Dr. Scott Gottlieb on The Future of COVID-19 & How We Can Defeat the Next Pandemic with Scott Wapner of CNBC. Dr. Gottlieb's new book, "Uncontrolled Spread" identifies the reasons why the US was caught unprepared for the pandemic and how the country can improve its strategic planning to prepare for future viral threats.
MODERATOR
SPEAKER
Dr. Scott Gottlieb
23rd Commissioner of the U.S. Food & Drug Administration
Scott Wapner
Host, Fast Money Halftime Report
CNBC
TIMESTAMPS
EPISODE TRANSCRIPT
Scott Wapner: (00:07)
You're the man of the hour. I think everybody owes some debt of gratitude to you for your guidance through this whole thing. I know I do, a lot of journalists who relied on you for information are thankful for that. I wasn't sure, frankly, if we'd be even sitting here. The fact that you're here, we're both sitting here, we don't have masks on, that's like the Good Housekeeping seal of approval of this conference in and of itself, that you're willing to be here in a room with all these people. Are you comfortable?
Dr. Scott Gottlieb: (00:37)
Yeah, I am. Look, the prevalence right now in New York City's low, and this venue's done a good job of creating a safe environment with vaccinations, they've kept people distanced. I think that we're still here in the Northeast due for some surge of infection from the Delta variant. I don't think that we're through it. There's a perception that the sort of bounce that we had in the summer was our Delta wave. I don't think it's quite come yet, but I don't think it's going to be anywhere near as dense as what we saw in the South.
Scott Wapner: (01:04)
So you said something to that effect a couple of weeks ago that I certainly took note of, when you said quote, "I don't think that was the true Delta wave. That was the Delta warning. Our true Delta wave is going to build after Labor Day here in the Northeast. I do think labor day and the return to school are going to be incubators for spread." That's a little worrisome. How bad do you think it's going to get here in the Northeast, now that we're here post-Labor Day and school's started?
Dr. Scott Gottlieb: (01:31)
Well, look, you're seeing it right now. I don't know what people are seeing anecdotally, but you're seeing more infections, more outbreaks in school settings, and so, that's going to continue to build. Right now, we were at, when we sort of peaked out here in New York City, so let's take New York City, we peaked out at about 20 cases per 100,000 people per day when we had that mini Delta surge. Louisiana and Florida peaked out at about 110 to 120 cases per 100,000 per day, considerably more. I wouldn't be surprised if we got to 50 cases per 100,000 per day at some point at our peak, when Delta sweeps through, somewhere between 30 and 50. That's about what North Carolina's at right now. I don't think we're going to get above that. There's so much prior infection, so much immunity acquired through vaccination or previous infection here, I don't think that there's enough people who are susceptible to create the kind of condition we saw in Florida and Texas, but I don't believe we're through this.
Dr. Scott Gottlieb: (02:23)
And the final point, what you saw in the last spring was you saw very dense epidemics in Michigan, we all remember that, and also in Massachusetts, as B.1.1.7 swept through. What happened there was B.1.1.7 got into those areas earlier, and they reopened their schools and then the schools became sources of community spread. So the schools will become sources of spread here in the Northeast as well.
Scott Wapner: (02:50)
You look at the fact we have more Americans hospitalized today than we did a year ago, and it seems insane to me that we're still doing 170,000 cases a day. Should we be alarmed by that? It feels like we've become numb to this whole situation.
Dr. Scott Gottlieb: (03:08)
Well, I think we have defined what success and failure looks like differently over time, and we are somewhat complacent with a very excessive amount of death and disease. I would expect to see cases decline quite quickly at this point. Most of this is being driven by the epidemics in the South, where they let the virus spread largely unfettered, where you had a lot of susceptible populations still, you didn't have high vaccination rates. There's a perception that Florida had very high vaccination rates, but if you look, a lot of it was vaccine tourism. Their vaccination rates probably weren't that much better than other Southern states. So there was still a lot of susceptible communities, and Delta, because it's so contagious, has been very effective at finding pockets of geographic and social compartments that have pockets of vulnerability, getting into those pockets and infecting people, and that's really what you saw happening in the South.
Scott Wapner: (03:57)
You've said that COVID is going to be endemic, right? You wrote in The Atlantic that how endemic COVID becomes a manageable risk. You just wrote this the other day. How do we manage it? What is life, what is the new normal going to look like with COVID as a part of our lives?
Dr. Scott Gottlieb: (04:14)
Well, look, we've been far too complacent about the spread of respiratory diseases in the winter time. We allow influenza to infect and kill far too many people every season, and there's things we could be doing in our daily lives, in workplace settings and school settings that could cut down the risk of flu substantially, and we've seen some of the mitigation we've adopted for COVID has substantially reduced the incidence of flu. I don't think we're going to have the luxury of being complacent about the risk of the spread of respiratory pathogens in the wintertime anymore.
Dr. Scott Gottlieb: (04:40)
We're going to have to put in place a heightened level of vigilance. That doesn't mean shutdowns, it doesn't mean dramatic intrusions into people's daily lives, but it means trying to improve air quality and filtration in buildings. We made buildings green, we sealed them tight. We now have to put hospital grade air filtration in to prevent outbreaks in that setting. It means masks are probably going to become more commonplace, at least on a voluntary basis. I think culturally, we're going to change around masks. It means a lot of workplace settings are going to mandate vaccination for flu and COVID to better protect those environments.
Dr. Scott Gottlieb: (05:09)
It means a lot of businesses are going to make decisions to hold conferences in the fall or in the spring, because they know that winter's going to be peak COVID and flu season. It means business is probably going to look for ways to de-densify offices in the wintertime. Maybe not crowding 30 people into a conference room, but having people sort of Zoom in meetings. Even within the office, the structure and the work function in the office is going to be different, and the idea of going to a holiday party on December 20th and getting 40 people in the back of a restaurant in a room that's equipped to fit 10, I don't think we're going to be doing that.
Dr. Scott Gottlieb: (05:38)
I think we're just going to do things differently, and it doesn't mean our lives change in such a dramatic fashion that we lose a lot of things that we enjoyed and were very important to us, I think we just need to defang this virus and flu as well, because the final point is that if you look at the impact of flu every season, not just in terms of death and disease, but the productivity impact, it's substantial. I mean, the studies that have looked at this are billions of dollars, and sometimes tens of billions of dollars. If you have the twin thread of COVID and flu circulating alongside each other, I think it's going to be too much of an impact on business to sustain the cost of both of those pathogens.
Scott Wapner: (06:15)
It's something that we're going to have to look forward to. There was very big news just this week, and I wanted to get your take on it, because I think everybody who's been vaccinated is thinking about the idea of a booster shot. I don't know if you've had a booster yet, I haven't. I don't know if anybody even in the room has had their booster, but in a study published in The Lancet, which as you know, and most of you may or not know, is sort of the bible of medical journals, or certainly one of them, two prominent FDA experts from the agency that you used to run say, "Most people will not need a booster shot, because the vaccines that we've gotten so far work so well." Do you agree with that? Because there is a debate, I think in the ether of whether you need one, whether you should get one, whether nobody needs one yet, what do you think?
Dr. Scott Gottlieb: (06:59)
Well, look, and there is an open advisory committee today at FDA that's going to be adjudicating this very question-
Scott Wapner: (07:05)
Today?
Dr. Scott Gottlieb: (07:06)
Today, right now. Actually, this week. The data came out today, so it's Friday is the meeting. The data came out today.
Scott Wapner: (07:13)
Okay.
Dr. Scott Gottlieb: (07:13)
But there's going to be data presented by the Israelis and other groups looking at the decline in efficacy that's been observed, particularly in an older population that was vaccinated a long time ago. I think that we're going to arrive at a point where boosters are going to be recommended for some portion of the population. Ultimately, FDA and CDC are the arbiters of this, but in my view, looking at the data, I'm on the board of Pfizer, I've looked at some of the data that they're looking at coming out of Israel, you see a decline in efficacy over time, particularly in an older population for people who were vaccinated back in January and December, so a long interval ago.
Dr. Scott Gottlieb: (07:47)
I think the controversy for public health officials, the sort of main controversy, is the original premise of the vaccines were that they were going to prevent you from getting really sick, being hospitalized, and dying. That premise is still very much intact, even for people who were vaccinated a long time ago, even for older individuals, we're still not seeing a real dramatic increase in hospitalizations and severe disease for people who are vaccinated. What we are seeing is a rise of people who are developing symptomatic disease and infection. That was the second premise of the vaccine, that the vaccines can prevent you from getting any infection at all, and prevent you from spreading the infection.
Dr. Scott Gottlieb: (08:22)
That wasn't our original expectation of the vaccine. When the vaccines were first authorized, the premise was they're going to prevent you from getting really sick. Then we learned, "Wow, these vaccines work even better than we thought. They prevent you from getting any infection and from spreading it." So a lot of public health officials look at that and they say, "Why should we give boosters to the population, when the reason why we made these vaccines available in the first place is still fully intact? Why should we give boosters just to achieve something that was never part of the original premise?"
Dr. Scott Gottlieb: (08:50)
And in the other argument that enters into this, which is entered into that Lancet article is, well, if we boost the American population, we're taking vaccines away from other countries where there's no vaccine at all. I think that second part of the premise is flawed, insofar as this is not a zero sum game. We have already purchased these vaccines, the Biden administration has. There is no way that the Biden administration's going to let go of those vaccines, because they're going to want to hold onto them as a matter of national security, enough vaccine to reinoculate the entire population as a hedge against what we don't know.
Dr. Scott Gottlieb: (09:20)
The reality is, from the global situation, we have a lot of supply, and the challenge that we're going to see emerge very quickly is a problem of distribution. 5.8 billion people have received a vaccine globally, 380 million Americans. So we've given a lot of vaccine already. Now, there's billions of people who still need to be vaccinated, but the challenge of reaching those people isn't going to be a supply challenge. There's going to be literally, maybe tens of billions of doses available over the next 12 months. The challenge is going to be distribution, and frankly, convincing people to take the vaccine. There'll be hesitancy abroad as well.
Scott Wapner: (09:51)
Let's talk about just getting our own citizens as vaccinated as we possibly can, specifically children. One of the greatest days of my life was when I could take my 12 and 15 year old and get them vaccinated, and the relief that that brought. There are people in this room who have kids who are younger than 12, who don't have a vaccine yet. When can they get it?
Dr. Scott Gottlieb: (10:11)
So, just to sort of table set this, to your point, I think a lot of the residual anxiety that people who are vaccinated feel is around children in their households, and the concern that you're going to go out and get COVID, become asymptomatic or mildly symptomatic-
Scott Wapner: (10:26)
Bring it home.
Dr. Scott Gottlieb: (10:26)
... and bring it back into the home. I think a lot of people talk about well, that vaccinated people are overestimating their risk, and I think most people are cognizant that the risk is substantially reduced. What they're worried about is introducing the vaccine into a home setting. Pfizer has said that they'll have data on the vaccine for ages five to 11 at the end of September, and they'll be able to file with FDA for authorization of that vaccine within days, and FDA has said publicly that they expect the review to be a matter of weeks, not months. I interpret that to be FDA signaling that could be a four to six week review.
Dr. Scott Gottlieb: (11:00)
Now, ultimately, FDA has to be an arbiter of the data that the company submits, but if everything goes well, if the data package is good, I have confidence in the company to forward a good data package, and the review goes smoothly, best case scenario, you could see a vaccine available for five to 11 by the end of October. Perhaps it slips into early November, but you could see a vaccine certainly within this year, maybe by Halloween.
Scott Wapner: (11:24)
Also, I often wonder sort of we are where we are, would things be different if we had reacted differently from the beginning? And you do spend a good period of time in your new book, I urge everybody to read it, it's Uncontrolled Spread is the new book by Dr. Scott Gottlieb, Why COVID-19 Crushed Us and How We Can Defeat the Next Pandemic. You write the following: "The federal government started off in a weak position with plans that were ill-suited to countering a coronavirus. This mismatch between the scenarios we drilled for and the reality that we faced, left us unprepared. Poor execution turned it into a public health tragedy." What was the biggest mistake? The most costly thing we did from the beginning?
Dr. Scott Gottlieb: (12:04)
Well, we had a plan on the shelf that we thought was applicable, and that plan was geared towards a pandemic involving influenza, and I don't think we fully appreciated how different this coronavirus was from flu, in terms of how it spread, the kinds of preparations we would need, and we stuck with that flu-based plan for far too long. But I think the other costly mistake was that we had an expectation that CDC was going to be able to operationalize a national response to this, that they had the capacity not just to surface information and guidance in sort of a near real-time fashion that would objectively inform us on how to reduce risk in our daily activities, but that they would actually be able to operationalize the manufacturing deployment of diagnostic testing, help scale up vaccine manufacturing, help deploy mass vaccination in the population. They had no logistical capability.
Dr. Scott Gottlieb: (12:54)
They're a very retrospective organization, they have a retrospective mindset, they're a high science organization. They would much rather gather data and do a deep analysis and tell you in four months how COVID's spreading. Meanwhile, we have to spend the next four months figuring out how to reduce that risk in our lives. What we needed was the equivalent of sort of a JSOC, a Joint Special Operations Command public health response that surfaces information in a real-time fashion, surfaces guidance in a way that it's interpretable and actionable to consumers. We didn't have that organization, and the problem was we thought we did. Everyone said, "The CDC has this," and CDC didn't raise their hand and say, "Hey guys, we really don't have this. We need to create some new entity."
Dr. Scott Gottlieb: (13:38)
The other thing is we just lacked the resiliency. We thought we'd be able to scale the manufacturing, and biologics, and vaccines, and diagnostic tests. We thought we had an ample supply chain for something as simple as a nasal swab used to collect samples. We lacked that capacity to scale the kind of manufacturing we needed to respond to this.
Scott Wapner: (13:55)
You go after the CDC pretty hard. I mean, you have a chapter that's entitled, The CDC Fails, and some of it you... I mean, you do, you wrote that it. Some of it, you almost make the case was deliberate in things that they did to undermine the overall efforts around testing from the get-go, that hurt the country's response. Isn't that true?
Dr. Scott Gottlieb: (14:16)
Well, it wasn't deliberate in a way that it was sort of malfeasance. I think it was deliberate in terms of how the agency operates. So, just to sort of build on that point, they wouldn't share viral samples with any manufacturers. So in order to make a test, if you're Roche, and you want to make a test for COVID, you need an access to a sample of the virus. CDC said, "We're not going to share the viral samples," and then they said to the manufacturers, "If you want to make your own test, you've got to license our intellectual property, because we developed our own tests." So on the one hand, the manufacturers couldn't make their own tests, on the other hand, they had to enter into a protracted negotiation in the setting of a crisis, to license IP from the CDC, in order to make a test. And what did manufacturers do? They sat on the sidelines.
Dr. Scott Gottlieb: (14:57)
So the big manufacturers, the commercial manufacturers that had to get in this game early, all sat on the sidelines, waiting for the CDC to roll out its test. CDC botched the rollout of their test, because they insisted on doing all of the components within the same facility, so they contaminated their tests. They were literally making tests in the same facility they were running samples that they were getting, so lo and behold, the virus jumped from the samples that they were getting, the patient samples, into their manufacturing process, and contaminated all their tests, and that's why we had no testing.
Dr. Scott Gottlieb: (15:27)
The testing void finally got filled when FDA, on its own, turned to a contract manufacturer and said, "We need you to start making what we call primary probe kits," basically the ingredients to a diagnostic test. But early on, someone needed to say, "We need to turn to the commercial manufacturers." This had to happen in January, "Or we're not going to have enough capacity if this becomes epidemic in March." And what happened was we didn't have testing in place, and a lot of our problems, I could trace a lot of the problems that we suffered, both political and public health, back to the fact that we didn't have a diagnostic test early enough to turn over infections.
Scott Wapner: (16:04)
Did people unnecessarily die in this country because of the CDC's lack of action, their, in some cases, ineptitude? Can we say that?
Dr. Scott Gottlieb: (16:15)
Look, people unquestionably died in this country because we didn't have a diagnostic test. There will be people who argue that there were multiple components that were at fault in terms of not being able to operationalize that test. What CDC would say, and I've talked to people at CDC, is they would say, "We couldn't do this. We needed the Secretary of Health and Human Services, someone above us in the political chain to go to private industry and say, 'We need you to get in this game.'" And there's some truth to that, but there was no leadership above CDC, that the political leadership assumed that CDC would be able to do this.
Dr. Scott Gottlieb: (16:48)
But CDC continued to say, "We will be able to do this," and what happened when CDC was having these conference calls, and I talk about in the book, where they would get on a call every week with the whole industry, and with FDA, and the public health community, say, "Another week, we just need another week," and this went on for four weeks, where they just said, "Another week," and everyone was just frozen waiting for CDC to act. So they froze the market in place, and it was at a time when we were becoming heavily seeded, we didn't know it, because we were relying again on the influenza-like illness surveillance systems. So we were relying on data of how many people were showing up with flu-like symptoms and testing negative for flu, and what CDC and others, NIH and others were saying was, "Well, look, we don't really see a spike in people presenting with flu-like symptoms who are testing negative for flu, so it doesn't suggest anything's circulating."
Dr. Scott Gottlieb: (17:34)
But what was happening was flu incidence was collapsing, because people were starting to Purell more and be more careful, so all of a sudden, flu incidence was going down. And if you look at the actual data, it wasn't green. It wasn't red, but it was orange. The number of people who were presenting with flu-like symptoms all through the month of February into hospitals and testing negative for flu, was at the high end of the normal range over a 10 year period. That should not have been reassuring in the setting of what was going on around the world.
Scott Wapner: (18:05)
I read your book, I feel worse than better about what's going to happen next time, because in part of what you say about the CDC, our lack of preparedness, and now we have an environment where you have such discourse within the public. What's it going to be like the next time?
Dr. Scott Gottlieb: (18:24)
Well, look, I think that there's an awareness of these shortcomings. I don't think that these issues around the CDC are controversial anymore. I think the public health crowd doesn't like to have this discussion in public, because they see the CDC as sort of an institution, a public health institution that needs to be kind of protected. But I think the biggest challenge we're going to face is the debate about the role of public health and public health officials in a moment of crisis, because I think there's a lot of people in this country who've lost confidence in the advice that public health officials gave, because it seemed to be shifting, it seemed not to be science-based, at times, it seemed to be arbitrary, and it's not just right, left, this isn't just a political discussion.
Dr. Scott Gottlieb: (19:00)
I think that a lot of Americans say, "Why did the guidance on masks shift so much?" And the best example of this was the six feet, the requirement they have to stay six feet apart. The single costliest piece of guidance issued in this whole pandemic was that you had to remain six feet apart. Most schools remain shut because of that guidance, because they didn't have the physical infrastructure to keep students six feet apart. Where did that come from? CDC actually initially proposed 10 feet, but a political appointee in the White House, in the Office of Management and Budget, at the outset said, "There's no way we can tell the public they have to stay 10 feet apart. People can't even measure it." So CDC compromised with the White House around six feet, and the six feet-
Scott Wapner: (19:37)
Did they pick six feet out of a hat?
Dr. Scott Gottlieb: (19:39)
Well, it was derived from old studies looking at flu and how far droplets spread in the setting of flu, but we also knew at this point that COVID was probably spreading through aerosols, and wasn't spreading through droplets. Now, imagine if that anecdote had come out back in March of, this was 2019... Actually, 2020.
Scott Wapner: (19:57)
2020.
Dr. Scott Gottlieb: (19:58)
People would've said, "That's political interference in the CDC's process. How dare the White House tell them that they can't have six feet, if they're asking for 10 feet," yet, we now know six feet was arbitrary. CDC subsequently changed to three feet when the Biden administration rightly wanted to open schools in the spring, and they knew that the single impediment to opening schools was the requirement to keep kids six feet apart. And so, CDC said, "We have this study from the fall, we did a study and we showed that if two people with masks on are three feet apart, you reduce transmission by 70%. So on the basis of that study, we can now readjudicate the six foot requirement." They ultimately went to set three feet, if people had masks, which begs the question, if they had that study for six months, why'd they wait until the spring to change their guidance, on the basis of evidence they had in the fall?
Dr. Scott Gottlieb: (20:51)
So when you hear things like that, it makes you feel like the process is arbitrary, and it's not as objective and science-based as it should be, and also, the CDC doesn't actually put out an explanation of how they reached their conclusion. So if you all want to go online and see how did the CDC come up with six feet, it's not explained anywhere. So that saps confidence, and I think the first challenge we're going to face is getting over the public's skepticism of public health officials, and trying to restore the role of public health officials in adjudicating these things in the setting of a crisis, because I think they have to have a role. I think there's a lot of skepticism right now in the public.
Scott Wapner: (21:32)
Well, I mean, you're right. If the public refuses to follow guidance in a public health crisis, if there's widespread opposition or protest, it becomes difficult or even impossible to advance additional measures to take strong actions. That's exactly what we witnessed during COVID. I do want to discuss with you the miracle of the vaccines, because it is nothing short of that, both from Pfizer and BioNTech, and of course, you sit on the Pfizer board. You write something in the book that just blew me away about the power of science and what these companies were able to do. You say, "Moderna never had the actual coronavirus on its premises. It never needed a sample, just the computational sequence of the virus's RNA. Once Moderna got the sequence, the entire process to construct a candidate vaccine took just two days, and in six weeks, Moderna went from having the sequence in their computers to beginning the manufacture of a vaccine to start human testing." That is remarkable.
Dr. Scott Gottlieb: (22:30)
Right. Look, we crossed a technological inflection point with these vaccines, and with COVID generally, in that we were able to drive therapeutics fully synthetically. Not just the vaccines, not just the J & J vaccine, and the Pfizer vaccine, and Moderna vaccine, but also the antibody drugs also would drive through synthetic tools. What I mean by that is using just information and genomic information to derive the initial constructs for these drugs. If this had been three years ago, we would've made vaccines by finding a cell culture that this virus can grow in efficiently, growing up a lot of the virus, inactivating it, cleaving off its surface proteins, and putting those proteins in a syringe. That's exactly how the Chinese made their vaccines, which aren't that effective, and that's how we make flu vaccine.
Dr. Scott Gottlieb: (23:14)
If this had been five years from now, the methods we use right now to come up with these vaccine constructs probably would've been mainstream, but we were right at that inflection point, and that allowed us to pivot towards the construction of highly effective vaccine constructs and drug constructs very quickly, because we were at this technological inflection point. Now, that technology has now been pretty well validated in the setting of COVID. So I think you're going to see a whole plethora of vaccines and therapeutics start to be developed based on these platforms, but we were straddling two scientific states of fitness, and in a way, this happened at a time that we had the capability to do this because a couple of years before, we would never have been able to do this.
Scott Wapner: (23:55)
It's truly remarkable. Let's conclude with a passage that you conclude your book with, and I'd like you to reflect on it. "Learning from what went wrong," you write, "We have a chance to build a safer future. COVID was the worst pandemic in modern times, it won't be the last. Weak leadership exacerbated the pandemic's toll, but even with a stronger and more coordinated federal response, we were poorly prepared for this threat. COVID crushed us as a result, and left our society permanently altered. What we learn from it and how we change will determine if we are better prepared for the next pandemic, or whether we just remain just as vulnerable." What's it going to be?
Dr. Scott Gottlieb: (24:34)
Well, look, I think we're going to need to look at public health preparedness through a lens of national security, and when you're looking at it through that orientation, you start to plan differently, not just what we do domestically, but what we do overseas. Overseas, we were excessively dependent upon multilateral commitments from different nations, people coming together in the world, health organizations holding hands and making promises that they were going to share information. We've seen time and time again, that failed.
Dr. Scott Gottlieb: (24:57)
So we're going to have to get our clandestine services far more engaged in trying to guard against these threats. We're going to have to look at how we build resiliency into our domestic capacity to do things like scale up manufacturing of drugs, of diagnostics differently, and not just have some of these industries built for maximal efficiency, but also maximal resiliency. And the federal government's going to have to offset some of that, the cost of doing that. I'll give you one quick anecdote.
Dr. Scott Gottlieb: (25:22)
After Hurricane Maria devastated Puerto Rico, I was FDA commissioner at the time, I called around all the CEOs who had manufacturing facilities on the island. Fully 10% of all the drugs used in the United States were manufactured in Puerto Rico. They were all offline, every company, with the exception one. I got to Bob Bradway, the CEO of Amgen, and I asked Bob, I said, "How's your facility?" And he basically proceeded to describe the most hardened facility I'd ever heard of. He had generators to back up his generators, enough fuel on hand to keep them going for months. I concluded that if there was ever a nuclear war, the only thing that would be left would be cockroaches and Neupogen, because he was making Neupogen in that facility. And I asked him why he had built such a hardened facility and he said, "We made an implicit guarantee to the federal government that there would never be an interruption in the supply of Neupogen."
Dr. Scott Gottlieb: (26:06)
Neupogen is a drug used for a lot of different things, including chemotherapy, but it would also be a drug that would be essential in the setting of a radiological attack to help rescue people whose bone marrow was poisoned by radiation. So the federal government made a strategic decision that they were going to build hardened sites around a nation to make sure there was never any interruption. They were going to pay Amgen implicitly for that guarantee. We need to decide what are the strategic capabilities that we need, and we're going to need to subsidize it, and we can't just keep it warm, we have to keep it hot.
Scott Wapner: (26:36)
He is Dr. Gottlieb. His book is Uncontrolled Spread. I urge you to read it. Thank you again for your service.
Dr. Scott Gottlieb: (26:42)
Thanks a lot.