COVID Lessons Learned with Donald G McNeil Jr.
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On September 28th, the Global Citizen Festival will gather thousands of people who took action to end extreme poverty. Join Post Malone, Doja Cat, Lisa, Jelly Roll, and Raul Alejandro as they take the stage with world leaders and activists to defeat poverty, defend the planet, and demand equity. Download the Global Citizen app today and earn your spot at the festival. Learn more at globalcitizen.org slash bots. It's on! It's on!

From New York Magazine and the Vox Media Podcast Network, this is On with Kara Swisher and I'm Kara Swisher. Today, our guest is former New York Times science writer Donald G. McNeil Jr. He has a new book coming out, The Wisdom of Plagues, Lessons from 25 Years of Covering Pandemics, which is due out January 9th.

The book is timed to mark four years since McNeil's first article in The Times about the COVID-19 outbreak, which soon turned into a devastating worldwide pandemic. There have been nearly 7 million deaths worldwide, more than 1.1 million of those in the U.S.,

Well, it's no longer called a global health emergency. We're in the middle of yet another wave of COVID illnesses, and there continues to be new reporting about the origin of the virus, still the subject of great controversy that I want to talk to Donald about.

Before we get to Donald, though, on has something new for you in 2024. For every interview, we're going to ask an expert for a question with a vantage point that helps me dig in from a different angle. Starting with this week's assist, former White House Chief of Staff Ron Klain.

I spoke with him last year after he left his job and also in 2021 on Sway about the Biden administration's COVID-19 response. That's because he also coordinated the U.S. response to Ebola for the Obama administration in 2014. Here's the question he sent us. This is Ron Klain. My question for Donald is in the area of pandemic response.

Donald, as you know, contrary to what most people believe, the World Health Organization is not a pandemic response organization. It does research, it does regulation, but it's not the responder.

As we've seen in many major outbreaks and epidemics, when there is a big outbreak in a country, that country's national health care system can be overwhelmed and it needs help from outside. There's really no global organization to do that. During Ebola, the UN launched a response effort. It didn't really work. And a variety of Western nations had to step in and help. Do you think there should be some global pandemic response unit? If so, who should run it? Where should it be housed and how should it be structured? Thank you.

Good one, and I'm using it. My thanks to Ron. We'll ask McNeil about that and also about his own controversy, his exit from The Times in 2021.

Hi, Donald. Thanks for joining us. Happy New Year. Thank you. You too. So it's been four years since your first article came out in The Times about what would later be known as COVID-19. Since then, we've had a string of variants. We're now in the middle of another spike and cases are growing in nearly half the U.S. states and ticked up by more than 50% worldwide in December. Are you surprised we're still talking about this pandemic or endemic or I don't know what to call it? And I want you to sort of reflect on what's happening right now.

Well, we don't talk about an endemic, but that's what it is. It's now essentially become like flu. I know we're going through a fourth season of it, but if you look at the statistics,

It's responsible for 3% of all deaths in the United States. And this is now in the middle of flu season, COVID season. So this is, I mean, everybody's got it, but very few people are hospitalized or die from it relative to previous years. But I am kind of shocked how casual people have gotten about it because I just noticed the other day,

Only 17% of the United States has gotten the last COVID booster. And only 33% of all people over age 65 have gotten it. And to me, that's just nuts. I mean, it's a disease you should pay attention to. It's become like flu. You know, you're not at very high risk unless you have, you know, are immunocompromised or you're very old or, you know, or bedridden. But

It's something you should, you know, get the vaccine for. Isn't that what typically happens, though? I mean, the flu, obviously, people do take seriously, but not that seriously, right? Yeah. You know, most people wouldn't get flu shots if their companies didn't make it easy. When I go get a flu shot at CVS, it's not like I'm waiting in a line of 50 people. But yeah, I'd say in general, most people kind of, you know, that was, you get

tired of it. You get sick of it. Pandemics are terrifying in the beginning, and then it's like, you know, a Halloween movie. You'd be just thinking, oh, no, not another teenager with the chainsaws in the garage or something. You begin to get tired of this stuff. So people were fed up after six months, and now it's four years, so I understand. But it's

It's a continuing threat, and it's worth, you know, the trouble of one shot that takes, you know, half an hour of your time at a drugstore. Well, we'll get into the controversy of the shots with a lot of people and the misinformation, but let's go back to the beginning of the pandemic. Scientists and health professionals were spouting a lot of conflicting and contradictory information in those early days, which I think contributed to people being doubtful about things.

They said to wash hands, disinfect everything, even your groceries. Everyone was doing that. Then stop doing that. Wear a mask. Don't wear a mask. Mandatory masks. Go to the hospital. Don't go to the hospital. Tests don't work. Test every day. As a science and health reporter, how do you deal with that? And I realize that information changes over time. How do you think about that covering it? Because I think a lot of people felt confused.

You get confused and you change the things you say as the facts change, as scientists do. I mean, look, normally as a reporter, I was just, you know, writing stories and sort of reporting what had recently been said. During the pandemic, I was suddenly on the daily podcast and people were asking me for advice. I would tell people, I'm not a doctor. I don't have an MD. You know, you should get your advice from doctors. But...

And I gave some wrong advice, too. There was a time when I wasn't saying anything about wearing a mask on the subways. I was wearing one glove, and I was washing my groceries with bleach. And because at the time, people didn't realize—they knew there was airborne transmission, but they didn't realize that there was this aerosol, the tiny, tiny droplets that stay in the air and drift, rather than droplet transmissions, which are the big ones that spew out. So the advice had to change. And Fauci changed his advice, and other doctors changed their advice. And, you know, even—

i was watching a podcast the other night of a doctor who was on fox news frequently and he essentially apologized for having given out the wrong advice in the beginning he was saying this is a ridiculous uh media inspired uh epidemic and it's not no worse than flu season and then he got it and the monoclonals pulled him back from the brink um and he changed his tune including on fox news so you know people who were honest

change their mind and say, I was wrong, and say, here's the best we know now. Why do you imagine it had such a profound effect on people and that the scientists don't know what they're talking about? It certainly started anger from people for scientists being wrong. There

There's a lot of anti-elitism in this country. There always has been. I mean, I feel it sometimes too because I get tired of being talked down to by elites even though I worked for the New York Times and I went to Berkeley and, you know, I would consider. But there's also, I mean, Fauci ended up personifying the elites and Fauci's real offense was not

the advice about masks, his offense was that he contradicted Donald Trump when Donald Trump was saying completely fallacious things about the virus, hoping that he would push the stock market back up and it would just go away. And he was saying, it's just going to go away. You know, it's just going to wash through the population and disappear by summer. And, you know, anybody who's followed these things know, no, it doesn't disappear in summer. Flu does every year, but flu's been with us for hundreds of years. And

This is new and we don't know what it's going to do this summer. And when Fauci would say things like that, it would piss off the Trump supporters and, you know,

You know, what can you do? Then they began to latch on to, how'd she lie about masks? How'd she lie about this and stuff? And I just, I found that execrable. And I particularly got bothered by the idea that he had to have Secret Service protection because he got regular death threats, including white powder sent to his house. So one of the things that they did latch on to was the origin of COVID-19. One of the revealing things in your book is about the lab leak theory, the hypothesis of the virus spreading.

may have been made and leaked from a lab in Wuhan, China. This has obviously been disputed by the Chinese. Many dismissed it for a long time as a conspiracy theory, especially after President Trump ran with that idea. You were hearing rumors about a lab leak in early 2020, and you write in your book that you now believe

There was a concerted effort by some of the leading virologists to throw you off track. Explain what happened here. It doesn't mean they're wrong. It's just that they were trying to do that. Okay. There's a lot of things were going on here, and it all looks much clearer now, four years later, than it did at the time. But...

At the time, there were all sorts of crazy rumors circulating about the virus, that it had snake genes, that it had HIV genes inserted. And all of us science reporters were running around trying to debunk each one of these things because it's hard to tell when somebody publishes a paper whether or not they know what they're talking about or not. So you have to call experts.

The experts I talked to said it appears to have started in the market. I still think the most likely explanation is that it did start in the market. I do not have—no one has definitive dispositive proof on either side. I think this is going to be one of those questions like, you know, was Cuba involved in the assassination of JFK or was Alger historically a spy that we're not going to get the answer to until an autocratic state opens its files. China says, we know it didn't come out of the lab.

We want to know, well, how do you know? What were the lab records? Exactly what work was being done in that lab? They're not answering that question. So all we have is all these investigations, hints, rumors. In February, um,

There were rumors, and they first appeared in very, you know, sort of conspiracy-oriented websites. There were suggestions that it was a lab leak from China, but the only evidence they had was that it was in Wuhan, where there was also a lab. And I heard a rumor from one of the editors, asked me to check it out, that there was a possibility that the U.S. government was looking into this.

So I wrote to a number of evolutionary virologists that I knew. Now, you have to understand, there are not a lot of evolutionary virologists in the world. I mean, this is like Einstein in, you know, earlier nuclear physics. There are not a lot of people you can go to. Tony Fauci is not an expert in this stuff, so he's not somebody I would have asked the question of. He's an infectious disease expert. But I was writing to people like Christian Anderson and a number of others that had been sources of mine before, and I did not know it, but...

But they were all on a Slack channel together. They didn't lie to me, but they left out the fact that they, at that time, were worrying about the possibility that it was a lab leak. I see. And they started putting me off back then in early February. To say, no, don't look into it, Donald. That's not— They said— I've been there. If this had been—because what I was asking them was—

And I didn't know they were together. I was asking them separately, but they were comparing my emails to them. I said, is there any way to tell if a virus has been manipulated in a laboratory? Are there base pairs missing, you know, that you would expect to be there? Are there inserts that you recognize as inserts, as anything? Because I didn't know if, you know, with the equivalent of CRISPR, if you chop up a virus and insert something, whether or not it leaves traces or not. And they said, essentially, yes.

had it would be possible to do it, but had that happened, we would be able to see it and there is no evidence of it. But they were still debating among themselves, hey, you know, this could have been inserted. I mean, one of them said...

All you need to do is put in 12 base pairs. And another one replied, yeah, but I didn't tell McNeil that. And one of them said, McNeil sort of nailed it, but let's not tell him. Uh-huh. How did you feel about that? When I heard it later? Yeah. I was shocked. I mean, these were scientists that I trusted, and I—

I rewrote that chapter of my book just in August when I found out that happened, and then I sent a copy of the new chapter to all four of them saying, hey, comment, please. Only one of them wrote back to me, and he wrote very long, very defensive, very we-didn't-lie-to-you emails. But my feeling is, well, you didn't out-and-out lie, but you left out a really crucial element of the debate you were having among yourselves. And his response was, it would have been reckless for us to tell you that.

I see. So they said they didn't know yet, so they didn't want to – because the conspiracy theories around it had become very thick by that point, correct? But by that point, they were still quite kooky, and they were mixed up with all the stuff about HIV genes and snake genes. A year later, more than a year later, I wrote a piece saying –

hey, we have all sort of, without agreeing among ourselves, we have all just sort of, just to ignore the lab leak theory. And I said, it's worth looking into. I'm not saying I believe it, but I'm saying it's very clear the Chinese have not told the whole truth. And the most interesting fact that I saw was that RATG13, which was the virus that the Wuhan lab disclosed it had in its freezers,

and talked about because it was proof that it's a bad virus. That virus had actually been known about under a different name for some years. It was virus 4991. And that virus came from a cave where miners, bat guano diggers actually, had died after digging bat guano and died of what looked like a viral pneumonia. So that undercut

a crucial premise of the paper that said, there's this famous paper called the Proximal Origins of COVID-19 paper by those scientists I talked about, which said, "This virus is so different from any known dangerous coronavirus that no lab would have chosen to play with it to see if they could make it into a human pathogen."

This undercuts that premise. If they knew that that was a virus that had come out of a cave where people had died, it would be a perfect candidate for looking at and doing gain-of-function-type experiments on in order to see. But they never mentioned that. Right. And by that time, it had become...

rather significantly. And it's still politicized. Obviously, there are various government agencies and institutions looking into the lab leak theory. There was President Biden's intelligence inquiry, which was inconclusive. Well, how do you look into something? You know, that happens. How would the Chinese look into something that happens secretly inside the United States government? They'd have to have, they'd either have to have really good signal interception to find, you know, people having an email saying, let's not tell the Chinese we blew up this, or

or they'd have to have a mole inside the government. And presumably we don't have somebody who was there inside Xi Jinping's lab at that moment it was being done. All we know is, you know, more work was being done than we knew about at the time. Were you surprised about the split between the findings of the National Intelligence Council and other intelligence agencies, the FBI, the Department of Energy, and the CIA? I don't see that they found anything. You know, I mean, the fact that somebody says...

Well, we think with low confidence that it was a lab leak. It's like, well, okay, tell us how you know that. What was your information? Did you get something, you know, did the National Security Agency pick up something, you know, on a satellite transmission? Do you have somebody who secretly worked there? There was no information. So I didn't think anything of it. The same way

you know, that revelation that three of the scientists, you know, fell sick, you know, a couple of months before, I thought, well, okay, fell sick with what? It was the height of flu season in a bad flu year. And later it comes out, well, they might have had typical virus. And I thought, okay, so three people in a lab with hundreds of people, because it's a big building, get the flu during flu season. Big deal. Not news as far as I'm concerned. If it

it had been a brand new virus and it had started inside the lab, my guess is it would have affected dozens of people because when there have been lab leaks in the past, they tended to hit the lab workers and their families. You know, the last leak of SARS killed a family member of somebody who was in a lab in China. So that, I mean...

That's what happens when you have a lab leak. Is there a point to paying attention to some of the, you know, not every conspiracy theory is wrong necessarily, but it definitely morphed in of itself. And I'm playing devil's advocate here because I think most of them are nuts, honestly. But when you think about it, not focusing on it creates an atmosphere where people doubt everything and they're already confused about the virus itself. Yeah.

I try to keep an open mind to all theories. I mean, I did check out the HIV genes and the snake gene stuff. You check these things out, but, you know, what you choose to believe is what seems to be the preponderance of the evidence. Right. And by the way, it's not just kooky conspiracy theories. The FBI and Department of Energy are saying it. Why is that? I don't know. They won't explain how they think they know.

So it's not very useful information. I mean, take our word for it from a government agency is not the most reassuring thing you can hear. No, and it's not over. Congress has been holding hearings about this. Former Chief White House Medical Advisor Anthony Fauci, who you mentioned, is set to get grilled before the House committee this month. Republicans are accusing him, lied to Congress about the funding of so-called insurgency.

gain-of-function research. Is this just political theater? And is knowing about the origins of COVID-19 really crucial from a global health and national security perspective? Okay, a great deal of it is political theater now. I mean, Fauci has been before Congress

between dozens and hundreds of times testifying, and he was grilled over this whole issue. The thing about gain-of-function research is there's some very semantic distinctions between what's, quote, gain-of-function research and what isn't. So some of this is a distinction without a difference. And so you could answer the question truthfully, no, we were not funding gain-of-function research in this case. Gain-of-function research is something that—it's like nuclear weapons research—

If you're going to make a bomb, if you're going to drop a bomb on somebody, you want to know if that bomb works. Well, testing bombs is really dangerous work, but you kind of have to do it. And with viruses, if you want to make a vaccine to a disease you don't know can infect people, you may have to make that virus dangerous to see how easily it could become dangerous to see whether or not it's worth making a vaccine to it. That's the core of gain-of-function research. It's very controversial, but

I'm not saying, oh, it should be banned forever, because same way nuclear weapons research is really controversial and really dangerous, but you have to do it. So you were skeptical about the lab leak theory in the past. It sounds like you still are, or you just don't know. I don't know. And anybody who claims to be sure that they know one side or the other had better put up or shut up, because I really don't think anyone has the answer. My feeling now is that...

There are arguments to be made on both sides. Clearly, stuff was going on in that lab that was coming close to the line, but whether the jump actually took place there or not, I think is, I don't know, but I think it's probably the less likely alternative for all sorts of reasons. I mean, one, as in the beginning of all other epidemics,

The doctors who noticed the outbreak, who were emergency room doctors in hospitals in Wuhan, who had no incentive to cover anything up, and all they knew was their patients were dying, and some of them were getting sick, and they raised the alarm. And they all said it centered on this market. These are the wet markets for people who don't know. Yes. I mean, it's called a seafood market, but actually it had other stuff in it. It had wild animals in it, including raccoon dogs and other things that had been known to be reservoirs for coronaviruses before.

this is the way MERS started. And then when you look at the environmental samples that were taken in the market, there was a very high percentage of virus in those samples. So, and then a lot of the work that Michael Woroby has done that showed that, no, there were not a lot of cases in Wuhan before the first market. I mean, yeah, the supposed patient zero was somebody who was hospitalized on December 8th. Well, it turns out

And that would be earlier than the case of the market. But it turns out he was hospitalized for oral surgery on December 8th, so he wasn't necessarily patient zero. There's been a lot of misunderstanding and a lot of, you know,

people sure of things they couldn't possibly be sure of if they look into the details of each claimed fact. That said, it's fueled an enormous anti-vax movement in this country and across the world, actually. And you subscribe quite a bit of the blame to anti-vaxxers, not just for COVID deaths, but for renewed rise in polio and measles in some communities. And in the book, you call for banning religious exemptions for vaccinations completely. Yes. Talk

Talk a little bit about that because some vaxxers, just to be clear, are ultra-religious. Some are just ultra-libertarian. I'll do what I want with my body. I'd love to understand why you want it. You think this should be absolutely, religious exemption should be bam. And what's the common thread in your opinion of these groups? What is the religious nature of a vaccination? Is a root canal a religious act? If you had appendicitis, would taking your appendix out be a religious act?

Vaccine, I mean, you cannot claim a religious exemption for wearing a seatbelt. You cannot claim a religious exemption in some states from wearing a motorcycle helmet. You can't claim religious exemptions for almost anything that we understand because state legislators understand how seatbelts work. They understand how helmets work. They don't understand vaccines, how vaccines work. So they have this kind of mysterious boogeyman, right? Well, something maybe, and you shouldn't question anyone's religion. Well, we

question people's religion all the time. Every major religion in the world used to practice human sacrifice. All the Abrahamic religions, Christianity, Judaism, Islam, are founded upon Abraham's willingness to sacrifice his son. Well, we do not allow human sacrifice anymore. There is nowhere in the United States that you can sacrifice somebody to your favorite god, regardless of what religion you belong to, and get away with it. You will be charged with murder.

We don't even allow people to engage in polygamy in this country, and polygamy is the normal standard in the Old Testament and used to be one of the centerpieces of Mormonism. So the idea that you can't question anybody's religious beliefs or that it's a get-out-of-jail-free card is just plain not true. And

you know, the freedom of philosophy, as in philosophical objections to vaccines, does not go back to the First Amendment. The whole notion of religions covering vaccine is a canard. I mean, all religions are in favor of vaccines because the only reason it exists is to save life. The top Jewish scholars, the top Islamic scholars, and the Vatican have all ruled on vaccines, and they have all come out strongly in favor of them again and again and again, literally over the centuries. So you have occasionally, you have

Some priests, some rabbis, some ministers saying, you know, I'm granting exemptions for my flock. These are renegade points of view. But they're not renegade now. They're very widespread now, especially among libertarians. They are absolutely renegade. All right. Libertarians—first of all, libertarianism is not actually a religion. It's a political belief. I agree. Yeah. Trust me. I spend a lot of time with libertarian lights. And their attitude is, you can't tell me what to do. Right. Well, you know—

The Supreme Court actually decided this back in 1905 in the case of Jacobson versus Massachusetts when there was a Lutheran pastor who said, "I have a religious objection to having a vaccine." And the Supreme Court said, "No, you have to have the vaccine, and it's not based on religious freedom at all. It's based on the police power of the state."

The state can't take away your gun if you're sitting in your house not using it. But if you walk down the street shooting at people, the police power of the state allows them to take away your gun because you're using it to harm people. If you are outside your house infecting people with a dangerous lethal disease like smallpox in those days, the police are allowed to take away your gun, as in they are allowed to give you a smallpox vaccination. That's what the Supreme Court held. The argument is that—

It's fine if you want to be a libertarian if you're not endangering anybody else. But when you're carrying an infectious disease, you are endangering other people. You are the equivalent of a man with a gun. And you don't get to say, oh, it's my body and I can do anything I want with it. No, that just doesn't fly.

Just the other day, Bill Maher was going on and on about the fact natural immunity was never allowed to happen and it would have solved everything. Natural immunity is the path through the graveyards, but that's the tough way. And if you've got a better way to end it without having a third of your population die, I think you want to take that method. Interesting. You write in your book, the COVID-19 pandemic changed America for the worse. I thought we would unite against a common enemy. Instead, once it was within our walls, we disintegrated into a fratricidal brawl.

I mean, the politicization of the pandemic has been severe, not just on vaccines, but a lot of the masks, everything. I'd love you to talk about that and the attraction of people increasingly to candidates like RFK Jr. Is it social media to blame or is it humans? What do you think happened here? Because it's not, even though you're calling it sort of a fringe idea, it feels very increasingly mainstream. Yeah.

I have a hard time defining at what point does something step over being French. Let me say, I have— I mean, what's the attraction of Robert F. Kennedy Jr.? If his name was Robert F. McNeil Jr., he would not be as big a candidate as he is. If it's, you know, Smith, Swisher, pick a last name. Swisher, he'd totally win, but go ahead. Yeah, all right.

So, I mean, what's his appeal? And he's got that, you know, Kennedy good looks and that Kennedy cranky voice and all the other things about it. And he was, you know, previously very good at environmental studies. But on this topic, he's gone absolutely kooky in my point of view. And he puts forth all sorts of extremely dangerous conspiracy theories. But it is a phenomenon that's gained strength and not dissipated. It feels like it. Maybe it's because of media or social media. If you had to make a stack rank list of

Who did that? Would you say social media, Donald Trump and his press conferences?

Where do you think it came from this time? I mean, social media is just the medium. It's like, you know, before there was the internet, there was paper. And paper was pretty good at spreading crazy ideas in the old days. And before that, there were whisper campaigns, you know, before there was paper. So I'm not worried about the medium, except that it allows you to reach a lot more people. And you had fewer editors filtering the stuff as you did during the days of newspapers. But yeah, when the rumors and the denialism comes from the very top,

from people that, you know, much of the country looks up to. Maybe not the elites on the coast that look up to Donald Trump, but a good deal of the country looked up to Donald Trump. And he's saying, you know, it's all going to go away. It's not really a threat or it's all China's fault. Yeah, people are inclined to believe him. To lose 1.1 million people

In the greater scheme of the American population, it's not that much. It's one-third of 1%. But we lost a million people, and I think we could have gotten away with losing only 500,000 if we'd had better leadership in this country, but we didn't. What do you think helped the most and hurt the most in this crisis, if you had to pick two things? Well, I think the vaccines...

were a miracle. I mean, I never expected they would get a vaccine basically from zero to arms in nine months, really, is what it did. You know, the previous record holder was four years for the mumps vaccine. I mean, that was science, and that was kind of the one part of the whole scientific enterprise that was not fettered by the rumors and the craziness that, you know, Operation Warp Speed was given $11 billion and essentially left alone to do what they could

And two very smart people were put in charge of it. The guy who used to be in charge of vaccines for GlaxoSmithKline and an army general who was a specialist in logistics. And they got that vaccine going. I mean, they made hundreds of millions of doses on spec.

ready to go if the test showed that it worked. And there it was ready. So if everybody had accepted that vaccine, if everybody had, you know, if the lies hadn't been told, if it hadn't been so polarized, we really would have ended up with only about 600,000 dead instead of 1.1 million dead. I am convinced of that. So what helped the most was the vaccine and what hurt the most was the disinformation. The lies, yes. Absolutely. We'll be back in a minute.

So you don't just write about COVID-19 in your book, but also a host of other pandemics and epidemics you've covered, Zika, Ebola, and AIDS. The United Nations estimates that more than 40 million have died from AIDS-related illnesses since the beginning of the epidemic. You got your start on The Global Health Week by covering a story about HIV-infected children in South Africa 25 years ago. Yes.

Yes. So talk a little bit about that, the mitigation of a pandemic that is slow moving. And you list fighting global poverty and making medicines cheaper as ways to head off future pandemics, both big issues in the developing world. But you're not talking about aid. Talk about what needs to happen when you have these kind of pandemics that people that move so slowly, people don't pay attention to them.

Well, so in the case of AIDS, I mean, I don't think nobody paid attention to AIDS. AIDS got headlines for years and years and years. Now it doesn't anymore, but we're 40 years in. AIDS, in the beginning, when it was discovered in the United States, top scientists very confidently predicted that we would have a vaccine within, we'd have a test within a year and a vaccine within two or three years. Okay, it's 40 years later, we still don't have a vaccine for AIDS.

The closest we have is PrEP, either by pill or by injection, and it basically gives you enough circulating drug in your system so that if you do happen to be exposed to somebody who has AIDS, you won't get it. And if you have AIDS or HIV, your levels will be suppressed enough so that you won't pass it on. So it functions like a vaccine even though it's not a vaccine.

To me, the most important thing that happened in the history of AIDS, and I hope I played a small role in this, is that the Indian pharmaceutical companies came along and drove the prices of the drugs down from $15,000 a year to less than $100 a year. And that allowed things like PEPFAR, the President's Emergency Plans for AIDS Relief, and the Global Fund to Fight AIDS, Tuberculosis, and Malaria to—

raise money and start buying those drugs. And when you, I mean, AIDS is now beginning to slowly drop even in Africa right now, not because people are on PrEP. PrEP hasn't worked very well. Not because people use condoms. Not because people are practicing abstinence. Not because people got enough circumcisions. Not because any of the other interventions work. But because a lot of men are on PrEP.

AIDS drugs now, and the AIDS drugs not only save their life, but they suppress their level of virus enough so that they don't pass it on. How soon do you think a vaccine will happen? I know there's been great strides and yet no vaccine. I'm not sure there will ever be a vaccine for HIV. The measles vaccine that was invented in the 1960s still works, the same vaccine, because the measles virus does not mutate very much. The flu virus mutates fast enough so that we need to change the vaccine every year in order to get a take.

HIV mutates. It's not that the virus itself mutates. It's the envelope of the virus and the things that act as shields to antibodies mutate so fast and produce so many variants that we can't make a vaccine that pierces those protective shells and neutralizes the virus. So I don't see that we'll ever make a vaccine because the virus mutates so fast. It's like trying to

I don't know, shoot a bullet at a rabbit that's racing all over the place or something like that. You know what I mean? You just can't hit it. It moves too fast.

So let's talk about response. You write in your book, it's impossible to predict what the next pandemic will be. What will matter is how intelligently and how fast you respond. We've reached out to an expert, in this case, President Biden's former White House Chief of Staff, Ron Klain, who courted the U.S. Ebola response during the Obama administration to ask if he had any questions for you. He asked about that response. Let's listen.

Donald, as you know, contrary to what most people believe, the World Health Organization is not a pandemic response organization. It does research, it does regulation, but it's not the responder. As we've seen in many major outbreaks and epidemics, when there is a big outbreak in a country, that country's national health care system can be overwhelmed and it needs help from outside. There's really no global organization to do that. During Ebola, the UN launched a response effort. It didn't really work. And a variety of Western nations had to step in and help.

Do you think there should be some global pandemic response unit? If so, who should run it? Where should it be housed and how should it be structured? So, Donald, is this different? You were pitching a Pentagon for disease in your book. Answer Ron's question, if you could. Well, I mean, he's absolutely right.

The WHO basically provides diplomatic cover for doctors that get recruited from all over the world to go into countries, 'cause they don't have a gigantic responsive task force. I mean, but my argument in the book was, you know, neither do we have that in the United States. The CDC is essentially a detective agency that can investigate an outbreak and give advice, but it then becomes up to either private doctors or the state healthcare departments to actually do the response. The CDC doesn't have the powers to do that.

Because the Constitution was written in a day when diseases travel at the speed of a horse-drawn wagon. So I think we need a rapid response capability in the United States, which we do not have. We have to have a way to stop letting private health care stop the effect of the response, as in...

When New York City was desperate for ventilators and people to staff them in the very early days of the pandemic, hospitals all over the country were hoarding their ventilators against the day when that would come to their town. That's exactly the opposite of the response we needed. We did not need governors all over the country competing with each other to look for PPE and masks and things like that for their hospital employees. We needed to be able to fight disease the way we fight wars.

If Connecticut gets invaded, you know, nobody says, well, it's up to the state of Connecticut to drive off, you know, the Japanese Navy. No, the entire country responds from the Pentagon. We need the same sort of capability, and I devote a whole chapter to that. Yeah, we do. So do we need that on a world front, as Ron Klain says? Yeah, that would be great. I mean, right now, you have a response, but it's really that the WHO asks for help, and as happened in Ebola—

many organizations like Doctors Without Borders and Aleema and some others come in, but also the United States came in, France came in, Britain came in, and the WHO had to sort of coordinate so that everybody played nicely with each other and they weren't all setting up competing Ebola treatment units, that they were all working together and dividing up the tasks. Some people take care of burials, some people take care of treatments, some people take care of hunting for cases, you know, that sort of thing. Yeah, it's crucial. And, you know, Bill Gates has been calling for this for years, saying we need a global response system

Who should run it besides Bill Gates? Well, no, Bill Gates shouldn't run it. I'm teasing. Just because you're rich doesn't make you write about everything. I'm aware of that, Donald. Okay, sorry. Well, I mean, who else but the WHO? Obviously,

You don't want the United States running it. You don't want China running it. You don't want Russia running it. You don't want Iraq running it because these things will all be politicized. You want some sort of – but fortunately, in this case, unlike at many others, the entire world is at stake. We have essentially a common interest. Nobody wants to die of name your disease. Right.

And so they all have an incentive to get together and they can fight about budgets. They can fight about responsibility. They can fight about, you know, the politics of diseases, whether or not you want to focus on abstinence rather than condoms as a mean of prevention or whether, you know, whether you want to use the Chinese vaccine versus the American vaccine or things like that. There will always be things to fight about.

But you really do need some sort of global response the same way we'd like a global response if the Martians invaded because we're all, you know, in this together. Do you see that happening? No, I don't see it happening. I mean, unfortunately – I mean, I've been covering the WHO for more than 20 years, and their response to COVID was really better than their response to any previous disease. You know, they –

really blew it on the big Ebola outbreak of 2014. They just didn't even declare an emergency for months and months. But their response to COVID was really right from the very beginning. Tedros held a press conference every day saying there is a window of opportunity to control this disease

And other countries should do what countries that are suppressing it have done, meaning the United States should follow China's example. Although he didn't want to say the United States should follow China's example. He should say this window of opportunity is there, but that window is closing. And he said that every day he began to sound like a broken record, but he was right. And we were mired in denialism and we didn't have tests. Do you imagine at least we will get one in this country? A global pandemic response team? Yeah. I certainly hope so. But it would require passing laws that...

current Congress has no interest in passing. It essentially means we have to create something like the Pentagon. We have to be able to create a federal response task force, not just the federal investigations task force, which is what the CDC is. I mean, they're like the FBI, but without guns, without handcuffs, without powers of arrest and a tendency to, you know, publish scholarly papers instead of cracking heads. And you want somebody who's able to say, okay,

We're taking over all the hospitals in New York City right now, and you, Mount Sinai, are going to treat COVID cases, and you, Memorial Sloan Kettering, you are going to handle births and deaths and cancer and this like that. You know, we need to be able to say we need to draft 30,000 doctors today. Now, during the Korean War, we could draft any doctor under the age of 51. There was a Doctors Draft Act. Doctors in those mass units were actually former civilians who'd been drafted into the Army because we realized we needed a lot of doctors.

We could do that again during a pandemic, but is that going to pass Congress? I doubt it, but I'd love to see it happen. What about technology, contact tracing for COVID-19 using cell phones? Worked well in Asia, especially in Taiwan, I think, and even parts of Europe, but not at all in the U.S. It's not the technology. It's not the tech. It's the people running the technology. The police have to catch you the minute you get off the plane and say, hand me your cell phone. You are downloading this app.

All right, and we are going to pay attention to this app, which says you are in your hotel room and you are going to stay in that hotel room for two weeks, never coming out. If your phone stays still for too long in that hotel room, we're coming to the door to make sure that you haven't left the phone behind and gone out on your own. It was not the technology. Contact tracing is all about human contact.

So when you think about how to make tech work, many people are worried about surveillance when it comes to health care, obviously. You say we need more. How does that work? You become very unpopular like me, and you believe in more surveillance. And it's not just about tech. It's actually about telling people

I am putting you in a hotel room for two weeks. You are not going to leave the room. You are going to open the door once a day, and I will hand you a bag of food, and you will hand out your garbage, and then we're going to close the door and lock it again, and you're going to stay in there until we know you can't spread your lethal disease in our country. So it's not about tech. It's about the willingness to be able to quarantine people when they are dangerous to others. And my excuse for it is, how do you save the most lives? That's what this whole book is all about. How do you save the most lives?

Sometimes you do it through brutal measures. I mean, you know, the heads of the CDC have all gone to medical school in the United States, and they've been taught, you know, you've got to be a sweet doctor, you've got to have a great bedside manner. In the old days, in the days when infectious diseases rampaged through this population all the time, the people who were in charge of the equivalent of the CDC, the Surgeon General, were actually quite tough people. They were like generals who occasionally had to order, hey, this unit, number here, number

you are going to fight a suicidal rear guard action to protect the retreat of the larger army. And all you guys are going to die. And I feel terrible about it, but I'm saving a hundred thousand lives here. And that's kind of what public health is about when you don't have an epidemic that's under control. Which doesn't seem like it's going to happen in this country. Sadly, no. People are going to say, you can't make me do it. And the answer is, well, you and your friends are going to die, or maybe you're going to pass the disease on to your grandmother or,

You know, maybe your kids are, yeah, enough of you take this baby, you can't make me do it attitude, and more Americans are going to die. All right. So I'm going to finish up. I'd be remiss if I didn't ask you about your departure from The New York Times. You wrote extensively about your departure on Medium. I'd like to hear from you. Can you briefly tell us what you think happened there?

I wrote 20,000 words on Medium because you can't say briefly what happened. You have to understand the background of my work as a union activist at the times. You have to understand the fact that, you know, it was –

I was undone after a 40-year career by an article in a rag like the Daily Beast that was sourced to anonymous teenagers based on a trip that had been taken in Peru two years before that had been completely and thoroughly investigated by the New York Times. And they knew the circumstances under which I had said the forbidden word. It was to ask a question as to whether or not somebody else had said it.

And all the other accusations against me that I was a racist were false. You know, no, I wasn't laughing at a shaman. No, I was not excusing blackface. No, I was not doing any other things I was accused of doing. And they panicked.

The Times panicked. They would not let me, on the day the article came out, tell the truth. I mean, and I misread the situation. I thought, this is ridiculous. This is the Daily Beast. It's a joke, and it's an article that has no sources other than anonymous teenagers. Why would the Times or the Washington Post even pay attention to it?

But instead, they thought it was this big deal, and it ultimately led to them asking me to resign a few days later. And I think, unfortunately, there has been a fair amount of panic in the management of The New York Times. And I'm hoping they're growing up. For people who don't know, the forbidden word he's talking about is the N-word, and you were using it in a context.

talking about a topic, not throwing it around just so people understand what happened. It was a different environment in 2021. There's, there were, there've been the Black Lives Matters protests of 2020, the Tom Cotton op-ed sending troops in to put down protests, which led to a lot of backlash from staffers. How do you think that- They panicked in James Bennett's case. Yeah, well, I'm going to ask you about that in a second, but how do you think that all factored in? And looking back, is there anything you regret about what happened?

Well, had I never asked the question, had I never –

use the forbidden word in asking the question at lunch in Peru? Had I decided not to go on the second Peru trip? You know, I had done it the year before and the students loved me. And then I came back and I gave the same lectures, but the students had a different set of leaders who were all about, you know, how to grow up to be a righteous anti-colonialist and how to believe in indigenous medicine and aren't shamans fantastic and, you know, isn't ayahuasca great? And I'm there saying, wait a minute, wait a minute. Ha!

Hold on. I mean, some native traditions, you know, in Peru, like cutting the baby's umbilical cord and then putting a lump of goat dung or llama dung on it to dry it up are really dangerous. And so I became the, you know, the old fuddy-duddy defending Western medicine and saying, no, you don't put goat dung on umbilical cord stumps. And I wish I'd never gone on that trip. Yeah, as it turns out, I wish I'd never gone on that trip. Yeah.

But did I think the New York Times would treat this kind of thing seriously? No. I thought the New York Times – I mean, one of the nicest things about working for the New York Times for 40 years was of all the institutions in this country, it was run by grownups and really intelligent grownups. And many of them, when I started, were veterans of World War II or veterans of the Korean War, and the newsroom was run by people who had been former foreign correspondents. And they knew a serious –

from a tempest in a teapot. People were fired. People were taken off beats. People were suspended. People were punished. But there wasn't this whole atmosphere of public flogging that has become part of the New York Times. It's very Maoist. Let's beat a confession out of the employee and then fire him. And that's something new. It's sort of post-Jason Blair, post-Malibu.

Judy Miller and the War of Iraq. The Times got into this mea culpa thing, and they decided that every time somebody raised a charge against somebody at the paper, they needed to be investigated publicly and flogged publicly. And very often, there was a rush to judgment. And the fact that in my case, even though they'd investigated the whole thing for decades,

couple of weeks back in 2019, they rushed to say, you know, we want you to resign, you know, just literally over the weekend. And I got a lawyer. But I assume you read James Bennett's piece in The Economist about the times, which I think is longer than yours. Oh, he has 17,000 words. I wrote 20. Well then. I think we both need editors. Yeah, that's what I was thinking. But I kind of enjoyed yours a little more. But what are your thoughts on it? And of course, let me explain this piece is about him being

essentially fired or resigning over this Tom Cotton op-ed, but probably a lot more of other stuff, but who knows. What did you think of it when you read it? I wrote James a note saying I was very glad he'd written it. He wrote me a very nice note back. James and I knew each other when he was a reporter a long time ago, before he was Jerusalem Bureau Chief and before he went off to the Atlantic and stuff. We knew each other slightly in the newsroom.

And I had heard that he was still hurt and upset by what had happened to him. And I wrote to him and said, hey, you want to take a walk? And so we did take a walk and have a drink on Roosevelt Island. And he told me later that our discussion of what happened to you versus what happened to me helped him resolve to write that piece, which was nice. I was very glad to hear everything in detail because it was –

shocking and not yet surprising because what happened was that A.G. Sulzberger initially stood behind him and then with the criticism not letting up, A.G. panicked and turned on him and basically told him to resign. And so did A.G.'s cousin, Sam. And, you know, they wanted a resignation. They wanted to hang him out to dry. And I thought...

This is very bad and it's panicky and it's cowardly and it's not the way the times used to run. It's not what their grandfather would have done, you know, who was in charge when I was there. Um,

And I think it's sad. I think since there hasn't been another really big, awkward scandal like that in a couple of years, maybe they finally learned to calm down. Maybe they've learned not to conduct all these floggings in public. Maybe they've learned to handle things a little more discreetly. But I don't really know. I'm not there anymore, and I don't have any insight into how it happens. We'll just have to wait for the next scandal to come along. Anyway, the last question after a plague on their house. Let's get back to real plagues and their wisdom, which is...

We call it the wisdom of plagues. After 25 years of covering pandemics and watching the world's response to COVID-19, where do you think we stand now? And are we better prepared to handle the next one? No, I'd say we're worse prepared because we're still very polarized. And it's going to take a while before we get over that polarization. So I think if another...

disease came along that were equally unlethal, as in maybe it's only going to kill 1% to 2% of all the people involved. I mean, the less we see the zombie disease with blood running out of people's ears and people dying in the streets, I think you're going to get exactly the same kind of doubt, the same kind of skepticism about vaccine, the same kind of disbelief in the disease.

Because we've gotten more polarized about this stuff. So, no, I'm quite despairing about that right now. And even though you say it's impossible to predict the next one, epidemiologists do have some guesses. Do you think it'll be a flu, a drug-resistant bacteria, fungi? Is the last of us correct? Give us your best Cassandra.

You know, the best way I look like an idiot is to go try to predict the future. So, I mean, I've noticed that when real doctors, public health experts are asked this question, they used to say flu. Flu is going to be the next big one. Definitely I'm worried about H5N1, avian flu going human to human. And then only one doctor I knew, Ian Lipkin, used to say, I worry just as much about coronaviruses.

And he turned out to be right. Now, when you ask them that question, they say, well, it might be flu, it might be a coronavirus, it might be a paramyxovirus, it might be a rhinovirus, it might be an adenovirus. They cover all bases. I mean, I definitely worry about antibiotic-resistant infections. And, you know, any kid who's got an ear infection, you may notice that they end up with, you know, one drug is tried and then that doesn't work, another drug is tried, another drug. Well, if you don't find the drug that works, if you eventually get an ear infection that no drug cures,

a lot of kids are going to lose their hearing. In theory, it gets sepsis. This is something that kills a lot of people in hospitals right now. I think we have to find a much better way to handle antibiotics, not feed them all to animals as much as we do, and maybe use them in mixes and maybe use them in injections rather than in pills.

for various reasons. I worry about that. I do not have the answer. I mean, yes, I worry about fungus. Yes, I worry about antibiotic-resistant bacteria. But viruses are the, you know, there are many, many, many viruses we do not have names for that we haven't even discovered yet that could come popping out of the animals that we interface with. And those are the obvious candidates, although you never know which one. You never know which one. Donald G. McNeil Jr., thank you very much. Thank you very much, Gareth Swisher.

Today's show was produced by Nii Moraza, Kateri Yoakum, Megan Cunane, and Megan Burney. Special thanks to Mary Mathis. Our engineers are Fernando Arruda and Rick Kwan. And our theme music is by Trackademics. If you're already following the show, you get a COVID booster. And by the way, I got to go get mine. If not, go to the RFK Junior website for more misinformation. In any case, go wherever you listen to podcasts, search for On with Kara Swisher and hit follow.

Thanks for listening to On with Kara Swisher from New York Magazine, the Vox Media Podcast Network, and us. You can subscribe to the magazine at nymag.com slash pod. We'll be back on Thursday with more.