The Washington PostDemocracy Dies in Darkness

The Health 202: Andy Slavitt describes life on the White House coronavirus task force

with Alexandra Ellerbeck

Sometimes, you’re not supposed to sleep at night.

So says Andy Slavitt, who spent the last five months playing a critical and central role in helping the Biden administration navigate what is hopefully the final chapter in the nation’s battle with the coronavirus.

Slavitt put in long hours at the Eisenhower Executive Office Building as a senior adviser to Biden’s coronavirus task force, helping to secure a steady vaccine supply and finding ways to persuade vaccine-hesitant Americans. Yet during the few hours he would return to his rented apartment one block from the White House, he would still sometimes have trouble dozing off.

“What I kept telling my wife is sometimes things are supposed to weigh on you so much that it keeps you up at night,” Slavitt told me over the phone this week. “It tells you something.”

That “something” was the pressure felt by Slavitt and his colleagues to protect the nation from the virus quickly.

Slavitt described a “heavy” feeling back in January and February, as he worried about variants and how quickly vaccines could be made widely available.

But then came March, when he saw a photo of a vaccinated granddaughter hugging her vaccinated grandmother and introducing her baby for the first time. It was the emotional high of his time at the White House, Slavitt said.

“I remember looking at that picture and I just started tearing up,” Slavitt said. “I felt like the sun was starting to poke through the clouds for the first time in a year.”

Now Slavitt is back to being a private citizen.

The administration asked him to stay at least through July 4, but Slavitt stuck to his original plan of leaving the task force in mid-June so he could start a tour for “Preventable,” his new book about the pandemic.

It’s not the first time Slavitt has worked for the federal government; during the infamous meltdown in 2014 he was brought in to fix the website and subsequently served as acting administrator of the Centers for Medicare and Medicaid Services.

But Slavitt has arguably as much influence outside the government as inside it. As the pandemic took off last year, he started the popular “In the Bubble” podcast to help explain and explore it (he plans to resume hosting for it for a final 10-week series). As the virus spread, Slavitt became known for long Twitter threads sharing his insights from phone calls with government and businesses leaders about how to tackle it.

Then, in December, Slavitt got a call from Jeff Zients, head of the president-elect’s new task force, asking him to join it. And that’s what he’s been doing ever since. As Slavitt took his leave this week, he shared with me his experiences from the past five months. Here are excerpts from our conversation, lightly edited for brevity and clarity.

H202: Walk us through the early days on the task force. What was it like?

Slavitt: If you put yourself in the shoes we were in the middle of January, it’s a very different feeling than we all feel today. Back then we had a set of very difficult circumstances … the people who were eligible for the vaccine, most of them couldn’t get an appointment and were frustrated, and the vaccines that were being sent out to the states, only half of them were actually getting into people’s arms. So with that backdrop it was a very heavy feeling; we had the variants coming and it felt like if we missed by a little bit the variants were going to potentially be quite strong and overtake us, so speed was everything.

We also needed to demonstrate that government could get the job done after a period in which that trust had been eroded. It was very interesting because the most minor of things triggered one of the biggest responses. I said something to the effect of: “The problem is we have a shortage of vaccine; we’re going to get more and we’re going to be frustrated until then.” I got a message from a nurse that said that was the day we all knew things were going to be okay because it was the first time we heard the truth. That struck a chord with me because it felt like people just wanted to know, even if the news was bad.

H202: Who did you interact with the most?

Slavitt: Jeff Zients; Ron Klain; the president and the vice president; Anita Dunn.

H202: Besides vaccines, what else were you focused on?

Slavitt: In addition to the briefings, the private sector had things we needed. We needed to basically reach out to people and say, “If you have a technology or you have a capability or something to contribute, we need you to enlist that.” I spent a lot of my time talking to CEOs, day in and day out. My assistant Kelsey said, “I need to make you a T-shirt saying ‘Saving the country, a 30-minute meeting at a time,’ ” because it was talking to Walmart, talking to CVS, talking to everybody and engaging them.

I think one of the real lost opportunities of the Trump administration playing down the virus was that you couldn’t ask people to get involved because the pandemic was supposedly ending at any moment.

H202: The vaccines became widely available faster than many people expected. Did the success surprise you?

Slavitt: If there were no variants, then vaccinating people at a faster pace would have been important. But accelerating it so we could keep pulling the dates up became more and more essential. There were points in March and April when you could see the case rates weren’t going down very fast; they were kind of bouncing around. We really poured it on with FEMA sites, using the pharmacy vaccination channels; we wanted to very quickly simplify to the point where everybody was eligible so the rules could go away and we would have an opportunity to allow for walk-in appointments and all those things.

Our sense of things was that people who were over 65 really wanted the vaccine, people over 40 wanted it — not to the same level — but the people under 40 were ultimately who we needed to reach and talk to, so we had to begin those efforts. There were points in time when I was spending half my time on the supply side of things and half of my time getting ready for focusing on how do we have conversations with people who aren’t sure if they want to get vaccinated or not.

H202: Why was there never a national vaccination advertising campaign? 

Slavitt: The media kept asking us, “Where is your big national campaign?” But everything we were learning was telling us that wasn’t the way out. The assumption was you need some big, broad advertising vaccination campaign that says get vaccinated and the people would do that. But running ads from the government turned out not to be the right answer, and we knew that early on just by listening to people.

The thing I thought was so important that we demonstrate we respect people’s process. If they want to decide quickly, if they want to take longer to decide, they are both very legitimate ways to go as opposed to try to pressure people. They didn’t want to hear from the government, they didn’t want to hear from pharma companies, they didn’t want to hear from athletes. They almost universally said they wanted to hear from their local doctor; possibly a pharmacist or maybe a clergy member or somebody else they trusted, but it was always somebody local.

H202: Biden was criticized for setting extremely modest vaccination goals he could easily meet. Was that the right approach?

Slavitt: When President-elect Biden said we need to get 100 million people vaccinated in 100 days, it was very early, it was toward the end of 2020. At that point in time there was no ability to have visibility into that and we were never hemmed by that. One of the first things I said was that’s a floor, not a ceiling. When it became clear the goal wasn’t enough, we doubled it.

H202: But now Biden faces the opposite problem. Daily vaccination rates in the U.S. are dropping. Will it be a political problem for the president if he doesn’t meet his July 4 vaccination goals?

Slavitt: One of the things that’s nice is the president doesn’t expect us to worry about the political side of it. He expects us to get the country back to being safe again and allow the country to be able to grow again and begin to vaccinate the globe. You do those things well, the politics tends to take care of itself.

H202: How did serving on the task force feel emotionally?

Slavitt: You’re so incredibly nervous. Every day, like clockwork, two sets of numbers came out that took all our attention. One was at about 1:00 every day; we got a report on how many vaccines were distributed or recorded the day before. The second was that at night we got a report on the deaths, hospitalizations and cases.

The roller coaster was a little bit like this. Seeing the vaccine numbers rise … was a sign that, okay, things are starting. Emotionally, it felt good. But the death numbers were still not going down. It was a very nerve-racking time.

We had that period of time when we were doing all that work, but we had yet to see it in the numbers. We were seeing it in the vaccinations, and then we started to see the visual evidence and it started happening everywhere, and then it came like a wave where we started seeing all these photographs of families being reunited.

It’s very hard psychologically for anyone to breathe easy who’s doing this work. But we’ve certainly gotten back a lot of the things in our lives that we need to and we are in a situation where what we have in front of us is challenging but manageable, as opposed to frightening and unpredictable.

H202: Are there ways you tweaked the vaccine rollout after learning what did and didn’t work? 

Slavitt: At some point in February and March, everyone was extremely frustrated; they couldn’t get an appointment. People were like, “Hey, Slavitt, why don’t you build a website that connects people to appointments?” I was like, “That’s not the problem.” It wasn’t a website problem; it was very simply a supply shortage. Imagine if, every time you went to buy a book, they were like, “We don’t have that book.” You can have the most beautiful website in the world, but if you can’t get what you want done, they think you have a bad website.

The technology we decided to build was a text line where you could text your Zip code, you could get the three places nearest you that had the vaccines in stock, and then at the bottom you can clock on a free ride for an Uber or Lyft, and you could also click and get a button to take care of child care. We were basically like, “Let’s use technology in a different way than people think.”

H202: Was it successful?

Slavitt: Oh yeah. It was great because it was just so simple. On your cellphone, text 438829. Literally in less than a second it tells you three places near you with a vaccine. These efforts to get young people vaccinated really requires stuff like that.”

H202: But would about the expensive mass vaccination sites? Those didn’t seem to vaccinate as many people as hoped.

Slavitt: We realized that unless we opened these channels, we were going to have this problem where only the privileged would continue to take advantage of getting vaccinated and the people most at risk — people who work on an hourly basis, people of color — weren’t going to have access. The amount of effort spent on access — they don’t always show up in the numbers in terms of larger volume of people. They’re not going to drive the numbers into the millions, but you’re going to be much more likely to be vaccinating someone who would otherwise be at risk of getting sick or dying than if you just send it to a suburban pharmacy.

H202: Anything else you learned about doing a successful vaccine rollout?

Slavitt: The first time you open a vaccination center in Oakland — what we learned was that all the people who were getting vaccinated came from San Francisco. We learned it wasn’t enough to make vaccines available in low-income areas because we found people from the suburbs would go in to communities they had never been before and get vaccinated. So we had to do things like reserve hours of the day for people from those Zip codes so they could actually use the vaccines that were sent there.

H202: Were you ever frustrated by the pace at which the CDC updated its masking and distancing guidance? The agency has been widely criticized.

Slavitt: One truism I find is the CDC, when they make a decision, will either be criticized for being too slow or too fast. And sometimes you’re going to be criticized for both by different people at the same time. 

Look, people have valid opinions; nobody has a monopoly on the truth. But the reality is I’d much rather have the people at the CDC making these decisions than anyone in the world because they are studying the data. They aren’t always going to be the fastest. But there’s a cost; if the first time someone says, “Hey, maybe we don’t need to wear masks anymore,” and the CDC says, “Okay, don’t wear masks,” and it turns out they were wrong, the cost of having to reverse themselves in public communications is so high that by definition they’re not going to be the first people out to make a recommendation.

H202: But was Walensky bowing to outside pressures when the agency revised its initially conservative mask guidance to say fully vaccinated people mostly don’t need to mask? The new guidance came just two weeks later.

Slavitt: Remember, she sat through a very painful [congressional] hearing. If she was going to make a decision for anything other than scientific reasons, she would have made it before the hearing, not after. That’s how people do things in Washington. She was willing to take the beating from anyone until her scientist told her they were comfortable.

I think … what people were feeling was surprise and whiplash, because they were feeling like “Oh, my God, I’ve been told to wear this mask for so long, and no — wait a minute — all of a sudden it’s gone,” and it was very hard for people to adjust to that.

H202: When would you learn about any new CDC guidance coming out?

Slavitt: They called us the evening before and told us they were going to make a release the next day.

H202: Your son has enduring symptoms from “long covid.” How is he doing these days?

Slavitt: Last night he wanted me to touch his hands because they were ice cold. It comes and goes, the symptoms, and I think when they’re gone he feels like he’s 100 percent himself. When they come back it’s rapid heart rate, it’s shortness of breath, it’s cold in extremities, it’s kind of a constant cold. He thinks he has brain fog, but I’m not going to grant him that one [laughter].

As parents, we have a go-to move, which is to say, “Everything’s going to be okay.” That doesn’t work with a 19-year-old.

H202: Why are you leaving the task force now?

Slavitt: Jeff [Zients] called me after Christmas and said, “We really need you to come in.” I said I just bought a house in California; my wife and I are just about to move into it. He’s like, “Just come in as a short-term government employee,” and so I said okay. I called Ron [Klain] and said can I really make an impact in 130 days? He told me by the time we get to 130 days we’ll either have this sorted or we won’t, so that was the deal.

H202: Did you have time for anything else while you were in D.C.?

Slavitt: I got an apartment one block from the White House, so I had no real social life. All the gyms were closed. On Saturday or Sunday I would try to walk around the mall, but other than that I was really there to work.

H202: What does it feel like to be done?

Slavitt: I do feel like I was in this very intense machine for a period of time when you’re doing nothing but one thing and you’re just submerged in it, so it’s a bit of a strange feeling. You learn to love the purpose of the work; it’s a great team. But on the other hand I haven’t seen my wife, I haven’t seen my kids. I’m looking forward to that.

Ahh, oof and ouch

AHH: The Biden administration released pared-down workplace safety rules.

The guidelines released by the Labor Department end months of speculation about the administration’s plans after it missed a self-imposed March deadline, The Post’s Eli Rosenberg reports

“The emergency temporary standard (ETS), as it was called, will apply only to health-care facilities — a much narrower purview than many advocates, labor unions and Democrats who work on labor policy had pushed for dating to the Trump administration,” Eli writes.

Health-care facilities that treat covid-19 patients must implement precautions such as mandatory mask-wearing, social distancing, cleaning and disinfection procedures and paid time off for employees to get vaccinated. The Labor Department will also issue updated guidance for facilities with elevated risk of infection, such as meatpacking plants and grocery stores, but it will not be mandatory.

OOF: Two members of an FDA advisory panel resigned amid controversy over an Alzheimer’s drug.

David S. Knopman, a neurologist at the Mayo Clinic, and Joel S. Perlmutter, a neurologist at Washington University in St. Louis, both indicated that their decisions to resign were sparked by the agency’s approval Monday of Biogen’s Aduhelm, also known as aducanumab.

“The FDA decision to approve Aduhelm set off a firestorm because critics say there is scant evidence the drug is effective. The agency cleared the medication under its program for accelerated approval, basing the approval not on the clinical data but on the drug’s ability to reduce amyloid beta in the brain. Agency officials said reducing the sticky clumps, which are thought to kill brain cells, was ‘reasonably likely’ to benefit patients,” The Post's Laurie McGinley reports.

The FDA advisory panel had found that the clinical evidence did not support approval of the drug. 

“The whole saga of the approval of aducanumab … made a mockery of the [advisory] committee’s consultative process. While I realize that the committee is advisory, the approval of aducanumab appears [to] have been foreordained,” Knopman wrote in an email to FDA officials explaining his decision to resign.

OUCH: A drop in childhood immunizations during the pandemic could raise the risk of other outbreaks.

“Routine childhood vaccinations dropped dramatically during the early months of the coronavirus pandemic, and although they began rebounding last summer as families rescheduled doctors’ visits, many children and adolescents are behind on their shots, according to a federal health report released Thursday,” The Post’s Lena H. Sun reports.

The agency warned that the lag could lead to outbreaks of preventable illnesses, such as measles and whooping cough.

The CDC changed its guidance last month to allow for the coronavirus vaccine to be given at the same time as other vaccines and recommends doing so if children or teens are at risk of falling behind on recommended shots.

Meanwhile, regulators are trying to determine what standard of evidence is needed to approve coronavirus vaccines for children under the age of 12. Some members of an FDA advisory panel are pushing for faster authorization, given concerns about the spread of new variants and a potential resurgence of the virus in the fall. 

Sugar rush