As the 17th Surgeon General of the United States under President George W. Bush, Dr. Richard Carmona was “America’s family doctor,” dedicated to what he calls “health literacy”: explaining medicine, public safety, and public health policy in a language we can understand. Carmona is active in the COVID-19 response, is a colleague of Dr. Anthony Fauci’s, and this isn’t the first public health crisis he’s faced -- making his an invaluable voice in this age of coronavirus.
Dr. Carmona joined anchor Amrit Singh for a Spectrum News 1 special interview on all facets of this COVID-19 crisis – from the science and treatments of the virus to the economics and politics of making policy in response. Carmona’s experience as Surgeon General, and the Congressional testimony he gave after his tenure – about the political pressures he faced from the administration while he was in the post – makes this interview valuable context for understanding the Congressional testimony of Dr. Fauci, and the nation’s now-ousted top vaccine expert, Dr. Rick Bright, and the others sure to come.
Watch the full conversation above.
A few of Carmona’s key insights:
THE FRAMEWORK FOR RESPONDING TO A HEALTH CRISIS
Dr. Carmona spelled out the “continuum we deal with” when confronting health crises: “We first attempt to prevent, then respond, then mitigate, then recover. We are still in mitigation and moving toward recovery.”
VACCINES: TIMELINE AND SAFETY
The medical community and Fed Chair Jerome Powell both agree that this crisis will persist in some form until we have a broadly administered vaccine. But how long will that take to do safely, and at scale? Especially since no scientist has ever successfully developed a vaccine for a coronavirus (like SARS and MERS).
The record for the quickest development of a vaccine is four years, for the mumps in the late ‘40s. Although science and technology have created the means to expedite some aspects of the process, others like clinical trials to ensure long-term safety, cannot be accelerated without risk. When asked about his prognosis for the development of a timely vaccine, Carmona said “I’m cautiously optimistic, because in effect we are crowdsourcing potential vaccine information to accelerate the timeline from a treatment to a vaccine.”
On the other hand, he added that “the more we accelerate, the chances of making a mistake from not having all the information is thrust upon us.” But he believes in Fauci’s prognosis: “You are probably looking at a year to two years, though there are variables you can’t control and it could be longer.”
WILL A VIRUS MUTATION RENDER OUR VACCINE MOOT?
“It doesn’t necessarily render it moot, it may make it more difficult. Because vaccines are developed for a specific virus and a specific protein on that virus, of which there are many, and that is why there are many trials going on. Many of my colleagues are looking at ways to neutralize a virus and develop a vaccine that isn’t dependent on the mutation but can circumvent the mutation. So that’s the big challenge”
THE INTERNATIONAL RACE FOR A VACCINE AND THE IMPLICATIONS OF WINNING
We’ve heard some foreign officials say that they would have a duty to inoculate their own country entirely before sharing a vaccine with other countries, if they were first to develop a vaccine. In a scenario where every day is of the essence, how concerned is Dr. Carmona about this international vaccine race?
“It’s a concern, I wouldn’t say I’m worried. But I’d hope the greater good for the world would prevail and we’d share.” Beyond relying on global altruism, though, Carmona expressed faith that the United States would be first to a vaccine.
“In just about every category of research we are the leader,” he said. “Our National Institute of Health, our CDC, our universities which are largely funded in some of these projects by the federal government are the economic driver for our pharmaceutical industry.”
ON THIS CORONAVIRUS’S DISPARATE EFFECT ON MINORITIES
Dr. Carmona has co-authored a study in the Journal of the American Medical Association which explores the distressing data about COVID-19’s disproportionate instance and fatality rates in minority populations. For example, according to John Hopkins 34% of all coronavirus-related deaths are African-Americans, while they constitute 13% of the U.S. population.
“It became glaringly apparent that blacks and Hispanics were dying at a disproportionate rate” from COVID-19, says Carmona of the impetus for his research. “And then when you drill down into what we call the ‘social determinants of health,’ they are populations that are more than likely to be struggling anyway. And yet we don’t look through that lens often enough.” This includes poor Anglos in Appalachia.
In his paper, Carmona calls for greater logging of racial data in coronavirus cases -- as of early May, just 35% of coronavirus-related deaths in the United States had racial data logged. With this data, new policy and programs can be devised to approach and educate these “more vulnerable communities, so we can reduce morbidity and mortality by preventing these problems.”
ON REOPENING, AND THE BALANCE BETWEEN THE ECONOMY AND EPIDEMIOLOGY:
The prospect of reopening is a hyperlocal concern. While a state like California has a state-wide phased plan for reopening, the governor has given extensive authority to local jurisdictions to fine-tune policy based on regional variance. How does Carmona give advice on how to set this policy? What is the economic value of a human life?
“First and foremost, there is not a single answer. So looking to the federal government to impart some great wisdom to you doesn’t work, because each community is disparately affected … each of our states is acting like a separate country because the disease and economic burden is different, the population density is different, the social determinants of health are different. So to suggest that you could have one answer doesn't make sense. Yet the basic science and policy approaches are the same.”
In making the assessment on a hyperlocal level, “first you have to say what are the variables. Most importantly is what is the instance of the disease in our community? Is the curve still high?” The biggest concern is to regulate the peaks and spread of the virus. Once the curve is flattened, each municipality would face decisions as to tactics, which could include allowing less vulnerable populations to return to work, amongst other options.
“There is risk in anything you do. The goal is to reduce the risk.”
HOW MUCH IS POLITICS SHAPING THE INFORMATION WE ARE GETTING FROM THE WHITE HOUSE?
In 2007, Dr. Carmona testified before Congress speaking about some of the political pressures he felt as Surgeon General that prevented him from sharing the full extent of his research into health crises that were occurring at the time, so he knows what that would look like. How does he feel the White House and the coronavirus task force are doing in disseminating information to the public? Are politics playing a part?
“I think it’s probably the most difficult that I’ve ever seen in my career. Our job as uniformed officers in the United States and reporting to the Commander-In-Chief should always be reporting the truth as we see it: and that is what is the best scientific information available that I can provide to elected officials and the public so they can make decisions that would benefit them.”
He added, “But we should never, ever attempt to suppress the words of truth that may be inconvenient to a given political party.”
Does he think we are getting that truth now?
“I think there’s a problem. I talk to my colleagues in Washington and many of them feel restrained. In fact, some feel intimidated, because they see what happens when they render an opinion that might be contrary to what the President or one of the close-knit people around him say.”
He went on: “We should be thanking these people for their honesty. We should be commending them for providing the appropriate due diligence necessary to run our democracy. And that doesn’t mean you have to accept what they’re saying.”