(announcer) Here to discus the long term impact of today's political uncertainty on American healthcare.

Please welcome Doctor Demetre Daskalakis former director of the CDC' National Center for Immunization and Respiratory Diseases, with Atlantic contributing writer Evan Smith.

[applause and instrumental music] (Evan Smith) Good morning.

(Demetre Daskalakis) Good morning.

(Smith) Until a few weeks ago, Doctor Demetre Daskalakis was one of the nation's most faithful and most expert stewards of public health.

An infectious disease specialis who, as you heard, was director of the National Center for Immunization and Respiratory Diseases at the centers for Disease Control and Prevention.

But during the last week of August, following the firing of the CDC director, Doctor Daskalakis resigned alongside two other top officials of the agency.

He did so quite publicly, posting a lengthy statement on social media.

It read in part, I am unable to serve in an environment that treats CDC as a tool to generate policies and materials that do not reflect scientific reality and are designed to hurt, rather than to improve the public's health.

We're lucky to have him at the Atlantic Festival.

Doctor Daskalakis, welcome.

(Daskalakis) Hi Evan, nice to see you.

Thank you for having me.

(Smith) So, there is so much news out of your world that we could start almost anywhere.

But let's talk about what literally happened while we were backstage.

Secretary Kennedy's amen chorus vaccine advisory panel has been meeting over the last two days to vote on vaccine recommendations yesterday for measles, mumps, rubella, chickenpox, today for hepatitis B. Tell us what happened.

(Daskalakis Other than just a lot of chaos, which I think is probably what the goal was, yesterday, the main focus was on the measles, mumps, rubella chickenpox combination vaccine.

And, they voted with really no new information.

Nothing new happening.

No real reason to revisit.

They voted to, not allow kids under four years ol to get that combination vaccine.

Now the kids can still ge measles, mumps, rubella vaccine, plus a chicken pox vaccine.

So two shots, bu they can't get the combo shot.

So it's kind of like low intensity what they did in some way because 85% of kids were going for the the MMR plus the separate varicella or chickenpox shots that only 15% of kids took the combo.

So it's more the principle that they with no data, with no reason to do it, have just removed a vaccine from the pediatric schedule.

(Smith) That's the problem.

The problem here is you've identified as your fired former boss, Doctor Monarez, identified in Congress this week.

There is no scientific basis for this decision.

(Daskalakis) So usually when question come to the Advisory Committee for immunization practices, there's something new or someone's identified something that needs to be discussed, (Smith) or there's a precipitating event.

(Daskalakis) Right.

There's a new vaccine, there's new safety data.

Something happens.

So the agenda for this meeting was decided by Robert F Kennedy, Jr.

Like he just said, this is the agenda.

The team had one month to prepare.

Usually questions take about 12 months to go over through a process.

And so the CDC scientists who, I'm going to say out loud, are amazing, hustled.

And they put together documents and presentations.

That at least gave part of the story, but didn't go through the process to look at all of the story.

And that's what we saw yesterday, fall apart with the chaos at the end wit crazy votes that made no sense.

(Smith And let's just for the benefit of people here and people watching, this was a 17 member vaccine advisory panel.

Secretary Kennedy dismisse all 17 members summarily earlier this year, replaced them first with eight and then eventually another four, most of whom agreed with his vaccine, vaccine skepticism.

(Daskalakis) Yes.

(Smith) Right.

So he basically stocked cabinet with people who he knew would carry the same message.

(Daskalakis) And he said that.

(Smith) So he said it out loud.

(Dakalakis) Yeah.

All of the people that were let go of the 17 that were, were dismissed.

They found out in a Wall Street Journal article and on X. So that's how these very well respected scientists learned that they were terminated.

(Smith) Right.

(Daskalakis) And in that Wall Street Journal article, what he said was that the previous administration had put all of these political appointees on this panel.

And now I'm getting rid of them so I can, you know, make America healthy again.

Radical transparency, gol standard science, which is all Orwellian doublespeak.

So they were removed, and then in come a group of people who are entirely ideologically aligned to R.F.

Kennedy, Jr.

There's one who wasn't.

And so the rest were all aligned.

And so that's it.

(Smith) So today, actually, the news was a little bit better.

There was a vote on the hepatitis B vaccine recommendation, which many people assumed, I assumed maybe even you assumed that, you know, assume the worst.

But in fact, they tabled it.

(Daskalakis) Right.

So, a couple of days ago I put out on social media that they should table it.

(Smith) Yeah.

(Daskalakis Because that's the right thing that they should have done.

And so I'm not saying that they listened, but I feel like the combination of Senator Cassidy, who's a hepatologist, saying, you know, this hepatitis B vaccine prevents liver cancer, death and transplant.

Whatever we've been doing in terms of being very vocal, whatever Susan and Deb Houry did, in Congress, maybe that dislodged this, this plan.

But yeah, so they tabled it.

So now what that means i maybe they're going to take it into the likely 12 month long process of review and then potentially with the entire story, with all of the parts of the story reviewed, they can make a decision.

You know, I don't know if that's what's going to happen.

(Smith) No guarantee that that's going to go well.

But at least for the moment, flat is the new up.

(Daskalakis Totally.

But well totally take that kids can still get, that they have not removed access to newborns for hepatitis B vaccine.

That is like a small miracle today.

(Smith) So instead of science, we get what?

(Smith) We get feelings as facts, we get politics.

You actually today on socia media talking about this said, this is what public health has become, a manifesto.

(Daskalakis) Yeah, I mean.

(Smith) A manifesto.

I mean, I don't even have to sort of say that as a dramatic soundbite.

You can go to the CDC website and now on their landing page about CDC, they put up a several page manifesto that, in effect, just goes through the administration's priorities and says that they're going to be fully aligned.

And so, you know, they were talking about gender ideology, all of the things.

And they're going to say CD is fully aligned to this agenda.

The CDC historically has not aligned itself to a political agenda.

(Smith) Right.

(Daskalakis) That's not what it does.

(Smith) The point is for it to be independent and have it be independent based on scientific evidence.

Daskalakis: That's correct.

Smith: Right.

(Smith) And in fact, now we flip the table here.

(Daskalakis) it is an ideologic machine.

(Smith) Let me ask yo about the motivations for this.

This may seem obvious, but I do want to ask just this about ask you about this.

Is it ignorance or is it malice?

I asked because a word jumped out at me when I first read your resignation letter: designed.

What you said was designed to hurt the public's health.

That suggests intentionality.

(Daskalakis) Yeah.

I 100% stand by what I said.

(Smith) You think it's malice?

(Daskalakis) It's malice.

I do think it's malice.

I mean, I think that there is.

Okay.

These people really don't know how to govern at all.

Right.

Let me just start with that.

So I work in government for a long time.

They don't know how to do anything.

And so the initial shock and awe at CDC where the just like, randomly fired people did searches of people's jobs and said, oh, it says equity in their title, so fire them.

So that part was sort of shock and awe.

The subsequent pieces have been really designed to remove the scientific leadership, like Doctor Monarez said, and I believe her, that when she talked to RFK Jr on the 25th, he said, keep firing people until you get down to a level where the people are just going to do what I say.

(Smith) Yeah.

(Daskalakis) Did you hear the gasps?

(Smith) Right.

(Daskalakis)) But that's what he said.

I mean, I 100 believe it because like, I mean, that's what we're seeing happening at CDC, at NIH and all these other health organizations where it's like, remove the people who now go to the people who, like, are lower in the totem pole until you get to the place where you have compliance.

(Smith) I mean, I watched th confirmation hearings when then nominee Kennedy was before the Senate, and I know what he said, in his confirmation hearing.

I know what he implied Daskalakis: Yes Smith: in his confirmation heari But obviously we now see something the opposite of what he said.

(Dakalakis) Yeah.

(Smith) Right.

Do you have any doubt that this is his agenda?

There's not a Stephen Miller of public health pulling strings in the department.

This is his agenda.

(Daskalakis) Yeah.

I wonder if Aaron Siri is involved.

(Smith) Tell me who that is.

(Daskalakis) So, I mean, I think that there's a lot of folks that could be involved, but I think that there's, you know, th Children's Health Defense Fund, the organization that he set up that is like staunchly anti-vax who came down to Texas and were promoting therapies for measles that weren't real and sort o touting the bravery of doctors that took care of kids with measles while they while they themselves ha measles, which is malpractice.

So, so, I mean, I think, I think that the answer is that, you know, this is all very purposeful.

(Smith) Yeah.

(Daskalakis) And, Yeah.

(Smith) But, but of course, I have to point out, this is a little bit of trivia, it's not material necessarily, but it's interesting to me.

You know what you know of his motivations second hand.

(Daskalakis) Yeah, I read his book.

(Smith) You don't know it first hand because you never, you told me this this week, and I was like, what?

You never met Secretary Kennedy in the seven months that you were the immunization lead at CDC.

(Daskalakis) Yeah, lets... (Smith) You never even talked to him?

(Daskalakis) No.

(Smith) You didn't even get on a zoom with him.

You literally had no FaceTime, real or virtual.

(Daskalakis) Nope.

(Smith) And how ordinary is that?

How unusual is that for somebody in your job to literally have no contact with the Secretary?

(Daskalakis) I mean, the man seem pretty interested in vaccines, so it seems rather odd that he wouldn't talk to the vaccines chief.

(Smith) Yeah.

(Daskalakis) So I'm just just, you know, realistically speaking, seems like maybe.

So I went, like, last administration, I would routinely meet with Secretary Becerra.

I had a lot, you know, you know I was the head of the national Mpox response at the White House.

I was in the Covid vaccin response, all of those things.

And those are big ticket items like really important things.

And I would have meetings wit Becerra not by myself, but like the context of briefs.

We offered Secretary Kenned brief after brief, after brief.

Let's briefly about measles.

Okay.

So if you're tracking he' never been briefed about measles by any subject matter expert at CDC no matter what he tells you in front of Congress.

He said that, “I was briefed by, He said a name, Bill Thompson, who is someone who has a history in vaccine, but he has nothing to do with measles, nothing to do with the responses he needed to be briefed on.

So literally, I've never met the man.

The senior leadership at CDC, other than Deb Houry, has never met the man.

He has never done a zoom to CDC, even in a large group.

We've seen him address HHS and spout all of the Orwellian doublespeak gold standard science, radical transparency, but I've never interacted with him at all.

(Smith) Quite, quite extraordinary.

(Daskalakis) Yeah.

(Smith) So after you quit, you gave an interview, well, you gave a couple of interviews, but the one to The Advocate, (Daskalakis) Yeah.

(Smith) I read with some interest.

And you said the CDC you knew is over.

Unless someone takes radical action, there's nothing that can be salvaged.

I mean, that's, you know.

No, actually, tell us what you think.

I mean, you know, like like that's bad.

I mean, you're saying... Daskalakis: Not good.

Smith: Yeah.

(Smith And look, we've spent a lot of time talking about vaccines, but as we were talking about backstage, there are a whole bunch of other things we could be talking about that fall into the same category.

We're no longer going to do mental health screenings for children in schools when we have said repeatedly that gun violence in schools is not about guns, but it's about mental health or fluoride.

Bye bye to fluoride.

(Daskalakis) Right.

Right.

(Smith) In water.

Like there are a whole bunch of things that have happened.

You believe that now so much damage has been done that effectively, it's over.

(Daskalakis) Yeah.

I mean, I think that it's probably really har to salvage for lots of reasons.

So one, like they radically cut the place.

There's no staff there.

There's no there's no more legacy of expertise.

Like hundreds and hundreds and hundreds of thousands of years of expertis have been cut out of that place.

(Smith) Yeah.

(Daskalakis) You know, the ongoing denigration of public health officials and staff means that who in the hell wants to be a public health person anymore, right?

Like, are you going to go to your to get your master's of public health?

as a quote, my friend Robert Malone from the ACAP says, a master's of public health is a socialist degree because it's worried about about the community and not the person.

That's that's what we're up against.

(Smith) So the first the first level consequence of this is we all suffer for not having the CDC, but the second level consequence may be that we dissuade anybody from becoming the next generation of public health experts.

The next Demetre Daskalakises are not going to go into this field.

(Daskalakis) Yeah.

I mean... (Smith) As a consequence of it.

(Daskalakis) I think that that's right.

And I mean, I think the the rhetoric around attacking public health vaccines, that's why 500 shots were fired at CDC.

Like when... (Smith) We haven't talked about that.

But of course that was an extraordinary thing (Daskalakis) when I moved, when I quit, I had to go to my office.

And, you know, because I'm such a terrible public health official, had to dust off lots of my trophies.

So I'm like, literally glass dust because I had surgery the day of the, of the, of the attack.

Had I not had surgery that day, I would have been sitting in my office when the when that bullet went through the window and so, you know, that's real.

And so the verbal attacks, oh, and this is an example, when Secretary Kennedy, he came to see the gunshots, we were all not there because we were working from home, because, I mean, you can't work in glass.

And, thoughts and prayers is what he gave.

And then he immediately went and did a interview where he said, don't trust public health experts.

So he's as responsible for those gunshots as the gunman, in my opinion.

(Smith You surely know that yesterday and in fact, the last two days, what we've seen in response to the CDC effectively going offline, (Daskalakis) Yeah.

(Smith) Has been coalitions of states saying in place of the federal governmen making vaccine recommendations, we're going to do it together ourselves.

So two days ago on the West Coast, you had California, Oregon, Washington, Hawaii.

Yesterday you had a coalition of states on the East Coast to say, we're going to step in and we're going to make vaccine recommendations.

I mean, look, I understand the world today.

We're living in the United States of you do you.

Right.

Like, this is an every man for himself, every woman for himself world.

But is this really the best way for us to manage the infrastructure of public health by saying we're going to it's going to be reduced to coalitions of states stepping in?

(Daskalakis) No, it's not good.

I mean, they have to do this because they're not given a choice.

They have to step up or otherwise, the health of the peopl that they serve will be damaged.

(Smith) What are the complications of that?

I mean, is there a problem with, you know, it unequal recommendations?

(Daskalakis) Yeah.

(Smith) In this coalition of states and that coalition of states, an inconsistency?

(Daskalakis) 100%.

It's going to be I mean, what happens i you create I have and have not sort of situation in the US, which we already have, but now it's going to get worse.

Like I'm not hearing about Mississippi, Alabama, Louisiana and Georgi coalescing into an organization because it's not reall in their sort of political will.

And it's als they're not resource to do it, (Smith) but also Dr.

Daskalakis, if those states, Im going to make an educated assumption here that if those states put together a coalition, their recommendations would be wildly different than the recommendations of the in the northwest or in the East (Daskalakis) Maybe, maybe.

I mean, it's I think it could be because of this sort of environments.

But I do think that the patchwork that it creates is going to cause confusion to providers and to patients, and whenever a patient and a provider are confused and they don't know what to do, they tend to move to an action.

(Smith) Right.

A realit that we talked about this week, is that what we're seeing right now did not happen overnight.

I mean, as much as you might want to say, you might want to say others might want to say, this is about Robert F. Kennedy, Jr.

This is about this administration's HHS.

The reality is that we have been debating and arguing over many of the things we've been talking about for several years now.

Predates Trump 2.0.

It was really the pandemic.

(Daskalakis) Yeah.

I agree.

That was the catalyst for this.

That' what started us down this path.

At that time, you were working right here in the city of New York on pandemic response.

You were here back then.

So how did we get from there to here?

(Daskalakis) I was, you know, I was o this really interesting podcast, right after I resigned.

And it was with folks that were from the MAHA perspective.

And this one person said this fascinating thing, which is I didn't think about public health at all.

And then the pandemic came, and it seems like they were in my business for the first time.

And so I feel like, you know, public health, like, dutifully lives below the radar to make sure that things are going well.

So you don't know that we exist.

And so all of a sudden, we're front and center very politicized right up there.

And people didn't necessarily do a great job, frankly, during the pandemic.

(Smith) Who are, when you say people, who?

(Daskalakis) I think everybody.

I think me included, in New York City.

I think all of us like, you know, in the middle of the catastrophe, you know, I think that there were sort of political pressures to say that you had more sort of, you know, confidence in some of the things that you were saying to build confidence in the community more than yo necessarily had scientifically.

Like, you know, one of the things that keeps getting brought up is, you know, we are 100% confident that the Covid vaccin is going to prevent infection.

Remember that we live that together, and that's not what really played out.

And so I think that that's just, you know, something that is a lesson to learn that the absolutes of science, nothing is actually absolute.

And, you know, one of the things that I think about is, you know, very often, like scientific truths change over time as new data emerge.

And in this sort of era before, you know, fast social media like that would just sort of happen gradually.

But you can now take snapshots and say, on Tuesday, you said this, on Wednesday you said that.

And so the science changing is then sort of billed as being something that is disingenuous or false claims.

So it's just like the speed at which we are getting the information means that, you know, as science moves, it looks like someone is either lying or doesn' know what they're talking about when the data changed.

(Smith) But of course, exactly wha you just described is the basis out of the mouths of people who are themselves vaccine hesitant for vaccine hesitancy.

Well, you told us that the Covid vaccine was going to be all that and it wasn't.

So why should we believe you now is what they're saying.

(Daskalakis And that's going to be a decades long sort of discussion, (Daskalakis) because I think it's going to be hard to get there again.

(Smith) So let's talk.

I was asking you abou how we got from there to here.

Let's talk about where here is specifically, we had some really interestin data points published this week.

Washington Post, Kaiser Family Foundation, results of a poll were published at least 1 in 6 parents have skipped or delayed a vaccine for their child other than Covid or flu.

1 in 6.

So we're talking about measles, mumps, rubella, tetanus, whoopin cough, hep B, chickenpox, polio.

52% of parent did not vaccinate their children for flu in the last year, and the CDC own estimate show that a majority of children had receive flu shots every year since 2010.

It's been declining since 2019.

How many flu deaths among kids you cited today or yesterday?

(Daskalakis) 271 .

(Smith) 271 flu deaths in children.

(Daskalakis) 90% unvaccinated.

(Smith) Right.

90% of vaccinated.

And to the point about unvaccinated, this is from an NBC news report this week among states collecting data for the measles, mumps, rubella vaccine now, 68% of countie in the country have immunization rates below 95% which is the threshold for herd immunit to protect against an outbreak.

So literally one third of the country is no longer at the herd immunity threshold.

Crazy.

(Daskalakis) Crazy.

(Smith) Crazy.

(Daskalakis I mean, when the call is coming from inside the House, from trying to sort of destabilize sort of the vaccine effort, it becomes really hard for public health to try to improve confidence in vaccines, understandin that it's an uphill battle, righ So now, not only is it an uphil battle, but we also have, like this entire burden on our backs trying to pull us bac even further by creating chaos.

Myths and disinformation, confusion and chaos.

(Smith) Right.

I want, I want to spend, we have a couple of minutes left.

I want to spend a little bit of time talking about the measles outbreak of the last year.

Because I live in Texas.

You actually worked on the measles outbreak in Texas at the CDC.

This was a legitimate outbreak, the largest measles outbreak in 30 years, 762 cases of measles detecte more than two thirds involving children, 96 peopl hospitalized, two children dead.

Almost all of those infected were unvaccinated.

The epicenter of the outbreak where it originated and where more than half the cases were diagnosed was Gaines County, Texas in West Texas, the vaccination rate there is only 77%.

(Daskalakis) That's right.

Right.

(Smith) So this is exactly the the simulation being run.

Daskalakis: Yeah Smith: What you're talking about (Daskalakis) That's right.

And you know, I got to go to Seminole.

Actually Lubbock, Seminole and Austin, and sort of got to sort of see the story.

And, you know, I'll say that one of the challenging parts, I mean, I led the measles response in New York City, and that happened in Brooklyn and in the Haredi community in 2018, 2019.

And so I kind of I have a lot of measles experience, especially with close knit communities that may be really hard to communicat sort of vaccine information to.

And this was an example.

It was mainly among Mennonites in that area.

And, you know, it was a hard thing to do at baseline.

But I'll tell you, the hardest part was having to dea with the mis- and disinformation on the ground, as well as the mis- and disinformation that Secretary Kennedy was, wa touting throughout the country.

So he, you know, went weeks and weeks not saying the word vaccine once, while we were trying to increase measles, you may I'm never forgetting, like, we were in the midst of a measles outbreak and he had the first cabinet meeting with the President, and he says, yeah, it's no big deal.

And then he got the number of deaths wrong, which maybe he should have been briefed.

Maybe he would have gotten the number of deaths right.

But literally, like minimizing the importance of an outbreak that had already outpaced last year's measles cases by the time he said that.

And then saying, you know, measles vaccine prevents this, and then three seconds later saying vitamin A inhaled steroids and antibiotics that like, do nothing, for thi are the way that you should go.

And then saying that the doctors that supported those, those strategies were actually heroic.

That's not helping anyone.

And so, you know, those deaths, those that that the fact that we couldn't control that outbreak as, in the time that we did, that's that's why.

(Smith) And this is, I think the takeaway, this is why the conversation around vaccines is so complicated.

People say, well, you know, you're impacting my liberty.

If I choose not to offer a vaccine to my kid, that's my choice.

And they liken it sometimes to the seatbelt requirement.

You know, when the governmen mandated the use of seatbelts.

Well, the only person who is hurt if I don't wear a seatbelt is me.

That's not the case with these vaccines.

At some point your liberty is my problem, right?

At some point, your liberty is my problem.

Because if these are infectious diseases and you choose not to get vaccinated, you're impacting all the rest of us.

(Daskalakis) That's right.

I mean, it's like if I crash and have my seat belt, your airbag goes off and hopefully you don't get killed, right?

So so you know, this especially measles, mumps, rubella is a great example.

Many people just can't get the vaccine.

So if you have friends who are immuno-compromised, bone marrow transplant, whatever it is, they can't get it.

So the protection of the population means that you're protecting the people in the population that can't get it.

So it's not at all a seatbelt.

It is a social contract, which may be a different conversation for another day, because that seems to be not prioritized.

(Smith So in the last 20s that we have, can we un-dismantle this?

I mean, I keep looking at the dismantling of everything in government over the last seven months, and I keep asking myself, what's it going to take to un-dismantle this?

Assuming people were put into into position of responsibility, who wanted to understand, how long would it take?

What would it take?

Is it even possible?

(Daskalakis) Yeah.

I mean, and in, in in public health there's three things that you need.

You need community engagement, so understanding what the people need.

You need good science and what really lifts the whole thing up is political will.

So where there's no political will, who cares about the science and who cares about the engagement with the community?

It's not going to matter.

So I think that the first step in this is dislodging leadership that's not actually responsiv to the needs of people's health.

And so you can interpret that as you wish.

And and then and then the other part is this is going to take decades to fix.

What was destroyed in eigh months will take decades to fix.

And s that means that we are at risk not only for like my health and your health, like we have zero global visibility in what's happening with infectious disease right now.

We have like a 60% reduction in the number of samples that we're getting at CDC to look at what flu is circulating and what the next pandemic strain is going to be.

We've gotten exactly zer polio specimens since February, and usually it's in the hundreds globally.

We've not done one measles lab training to make sur labs are doing the right thing globally to sort of provide us information.

And over 70% reduction in understanding of what's circulating, what's circulating in Covid.

So, red flag is up and I can't put it up any higher.

If there's not a change, we are at risk for our personal healt and the security of our country.

(Smith) All right.

We have to stop there.

Thank you so much for being here.

And thank you for your service.

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