Dr. Deborah Birx says she 'knew' COVID vaccines would not 'protect against infection'

In this exclusive video, Jeremy Faust, Md, editor-in-chief of MedPage Today, and Deborah Birx, MD, former White Business firm Coronavirus Response Coordinator, accept a candid discussion about Birx's new book, Silent Invasion: The Untold Story of the Trump Administration, Covid-19, and Preventing the Next Pandemic Before It'due south Too Late, which details the American pandemic response from within the White House.

The following is a transcript of their remarks:

Faust: Hi, I'm Jeremy Faust, editor-in-main of MedPage Today and the author of the "Within Medicine" newsletter on Bulletin.com. I'thousand joined today by Dr. Deborah Birx. Thank you for joining us, Dr. Birx.

Birx: Happy to be here.

Faust: Cheers. Dr. Birx was -- well, before she became a household name, Dr. Birx ran the CDC's Division of Global HIV and AIDS and she oversaw PEPFAR, which is the President's Emergency Plan for AIDS Relief, which is 1 of the most successful public health interventions that our authorities has been a role of in recent decades, I would say. So, of course, everything changed in 2020 when she became the outset White Firm Coronavirus Response Task Force Coordinator.

Her new book, Silent Invasion, is a detailed account of what it was like on the within, and it is fascinating. I just finished reading information technology. Information technology is bold. Yous pull no punches. Thanks for writing it, and thank you for being hither.

Birx: Thanks. Plain, I've written a lot of scientific manufactures and a lot of capacity, merely that was my first attempt to interpret science into a book format.

Faust: So permit's talk nearly this book, Silent Invasion. I recall I'm the intended recipient of this book in the sense of who I vaguely thought you were and who you are. Tell us about that gulf. What do people think of y'all and what exercise I successfully know now that I've read it?

Birx: Well if you asked anyone around the globe in HIV, they would tell you lot who I am: hard driving, data driven, will do anything to ensure people'due south lives are saved.

I knew when I was working on HIV that my patient was never the Ministry of Health; my patient was the community at hazard for illness. So that's how I went into the White Business firm. Yes, it was where I was working, but my loyalty was to the communities and the Americans that were at risk for COVID.

Faust: Merely you strike me in the book as just a complete data wonk.

Birx: Yes, total information wonk.

Faust: And that's pretty much why you were brought in, is that correct?

Birx: I recall so. I call back two things: i, I had actually battled a pandemic, and successfully -- I mean, we have actually made incredible strides on HIV and HIV/TB in Sub-Saharan Africa and effectually the globe.

Simply secondly, we did that through data. Making everybody visible that needed our help, not only the people nosotros could encounter, only the people we couldn't see, and that's what information allows you lot to do.

Merely information is irrelevant if all it does is create an article. Information has to lead to action. Data has to exist transparent.

Then anytime we would change policy or guidelines or inquire the Ministries of Wellness to change policy or guidelines, we all agreed on the data and the reason that we needed that policy modify. I think in this country, we need to make information accessible to every American so they tin can clarify it themselves.

Faust: Aye. I hateful, this is what I write about in my newsletter, and it's sort of my little shtick too. I was like, "Oh, okay. She was me in the White House." That's what it kind of felt like.

And in fact, at that place'southward this moment in the book where you talk almost how you're on Google using Google Translate to read the Diamond Princess [prowl ship] statistics. I did the exact same thing. I wonder if nosotros could find out, yous know, how you lot can see page views, like how many people translated the Diamond Princess pages from Japanese to English language. Well, at least two.

Tell me well-nigh those moments and when you started to realize the extent of asymptomatic transmission of this disease.

Birx: I felt like information technology had to be happening in January, because you don't build a 1,000-bed hospital in a matter of days, or a x,000-bed hospital, if you don't have unbelievable community spread. Because we don't take whatsoever viral diseases that just crusade severe illness in one tiny group. Other people take to become infected and non be seen.

But I couldn't prove information technology. I think the Diamond Princess, for those like yourself who really took the fourth dimension to really look at what happened in the Diamond Princess, y'all knew information technology had to be the crew. And so to me, it was very clear, but non to everybody.

Faust: And also the transmission dynamics are and so bizarre.

Birx: Exactly.

Faust: Considering y'all have a spouse living in a motel and not getting information technology from their spouse. Yet at the same time, as you mentioned in MMWR -- the CDC's journal on morbidity and mortality -- in the study, we run across this thing where one person in a choir gave it to dozens of people.

So it's just a very strange pathogen, correct? It exploits our assumptions that we're gonna hunker downward when we get sick, and this virus says, "No, I'thousand gonna spread right before that happens."

Birx: "And I'thousand gonna spread it with young people who don't know they're infected."

I just desire to always, ever brand this articulate, as with HIV or whatever infectious disease, people are not intentionally spreading information technology. They truly don't know. And it's our task equally those of united states in medicine and scientific discipline and technology and healthcare to make sure that they take the tools to employ that successfully to protect themselves and their family unit.

Faust: And then when y'all talk about kind of realizing the extent of asymptomatic transmission ...

Birx: I love that you were doing the Diamond Princess translation too. I just dearest that.

Faust: Yeah. I mean, information technology was very frustrating because they wouldn't update it frequently enough. And I took home two messages. One was that this is a very contagious pathogen. 2 is that this is very, very dangerous for my parents' generation. And I thought it may be fine for everyone else. It took until later datasets to realize that nosotros'd had backlog bloodshed in young people, which -- nosotros merely didn't have a large enough N at that signal.

Only y'all talk about in the book, I love this, y'all said at that place are somewhere between iii and x times, if given the tip of the iceberg at the outset of an outbreak, if at that place's a hundred cases, there's probably 300 or at that place's probably a m.

So this is the first fourth dimension nosotros e'er heard about an R-naught for this virus. That's the reproductive number. This is the number of people that the average person who gets infected subsequently infects. That's called an R.

The get-go number we were given was 2.58, which was a very alarming number, and then information technology was upgraded. Only actually, when you accept into account asymptomatic manual, it's far higher. And I was part of a squad that actually thought it was much higher.

What exercise yous recall the R was? Then I'll tell you what we idea information technology was.

Birx: I thought it was between 4 and 5. When I tried to pigment that picture in the book -- because I had this group of people that I'grand then grateful that came and worked with me because I didn't know what was gonna happen to their careers. I was older in my career, so even though I knew it was going to be terminal for my career, I didn't want that to happen to other people. But they understood how much I valued data and they understood I would demand a team.

So three or four people showed up, and we argued about that and the degree of asymptomatic spread, because those ii are so critically linked. Then, I thought asymptomatic spread was well into the fifty%-60% range -- past age group, it could vary up to 85% -- and we were able to become that data from colleges when they started testing regularly. Merely that's what was driving the doubling and tripling of the R-naught for me.

Faust: I'll tell y'all a funny story. And so, I was the heart author on a paper and nosotros thought information technology was more than likely in the teens. This was sent to a journal and they sent it back and they said, "Well, that'due south impossible because information technology would take to be an airborne virus." And that was the end of that.

Birx: Aye! What's upsetting to me is you and I looking at the Diamond Princess data are like, "This is an aerosol. This is highly contagious. This is being spread asymptomatically. This is going to be a huge problem." And other people are saying information technology's on surfaces, that it's droplets, not realizing that that is only incomplete, partial RNA fragments.

That results in everybody wiping downwardly their groceries rather than agreement aerosolized spread, which means it stays in the air for a number of hours. I ever say to people, it doesn't affair who's in that room when y'all get there. It matters who's in that room before.

Faust: Turnover, right? And this is the thing, I'm not a domain expert on aerosols, but recognizing that -- in that location were a lot of people who were very territorial proverb, "Oh, information technology's non airborne." And I said, "Well, wait, I don't know. All I know is that it'south airborne enough."

Birx: The data said it was airborne.

Faust: Information technology was moving through the air, and I didn't want to go into whether information technology was extended droplets or this or that.

Talking about asymptomatic transmission, and you practice talk almost testing, and we all know the documentation of how we didn't practice testing right. We accept a lot of understanding on the employ of rapid antigen tests and the thought that these are tests that might miss an early infection, they certainly will miss a late infection, but they should become you correct when you're contagious, which is really the way you lot stop things. When did you lot first sympathize that?

Birx: Very early. So when we had that offset coming together on March 4th with the companies -- and these were companies I knew from HIV and I knew their capacity to produce tests -- and we asked for PCR tests, antigen tests, and antibody tests because I knew nosotros had to become into the community and it had to be elementary and fast because we needed the 20- and 30- and 40-somethings beingness willing to exam.

They were non going to go sit in a bulldoze-through for 4 hours and wait v days to go an answer. That wasn't going to happen, only people would come past speedily to do an antigen test. And they would've come dorsum daily if nosotros had asked them to. People were very responsive and really responsible. I never saw in all of my trips people being intentionally irresponsible.

Faust: The rapid story is a little flake murky, simply it seems like the FDA didn't really approve or authorize many. Is that fair to say?

Birx: And then hither's the circular reasoning -- and you would understand this completely. And then, all of the original tests were done on a set of specimens that were collected from people who were symptomatic, because nosotros didn't have enough tests to test for people without symptoms. So they wouldn't approve it for asymptomatic use, and that was its value!

And so, considering they wouldn't approve it for asymptomatic use, fifty-fifty though I showed them that the viral load in the nasal cavities were identical betwixt the asymptomatic and the symptomatic, they wouldn't corroborate information technology for that.

And that resulted then in the CDC sending out guidance that it was provisional. Well, no i's gonna test twice! And nosotros didn't accept the resources to have everybody who was antigen positive go back and go another PCR.

Then information technology just really hampered us, and they didn't corroborate antigen tests for asymptomatic testing until the summer of 2021.

Faust: Right. Practise you think these tests are all the same misunderstood?

Birx: Totally!

Faust: A lot of my colleagues, some really smart people, say that it gives people a sense of simulated security and therefore they go and they infect people.

Birx: Absolutely not. If yous explain it correctly and you lot say to them, "These tests are for that moment in time. Y'all may exist negative tomorrow or yous may exist positive. And so if you're seeing your grandmother 3 days in a row, you're gonna take to examination 3 days in a row."

I think we've gone through 500 or 600 antigen tests. I mean, we definitively use testing. Even my daughter'southward children's preschool tests weekly. I'grand so proud of that because it makes a huge divergence.

The colleges that tested weekly had less than 1% to 2% customs spread. The colleges that tested but those with symptoms infected 20% to 30% of their population. It's very clear. You lot have to find the pre-symptomatics and the asymptomatics.

Faust: Yeah. I think that's a huge thing that people don't understand -- it's actionable information.

I had a colleague, a friend, call me a few months ago when there was a concern that maybe they [rapid tests] don't piece of work for Omicron. And they said, "Nosotros had a family reunion" -- and this is a really smart person -- "and everyone tested before they came. And a couple of days later, everyone got ill." And I only said, "Well, wait a second. Allow'southward look at the number of cases at that place are. The exam was good on Wednesday, but by the time yous had your fiddling affair on Friday, that was erstwhile news."

Birx: So whenever I walk into an occasion, which I'm sure is a downer, whether it's a wedding or otherwise, I say, "There are at least two or iii people infected in here. So permit's all be respectful and accept intendance. And unless you tested the second before you walked in in the car, I can't tell that y'all are negative, and that's why I'1000 masking."

Faust: I asked the audition here today in my session: what would y'all rather practice? Exist in a room full of boosted people in the by several months but take not tested, or in a room total of anti-vaxxers who all had a rapid antigen exam that was negative a few hours ago. They looked very puzzled, and I've asked this question many times to many people, but it'southward not close. You want to be with the people who take negative tests regardless of their status.

Birx: Exactly.

Faust: Yep. But our minds just don't work that way.

Birx: Well, I remember information technology's because, and I hold usa responsible as public health practitioners and people who take reported on this, and I really appreciate your reporting because you've really tried to go far very clear about what nosotros know and what we don't know.

When we make broad statements, when we say to people that these vaccines are going to protect confronting infection -- i, it wasn't studied; ii, we already knew re-infections were rampant with natural amnesty. And then the vaccines that were designed to mimic natural amnesty are going to have re-infections. We imply that masks only work in one direction.

And you know, Americans have amazing common sense, so when they hear that, they stop trusting the bulletin. I think we are simply as guilty for creating that sense that they don't trust us. We've waffled on tests and we haven't made them clear, nosotros've waffled on masking, nosotros've non been clear on vaccines, and so nosotros wonder why people are dislocated.

Faust: Yeah, I agree. And I call back we should exist apprehensive nearly what we know at all times. Which is not really our best -- nosotros're not so great at that.

Birx: Well, I think if you had lived through the AIDS pandemic, you would exist very adept at it because when y'all've lived through that humbling "I don't know and I can't fix it," that makes you very articulate on "This is what I know, this is what I don't know." And then we accept to work in between.

Faust: It'south funny how lived experience matters. Some other part of your volume that actually really struck home for me was where yous talked most the experience at Elmhurst Hospital in Queens, [New York,] which actually probably saved millions of lives.

I trained there equally an emergency resident at Mountain Sinai and Elmhurst. So for me, when I started hearing stories from my colleagues at Elmhurst and hearing the sounds of their voices, I knew that this was real in a way that I hadn't really understood. And as you say in the book, this landed for Trump, didn't it?

Birx: Totally. I don't think I would've been able to convince him of the 30 days and the reopening criteria if he hadn't had the Elmhurst experience combined with his friend beingness hospitalized and so succumbing to COVID. I recollect that was so real and personal, and somehow we have to figure out as practitioners how we tin can brand information technology real and personal without people having to have that kind of level of intimate feel.

I think that'southward what we can learn from media training. That'south what we could learn from big marketers, considering we accept to figure out how to make our messages existent for everyone.

Faust: I mean, that's like the Ryan White approach with HIV, right? Or Tom Hanks doing Philadelphia? That's really what that's about.

Birx: Exactly. And I think showing people that that is the experience, and y'all don't have to live it.

Faust: Yeah. Megan Ranney and I wrote a piece about this in Apr or May, and we said, "Look, by the fourth dimension that everyone statistically knows one person who has died of this virus, in that location will exist a 1000000 deaths." And nosotros don't desire to wait for that.

Birx: Nosotros don't. And we did.