLAVITT: It's interesting. And this I think we can't get through without a little bit about the role of the president. Again, I would argue that this is not a Democrat or Republican thing because I think a Mitt Romney president would have been a much closer response to a Biden response than a Trump response.

CHRIS HAYES: Yeah, and I think to me, the gold standard example of that is DeWine in Ohio, where, left to his own devices, I think did a good job. Although, they end up facing his own right wing insurgency.

ANDY SLAVITT: Right. If you just take the three sins of the president that I would call out, that we paid dearly for, one is his power of denial. We've learned that he knew quite early that people were going to die, and yet he went to bed every night until the NBA and the stock market forced his hand. He knew as early as anybody what was going to happen. But his historic ability to just deny reality and convince his followers to deny reality was the play he had. The second thing he did, which I think was very dangerous, was any dissent that emerged in his administration, he squelched it, whether it was Nancy Messonnier, or Tony Fauci, or eventually Birx, people were either fired or intimidated. Or, and there's a passage of the book, where there is a conversation that I’m party to with Reince Priebus,where they basically talk about their strategy of shopping for opinions, basically saying, “Hey, this is our opinion, now let's go find the expert that will validate it,” and they did that with Scott Atlas. And then the third thing that he did, and I think this is the thing that people around the world who I talked to, who have been leading these efforts have the most difficult time relating to, which is he basically exploited the political divisions that exist in this country to make them mirror how he wanted people to behave around the public health crisis.

And never was it more clear, never was it more clear than when he rolled out this big process of saying, “This is what it will take for us to open up,” and then saw protests in the state of Michigan and Minnesota and sent those two famous tweets: “Liberate Minnesota,” “Liberate Michigan”. And the day after they made this announcement. It was so incredible. The people in the White House, and I document it in this book, literally upon hearing this, had to call the lawyers and say, “What just happened here?” because they had done all of this analysis very carefully. The president had appeared to stand behind it, when the whole time he was winking at the crowd. I don’t know… politics feels like it is inevitable, everything that goes on in this country right now. I would say if we were ever to have a shot at having a less political event, it would have been a global pandemic, but we had a president who felt it was very much in his interest to exploit those divisions.

CHRIS HAYES: Well, and that point is an important one because it speaks to a larger point about who's the dog and who is the dog walker, and who is in control? The thing about Trump, people talk about his incredible mind control of the base. But the thing he is most terrified of is getting on the wrong side of that base. He is as much finger-in-the-wind with them as he is telling them what to believe. You really saw it in that moment. That moment is a perfect example.

They came out, they convinced him this was the plan, he unveils the plan, and these protests happen and he's terrified. You know the other place you see it? Right now, is on vaccines. There's a universe in which he calls it the Trump Vaccine and he's out doing vaccine stuff all the time, and he gets vaccinated in public. He's occasionally done little stuff like that, but he's so terrified of the base’s contempt for the vaccine and vaccination that he won't actually really truly own it and get out there because he's as scared of them as anyone else is.

ANDY SLAVITT: Well, that's what a populist is. A populist is not driving ideas, a populist is... And he's a good one. He pays attention to fears. And he had a lot of mechanisms for doing that. One of them, of course, was Twitter. If he sent out a message and he saw how rapidly people liked it or retweeted it, or whatever, he knew he had a theme because he was registering with his people. When he gave his rallies, and he got the loudest cheers, so he found that he could mock everybody who took this in any way seriously and, I think, misled him into thinking that this was a viable track to be on. I will say that the day that the stock market went back up, and in the book, I document this, he got front page copies of the newspaper showing that the stock market recovered, signed them, autographed them, gave them to his staff, and front that moment on I believe – as far as he was concerned – the pandemic was over.

CHRIS HAYES: Yeah, I remember covering that and being astounded. And it was always so clear. It was so clear that the market was all he cared about. Remember that Friday afternoon press conference where he brought out all the CEOs right into the close? They came out, what, the markets close at 4:00 I think, right? It was like a 3:15 press conference and that was the one where we brought out CVS and Google, and you were going to be able to drive into any Target for a test.

Target started having to put up signs in their parking lots being like, "We don't have tests." The whole thing drove this rally into the close and it was like, "Boom, mission accomplished."

ANDY SLAVITT: The next day, Saturday, a senior leader at Google called me and asked me what I thought they should do because they did not know what to build.

CHRIS HAYES: Yes, he just announced this new Google website.

ANDY SLAVITT: Right. And prior to that, the staff had called me and said, “We’re doing this. We’re putting this on.”Now, in a normal situation with a normal administration, the staff views their role as to protect the president from his or her worst instincts. Giving the president something half-baked is something that is considered a sin in the administrations I've worked in, and I've only worked in two. But certainly, from everyone I talked to who's worked in other administrations, that's something a staff should be very, very careful about. And when you have a president that you know will take anything half-cocked, and to to try to make it into something bigger, you know what you're doing. There's an anecdote in the book of someone presenting to the president, who says, "Mr. President, you promised a 10. We can deliver a four that I think you could turn into a six." And the president thought about it and his response was, "How about a seven? Do you think we could turn it into a seven?

CHRIS HAYES: Wow. So, where does this leave us in a broader conversation about American healthcare? One thing I think has been interesting, people have made this point, there was something miraculous about the vaccine experience being an experience completely independent of the normal complications of America's private healthcare situation. Like, you show up. You have an ID. You get the shot. That's it.

ANDY SLAVITT: Where’s my copay? Where’s my deductible?

CHRIS HAYES: To be honest, yes, there's the copay and deductible, which is the pressing problem, but even one level below that, and less urgent than paying, is I didn't have to fill out any paperwork. What I did not get was six weeks later an inscrutable EOB document in the mail that had 90 different numbers which don't add up, and then something in parentheses that's $93.71 that says, "You don't owe this, but someone does and we'll get back to you about whether you're going to pay it or not." It was kind of a revelation to have free point of service healthcare in America.

ANDY SLAVITT: It is an excellent point. And not for nothing, there's a chapter in the book called “The Folly of the Free Market Pandemic.” There were a lot of people that did quite well because we refused to reign in people’s opportunity to make money here. When people didn’t go in and get health care, and when people got dropped from health insurance coverage, the health insurers just ended up with a massive windfall of tens of billions of dollars for not doing anything because people weren’t using their health care services. And there were then millions of people that lost their insurance because they lost their jobs. So you’d have to ask yourself, what is a good system? One of the definitions of a good system is that it's resilient, that it takes care of you in tough times. And that was so obviously not the case here. And then, you’re exactly right, we have this example where we’re like, “Okay, now everyone needs health care. Let’s just do this. Let’s just pay for it and give them health care.” And people were like, “Okay, but that’s a one-off. Health care can’t work that way. We can’t just pay for health care and give it to people with their taxes. That would be crazy.”

CHRIS HAYES: And to me, how this exposed some of the craziness of American healthcare, that basically the hospitals all almost went bankrupt because they weren't doing the surgeries that keep them in business, while the insurance companies were making windfalls because people weren't going in for routine healthcare. It's like,something is very wrong with this picture. Particularly when you're looking at these hospitals, every day is a story about how this hospital is melting down and there's bodies ... this crazy, all hands on deck, front line workers working 16 hours, seven days a week. People in PPE, risking their lives. Meanwhile, the hospital is losing $100 million a month. It's like, "Whoa, what? Why? How have we created a system where that’s the case?"

ANDY SLAVITT: Right. And as either as a taxpayer or a customer, who do you want your money to fund: the hospital that takes care of you, or the intermediary that sits above it, and denies your claims or does whatever? I'm not suggesting that they're by definition evil. They're participating in an equation that just doesn't work for people is probably the better way to think about it. There are lessons to be learned from this pandemic. There are deeper lessons to be learned about race in health care, about inequality in health care, about inequality in our society. I spendthe last part of the book essentially saying, in effect, the only way to solve these problems is if we decide to become better people and a country that is more committed to the common good because these things are here. They are visible for us now, but they are just as easy to ignore as it is to go back inside your gated community and order room service and wait for the pandemic to be over.

CHRIS HAYES: Yeah, the big lesson here is about, to me, solidarity and social cohesion. That is the overwhelming story of this pandemic, is how we can come together as people and how we can turn on each other as people, as Americans, as fellow human beings, and the places that were inspiring, where people turn towards each other and helped each other and stood in solidarity with each other, and the places that were really upsetting and depressing, where people turned against each other. We saw a lot of both.

ANDY SLAVITT: Yeah. We saw a lot of the ugly side, right, of our country inside. We saw a lot of the beautiful side. We saw a lot of the heroic things. I think what President Biden has attempted to show is that in our best days, we're capable of amazing things. And it's when we try to put divisions aside and go through this together. And I think it's very difficult to do in this day and age, obviously. It's more difficult than it's probably been since the Civil War. But we have these moments when we see, "Wow, there's incredible potential here." And one of the reasons I joined the administration, in addition to being asked to do something important, was that we can believe in each other and in our government and in our ability to take care of ourselves and solve problems again, or the forces that are attacking democracy will have a big leg up.

CHRIS HAYES: Andy Slavitt is a former White House Senior Advisor to the COVID Response. He's host of the podcast “In the Bubble.” He's author of “Preventable: The Inside Story of How Leadership Failures, Politics, and Selfishness Doomed the U.S. Coronavirus Response.” Andy, great to have you on the podcast. Thanks so much.

ANDY SLAVITT: Thanks for having me, Chris.

CHRIS HAYES: Once again, my great thanks to Andy Slavitt. I’ll definitely be checking out that book, “Preventable: The Inside Story of How Leadership Failures, Politics, and Selfishness Doomed the U.S. Coronavirus Response.”

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