What do Monkeypox, COVID-19, and James Comey have in common? Each of them revealed weak spots in our institutions, including a tendency among people in positions of influence, power, and public information to filter what they know and what they should convey through the lenses of mass psychology and political analysis. Monkeypox isn’t deadly or new, and yet the response too slow to contain the epidemic, and the communication around it from experts and professionals has been roundabout and convoluted. President Biden’s former senior COVID adviser, and host of the podcast In The Bubble, Andy Slavitt joins to shed light on the Monkeypox outbreak, and on how political pressures brought to bear on leaders can warp decision making.

TRANSCRIPT

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Brian Beutler: Hello and welcome to Positively Dreadful, with me your host, Brian Beutler. We’re about two and a half years into the coronavirus pandemic now. And for almost the entire time after the goal of eradicating the virus slipped out of reach, we’ve kind of danced around the question of the next pandemic. What do I mean by that? I mean, experts have indicated, without always explaining why that novel diseases are becoming more common, that there will be more deadly pandemics, that there’s no reason to assume that the next one will be milder than COVID 19, and that with any luck, everything that went wrong with efforts to contain the coronavirus will chasten global leaders in a way that helps us better weather future pandemics. So ideally, the next time doctors notice people getting sick with something they don’t recognize, they’ll alert the world sooner. They’ll institute containment measures more aggressively. If those fail, people will be able to snap into the stop the spread mode. With less uncertainty, economies will be more resilient to pandemic conditions. Scientists will be faster to produce vaccines and therapies, though they were very fast this last time around, too. Regulators will have new, streamlined procedures for pandemic conditions, and public health experts will do a better job communicating with the public about risks and mitigation and the uncertainty around both. It’s a nice thought, at least so long as we’re doomed to be stuck in an age of pandemics. But it’s also pretty plainly not what’s happened yet in the U.S. at least COVID 19 exhaustion and a kind of tacit political détente around the issue prevailed. Pandemic preparedness slipped way down the legislative priority list. We’ve been living with Omicron sub variants for the better part of a year now, and we’ve grown almost no faster at deploying vaccines. The updated COVID vaccines will be available in a few weeks, which puts them on a somewhat faster time frame than the beginning of the pandemic and the general availability of the first-generation vaccines, but only by a couple of months, which isn’t a great match for how quickly this virus keeps mutating. And in the middle of all that, we got a monkeypox outbreak, which seems, among other things, to have shone a light on some of the ways we’re still stuck in 2019. The good news, of course, is that monkeypox isn’t new and it isn’t causing mass death. It’s been studied for a long time. And vaccines that either block transmission or reduce disease severity existed before experts detected this outbreak. But given all those advantages, the response hasn’t been fast enough to contain the epidemic. And the communication around it from experts and professionals has been, I think, in some ways, a little troubling. How so? Well, it’s not exactly a scientific critique, but for one thing, I’m paid to be informed about current affairs. And going into this week’s episode, there were a lot of basic things I didn’t really understand about monkeypox. One thing I did know is that the overwhelming majority of cases have been diagnosed in men who contracted it through sexual activity with other men. From the outset, that struck me as the key thing for the public to know for mitigation purposes, for resource targeting, helping all people gay or straight, male or not, assess the risk to them. But the communication around this seemingly foundational point has actually been pretty muddled. And I know that because I’ve talked to a lot of gay men, friends of mine, people in high-risk communities who, like me, pay close attention to what’s happening in the world. And they all say that there has been confusion about this among their peers. They are the ones who have had to convey this key fact to people they know, because the kind of ambient information has been a little unclear. And it’s ironic because I think the people responsible for dialing down the clarity think they’re being helpful. They think conveying this simple truth clearly will fan stigma and resentment and homophobia, particularly now in this reactionary moment where right wing activists have placed targets on the backs of LGBT people across the board. But in my nonscientific experience, the people who are in essence, the objects of this exercise in sensitivity are pretty upset about it, because absent clarity, it’s the people they care about who are getting sick. The BuzzFeed reporter David Mack has been particularly emphatic on this point. He wrote recently, quote, “Monkeypox is currently spreading overwhelmingly through sex and not through fomites or airborne transmission, despite what you may have read on social media. And no, it’s not anti-gay to say this.” And of all the weak spots that first COVID 19 and now monkeypox have revealed about our institutions, this is the one that I think is the least specific to pandemics in public health. This tendency for people in positions of influence, power, public information to filter what they know and what they should convey through the lens of something like mass psychology or political analysis. Instead of saying what they know to be true or following their institutional rules or best practices, they get fixated on this question of how their actions will be perceived by various interested party and let their assumptions about that determine how to proceed. We continue to see this in communication about COVID vaccines. We see it under the broad umbrella of debates about political correctness. We saw it quite famously during the 2016 election in decisions that reverberate terribly through today. So that’s all. Admittedly, a ton of ground to cover from basic facts about monkeypox to big picture trends in American leadership. But fortunately, I think we have the perfect guest to speak to all of it. Andy Slavitt was until recently senior COVID adviser to President Biden. Before that, he ran the Centers for Medicare and Medicaid Services under President Obama. So he knows how political pressures are brought to bear on leaders and how that can warp decision making. He’s also the host of the excellent In the Bubble podcast, where he tries to surface the best, most current thinking about any number of global crises, including the monkeypox outbreaks. So without further ado, Andy Slavitt, welcome to Positively Dreadful.

Andy Slavitt: Thank you, Brian. Great to be here. Appreciate you inviting me.

Brian Beutler: So first, was there anything in that wind up that you take significant issue with?

Andy Slavitt: I just thought it was a really great takedown, very thoughtful. It’s a really interesting tension you describe. The most important thing in the public health crisis is clear communication. And there are things that get in the way of that, including our own perceptions, psychology and politics. Sometimes that doesn’t help the cause. And so I think a lot of that you talk about is going on. I would also say that, you know, this a skin-on-skin contact situation. Skin-on-skin contact happens with people who have lots of sexual partners. It happens at other places like colleges. We got kids going back to college. And I have it on good authority that people have a lot of sex in colleges as well. [laughter]

Brian Beutler: No!

Andy Slavitt: That’s what I hear. That’s what I hear.

Brian Beutler: I’m just kidding.

Andy Slavitt: And so, I think we should be very focused on the core population this impacts, which is the as you described it’s the MSM population, men who have sex with men. We should also be able to look out for people who are having skin-on-skin contact in other places. And while I agree with everything you said. What I would, where I think we need to stop short is to say that the end solution to this is to tell men not to have sex with men as a long term solution. That is not what this is about. We actually have vaccines and therapies and what we need to do is say, hey, these are public health precautions we need to be taking in the near term while we vaccinate everybody. And then we can all go back to our lives. And I think you can do that in a very non-judgmental, very clear, very scientific, very straightforward way.

Brian Beutler: And I think also, you know, my sense and I want to get into this question about the sensitivities, but I do think that there’s probably a hangover effect from the 1980s and the AIDS pandemic, and people remember how badly society treated AIDS patients. And but I think it’s you know, we’re we’re a generation on from that we’re a more tolerant generation. And I don’t think that clear communication about how monkeypox is transmitted would send us 40 years in reverse. But I do want to put a pin in that, because as much as I think that that’s like critical to what I want to talk to you about, I, I meant it when I said there’s like a lot about monkeypox that even after prepping, I still don’t understand. And so I can I start with a dumb question, which is what does monkeypox due to the body? I’ve seen the pictures, so I know that I know about lesions, but I mean, systemically in the way that we think of COVID 19 as a disease that attacks the respiratory and vascular system, what is happening inside somebody who is sick with monkeypox?

Andy Slavitt: Well, so I’m not a scientist, Bryan. I’m a podcast dude. No, I would. [laughter] So so I’m but but I talk to a lot of scientists, and I think what they would tell you is that this is a disease that has been circulating in Africa for some time in a very specific way. And the presentation we’re getting now, and indeed the mode of its spreading now, is that part of monkeypox is actually novel. And one of the reasons why people have had a tough time at the outset is because this particular incarnation of monkeypox doesn’t look like what older versions look like. Older versions occur on the face, primarily very disfiguring. Here, what happens is skin-on-skin contact with someone with monkeypox, unlike COVID 19, generally speaking, you’re rubbing it up against somebody who is symptomatic. In other words, if you looked at it closely, there’d be something that looked like a rash or pimple or something like that that’s skin-on-skin contact is highly contagious when it’s skin-on-skin, while it can spread other ways technically. In other words, if you if you had some of the lesions in a bedsheet and you flung the bedsheet up and down and breathed in the air. Yes, there are cases where people have gotten a monkeypox through a respiratory tract. That is very rare. That is the exception. So when people talk about aerosolization, all these other things, it really is skin-on-skin contact. And then over some period of time, an incubation period this grows. And so there’s a period of time when people don’t feel infectious. It starts to grow. They start to notice something funny. And then it really gets bad. And it can be bad for a period of a few weeks. And that could. So that’s essentially what people experience. That’s essentially a bit about how we understand the current risk to be working.

Brian Beutler: So as far as you know, if there were significant risk to the general population, do you think it’s safe to assume we’d have seen it by now? I know you mentioned college and it’s interesting because this kind of the outbreak began in May, which is sort of conveniently timed for school, both like K through 12 and and college to be mostly out. But would we have expected to see like big classroom outbreaks or campus outbreaks at this point? Or is it still too early to tell?

Andy Slavitt: It’s unlikely that unless someone is in a unique kind of environment, that it’s very high risk. So, for example, if you’re on a wrestling team like that, that’s that’s the kind of situation you’d be concerned about. You know, you can imagine, you know, if you’re doing diaper changes at a preschool. Right. There are those are situations. But what’s different about that is they’re kind of one off and at best linear—

Brian Beutler: Mm hmm.

Andy Slavitt: —1 to 1 experience. The sexual networks that have been described here are a many to many situation.

Brian Beutler: Right.

Andy Slavitt: And some some large percentage of the spread has occurred at at raves, at events, at parties like I think something close to 40 to 50% of people who’ve got monkeypox have been at a party where they’ve had sexual contact with more than one person. So you can imagine, like what, what how this spread would occur, like rubbing against someone in the elevator ain’t enough, maybe a one on one wrestling match. You could see a little bit happening. But a sexual networks where many people have skin contact with many, many other people is a fairly specialized, unique thing. So this isn’t transmitted via sex. It’s possible it could be transmitted via semen. It’s possible there’s an argument to be made about that. But by and large, this is skin-on-skin contact when there’s a lot of it in a big network. And infectious diseases love a tight network of spread. And that’s what’s happened.

Brian Beutler: Got it. Okay. So I know you recorded an episode of your podcast on this recently, but what is your sense of the public health response to monkeypox so far on a spectrum between total failure and like a perfectly function, well-oiled machine.

Andy Slavitt: Under clubbing it at first and now getting better? I think one of the one of the best answers to the conundrum you raise is and we know this, we talk about this, we talk about diversity, inclusion. Stop talking at people and bring people in who actually are part of the community.

Brian Beutler: Mm hmm.

Andy Slavitt: So don’t guess about how people are going to react who are part of the LGBTQ+ community. What the White House finally did is they brought in Demetre Daskalakis, who has been an AIDS scientist, research advocate, part of this community for years, and he’s now in the White House and running communication, particularly with this core-ly affected group. And he has lots of friends that have monkeypox. He told me this. He knows what it’s like to be discriminated against. He also knows what it’s like to see friends get sick and die needlessly from bad messaging. Yeah, so guess what? All of a sudden this clears stuff up. And I think as a general rule, if you’re struggling to understand how to communicate to a population, why don’t you bring in someone from that population and start listening to them and have them do a lot of the talking? And I think to be true, it’s well suited for that.

Brian Beutler: So you started slow. It’s improving. I know it’s very different from COVID. And I think when people talk about the next pandemic, they’re really thinking about something with a high R-naught. It’s going to spread fast. It’s going to infect everyone in all age groups of all sexualities, etc.. But if you can, how does the monkeypox response auger in your mind for whatever the next pandemic is? And then as kind of an umbrella question, why is there such broad expert consensus that pandemic risk is increasing just generally and that we’re going to have more?

Andy Slavitt: Yeah, well, look, as a rule, what’s happening is there’s a certain type of virus, lots of viruses that are resident in animal species. And as a rule, we are closer and closer as we change the climate, as we deforest, as we do factory farming, all those practices bring us into closer, closer contact. Things like wet markets, different animals come closer together that have never been together before. And so viruses are spreading in in new ways. And so we’re seeing a couple of different phenomenon. One is novel viruses that have never been in humans before. Second, a new iterations of viruses that have been around a long time like Monkey Pox. And Brian, we can’t forget that we’re also seeing old viruses that we thought were long past us, like polio. Here again. And that’s for a different reason, that polio is a completely different phenomenon. Polio has a vaccine that’s 99% effective. If you take it. And that’s still effective if you don’t. And we have communities around the country now through the first case of polio in Rockland County, New York, a young man, 20 years old, paralyzed since it happened in decades and decades and decades in the US. And that’s because we have 40% of the kids in that community that are two years old whose parents have not given them the polio vaccine. And so we are open again based on the attitudes people have toward vaccinations, based on the fact that we have had the luxury of not living in a country that’s had a lot of infectious disease for a long time. So we’ve stopped doing smallpox vaccines that makes us vulnerable to monkey pox. We’ve stopped taking polio vaccine to some parts of the country, which has made us which made polio more available. So that is really the second phenomenon. The first is that we are seeing more things can happen because there’s more chaos and more interaction. And the second is we’ve decided to protect ourselves less than we did in the past.

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Brian Beutler: All right. So let’s let’s talk about the the communication question that I raised in the intro. And I, I do think that, you know, you pointed to like a great solution to this. And I know this has been a cornerstone of how public health professionals think about what their job is, is to find validators in communities and try to get them to be spokespeople for getting people vaccinated or other prevention measures for any kind of disease. Right. I feel like and I have no way to quantify this, but I feel like the mode of leadership that I described where the experts talk at people, as you just described it, is dominant or ascendant in a way that it wasn’t before. And I don’t know if it’s the Internet. I don’t know if maybe it’s always been like this. And I just didn’t know it before until I started associating it with big institutional failures. But is it does it strike you the same way that we’re we’re in a period where there’s a, on the one hand, sort of cascading crises or at least risks. And on the other hand, you have people who we should turn to to sort of help mitigate those risks. And they are kind of engaged in punditry in their own head about when they should say instead of instead of just being as clear as possible.

Andy Slavitt: So it was it’s a great question. And I was given responsibility January 20th, 2021, for going out and talking to the public and the press directly about where we stood with the COVID crisis and the vaccination, as, when, President Biden took over. So I spent a lot of time thinking about this question. And you do recall that we took over for the administration, who as I think has been well documented, maybe you’ll dispute this, but its well documented, that the people who were out speaking had as a primary goal to make sure that the president, the former president looked good and liked the message. And in the case of COVID 19, the president decided that he thought the problem was being way overblown, and he stuck with that up through waves of cases and deaths and everything else. And that’s just where he was. And so President Biden said to me, he really only gave me one bit of guidance when I went to talk to the public, which is he said, Don’t worry about how you make me look. Just give people the information they need. Very clarifying for me because he wasn’t even saying make sure it’s well, he just said tell people what you want to make them understand what would help them. And the image I got in my head, Brian, was of me, I think to my sister or someone who is very well educated, very smart, I have a lot of respect for. And if she called and asked me a question like, Hey, can I take this trip or am I worried about this? Or Should I take this vaccine or that vaccine or this booster, that vaccine? I would want her to have like every bit of information that would help her. And I would talk down to her and I wouldn’t worry about the 500 corner cases. I would just talk very simply and clearly, Well, here’s what’s going on and here’s what I think you should do. Here’s what I be careful of. You might want to think about this. You might want to think about that. And every time I went to talk to the public, I just had in my mind a very simple conversation as if she were right in front of me. And so you’d say, okay, well, that makes sense to me. Why don’t people do that? And the truth is that there’s a lot of reasons why I think people don’t do that. One of them is that people are when they’re talking to millions of people, they forget the individual. Another is people want to score a political point, even if it’s not to impress your boss. Sometimes it’s to express competence. And we live in a gotcha world. Right. So every journalist who’s in the audience asking me questions, every person in Congress who can have a hearing is looking for some weakness, looking to catch me in something. And so I might go, Oh, maybe I should be 10% more careful. Maybe I should not say it directly so that I don’t get caught. But. I found it much easier to say when people said, Why do we have more vaccines? To say oh, we have a shortage. Like speaking proverbs, not paragraphs. We have a short list. Right. Well, then you can say anything you want. But I’m like, didn’t did I do? Like I said, we have a shortage, so we’re fixing the shortage as quickly as possible. I think we can fix it within four weeks or so. In the meantime, it’s going to be uncomfortable because we in this country are used to getting what we want when we want it. That’s not going to happen for the next four weeks. It’s going to be tough, but I’m leveling with you. And you can and trust it. I’m not. It’s not good news or bad news just is. And that’s I think, the thing that I try to capture every time I talked to the public.

Brian Beutler: It’s funny because, you know, I feel like if you just spin the logic of being just giving people a straight dope out, it leads you to better political or at least limiting political risk to yourself. Right. Like, I it’s it’s a movie, so whatever. Like the the movie Contagion, you know, on the one hand, you have, you know, CDC director, whoever is telling people not to panic and separately, quietly, he’s telling his family, get out of town. And then and then this comes to light and it creates a scandal. And like this actually happened in real life all over the world, where, like, political leaders were behaving differently in private than they were preaching to people how they should behave in their in their public comments. And it creates a problem for them. So I think what you’re saying points to I think hopefully what we could maybe end up like arriving at as guidance for for future leaders to avoid the kind of, you know, people getting wrapped around the axle of their own projections about how what they’ll say will be interpreted. But the Trump thing, I think, is a little different. Like, you know, when I broke this down, thinking about it ahead of ahead of the conversation, I actually kind of excluded all sort of Trump like figures or just people who, you know, a problem arises and they and they begin immediately think about how to protect themselves or we’re operating in bad faith or whatever and like that, like that is a big problem, but it’s sort of a separate problem. What do you do about bad actors?

Andy Slavitt: Even if you put that aside, you still have the challenge that you’re talking about.

Brian Beutler: Yes. And I and so and so, like, you know, you broke it down. And I think a helpful way the way I broke it down was, you know, the monkey pox communication issue. I think you could lump that together kind of loosely with other examples and put it into like a I don’t love the term of a political correctness bucket where people are, you know, sort of bending their communications in ways that they hope will be either less offensive or less stigmatizing. And they’re trying they’re trying to be good.

Andy Slavitt: Yeah. And there is there is a social media aspect to that, because the 5% of the people that we get really pissed off are the people on social media that will torch you. Nobody likes get torched. But you got to kind of ask yourself in those situations if I’m taking legitimate heat. I want to know it. I want to take it out and listen to it. And if I’m taking heat from people who are just throwing stones cynically, then you know what? That’s part of the job. Yeah. That’s just going to happen. And. And if you try to please everybody. You’re going to fail. You’re gonna just fail. So if you go for that mushy zone, Brian, that you’re talking about, we are like and I want to call it out as it is because I might offend somebody. I think you end up in more trouble.

Brian Beutler: Yeah, I agree. And then so so so that’s I think one locus of, you know, this this phenomenon emerges from that a fair amount. And then I’ve noticed it similarly with COVID 19 vaccine communications, it’s, I think, better overall. But there are there’s a recurring pattern of people trying to game out how the availability of vaccines or the recommendation to get boosters will change public behavior. Just this week in The New York Times, The Times quoted a virologist who said, and this is a quote, “The potential downside is if the public thinks that this Omicron containing booster is some kind of magic bullet that will give them super strong protection from infection, is there a risk that they will change their behavior to increase their exposure?” So instead of saying new vaccines coming out, it’s X percent effective, you should get it because it’ll make it less likely that you get sick. Or if you do get sick, it will be less severe. And just trying to imagine how a million strangers will behave if they hear that news and based on their own imagination—

Andy Slavitt: People are smarter than that person thinks. I think people are much smarter than that person gives them credit for.

Brian Beutler: But where where is a virologist? I mean, it’s not part of the training in virology. Or is it to try to psychoanalyze mass population before you give them medical advice? I I’m fascinated by why. I mean, I get the I get that the person who the source that that they quote in this article was not trying to be an asshole or anything like that, but was trying to help, you know, it was like is like, what’s the best use of my influence here to try to limit the number of people who get coronavirus? I think that’s a good goal. But but they know how well the vaccine works. They don’t know how mass psychology works. And yet it’s it’s everywhere. This kind of bank shot argumentation or advice giving.

Andy Slavitt: Well, people people make both mistakes. They oversimplify and dumb it down when like when they say this is a highly effective vaccine, you should take it. And I don’t want to hear your nonsense that you’re pushing back about why you don’t want to take it. I just telling you this is the best thing and you don’t need to know. Like there is there is a talking down. To people who have questions to say, I want to know more about this vaccine, how long it’s been around. I want to I want to ask the legitimate questions. People will skay over that stuff too quickly and not engage people. In the way that says, you know what? There’s legitimate questions. Let us find people that you trust to give you straight answers and how to think about it—

Brian Beutler: Mm hmm.

Andy Slavitt: Take the tack that we just want you to have all the information. We’re not trying to convince you to do something to your body you don’t want to do. We’re trying to give you all the information you need. That’s one mistake. The other mistake is the one you were describing, which is to say. I think I know. What should happen. But I don’t want to tell you, because if I tell you, you might take it too easy or you might do something in response to that information and that people could smell that a mile away. I think people can smell when they’re not being leveled with when people are talking down to them. And you want if you ask people their real gripe with government or people they don’t trust or or establishment or elites. It’s that they don’t respect them. They talk down to them and they think they know what’s better for them, but they’re not willing to actually fundamentally get into dialog with them, and they can smell that a mile away. And it’s not just the public health communication. You go back to the Iraq war and go to the 2008 financial crisis. If you go to almost any crisis we’ve had where people have sort of swept away people’s concerns, and that’s accumulated. And that’s why there’s so much and one of the reasons why there’s so much anti-establishment sentiment out there. What you have to remember when you’re running at something like the vaccine is that the people who trust the messages from the government are going to get vaccinated. Right. The question is, you’re you have to talk to the people who are going to be skeptical of what they hear. So how do you talk to people who are skeptical? Well, the first thing you do is you listen and understand why they’re skeptical. And then you essentially try to just make sure that they you find out who, if they’re not skeptic, who they don’t have skepticism for, and you give them facts and you let them have reasoned conversations. And that whole thing takes longer. And it’s not, as, you know, public health professionals, they get frustrated or politicians they get frustrated if people don’t listen to them, don’t believe them. But the reality is that’s the box they’re in and that’s the box they have to navigate from.

Brian Beutler: So the last bucket that I came up with where I see this phenomenon stem from is I wrote it down as the Jim Comey problem, but it’s where leaders in institutions, I think particularly that feel the need to stay above the partisan fray or avoid any hint of favoritism between parties or ideologies they succumb to outside partisan pressure or the desire to avoid the appearance of partisanship and skew their decision making away from the public interest to their institutional interests and in in trying to manage how they’ll be perceived by doing what what the rule book tells them to make a hash of things. Right. And and it’s not, you know, the Comey example is so vivid and we all remember it and the consequences of it. And, you know, I don’t I don’t think Jim Comey did that with the goal of electing Donald Trump. I just think that he got like some like in improper pressures in his head, like thoughts about what the right thing to do in the moment is given his role and the FBI’s role. And who would be mad at him if he did X, Y or Z, and instead of just doing what the rules said to do and it screwed everything up. But I mean, the Obama administration, the White House around the same time succumbed to a different version of the same thing around the very same issue where you had Russian interference happening in the 2016 election. They could see it. They knew what was going on. They didn’t want to alert the public on their own because they didn’t want to be perceived as interfering in the election on behalf of Hillary Clinton. And and, you know, the FBI didn’t want to get involved because they didn’t want to, you know, piss off Republicans, I think, essentially. And so the communications around this interference were really mealy-mouthed and too late and nonspecific. And I think it wears pretty poorly in hindsight. But in both cases, you just have. Leaders who are not letting what the public needs to know or what like what the best way to preserve people’s constitutional rights are as your lodestar. And it’s like, if I say this, who’s going to get mad? Am I going to get hauled before Congress? Is there going to be a lawsuit? And letting those considerations sort of pervert what their real role is. And, you know, I think those examples are all from 2016, but it continues to happen. It happens in my industry because I know reporters are deathly afraid of being accused of bias, and that fear warps how they present facts to the public all the time.

Andy Slavitt: And that’s how you get to both sides, ism and all that. But look what you’re talking about. You put Comey aside, even if it were Merrick Garland, sits today. If he’s facing the exact same things, pressures from the left to tell him prosecute. I don’t care what you know, there’s I’m sure there’s evidence, pressure from the right to say you’re a political body. We have an election coming up and you’re pursuing an ex-president. And both parties believe that the Justice Department is politicized by the other side. Both parties believe it. So in many ways, the Justice Department faces a similar parallel situation to what public health officials and health departments face is that people believe that their message just isn’t coming from a good place, that their actions aren’t coming from a good place. And if you’re a Democrat, describe Merrick Garland. They’d say he’s a by the book person who’s going to interpret, you know, the law. And if there’s a legal issue, he’ll pursue remedies, whether it’s regard to Mar-a-Lago or regards to January 6th and you’ve got Republicans who will say that no matter what he does, it will look like trying to diminish the guy that is the frontrunner to run for president against his boss. And in that situation, the Justice Department, as you as you know, and as you pointed out, tried to create guidelines which said, Hey, if it’s close to election season, we’ve got to be very, very careful. And not do X and Y and Z that’s there, too. That’s there because the long-term faith of the Justice Department is something that somebody once decided they wanted to protect. And when you’re Donald Trump and you basically try to tried to neuter the Justice Department and put it put idiots in charge of it, then of course, you think the Justice Department is corrupt when the other guy’s running it and that sort of it’s a it’s a different situation and it’s that with Garland faces you know he needs to have like everybody else does a set of principles behind how he’s going to take the actions he takes and to communicate what he communicates. And a lot of people would say, if you can find a way to use the law and keep politics out of it, then you should take that forward. Who comes up and let someone else deal with the politics? And whether that’s possible or not or how he pulls it off, very difficult, very challenging, can be very interesting to see.

Brian Beutler: So can we boil this all down? Is there a way I mean, I can’t, but maybe you can. As somebody who’s led big institutions. Is there like like a best practices? How would you boil down best practices in this regard to anyone leading any institution where they are susceptible to having sort of outside pressures warp their leadership decisions?

Andy Slavitt: I get asked this question all the time from people currently making this decision that having to speak to the public, always tell the truth, always ask yourself where you’re spinning yourself and where you’re not. It’s not it’s not to say that we don’t want to have influence, influential communications, or to sell or sell or tell our side of the story. But you have to try to separate facts. From those times when you trying to say, here’s what those facts mean to me, and they tell me the following. I think you have to have the ability to connect to where the public is right now. And it’s interesting because when I went into the White House, the first thing you do is you figure out how to test messages and all those other things. The first thing you really should do is the other half of communication, right? It’s not talking. That’s the listening part. What do what do public data say, what a survey say? Can you get a bunch of people in a room and listen to them? We engage it. We wanted to communicate with conservatives. We got Frank Luntz to come to the White House and tell us how conservatives were processing the issues around vaccinations and so forth. You do a lot of listening. It allows you to know where people are. And too often when you’re leading institutions, you know the message that you want to get out. But you have no idea whether they’re going to land or how they’re going to land. And if you want the messages to land, well, you’ve got to lubricate the field a little bit. Right. You got to say, hey, I think where people are on this issue, too, is the following. They’re tired, they’re disbelieving, they’re whatever. I get that’s where people are into that fray and we’ve had a really interesting scientific advance or really significant advance of justice or a really significant thing that’s happened. And I’m going to lay out the facts and I’m going to and then I’m going to lay it out so I can explain it and then you come on your show, Brian. And if you want depth, if you want someone to come on and to say, give me a long form way of how you’re thinking about it, etc., there’s forums to do that, but I found the times I got myself in trouble is when I’ve overthought it. It’s one thing to have it plain talk, plain English, just speak very directly, short sentences, very declarative. And then when you don’t know, you say, I don’t know, but here’s what I think. Here’s when I’ll know. It’s my job to figure it out. But here’s what I’m telling people now until we do know. And short sentences, truthful sentences always works better. What you start preposition and you know, it can be this and well it sort of is this and I don’t want to offend anybody but that, like you lost everybody. That’s. It’s very it’s very simple. The better.

Brian Beutler: It can’t be the case, though, right? That as big as the problems that stem from this this phenomenon can be. Where where leaders get turned around in their own heads based on fears of how they’ll be perceived, what the reaction will be or what the consequences will be, and let that be their lodestar instead of the truth. It also seems like can actually be the case that the correct amount we want those same leaders, the amount of time we want them to put into the question of how the words and deeds are likely to be received is zero, right? Like we should want them at some level contemplating. If I do this, what are the consequences going to be? What are bad actors who might exploit what I have to say? What are they going to do that that should at least be part of the calculus? I mean.

Andy Slavitt: It is part of the calculus, right. But it’s not—

Brian Beutler: How do you how do you make it be part of the calculus without letting it take over and and and set you on on a completely wrong path?

Andy Slavitt: Look, I think if you begin with. Okay, let me give you it’s too hard to talk about this without going through an actual example because it gets very theoretical and both of us are having trouble connecting this. So we launch and we roll out the vaccines, Johnson and Johnson. The FDA decides to pull Johnson and Johnson from the market because they’ve got concerns. Okay, what goes through your head? Okay, aha, all the anti-vaccine people are going to say I’m not taking any vaccines. What goes through your head? People are going to lose faith and lose confidence. What goes through your head? Well, maybe I can spin this and say, see, look how safe and safe we are. What goes through your head? I gotta show how the FDA is smart. What goes through your head? I want to make sure that it’s very clear that we’re not interfering with the FDA when they make this decision, that this wasn’t politically motivated. All that stuff is the noise around the facts. What are the facts important to tell people? There have been X million people who’ve taken the J&J vaccine. What we’re studying now is the fact that, you know, 18 people who are the following ages and have reported these symptoms, this is what’s called a signal and it signals what we investigate. The reason we investigate this signal is because if indeed it’s the case, what most doctors do to treat it is that obvious. And so we want to make sure we understand how much this is happening. We want to make sure that we let a couple of weeks pass to see if there are 15 cases or 500. Now, what happens when you do that, Brian? Everybody who’s taken J&J says, oh, did I just take a bad vaccine? And the people who haven’t taken J&J might say, or haven’t taken any vaccine say, well, maybe I want to wait. But you know what? You can’t do anything about that because the facts have been played out and you can try to obfuscate them. You can try to manage the best, and you could try to do all those things. But if you give people the basic facts and then say, we’ll have an update when this gets, when this gets studied. In the meantime, we have found no issues with Moderna. We found no issues with Pfizer. And, you know, and you can then continue. So you have to be wary of what those audiences think. But no one’s no one’s going to be fooled either in the moment or it’s going to be. We all know it’ll be a month or two months or three months later, when you hid information from the public, it came out later. Then you shot all credibility. So if you’re being even slightly long term in your thinking, you just sort of throw the facts out there. Unvarnished, unvarnished, unpolished. People will have a reaction. They may not like what they hear, but the truth is, maybe they shouldn’t like what they hear. Right? Maybe they shouldn’t. But but what you’re what you’re maximizing for is long term trust that you’re on it. You’re watching the program and that as you see things, they’ll know instantly. And so what I was able to say is we found out about this 8 hours ago. We’re talking to you now because we made this decision last night, you know, and everybody wants to do the tick tock, what happened? When did you know? When did you find out? We find out last night. We confirmed it. We verified we we touched base with everybody on the top and we made a quick decision arrived at it this morning. We think it’s the right decision. We’re going to monitor the situation. And of the of 15 or 20 different ways you could handle that situation. None of them are optimal. Right. But that is the one that keeps you and your integrity with the public intact. I’m sure there’s other examples that are harder. I’m sure there. But I will tell you at the time that did not feel obvious. At the time it wasn’t like people sat there and said, Oh, well, this is clearly the way through it because it was bad news and people were just starting to get vaccinated and there was a lot of doubt out there. And all those things you mentioned go through your head.

Brian Beutler: Yeah, I remember. I remember some amateur epidemiologists outraged at the sowing of doubt in the vaccines, and they shouldn’t have said anything. It’s like, do you really think that the government should have concealed this information from people? Like, would we be better off if they got out some other way? And then it turned out that they were engaged in some kind of cover up? Like, how could that be better?

Andy Slavitt: And the smart people on Twitter said, You really did this for 20 out of 8 million, when we have more car accidents and we have more this and we have more that. And by the way, like that criticism valid, important to take on. Are they right? Are they wrong? You know what? I’d like to think that if they were making the decision instead of on Twitter criticizing it and they balance everything out, I think it’s very easy to at some point come to the conclusion, as you said, that, you know what? That may be true, but you got to you’ve got to still be honest with the public about it.

Brian Beutler: When you guys were devising that response and what making decisions about what to say, you know, I imagine you anticipated that anti-vaccine forces in the country would jump on this episode to advance their own ambitions of trying to get other people to be anti-vaccine, not get vaccinated. And I can’t recall sitting here whether the whether the communication from the White House and and those press calls anticipated that and sort of pre-butted it in any way. Was that part of the response? Was it discussed? And how does that fit into this question of like when you’re when you’re trying to figure out how to how to give people clear information? How much should sort of, you know, knowing knowing who your opposition is or the people who want to trip you up, what how they act and what they’re likely to do in response, and what can you do to get ahead of them so that they don’t use what you said to poison other people’s minds?

Andy Slavitt: It it has its place, but you can’t confuse it for the core news, because if you think the core news is our vaccines are really safe. And then. And then you give them the Johnson Johnson news, the people are like that’s not what I’m hearing. I mean, so you just. You have to acknowledge and then and then look. One thing you know for sure is the press is going to ask you and you’re going to have plenty opportunities to make that point. But you make it a secondary point and you say, look, it’d be reasonable to ask, given what we saw in Johnson and Johnson, do we have reason to be concerned about about something broader, about A, B and C? And I think what I can tell you, and I think it’s demonstrated today is when there’s even the slightest problem, the slightest signal. People are all over it and they’re going to tell the public right away. So I hope this gives you confidence that this is not a government or an FDA that’s going to hide things from you. And in fact, there may be occasions when they when they are worried and didn’t have reason to worry, but they’re glad. They’re glad they did. You know, my kid was out till two thirty in the morning. They were [?] past midnight. I called the police. They came home at three. And I felt like an idiot for calling the police. But you know what? It’s my job to watch your back. So it’s my job to be. To be extra careful. And that’s what that’s what happened here. And that can sow additional trust. And then it gives you actually the standing to take on the anti-vax community, because then you can say to the anti-vax community, no, no, that’s not a problem. This minor thing here was a concern. The things you’re talking about, those things are not true. And that’s a more credible position in that particular situation than if you allow them to say, this happened and they hid it from you, and that’s how you can’t trust them. And that’s how, you know, these vaccines are bad.

Brian Beutler: So what can people who have like relatively little power or influence, what can they do to inculcate or create an incentive system for a better leadership culture so that institutional leaders in public health or any other important realm strike a better balance in this regard than they currently do. Like, I can’t even picture what an effort aimed at that would look like, but I’d like to think that people of good faith could take it upon themselves in some way to encourage better behavior.

Andy Slavitt: The question we got to ask ourselves, all of us now in this day and age, is what sources do we trust? We can ask ourselves what sources rile us up and make us motivated to go to the polls and make us excited and speak to our. That’s fine. There’s a place for that, but there is in a very important place for what sources do I trust? Something happens in Ukraine. Something happens with a public health outbreak. Something happened to the justice system. Who do I trust? And if I want to get riled up one way or the other, I know the cable TV show I could put on it or I know the podcast I can listen to. Doesn’t mean that, like when something what I really want to know what’s happening. Those are the places, the same places I would go to. And I think, you know, your show, our show, I mean, your particular, you know, look, there’s shows on Crooked that are like, hey, let’s talk about the politics of this. And people go to sort of that their shows are crooked like like this show, which is like, let’s go deep, let’s understand it. And if you’ve got the patience for Longform, that’s great. There’s publications that we all read that we still basically trust for all the criticism we can throw at them. And so I think in primary, I mean it’s like, don’t get fooled by Tucker Carlson and don’t get fooled by whatever the the left equivalent is of that into thinking that the shit that he says are factual. I mean, it’s entertaining. I, he, he bashed me plenty of times and go have at it, you know, and if that entertains people and it gives you ratings, that is a thing. But don’t confuse that for I saw on Tucker that vaccines became X and Y and Z. That is not the purpose of that show. And it can be confusing what’s entertainment, what’s information, all that stuff. But the primary role we can play is like when people are like, yeah, Tucker Carlson said that and nobody fucking believes them. [laughter] Right? Like he said that and nobody believes them like that. Is that is where we take our power back. From the people who are trying to mislead us purposely, even as people get better and then reward the people who are getting better and better at being honest and telling you the truth. I’ve got some of the best reaction from the public, like literally emails, texts, phone calls when I delivered some bad news. Then when I delivered good news, it surprised me. It surprised me. But I had nurses and doctors. Look, we had, this was a couple of weeks after we took over from Trump, who said, Today was the first day I feel like someone leveled with me and told me the truth. One nurse said, This is the first time someone said something that looks like what I see in this hospital. And that’s an incredibly comforting feeling because it makes me believe we’re going to get through this. I saved that note because it was to me encouragement that for all the crap you’re going to take in the end, bringing back people’s trust, earning back people’s trust pays pays a lot of dividends. And it saddens me every time someone who whether they’re Trump like or whether they’re a well-meaning sort and in an administration I support does something to squander that. And and I agree with the premise of your show here. That well-meaning people squander it and can squander it just as easily as people who are trying to deceive us.

Brian Beutler: Yeah. I mean, I think Tucker or maybe it was Fox News won a lawsuit a I assume it was a defamation lawsuit by saying nobody could possibly mistake Tucker Carlson for somebody providing real information. Right.

Andy Slavitt: But people do. But people do.

Brian Beutler: I know. I know. And that’s what I mean, is they can worm their way out of consequences for for how they conduct themselves. I would like to think I guess the spirit of the question is I’d like to think that there’s a way for the next Jim Comey to avoid making that mistake without having to make it and then pay the consequences the way he did, both by, you know, contributing to Trump, getting elected and then getting fired. And like, you know, the next president in the Obama administration shoes were they they have, you know, critical information that they think the public should know, but they feel like it would be a little bit out of bounds or weird for them to step forward and say it like they should. There should be some positive feedback that they get that encourages them to do the right thing so that they don’t learn that they make a mistake on election night when, you know, the guy who was getting all the help from Russian interference wins the election. And I do think I’ve noticed that the Biden administration has learned that lesson. And I think that the example you gave about the communications around the J&J pause, but vaccines in general has been like a good example of that. But the positive feedback would have to come in the form of election outcomes or something.

Andy Slavitt: Well it is, yeah—

Brian Beutler: So that yeah, like, like where, where can, how do you, how do you get, you know, a critical mass of the population to care enough about this so that they, they reward the good leaders who do the right thing and and punish those who are trying to hide the ball from them in order to preserve their reputation for integrity or whatever else it is that’s motivating them not to be straight with people.

Andy Slavitt: Look, look, it’s hard to be massively encouraging on this question, Brian. You know, Liz Cheney just lost in a landslide to someone who strategy was to go from a truth that she understood she was basically a reasonable person, from what I understand, her opponent, to a strategy of of lie and play to the crowd and win. And Liz Cheney ran on principle, which she didn’t have to do, but she did and she lost. So it’s hard to be encouraging. There’s probably way more examples of that than there is the other, because people know politicians. They know how to play to that side of our to that side of us. But I will say my experience is when we do elect someone, a person of principle, when you elect Chris Murphy to the Senate from Connecticut, you know, you get someone who will navigate a gun bill based on reason and intellect and not hyperbole. When you do elect Joe Biden, who has a principled point of view. You may not agree with him on all of it. You may not agree with him on student loans. You may need to agree with him and any one of these matters. But he has a strongly held principled view. And when he says, I don’t really care to get out of this crisis about my own popularity, as much as I care about giving people the information they need that saved their lives, that’s worth rewarding. It’s worth looking at. And if you’re out there and you’re like, I’m frustrated with this politician because he’s not giving me good news. Get past it. Get past that. Ask yourself if they’ve got the fundamental competence to do the right things as they’re leveling with you and making things better. And, you know, we’ve seen Biden dip in the polls and you can people who criticize him say because he’s not working it every day. But guess what? Behind the scenes, he was getting a lot of stuff done and it would be nice to step back and remember that when we think about who we’re supporting and who we’re not, that someone who is not just who they are, who you elect, but all the people they appoint. Right. It wasn’t just Trump. It was Betsy DeVos. And what’s his name from education and what’s his name from EPA and what’s his name? And it was always a his, from HHS, who are all worse than the next. And I think it’s worth remembering when you elect someone, when you vote for someone, the executive branch, you’re not just voting for that person. You’re voting for all the hangers-on and scam artists or honest people, whoever they surround themselves with, it makes them who they are. All those people are going to be the ones making the day to day decisions. And we learned that with Trump. And then you look at the appointments that President Biden’s made and the people running those offices, those departments, and you get something different. So we’re reminded again and again we don’t have power. Every day in this country. But we were reminded that we have power not just to vote, but to get other people to vote. We have power to organize, have power to do a lot of things. And we decide what matters. And by the way, just one final thing. Like, and you know this, Brian, over the last 30 years. The three most impenetrable forces in Washington, D.C., have been the drug lobby, the gun lobby and the fossil fuel lobby. Unbeatable. Unbeatable. The last 30 years track record of giving us no gun legislation, no prescription drug negotiation, and no renewable energy. Well, guess what? In the last two months, the people we talking about here, powerless people, people who were out in the real world have taken action to defeat all three of those entities for the very first time. And that’s a spectacular statement. I think that what we do matters. They’re gonna, those three groups are going to come back with a vengeance. They’re going to battle back. But we now know, and I think Crooked Media is part of this story because of the very unique way you get people involved with the process. We now know that informing people and getting people connected makes a difference. That gets us huge issues.

Brian Beutler: That’s a wonderful note, I think, to end the conversation on. Andy Slavitt, thank you so much for spending so much of your time with us.

Andy Slavitt: Good to be here Bri.

Brian Beutler: All of these episodes tend to combine an exchange of ideas with me learning in real time from people who just know more than I do. This episode was weighted much more toward the latter for reasons we discussed and were actually embedded in the subject. Like, for instance, I think monkeypox communications have been pretty all over the map, and I’ve even seen them devolve into arguments over masking in schools and things that seem basically orthogonal to the risk factors of the disease itself. But also, I just hadn’t considered high school and college wrestling or that the whole monkeypox outbreak thus far has occurred during summer vacation. But the most lasting thing I hope you all listening take away from the discussion is that closing bit that we want leaders who are guided in their words by unvarnished truth without necessarily implying that they should never take into account how bad actors might twist and torture them. It occurred to me, while Andy and I were talking that we had this debate in opinion journalism too, all the time, actually, where at one extreme you have people who will not broach topics that they think or fear could empower the other side. And on the other end, you have people who say the best practice is to be totally heedless of how your words might be exploited by bad actors. And both approaches, frankly, seem very wrong to me. Self-censorship and just letting bad things fester to avoid imagined consequences isn’t defensible. But you don’t have to pull any punches or shade any truths if you want to criticize, for instance, college speech norms or the Democratic Party leadership. You can just do that in a way that anticipates how manipulative people will try to exploit your words and discredit them in advance. With monkeypox, that would entail clear, honest assessments of how the disease spreads and whom it’s spreading among. Paired with preemptive condemnation of anyone who would use that information to advance bigoted ends. It’s actually not a hard language challenge to solve, and it’s a righteous one. Positively dreadful is a Crooked Media production. Our executive producer is Michael Martinez and our producer is Olivia Martinez. Veronica Simonetti mixes and edits the show each week. Our theme music is by Vasilis Fotopoulos.