DR. MURTHY: Well, thanks so much, Paige. I’m looking forward to our conversation.
MS. WINFIELD CUNNINGHAM: We have so much to talk about today. But let’s start off with this advisory that you issued yesterday around misinformation, calling it--around COVID-19, calling it an urgent threat--one that continues to put lives at risk. What are some of the specific pieces of information that you consider to be the most threatening?
DR. MURTHY: Well, Paige, I’m deeply concerned about the consequences of health misinformation. It’s why I issued this advisory. And to set the table here, surgeon generals' advisories are not things that are issued every day. These are products that we produce on rare occasion from the office when there is an urgent public health threat that we want to call the country to action around. And health misinformation fits that category.
What we’re seeing even with COVID-19 alone is that misinformation around vaccines is impacting people’s decisions about whether or not to get vaccinated. It’s leading many people to forgo the vaccine. And we know now, especially with the delta variant, that the vast majority of people who are getting sick--and more than 99.5 percent of the people who are dying from the virus--are people who are unvaccinated. We’ve seen misinformation about masks lead people not to wear masks. We’ve even seen misinformation about the virus to lead people to not even think it’s real.
And so, misinformation is really consequential. It is not new though, Paige. We have been struggling with health misinformation for years and years and years, for generations. But there’s something different now. And what’s different is the speed and scale at which it is spreading, aided in large part by technology platforms and by--in many cases are often inadvertent, you know, sharing of information on these sites. So that is why I issued the advisory yesterday. And in it we called the country to action around this, laying out a series of steps that individuals, healthcare professionals, educators, research professionals, technology companies, and government could take to stem the tide of misinformation.
MS. WINFIELD CUNNINGHAM: But you mentioned that it’s pretty uncommon to put out this kind of an advisory. Why right--why now? For example, we’ve seen this misinformation for a really long time throughout the pandemic. Why perhaps didn’t you put out the advisory sooner? What led to this moment?
DR. MURTHY: Well, we began developing it some time ago, actually shortly after I began my tenure as surgeon general at the end of March/early April, because we knew that misinformation was harming us. And we took a few weeks to put together the information so that we had clear lanes for stakeholders like technology companies and educators and healthcare professionals to follow. We took some time to put together the research to bring together the best knowledge that we currently have in the United States and around the world around health information, and we pushed this out.
And the reason that we’re doing it now and not waiting further is that, you know, this is a threat in this moment. And we’re--this is only going to get worse unless we step up to do something about it. The thing is, Paige, it’s COVID today, but it’s going to be other conditions tomorrow. If we want to think about pandemic preparedness for the future, we have to not only think about how we build up our manufacturing capacity for testing and supplies and how we resource our departments of public health. We’ve also got to think about information--about how people get it, about how it’s disseminated, and about how we ensure that people have access to accurate information so they have the freedom to make good decisions about their health.
MS. WINFIELD CUNNINGHAM: But I want to throw a question at you that I often hear of critics, and particularly free speech advocates. And they say, you know, we talk about combatting misinformation, but it brings up concerns about censorship as well, and how far should the government or tech companies go in regulating this. For example, Facebook for a while was removing claims about the origin of the virus, then they reversed course. Can you respond to those concerns to critics who say this can lead to the suppression of free speech?
DR. MURTHY: Well, it’s an important question. And one of the things we raise in this advisory is that this is a starting point, not an ending point for our work on misinformation. And not only are we laying out important actions that have to be taken but we have also raised important questions that have to be considered.
And, look, free speech is one of the bedrock values in our country. It’s something that we’ve got to protect. But in my mind, that is not inconsistent with the idea that we can also prevent people from the harms of misinformation. You know--I mean, on technology platforms in particular where they have seen health misinformation cause harm, I believe that they have an obligation to inform users about what is true and what is clearly false.
I’ll give you an example, Paige. When you think about the measles vaccine, we know that there have been myths that have been circulating for years about the vaccine causing autism. This is based on a study that was done years ago that was later debunked. This has been disproven time and time again. But it--these rumors about the measles vaccine and autism spread like wildfire on social media, even though the scientists knew that this was inaccurate and said it time and time again. That stands as a clear example where a platform having rules and constraints around sharing misinformation like that seemed perfectly appropriate. So I believe we can respect free speech while also protecting people who are harmed by health misinformation.
And finally, just consider this. If you’re a mom or a dad out there, like me, and you’ve got small kids at home, and if somebody, God forbid, gets sick, or if you see the virus coming and you’re thinking how can I protect my children, it is your right to have accurate information that you can base your decisions on. And right now, it is very hard for people to figure out what’s true and what’s not. And a lot of people will also share content they come across, thinking they’re helping others, not realizing that content is false. So we have an obligation as a society to make it easier for people to understand what’s based in science and what’s not, because this amounts effectively to false claims, that articles and other posts are making about COVID-19, about other health conditions that are misleading people and hurting them. We cannot tolerate that.
MS. WINFIELD CUNNINGHAM: Well, let’s turn to the news out today. And we’ve--it’s been announced that Pfizer has been given priority consideration for getting full approval of its vaccine, it says, by January 2022. I know there are a lot of concerns mixed in here about, you know, trying to convince more people to get vaccinated, and perhaps full approval could help. But can you talk a little bit about that timeframe? Is that an appropriate timeframe? And then do you think if we do full approval, will that bring some more people on board with getting vaccinated?
DR. MURTHY: Well, it’s a good question, Paige. You know, on the former I’d say, you know, I’m going to defer to the FDA on their reasons for their decisions around the prioritization of the time schedule. But what I can say about the vaccine, whether it’s Pfizer’s vaccine or Moderna’s vaccine getting full approval, is that there are some people for whom I think that would be helpful. We know from surveys that some people say, gosh, if there was--you know, if it was actually--went through the approval--the regular approval process, you know, and was fully approved, that that might change their mind. Now here’s what I would say to that, is that even though I think some people may be helped by that, I think you can look at what’s happened already with the vaccine, which is not only has it been studied in clinical trials, issued an authorization by the FDA but it has now been essentially given to millions and millions of people in the United States and around the world. We have more experience with this vaccine than we do with many other health products that--you know, at this stage of their development.
And what that experience tells us is two things. One is that the vaccine remains remarkably effective at reducing infection rates in communities. The second thing is that it also has a very strong safety profile and that the rare risks, you know, of anything you may experience with the vaccine are far outweighed, in fact, by the tremendous benefits that you receive by not having COVID, which we know itself causes a variety of conditions, not just shortness of breath and fatigue, but it affects the heart, it affects the kidneys, it affects the nervous system and the brain. This is not a simple virus. This is a complicated virus with real consequences to our health. And so, again, I do think that for some people the FDA approval process may make a difference, but I do think that we have a fair amount of experience right now, a tremendous amount of experience that tells us that, again, the benefits of this vaccine far outweigh any risks.
MS. WINFIELD CUNNINGHAM: I want to ask you about a drug that for some reason has become sort of controversial and it’s seen as a COVID-19 alternative therapy potentially. It’s ivermectin, which is an anti-parasitic treatment. I know there’s been more attention on this drug in recent days. How do you view that drug? Do you see it as potentially effective, or are people overstating its potential?
DR. MURTHY: Well, look, I think it’s always good to ask questions and to consider what additional therapies may be helpful when it comes to COVID-19. And what we’ve got to do, though, is subject those ideas to rigorous study. And you know, I appreciate that there have been many ideas that have been put forward about existing drugs that people think may be helpful. But in some cases, when we’ve actually applied rigorous study to those drugs, they haven’t actually help up as being useful. And one clear example of that, you know, we’ve seen that--you know, sort of examples of that in the news, I would say, you know, hydroxychloroquine being one of them.
But I do think that the scientific process has got to take precedent here. And I know that sometimes, you know, when you’re in a situation you’re facing a virus that’s scary, that’s hurting a lot of people as COVID-19 has, that there can be a rush to try to anoint a certain drug or other therapeutic as the cure, if you will. But we’ve got to be cautious because we’ve learned from the past that without having solid, reliable, reproducible data that tells us that something is both safe and effective for treating COVID-19, that we run the risk of doing more harm than good by promoting its use prematurely.
MS. WINFIELD CUNNINGHAM: Well, and it’s been interesting to see how this drug has somehow gotten controversial. I’m not even quite sure how that’s happened, because it’s a drug. But you know, there are people who just insist that this drug should be further studied. Do you think it’s worth having CDC and FDA researchers test the drug to see if it’s worth using or incorporating into treatment of COVID-19 patients?
DR. MURTHY: Well, listen, I’m certainly all for applying, you know, science to testing theories, whether it’s in medications--new medications or whether it’s other approaches. But I think what this points to, Paige, your point about there being a lot of controversy around this, I think also points to the fact that there are--there’s a lot of misinformation about this medication and others that tells people that they are scientifically proven to work and to be highly effective against COVID when the data isn’t quite there.
And this is another one of those places where misinformation can be very harmful. It can not only lead people sometimes to take medications that are unproven and to have, you know, unrealistic hopes for the effect that that medicine may have, but they can also generate controversy and disagreement and deepen divisions between people, you know, when people aren’t able to understand, again, what’s true and what’s not. So when it comes to the science, I think what has been challenging, Paige, about misinformation during the time of COVID is that our understanding and our knowledge has been rapidly evolving.
And sometimes that’s not easily conveyed. Sometimes it’s not effectively conveyed. And so, you know, if today, you know recommendations say one thing, and more research develops and the recommendations change, people might think, hey, they said something yesterday and they said something new today, that sounds suspicious or something seems wrong here. But the reality is that this is what happens in science, is that things change based on data. But we’ve got to be clear with people about what that data is. And when there isn’t data, when there is sufficient evidence to support a medication or another approach, we’ve got to be clear about that too. That’s a place where I think health--you know, technology platforms can play an important role in partnership with scientific authorities.
MS. WINFIELD CUNNINGHAM: Well, let’s talk about masks for a minute. And I know that those of us who have been vaccinated have enjoyed not having to wear them during the summer heat. But yesterday LA County announced its reinstating indoor mask requirements regardless of one’s vaccination status. Do you agree with that move?
DR. MURTHY: Well, I certainly think LA County and other counties have the right to make decisions about how to best to protect folks from COVID, and that includes around masks. Look, the CDC when it issued its guidance about almost two months ago now, you know, around masks, what they were--what they were essentially basing their guidance on was science that was telling us that if you are fully vaccinated--that means two weeks after your last shot--then your chances of getting COVID or passing it on to somebody else if you do get it--are actually quite low. And for that reason, they give people the flexibility to make a decision about whether they use masks or not if they were fully vaccinated.
But two important things to say here. One is that the guidance for unvaccinated people is still the same, which is that you should be masking when you’re in public places, and especially gathered indoors if you are unvaccinated. You should still be washing your hands and keeping distance from others because your risk of transmission is substantial. But localities and individuals can still make up their own minds about masks depending on their individual situation. So if you happen to be in an area where vaccination rates are low and the virus is spreading, more and more cases are developing, or if you happen to live at home with individuals who are unvaccinated or if you yourself are immunocompromised and at risk, then you may choose to continue to wear masks. And if you are a county like LA, and you’re looking, again, at the numbers around you and seeing cases rise, you may choose, again, to put more measures in place to reduce the spread. That is perfectly fine.
In this phase, Paige, of COVID-19, what we are seeing is a shift to more and more local and regional strategies because we have very different vaccinations rates in different parts of the country. Some places where we’ve got 80 plus percentage of adults vaccinated, and others--other places where we have less than 30 percent of people vaccinated. And that is going to merit different strategies.
MS. WINFIELD CUNNINGHAM: But on that issue--so to reinstate the mask mandate, you know, as you mentioned, the CDC guidance stressed that if you are vaccinated, you have a really tiny chance of contracting the virus or spreading it to others. So I guess I’m wondering in LA or other places that are putting these in place, is it really going to help slow the spread? In other words, is the point of these perhaps to just make sure that unvaccinated people are wearing their masks since it’s hard to enforce something just on unvaccinated people, so then you sort of apply it to everybody? Is that sort of the merit in these things, considering what we’ve been told about vaccinating not--vaccinated people not spreading the virus to others?
DR. MURTHY: That’s the primary benefit, I believe, is to ensuring that people who are unvaccinated are not spreading the virus unintentionally to others. And look, you know, if you are again fully vaccinated, your risks of getting sick and transmitting the virus are low. But we know nothing is 100 percent, right? Like no vaccine is 100 percent effective. And that’s why you see a small number of breakthrough infections. Now again, some people may decide that, you know, that risk is too much for them, and they may want to continue wearing masks, and especially in an environment where you’re not sure if folks are vaccinated or not, you know, some people may feel more comfortable with masks.
So I think counties that see a lot of virus circulating, that know they have a lot of people who are still unvaccinated, I think for them to take additional measures to reduce the spread of the virus is perfectly reasonable.
MS. WINFIELD CUNNINGHAM: What has LA seen in terms of numbers that’s driving this concern that’s causing them to reinstate the mask requirements?
DR. MURTHY: Well, you know, I won’t speak for the county because, you know, I haven’t been part of their internal decision-making process, but I can say from the outside, if you look at, you know, LA County, you’ve seen--you do see cases going up, you know, which folks see in, unfortunately, many counties now around the country. You know, different counties may have different thresholds for when they decide to pull the trigger, if you will, on additional restrictions. And, you know, that depends on the people who are involved in driving decisions in Department of Public Health, and that’s why these decisions may vary from county to county.
But I think what we’re seeing, Paige, which is worrisome is a growing number of counties which are moving into a high transmission category, and these are very often counties that have low vaccination rates. It’s one of the reasons why the administration has put together surge response teams to bring additional testing, vaccination reinforcements, to bring additional laboratory capacity, as well as therapeutics like monoclonal antibodies, and technical assistance to help communities in targeted ways. This is part of what I mentioned earlier, which is a shift that we see in the COVID-19 pandemic here in the United States from a broad national pandemic to a more regional local pandemic that takes a more targeted approach.
MS. WINFIELD CUNNINGHAM: I know the other thing we’re all paying attention to is the delta variant. And although I’d love to not be having to pay attention to the delta variant, but, you know, I know that I often go to our tracker here at The Post, look at what’s happening with cases, but also what’s happening with hospitalizations and deaths. Though we’re obviously seeing cases go up largely because of this more transmissible variant, but do you expect to see hospitalizations and deaths increase as well? And I know that’s something we may not know for a few weeks.
DR. MURTHY: Well, it’s a good question, Paige. And because we are seeing the cases primarily crop up in people who are unvaccinated, I am worried about hospitalizations and deaths. Here’s the good news, though. We have done a really good job as a country at getting the vast majority of seniors vaccinated. And we know that seniors are the ones who are at high risk of death and hospitalization when it came to COVID-19. So I do think, unfortunately, we will see an increase in hospitalizations and deaths. We’ve already started to see that actually in a number of counties that have been hard hit, driven by the delta variant over the last few weeks. But I don’t think that it will be nearly as bad in terms of hospitalizations and deaths as what we saw in January.
Now of course, it was a terrible situation in January. We had hundreds of thousands of new infections a day. We were losing thousands and thousands of Americans each day. It was terrible. I don’t think it’ll be that bad. But that shouldn’t be our bar of what’s acceptable. In this moment, every person who gets COVID-19, in particular every death from COVID-19, is one that may have been preventable because we have a vaccine--several vaccines now, three--that are highly effective, particularly in preventing hospitalizations and deaths.
So I do think that, unfortunately, we’re going to see this get worse before it gets better. But this is a moment where we need to not only look to what the government’s going to do but we need to ask ourselves what can each of us do to help vaccinate and protect our loved ones and our community? So asking your family and friends if they’ve been vaccinated, if they haven’t been, asking them if you could do anything to support them in that process. If they need help making an appointment, they can go to vaccines.gov. It’s so easy now to get an appointment compared to how it was before, and you can even walk into many places, get vaccinated on your own schedule. But if they have questions about the vaccine, you can also find scientific, evidence-based information at vaccines.gov.
So, however we do it, all of us have to step up and recognize that as individuals, as teachers, as employers, as people who know--people in our lives who love and trust us, we can play an important role in helping people get vaccinated.
MS. WINFIELD CUNNINGHAM: President Biden has recently talked about, in terms of doing vaccine outreach, actually going to door to door to reach people, visiting places of worship. Do you think this is the right approach? Will literally knocking on people’s doors work, especially in these more Republican voter areas where people are more resistant to getting the vaccines?
DR. MURTHY: Well, Paige, I know there’s been a lot of attention to this, but this actually comes down to a very simple idea, which is this is about volunteers in communities checking on their neighbors, checking on their family and friends. That’s what this is about. And we’ve seen a number of volunteers in communities who are concerned about COVID spreading in their communities who want to help, and they want to make sure people have the information that they need. So they’re reaching out to their family and their friends. They’re going into their neighborhoods, knocking on doors, offering people information, offering to talk if they have questions. And there’s nothing wrong with that. I think that that is--when we look out for each other as a community, I think we do better.
And if there’s one thing we’ve learned from COVID-19, Paige, it’s that we really do need each other. These pandemics are very hard to get through on their own, and especially when information is evolving and it’s changing, it can be really, really confusing. Sometimes just having a conversation with somebody about it can be incredibly helpful, especially when they know that they’re--you know, that they’re from your community, you know that they’re to help. And so that’s really what this effort is about.
But it’s one part of a larger strategy here, which is a strategy around helping support trusted messengers in communities so that they can reach out to the folks that they know and love and make sure they’re protected. It’s a big part of what we’ve focused on in the Biden administration. Again, this isn’t about convincing people to do something that they don’t want to do. This is about making sure people have accurate information so they can make the right decisions for themselves and their families.
MS. WINFIELD CUNNINGHAM: So all you’re saying sounds very optimistic. But of course, the fact remains that there is a certain segment of Americans that are very, very resistant to getting the vaccine. And just going to back to that door-to-door thing, I know since the president announced that, some Republicans have criticized it, saying it’s potentially an invasion of privacy. You know, how--what are some specific ways that you can reach out to that population of sort of even these tactics or approaches that you’re trying to take are being criticized?
DR. MURTHY: Well, I don’t think there’s only--there’s a single strategy that’s going to work to vaccinate the rest of our country. I think we need to use many approaches and strategies--strategies that are respectful, strategies that are inclusive, strategies that recognize that this isn’t going to be easy, but it’s going to take all of us. And so as we think about the months ahead, in addition to supporting neighbors and community members who want to reach out to their loved ones in their community, we also want to work with schools and employers who are interested in supporting their students and employees and their staff in getting vaccinated. We want to make sure that we are taking mobile units, mobile clinics that offer the vaccine and getting them even more out into communities--and we have--to ensure that it’s easier for people to get vaccinated than it’s ever been before. We’ll keep doing all of those things.
I think we will make progress. We’re actually right now in the country where we have the highest levels of confidence in the COVID-19 vaccine that we’ve had since December when the vaccine was first made available. That’s good. It doesn’t mean that we’re done, though. Because as you said, there’s still a portion, you know, of our population that is in the wait and see category. They’re not sure yet that they want to get vaccinated. And there’s still others who are disinclined to get vaccinated.
So it will take time. But keep in mind this, that there is not a switch that we’re looking to flip here in terms of hitting a magic number in terms of how many people are vaccinated. What we’ve seen, in fact, is that the more people who get vaccinated, the fewer places this virus has to hide and the more lives we save. And so that is the goal, just keep increasing vaccination numbers by making it easier to get vaccinated, reminding people that it’s still important because the delta variant is spreading, and to ensure that people have accurate information about the vaccine so they recognize this vaccine was developed, you know, with some of the best scientists in the world, it was tested rigorously, and it has been found to be extraordinarily effective and very safe.
MS. WINFIELD CUNNINGHAM: What about vaccine requirements? As we approach the fall, we’re seeing a number of colleges and universities mandate the vaccines. Should we see more of these mandates, and do you think this is anything that the state governments should get involved in, or even the federal government?
DR. MURTHY: Well, I do think, Paige, that we may see more institutions in communities such as hospitals or other employers or universities put requirements around vaccination. And that would not be unusual in the sense that we know, for example, that a decision that’s made at a local level has been around childhood vaccines, and we in school districts all over this country require kids to get vaccinated before they start school.
We also know that many hospitals require the flu vaccine for their employees and staff. And the reason they do that is they want to protect their patients. They don’t want a doctor or a nurse or another staff member to come in with the flu and then inadvertently give it to a patient who’s already ill with something else and then ultimately will have a harder time.
So I do think that you may see more requirements like that. And I do think also that if--you know, if--depending on what happens with the FDA process, that there may be more employers in schools that feel comfortable, you know, moving forward with requirements if--you know, in a scenario where full approval was issued for the vaccine. But regardless, what I think you won’t see is a requirement from the federal government to have people get vaccinated. This is a decision that historically has not come from the federal government around vaccine mandates. It has come from private institutions and from local government. I anticipate that will be the case this time around as well.
MS. WINFIELD CUNNINGHAM: Our time--our time is unfortunately drawing short, but I do want to return to a question about that misinformation advisory that you put out yesterday. You addressed--you talked sort of to social media companies, and what you see as their responsibility in this. Have you heard anything from Facebook? Have you set up a meeting with Mark Zuckerberg? What happens from here?
DR. MURTHY: Well, one thing I should tell you, Paige, is that we have been talking with and working with many of these companies over the last many months. You know, this is--my approach to this has always been that, you know, when you’ve got an all of society of challenge like this, you need an all of society response. And you’ve got to work with everyone, you know, to be part of the solution here.
And so we want to continue working with organizations, including technology companies. But what we also want to do is to make sure that there’s accountability here, that there’s transparency in what people are doing, that we are not just taking measures that sound good but ones that are actually having impact in substantially reducing the challenge of misinformation. And that’s why we’ll continue to dialogue with partners across the Board. We won’t shy away from being honest about whether we think sufficient progress is being made, and that’s the case, you know, with the technology companies in particular.
Paige, one last thing I’ll share just in general about COVID which I think doesn’t get talked about very often is the hidden toll of this pandemic, and that’s the toll on our mental health and well-being. I’m really worried about this, Paige. Because when I think about the months ahead, I think about the fall as when kids will be back in school, when many employers are looking to bring their staff back, you know, in a fashion similar to how we were in 2019, I worry that we may try to snap back into 2019 without fully appreciating the burden of this pandemic, without appreciating the stress and strain it’s causing in people’s lives.
There’s a reason we’re seeing anxiety and depression rates go up during this pandemic. There’s a reason that clinicians are burning out at such high rates, that public health workers and parents and caregivers are expressing high levels of depression and anxiety and PTSD and suicidal ideation. And so I think in this moment we have an opportunity to rethink our approach to mental health and well-being, certainly at a policy level to make mental healthcare more accessible, to invest more in prevention, certainly at an institutional level to make sure that schools and employers are doing what they can to help support students and employees with their mental health, but especially at a personal level, where we’ve had this stigma around mental health for a long time that’s prevented people from admitting what they’re struggling with. It’s prevented them from coming forward and asking for help.
But this pandemic I think has made many of us realize that we’ve all struggled in some way, shape or form during the last year and a half. And if we can be honest about that, if we can reach out to others with some kindness and compassion, recognizing that this has been a tough time for all of us, then I hope we will start down a path of creating a foundation in society for doing better to care for the mental health and wellbeing of all of our brothers and sisters.
MS. WINFIELD CUNNINGHAM: All important points and certainly things to discuss at a later time. I just want to press you a little more, though, on the announcement you made yesterday. You have to know that the tech executives were watching that very closely and wondering, you know, what that means for them, what the government is going to be putting pressure on in terms of trying to crack down on some of this stuff. Has Facebook reached out to you since then, and do you expect to have any conversations with them any time soon?
DR. MURTHY: Well, Paige, like I said, we’ve been in touch with many of the companies for months. I anticipate we’ll continue to be in touch and to work with them to address the threat of misinformation. You know, as surgeon general, my job is to alert the country when there’s a public health threat, to lay out pathways for action, and to convene the necessary players to take action that will solve these challenges. What my job is not is to make legislation or regulation. That is something that we’ll leave certainly to Congress.
But I anticipate we’ll continue to work with technology companies, with educators, with healthcare providers, and with others who have a role to address the challenge of health misinformation.
MS. WINFIELD CUNNINGHAM: Well, unfortunately our time is short. Thank you so much for joining us. I know that there’s been a real personal toll of the pandemic on you and your family, having lost family members. So, you know, this is something I know that you feel very deeply and are concerned about. So thank you for taking the time to join us today. It was a great conversation, Dr. Murthy.
DR. MURTHY: Well, thanks so much, Paige, and I so appreciate it. And thanks for the personal wishes as well.
MS. WINFIELD CUNNINGHAM: Well, I’m Paige Winfield Cunningham. As always, thanks for watching. And to check out what interviews we have coming up, please to--please head to WashingtonPostLive.com to register and find more information about all of our upcoming programs. Thank you.
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