Former CDC Chief Questions U.S Reaction to Chinese COVID Outbreak

Richard Besser – RWJF

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Marianne O’Hare : Welcome to Conversations on Health Care. This week we
welcome Dr. Richard Besser , CEO of the Robert Wood
Johnson Foundation and former CDC Director on the latest
COVID strategies and called for an equity centered revamp of
the CDC.

Dr. Richard Besser : We as an institution are looking to see what does it take to
dismantle those systems that create the barriers to help from
racism and other forms of discrimination.

Marianne O’Hare : Factcheck .org ’ Lori Robertson checks in and we end wi th a
bright idea. Now here are your hosts, Mark Masselli and
Margaret Flinter.

Mark Masselli: The new year begins with unsettling news. There's a highly
immune evasive Omicron variant, it's called XPB, and it's
quickly becoming dominant in the United State s and about
75% of confirmed cases are reported to be X B B.

Margaret Flinter: Joining us to discuss this latest chapter in the COVID pandemic
is Dr. Richard Besser, the President and CEO of the Robert
Wood Johnson Foundation. He's been a leading authority
t hroughout COVID. He's a former Acting Director at the
Centers for Disease Control and Prevention.

Mark Masselli: Well Dr. Besser, welcome to Conversations on Health Care and
Happy New Year.

Dr. Richard Besser: Happy New Year to both of you. It's, it's real ly great to be here.
Thank you.

Margaret Flinter: Thank you.

Mark Masselli: Well, and you know, your expertise in the pandemic includes
your leadership at CDC during the H1N1 pandemic. What's
your latest thinking about this new COVID variant .

Dr. Richard Besser: As a nation and I think as a globe, we are ready to move on
from COVID . COVID isn’t ready to move on from us. It's really
challenging. Early on in a public health crisis everyone's
attention is focused on doing everything they can to reduce
the imp act. People are focused on doing what needs to be
done. We're in a very different place in this pandemic. Now,
where any thought of broad government interventions and
mandates around behavior is a non - starter. Yet the virus itself
is still charting an unkn own course.

Margaret Flinter: Well, right before the holidays, you and other experts were
sounding the alarm about the potential for hospitals being

Richard Besser – RWJF

overrun with the tripledemic threat. The patients with RSV or
COVID and the flu, a lot of them children. Wh at's the situation
looking like right now on a national basis.

Dr. Richard Besser: So I'm a general pediatrician. And RSV is something that we
would see every winter. But it wasn't something that that we
really talked about as much as being a threat to the elderly .
Adults with underlying medical conditions. And now we're in a
situation where you have RSV the respiratory syncytial virus,
we have influenza, and we have COVID. If you look at the
overarching map, you see a situation where the color is not
good. It's red in many different places.

I'm in New York City and the situation is red. And that's an
indication that hospitals are being stretched. And that's a
problem not just for people who have a respiratory infection
that needs to be taken care of. But it 's a problem then for
people who have other medical conditions. So , it really is
incumbent on all of us to do what we can to take the pressure
off the health care system to ensure that the services are
there for those who truly need them.

Mark Masselli: Yo u know, China is seeing a wave of COVID infections, I
probably should say a tsunami, there's been reported at least
that 9000 people each day are dying of COVID in China, and
the U.S. has imposed a Coronavirus test requirement on
travelers from China. I'm wondering, is this a little too late
when COVID is in every country in the globe? What's your
thoughts on this?

Dr. Richard Besser: Yeah, you know, I think sometimes these kinds of measures
are more for show than they are for truly controlling a public
hea lth threat. I remember back in 2009, when H1N1 was just
starting to emerge. There were large numbers of people
hospitalized in Mexico , but H1N1 was already in the United
States. And there was a big call to shut the border down. And
the mathematical modelin g showed that it would be very
ineffective. We're in a situation now where 300 people or
more are dying every day in the United States from COVID. I
don't think that testing requirements on people coming in is
going to have any real effect on what we're se eing across the
nation. It is useful for people to know if they have COVID. So
they can get a appropriate treatment and take appropriate
measures. But it's not like you're trying to prevent a big bump
in the United States. Or if you are that's not the way that's
going to do it.

Margaret Flinter: Dr. Besser, it's a very important role the foundation plays in
the country a s the nation's largest philanthropy dedicated

Richard Besser – RWJF

solely to health. And I understand that one of the roles that
the foundation chose to play du ring these last three years of
COVID, included keeping an eye on and developing a database
of state policies that were enacted, specifically, in response to
the pandemic, of all of these individual states creating all of
their policies, are we moving towar ds a more coherent public
health response?

Dr. Richard Besser: What became clear to us at the foundation during the
pandemic, and following the murder of George Floyd and the
call for racial justice in America, was the really disparate
impact of this pande mic on people of color , on low income
communities and people in rural communities. And what it led
us to do as a foundation was to really focus in on issues of
health equity, and you know, who in America truly has a fair
opportunity for health ? And who doe s not ? And it's led us as
an institution, to pursue our vision of a culture of health in a
different way .

When we talk about a culture of health in America, we want to
recognize that health isn't something that's given to you by
your health care provider, it's something that is a result of
what takes place in the communities in which we live and
work where our kids go to school and play. And across
America, people's ability to lead a healthy life is not the same.
I , until recently lived in Princeton, New Je rsey, where life
expectancy at birth was 87 years, and I worked as a
pediatrician in a federally qualified health center in Trent, 14
miles away, life expectancy at birth is 74 years.

So there you have 14 Miles , 13 year difference in life
expectancy. What we saw during the pandemic was an
amplification of that. And it led us to raise the question of why
is it that in America, the color of your skin or how much money
you earn is such a driver in terms of f health . And we as an
institution are looking to see what does it take to dismantle
those systems that create the barriers to health from racism,
and other forms of discrimination. And we recently put out a
call, really to the CDC to center equity in everything it does as
our nation's leading public health i nstitution, because without
that, the next pandemic will have the same outcome as this
one. But if we don't intentionally look at who has the greatest
barriers, the disproportionate number of people of color, who
are in jobs that don't have health insuranc e, jobs that don't
have sick leave, or family medical leave , the disproportionate
number of people of color who live in communities that lack
access to high quality health care facilities .

Richard Besser – RWJF

If we don't address those issues, the next pandemic will have
the s ame outcome as this one. And that's not something we as
a society should be willing to tolerate .

Mark Masselli: A couple of thoughts there, certainly on health equity and the
barriers to health, and certainly one of them is access to
affordable health insu rance. And one of the benefits, I would
say that happened was the public health emergency declared
by the president that really sort of allowed people to be on
Medicaid. And that may come to an end, this could have a
profound impact on the health equity , o n the populations that
the foundation is focused on, what's your thought about what
Congress should be doing to address this issue, which could
start to roll out as early as April of this year?

Dr. Richard Besser: Yeah, Mark, we're the only wealthy nation that doesn't ensure
that everyone has access to high quality, affordable,
comprehensive health care. And what we're going to see with
those changes in the Medicaid policies, is a lot of people who
are on the edge of falling off that edge , who currently hav e
access to health care won't have that and, you know, the
pandemic is not over. You want to ensure that everyone who
has concerning symptoms is able to get in , be seen , be tested.

Individuals who are at risk for severe disease have access to
have the hig h quality drugs that can reduce the risk of
hospitalization and death. But you know, I'm very concerned
this last Congress didn't take this on and make some of the
changes permanent in terms of expanding Medicaid coverage.
I'm very concerned that states ar e going to be able to put in
more hurdles in terms of recertification as requirements to
maintaining Medicaid coverage. That's going to mean a lot of
people lose coverage as well.

There are many ways to get to universal health care. But as a
nation, we hav e to agree that on e’s income shouldn't
determine whether or not someone gets basic medical care or
basic services.

Margaret Flinter: Well, we want to really apply the foundation ’ s issue brief, the
centering equity in the nation's public health system. It s said
that CDC has to earn the trust of communities directly
impacted by health injustice. And it has to support community
based health infrastructure. What do you want that
community health infrastructure to look like? What do you
want the people leading a nd practicing in those systems to
know and do and I think it probably ties to this interface
between public health , primary care, community health , I
would love to hear your thoughts on that .

Richard Besser – RWJF

Dr. Richard Besser: I've worked in community health centers for over 30 years,
and have found it to be incredibly rewarding work. One of the
big challenges is ensuring stable funding, ensuring access to
the same services, the same drugs, the same care that you
would get at a facility where someone of higher income was
more likely to be getting their care. And that's not the case. In
our issue brief , calling on centering equity in our public health
system, we do call out the need for partnerships for
engendering trust.