Voices of HHS

Michael Caputo: Hello and welcome back to Learning Curve. My name is Michael Caputo. I'm assistant secretary for Public Affairs here at the United States Department of Health and Human Services. Learning Curve is a podcast designed to introduce you to the people here at Health and Human Services, who are deeply involved in the COVID response, as well as many other important health issues.

And one by one, I'm introducing the people who have taught me everything I know about this since the day I arrived now months ago. It feels like a day ago. I think I've had one day of sleep since I got here. But I want to introduce you today to Eric Hargan, who is the United States deputy secretary of Health and Human Services. And dep sec, this is not your first time in this rodeo, is it?

Eric Hargan: No, no. I was here as my second term duty at the department. First was under President Bush and now it's under President Trump. So, both times though I sat at Health and Human Services.

MC: And both times as deputy secretary?

EH: I ended as acting deputy secretary last time, and then as confirmed deputy secretary this time, and acting secretary for four months right at the beginning of my tenure here.

MC: Right.

EH: So, yeah, both I'm in the same chair in the same office in the same building in the same department as I was before.

MC: And here you are in a big city of Washington, D.C. But you're not a city guy, right? You're from Mounds, Illinois. That -- I've never heard of it.

EH: Yes.

MC: But I understand that's practically Missouri.

EH: Yeah, it's practically Missouri, practically Kentucky. Kind of they're at the tip of Illinois, right where the Mississippi and Ohio meet. I am from -- actually not from the big town of Mounds, which has about 800 people, but actually a farm outside with gravel road, the whole thing.

MC: Big town Mounds.

EH: Yes, exactly. They had stoplights, grocery stores, the whole thing.

MC: Would you -- you left the country and off to go to Harvard and Columbia.

EH: Yeah.

MC: Yeah. How did you -- how did that guy -- a kid from Mounds end up in -- at Harvard?

EH: Well, you know, I grew up in a family that really treasured that. My parents really encouraged that education from when I was a little kid. My dad early on, he had a friend who was an engineer at the VFW post that he took me to many, many days. He's VFW commander for a while, county commissioner, sort of a local political figure.

And one of the engineers who would sit there, he would quiz me. You know, he would have -- be at the bar and I would be hanging out with my dad going back and forth doing whatever it was. And he said to my parents one time, he said, "He's -- this kid is really smart. He could go to Harvard someday." That was when I was, like, five, right? And, of course, who would know in Mounds that I was going to end up at Harvard or anything like that.

But my parents kind of treasured that up and kind of kept encouraging me to do that. You know, they would -- they really got us started on a gifted and talented program at our local school. Just, you know, my dad got on the school board. There was a lot of things that my parents did to really encourage me and my sisters to get education. And so, that was kind of foundational pieces. It's like many people, it's my parents.

MC: So, Boston and then off to New York City for Columbia Law.

EH: Right.

MC: Right? How did you end up in the swamp here in Washington, D.C.?

EH: Yeah. Well, you know, there was almost foredestined in many ways. My -- I grew up -- my mother was an x-ray tech at our local hospital, 58 years, 1953 to 2011. And so, I grew up underfoot in a rural hospital, so around the areas of healthcare. And actually, my family goes back five generations in healthcare, back to Doc Hargan in the late 1800s. Same county, Pulaski County Illinois, going visiting his patients by horse and buggy and rowboat across the Ohio. He had patients across the Ohio and Kentucky, and he and his wife would row across and see the patients. So, really, we go back very far in kind of healthcare around and about in my family.

And my dad served as local county commissioner, you know, union shop steward, and a lot of other things locally. So, I kind of grew up both in kind of public service and politics from my dad's side and my mother side healthcare. And so, it was almost kind of HHS. And coming to Washington was almost like a -- almost like destiny for me to be involved in healthcare and politics.

MC: Well, what does the deputy secretary of HHS do? I mean, people know Secretary Azar a bit, especially during the COVID response, you know, and some of the scientists and doctors here or out there. The deputy secretary carries quite a load, don't you?

EH: Yeah. Well, you're the chief operating officer of the department and chief regulatory officer. So, everything dealing with, like, the budget, which is you know, $1.3 trillion and counting. So, dealing with 80,000 employees, the operations, and policy development, and regulatory system of this place that oversees it. Enormous number of different functions from Medicare and Medicaid to the FDA to CDC.

MC: It's in the midst of a pandemic or at the beginning of a pandemic, you had 80,000 employees to worry about. What was it like to send 80,000 people home with enough equipment to do their job telecommuting?

EH: I mean, that was one of the huge challenges was -- and in fact, the -- one of the things that people may not know that very weekend when we were preparing to send people home, in other words tens of thousands of employees to really get them telecommuting, we were hit with an enormous attack from overseas on our computer system.

MC: Really?

EH: We had the other largest attack -- people tell me it's the largest attack that people have witnessed sort of in internet history. It was launched on our computers. And it continued for some weeks. And there's -- the fiercest to that was in mid-March when we were doing telecommuting. I think it was fortunate in a sense that we've made the decision to do that. And so, our entire computer and IT staff was here working and preparing for the transition right when the attack happened. But those were some very late and sleepless nights.

MC: I bet. And then of course, immediately the Coronavirus Task Force takes root here at -- in the hunker building in HHS. And so, that basically you're working with all the doctors and scientists in one room trying to organize a response. What was that like?

EH: Well, you know, I have been here under President Bush in some fairly trying times. Hurricane Katrina would be an example. And we had gone through things like this before like the avian flu that took place and the responses. You know, I came here after 9/11 and there was a lot to be done in the wake of that. It's very different time.

And so, you kind of to draw on those experiences, but this really was -- took that and put it pretty much on jets. I mean, it was a completely --

MC: A hundred Katrinas.

EH: Exactly.

MC: And more, growing.

EH: Exactly. Yeah. I mean, it's a nationwide pandemic, so you're really dealing with something that isn't a localized. But terrible thing like Katrina and the success for hurricanes were at the time, or even then the ones that we suffered through early in this administration, Harvey, Irma, and Maria, that hit -- three different hurricanes hit different parts of the Southeast and Puerto Rico in the Caribbean at the same time just after one another. No, completely different thing. But it was mobilizing the entire department in one place. So, it was a great amount of collaboration and cooperation. A lot of people, I think, left their egos at the door, particularly early on, to get a lot of things done early on.

And there were challenges. Everyone saw them. They're in plain sight in many ways, right, because it's been very transparent what we're doing. I don't think people truly appreciate that. They're always looking for kind of conspiracies in the halls of government.

MC: Right.

EH: And in -- and I've had to tell people when they -- relatives and friends of mine from back home when they say, like, "Well, why should we trust the information?" I said, "I have to say you should trust us." I said, "That's an unusual person from my political background to say trust us," but it's -- I was literally just telling somebody today, I said, "There's very little gap between what I hear internally and what we put out there in terms of information in the data." We're trying to get the information out there as accurately and honestly as we can, so people can plan. So they have a way of dealing with the reality that we're dealing with this pandemic.

So, I think that's, that's been a gratifying part of it. There had been challenges all on from an implementational point of view, but really you're dealing with a once in a century pandemic. It would surprise me if there weren't places along the way where there were bare patches and things that we have to go back and revise and revisit. That wouldn't surprise me. I don't think it should surprise anyone. But overall, I mean, the department in -- done such a great job in many ways. You look at some of the achievements that have happened here and you see just what's going on right now with the Operation Warp Speed with just an absolutely that -- as I think Fauci said, "Fastest in the history of vaccinology."

MC: Right.

EH: There's your 10-cent word for the day, vaccinology.

MC: Vaccinology.

EH: Exactly. So, you know, you get that that we're moving so quickly and not just world class, I don't think we've ever seen this before, the amount of success so far, knock on wood, that we're having to get the vaccine, the therapeutic started up here. It's just been really fantastic. You see some of, if not, the greatest minds in medicine and science working at their highest and best to prepare this for the country.

MC: I know I've -- I don't think I've told you this. A lot of people don't know this about me, but I've worked in hurricane recovery since Katrina, every hurricane in the United States since Katrina, working on the victim side. And people know FEMA is involved. People know that FEMA has a leadership role, but they don't know. I mean, honest to God, it wasn't until I was in that, you know, kind of business for eight, nine years until I actually met, you know, my first HHS person. And really, HHS has a really big role in storm recovery and things like that. It's the health and the human services side.

EH: Right. And it's both really. I mean, people need both. They need both, right, when it's -- right, when things are coming right afterwards, and then rebuilding afterwards. It's all these things, because that's when people kind of need the help the most. And it's right when HHS is there that it's most important to have the federal role there. Because many times the local systems, you know, say in Katrina have just been smashed or obliterated, and to have that help from outside is what's absolutely necessary.

But it's often behind the scenes because, you know, FEMA and other agencies are more front and center to it. But backing things up with the stockpile and all the other things, the Strategic National Stockpile that we have here at the department and all of the many other resources that we can put together, teams of doctors and nurses, volunteers, or federal employees that come together to work sometimes for months on end outside of their normal jobs and away from their families and their loved ones, to help people out, to help their fellow Americans out. That's also one of the most gratifying things about this is to see how many people come together when these disasters strike.

MC: This time last year my family and I were in Puerto Rico working on the recovery from a hurricane that happened two years before. And there were HHS and FEMA people on the ground there.

EH: Yeah.

MC: Public health service people on the ground there still two years later. After Katrina, it was even longer. But the one thing I was interested to see when I first arrived here after the pandemic had begun is how closely FEMA and HHS work during these kinds of events. I mean, sharing offices and desks and coordinating in meetings from the -- you know, before daylight until late, late, late at night, you -- you know, you -- us we work very closely with FEMA, don't we?

EH: Yes. And we -- this was one of the things that worked hardest on when I was here under President Bush. A lot of the functions that we have now were really stood up under the Bush administration here at HHS. What is now called ASPR, the Assistant Secretary for Preparedness Response, that agency that does the stockpile that has all the a lot of the biomedical advanced research and development that we're relying on right now and a lot of the coordination done with FEMA is done through ASPR as well as CDC.

But ASPR was new. At the time it was actually called the Office of Public Health Emergency Preparedness. That's what it was when I was here before. And we stood that up, stood up BARDA and really worked through a lot of the issues under Secretary Thompson and then Secretary Leavitt. Worked through a lot of those issues, including a lot of the foundational things that we're relying on right now. A lot of the response plans that had their first iterations, their first drafts that we worked through in terms of pandemic influenza, that were really relied upon in coronavirus response as well.

The foundations were laid there, but it -- because we had what's called PAHPA, the Pandemic All Hazards Preparedness Act, by Project BioShield, Bioterrorism Act, a lot of the things that came out of that time in the wake of 9/11 and the hospital preparedness program that billions of dollars had been put in, but the tracks were laid down in those days, when there wasn't the kind of coordination and the kind of outreach and inreach done between the states and localities and the federal government on these kinds of issues.

That there -- that I can see the differences now compared to the differences then when I saw what was going on then and remember that, you know, and see what happened this time to see a much better, more efficient response that happened. And I think people tend to overlook that. You know, for pointing out flaws is to realize that a lot of things went better now than they used to go.

MC: Well, one of the things I remember from the earliest days of working on hurricane responses and people critics especially say, government always gets it wrong immediately after a storm or maybe immediately after a pandemic until they get it right. Because every storm is different. Every hurricane is different. Every place the hurricane makes landfall is different. And by the way, if we are having a hundred-plus Katrinas right now, every city that has a plume of virus is different. And so, we're learning from these things as we go along. I think that the lessons are really important. What kind of lessons do you take from, let's say, the earliest days of the virus that you find very important today now six months in?

EH: Well, I think what has been important in a lot of ways is how the early framing of how we were going to approach this is very different in the sense that we are partnering very closely with the private sector, instead of doing just a government only approach, which is a temptation for government always is to kind of draw on its own resources, to kind of sort of pull up the drawbridge, and do things the way that you know how to do them. Instead, there's been an openness to private sector involvement that I think has been -- has borne a ton of fruit all the way along. I think it's been -- that's been one of the good things is the openness, I think, to the outside world --

MC: Right.

EH: -- to do things. There's this emphasis on collaboration. What we've been calling, like, a whole of America approach, and that sounds like -- it's a slogan, but it's also actually the truth that we've been -- we've decentralized the response, instead of it being centralized into one decision maker who makes all the decisions. You decentralize those decisions to the state and local government leaders who can see what's happening on the ground better. And you do the things best that you're best at doing, surveilling, research and development, communicating, providing guidance.

A lot of the backups like the stock -- Strategic National Stockpile, to the efforts that are going on locally, and you try to perform that function. That I think has been good and the deregulation that the department undertook, at least at HHS, to kind of loosen up a lot of the regulatory areas that had kind of been pinching. That is -- that's led to say the explosion of telemedicine nationwide. You know, we've had over a hundred times -- went from 11,000 beneficiaries at the end of the first week of March to 650,000 at the end of the first week of April --

MC: And that's not going away is it, telemedicine?

EH: No, it's not. But see, that took both our Medicare and Medicaid agency, CMS, to have some regulatory -- move immediately to regulatory changes that loosen that up, helped pay for it, provided regulatory relief on people who provide it. Our HIPAA people made it so you can use every day programs to do it. Our inspector general sort of said, you know, for the duration of the emergency, they can -- sort of they gave some flexibilities in theirs.

Together moving those things quickly meant that people had access to health care that they wouldn't have otherwise had because they were scared to go into their doctor's offices. They were scared to go to their hospitals, but they needed health care. So, we were able to move really quickly early to provide those kind of flexibilities and enable people to get access, safe access to care nationally.

Those are the kinds of, like, immediate pickups that you look at you go, like, "That was a lesson learned. That was a good lesson learned." And in fact, it's one of the silver linings in all this is the fact that we've accelerated the development of so much technology and so much innovation, whether it's at the technological kind of whiz bang area, but also the system's innovation. How do people deal with each other? Both of those elements have been really accelerated in this country under pressure, pressure we wish we didn't have, right, the viral outbreak that we really wish we didn't have but which has driven the pace of change in a way that I think we're going to -- we will long term benefit in that way from this. You hate to say that there's any benefits out of something.

MC: Right.

EH: No one wants that benefit to have been encouraged. But nevertheless, there we are.

MC: That's really hard to even imagine a time before COVID at this point for, I think, for a lot of America. Americans who have lost their jobs, have lost family members. It's hard to imagine life before the time you were locked in your house and your business closed down, and your favorite restaurant is gone. It's hard to even imagine that. But you were really -- you were here before.

EH: Right.

MC: You were working on some of the President's most important initiatives, like for example, values-based care -- value-based care. Can you explain what value-based care is to the listeners? Because you've already kind of touched on it?

EH: Yeah. Well, value-based care is the effort to provide value to people in healthcare. You know, people are always kind of knocking U.S. healthcare it's too expensive. It doesn't deliver the kind of results that people wanted to have. A difference some ways with both of those areas that are at a kind of a technical level, but basically it means getting better care for less, right? That means that should get you -- people should pay less for their health care. They should have higher quality health care, and so you get more for less. That's value based in a really real nutshell. So, part of it is the financing side. So, we've been working on reforming the financing of care. Part of it is getting better value, delivering better value for that care so that patients get better care and kind of specific impactful areas that we think we can kind of move the needle.

So, like, for example, kidney health where the President, you know, found a place where there was a serious lack of improvement over decades in kidney care. And it's kind of driving us towards serious improvements in this area that affects millions and millions of people. And that with some serious focus on it can result in changes, betterment for people in one particular area. So, it's kind of broad changes to financing, broad changes in delivering value, and then some specific targeted areas where you can really move the needle.

MC: You mentioned the important role of deregulation has played in the coronavirus response.

EH: Yeah.

MC: But in reality -- I remember on the campaign in 2016, the President talking about deregulation has been a cornerstone in the presidency he won -- the presidency that he wanted. And in fact, it's one of the things I know that the President is really enthusiastic about.

So, much of what's been accomplished here during the pandemic has been based on deregulation. But you when we first met, you talked to me about how deregulation is really -- just very similarly to the President, deregulation is your passion.

EH: Yes.

MC: It must be very interesting to sit in your role to be the chief operating officer of the largest department in the American government, which is just absolutely overrun by regulations to sit there and have your passion be something that is absolutely necessary all around you.

EH: Yeah, I mean it's, like, once in a lifetime to be having a president, a businessman, who really understands the way in which regulation can -- when it's not well done, can really gum up the works for everyone. And somebody who understands it to the ground like that as a businessman who's lived with it for decades, and then calls it out inside government when he's president and kind of be here at that time when it's something from my point of view who, like, was, you know, deputy general counsel for regulations under President Bush. I was the regulatory policy officer of the department at the time. I started my time as acting dep sec. And then came back as the chief regulatory officer here with an intervening time as a professor of administrative law and healthcare regulations in Chicago, intervening in the middle. So, this is really part of my life for many, many years.

So, to be here at this time when we have the direction from the top to do this, to be in an area in which regulations carry a lot of weight, it's an area in which it's overlaid with a lot of regulatory, I'd say, incrustation barnacles on the kind of the ship of healthcare that, you know, we're nowhere near the hole in this. We could take off barnacles over and over again, and we wouldn't get anywhere near the hull of the ship at this point.

But, you know, some of the things that I kind of came here to do is to achieve that. And we had two years in a row, the first two years of the Trump administration, HHS was the number one deregulatory department in the federal government. We delivered over half of the savings that were done in the federal government. Not as the largest department but we over performed as well in terms of in terms of deregulation. So, that's a point of pride for me. That took a lot of work on the part of our agencies and our agency heads to be able to do that, to be able to lead that change from the instinct that is in government always, which is to provide more regulation. To be able to work -- to work counter to that, to be able to look intelligently at the regulations and say, "Here's what can be relieved. Here's what can be reformed," and to work at that because it takes time. It's time consuming. It's attention consuming. It's detailed.

But people have responded so well to this call that I think we'll be looking on that as kind of a permanent legacy of this administration, at least I hope we will. And, you know, the patients themselves, we hope -- I think I could say now are going to benefit from this. Both the healthcare sector and the patients ultimately benefit by this. They're going to get more access. They're going to get, like, lower cost and better care overall. And we're able -- people are able to coordinate better. People are able to deal with each other with that, a lot of the unnecessary regulatory burden. It's going to do better for everyone.

MC: I had no idea until I read --by the way, a prolific writer, you're published all the time and I had no idea until I read your op-ed on Taiwan and the World Health Organization that -- That I was really surprised to find out that you lived in Taiwan.

EH: Yup.

MC: What was that must have been?

EH: Yeah.

MC: I mean, how does that inform you now where you sit?

EH: Well, you know, Taiwan was -- when I was in college, I had -- I decided I was -- I'd been working as a work-study at Harvard so I had to work a certain amount of hours a week and I got a tax refund check. And I decided I'd taken a year of Chinese just to fulfill my language requirement. I decided, you know, what I want to learn more. So, I decided I would take the summer off, go to Taiwan. And it was a huge, important summer for me personally. It made me much more self-reliant.

I went there at 19 and didn't know anyone, didn't have a place to stay, didn't have anywhere to work. I got jobs teaching English at the local language academies to Chinese children and some Chinese businessmen who didn't -- who need to communicate with their sometimes American leadership over the United States. Kind of found a place to stay at a youth hostel and made my way for the first time in my life. So, Taiwan is a very, like, important part of my life, frankly. And so, I have a lot of affection for it, but it was a -- it was kind of -- it was a life-changing time being able to navigate from myself, teach English, study Chinese, get to know a new culture, a new country really for the first time. So, it was a great part of my memories.

MC: Well, not just memories though but you're -- now, you know, this year you've dealt -- I mean, certainly, the last time you were here, you were dealing with the World Health Organization.

EH: Yeah.

MC: You were dealing with the World Health Organization during the first couple years of this administration and then wham, the pandemic hits. And you're dealing with the World Health Organization as the chief operating officer of the department that coordinates that membership. And Taiwan is at the center of some of the biggest criticisms of the World Health Organization, isn't it?

EH: Yes. Unfortunately, the WHO has such a great history and it has such a great mission. And unfortunately, for it -- unfortunately, for all of us, they have left Taiwan out of it, a high achieving country. A country that's done very well in the pandemic. And WHO for its own reasons, and I think we can guess, decided to side against Taiwan and --

MC: Exclude them.

EH: -- exclude them. And when you think about it, a virus doesn't really know boundaries. There's no point in excluding a country for political considerations from discussions on healthcare. Healthcare is one area where you should leave that kind of thing at the door. You know, you should not be discussing that, especially when you have a country that, as I say, has done very well in its response here. There could be lessons learned. They don't just have to be lessons learned by the United States because we're willing to talk to them and learn from them --

MC: Right.

EH: -- which I have been, and we have been, but it should be everyone. And they can provide so much insight into what happened in China.

MC: Right.

EH: Remember, they're -- they speak the language. They're right there next to them. They have tons of ties to mainland China and to kind of, sort of leave that off to one side, it's --

MC: It seems incomplete.

EH: It's incomplete. It's not what their instinct should have been. Their instinct should have been, we're going to talk to Taiwan. We're going to learn from Taiwan. We're going to interact with Taiwanese doctors and health officials. We're going to learn everything we can from them and what they know. And that was just an instinct that they should have had, they didn't have it.

And as I say, I have respect for their history. I have respect for their mission. I worked with them closely here. I was a commissioner on one of their commissions of the WHO. We got a lot of things done. We got public-private partnerships put in for the first time for general global public health and WHO agreed to that. They do in their way they -- they're open to new ideas, but in this area, unfortunately, we saw them fall down and, you know, people sometimes make a political issue out of that.

Everyone comes under scrutiny in a situation like this. HHS no less than anyone else. We will be doing lessons learned and we should about how we responded. Everyone should; so should WHO. They're not immune to scrutiny and criticism. And this is an area and some of the areas where they didn't communicate as well, as quickly, as thoughtfully. Didn't react the right way. That's an area where they're going to have to understand that they're going to come under criticism even from people who, you know, could be their friends, have been their friends.

MC: We're talking to the United States Deputy Secretary of Health and Human Services, Eric Hargan. This is Michael Caputo. I'm an assistant secretary for Public Affairs at HHS, you know. We're leaving WHO and all the debate running up to that.

EH: Yeah.

MC: That was -- it was divisive, wasn't it? I mean, there was -- it was a real battle even among ourselves here, not just HHS but in government across the United States government. There are a lot of opinions and a real battle of ideas, wasn't it?

EH: Yeah. There were in here. But, you know, at the end, there needs to be a wakeup call for WHO about this issue. And I think that in many ways, some of this has been building for some time and, you know, there are -- but, you know, at the end of it, the -- we are leaving the WHO. And I think that will be a time for them to reflect on who has been their largest benefactor leaving them.

MC: [affirmative]

EH: And I hope that -- you know, this will lead to some far-reaching reforms on the part of WHO. I say that as a person, you know, in the U.S. government, and I hope they do better. I mean, I really do. And I hope that honestly, I think that they could serve a very well-functioning role they have in the past. We've dealt with them before in a very constructive way but there needed to be some honesty about what was happening and what had happened, and the President called that out.

MC: I think it's interesting when -- you know, I come from the conservative side of things, and I know a lot of you know conservative activists, conservative organizations. I've been moving in and out of them for 30 plus years and the first thing -- you know, you ask somebody in the conservative movement. WHO and the HHS is conservative that you can rely upon as someone who would deregulate and try to move the ball toward a more, you know, kind of citizen-centered society. There were of course, say, secretary or a czar, but your name comes up pretty quickly. And it's really -- I want to go back to the battle of ideas.

So, I came up in this game with our former Congressman Jack Kemp, the late Jack Kemp and I worked on his presidential campaign. He was my congressman. He was my quarterback. I'm a Bill's fan. And you know Kemp. I mean, you came up. You're a couple of years younger than me, but you're right there in the movement, the conservative movement. And he used to -- I mentioned earlier, the battle of ideas. Like, Congressman Kemp would actually assign the same duty to two different people and not tell them. And then when it came time for, for example, speech prep, two people would come in with the same speech and make it battle it out. And the strongest idea was in his heart -- he thought the strongest idea that would win, would win.

And people look at the doctors and the scientists who were involved in the coronavirus response. Most of them -- almost all of them let's say, you know, Dr. Birx who's from the White House and state, they come from HHS. It might be the National Institutes of Health with Dr. Francis Collins. It might be NIAID with Dr. Tony Fauci. It might be the Centers for Disease Control and Prevention with Dr. Robert Redfield. You have the Surgeon General, Dr. Jerome Adams. You have the Assistant Secretary for Health, Admiral Giroir. The -- I'm telling you, I've gotten to know all these guys not as well as you know them, but these are all very strong personalities.

EH: Yes.

MC: And when they sit down in the coronavirus task force, when they sat down when you were first involved here in this building, it's a battle, isn't it? These people -- scientists don't agree until they agree.

EH: That's right. And I think that that's been part of what we've seen out in public is that we're seeing science happening in public. That you see these intelligent, well-educated doctors and scientists who are dealing with what is, as we say, a novel coronavirus. They're dealing with something new and what you're seeing is that the entire community. Now, these are leaders here in the federal government and these are leaders in the scientific community, and you're seeing those differences of opinion that are being hashed out. And while people may go like, "I just want one answer." The public may say, "They're made -- if they're made nervous by the differences of opinion, they should be made more nervous if we had a unitary opinion."

MC: Right.

EH: That if we weren't having those honest differences of opinion and coming to conclusions through that, through an honest scientific debate, that should have been -- that should be more alarming if all you see is like a single unitary answer that just appears out of nowhere because that's not what's happening. That's not -- and I think it's -- to me, it's refreshing. It sounds -- it's messy. It's, you know -- it takes time.

MC: Science is messy.

EH: It's -- science is messy. It's messy. It's -- it takes time, and people have differences of opinion. They should have differences of opinion. They shouldn't, you know -- and they come from different perspectives, different areas of expertise. And they're -- as they gradually -- we come to an understanding of this thing that's playing out.

MC: Right.

EH: And you see how that's turning into progress in terms of the vaccines, progress in terms of the therapeutics and the diagnostics. It's happening quickly because people are able to honestly have these differences of opinion, hash them out, and then go forward. And so, I think that that's -- to my mind, that's a good thing is to see that in public even for myself as a nondoctor, nonscientist, but somebody who is been involved in these things for years and years. At this point, I think that that's a healthy part of our system and it's part of really the genius of the country.

MC: And yet the media quality -- Dr. Fauci says something that disagrees with the President of the United States and it is headlines. It's crazy out there, right? Dr. Redfield says something that disagrees with the President of the United States. It's the lead item on a CNN or Fox show. And I just don't understand because I've always thought the battle of ideas required opposing viewpoints.

EH: Requires ideas.

MC: It does.

EH: It requires ideas. Not all ideas require ideas.

MC: And the President appreciates all their ideas.

EH: Yes.

MC: I'm not -- I've watched it; you've watched it. You're coordinating it.

EH: Yes.

MC: The President listens to all of them.

EH: Yes.

MC: He does. And it's -- to me, it makes me -- it upsets me to see when Dr. Giroir says something about testing that doesn't exactly match what's coming out of the Oval Office. It's put out there as some kind of a flaw in the coronavirus response.

EH: I mean, people think that what's a bug, it's a feature, right? It's not a bug, it's a feature as they say, right?

MC: Right.

EH: That you have this disagreement, and I think people -- there are certain people that just kind of want a simple answer to everything. And they want a simple debate, and a black and white, and this is right and that's wrong. And they don't understand how kind of the process goes among intelligent, educated adults --

MC: [affirmative]

EH: -- who are trying to deal with a new situation. That you get more information, you change slightly, right? Hopefully, you don't get something completely backwards at the very beginning but that's the process of rationality. That's the process of democracy. That's the process of the battle of ideas. That's how it should be. And yeah, so something's a little bit off for somebody who doesn't say something exactly the right way. Well, these aren't robots. These are flesh and blood people.

MC: Right.

EH: You know, they're leaders in their area. They're experts—decades experts steeped in these things.

MC: And each one of them are very different.

EH: And each different.

MC: You know.

EH: Each coming from a different perspective, not wildly different. They're not you know -- we're not dealing with something crazy differences because there is a body of knowledge that people depend upon. But dealing with something new, you should expect this to happen. In some ways, you should want it to happen and not reach for the early, easy answers, black and white, and stick to it.

MC: You think of Dr. Adams who comes from a farm himself and actually grew up in, you know, a rather middle to low-income family.

EH: [affirmative]

MC: You think of Dr. Giroir, Brett Giroir who comes from Louisiana, darn close to New Orleans. And then you think of Tony Fauci who comes from Brooklyn but spent the last 50 years in Washington. And the clash of those ideas. I think in the regionality of, you know, where they come from, how they've been educated, you know, Giroir a pediatrician, Dr. Adams who I believe is an anesthesiologist --

EH: Correct.

MC: -- and Dr. Fauci who was a virologist and each one of these -- and then, you know, Dr. Redfield who did such leading and important work in the fight against AIDS.

EH: Right.

MC: And to watch those ideas collide and mix and then blend --

EH: Yes.

MC: -- into a response and to be one of the coordinators of that, that must be a pleasure.

EH: It's a pleasure to be able to facilitate all that, to be able to be one of the people who can be here when we are preparing what I think is ultimately going to be a very successful response to this over time.

You know, you see it happening. You see it coming together. And you see these successes starting to happen whether it's remdesivir, the early results on the vaccines, the early results on a lot of the research that's going on. You see that happening. It's -- and that is because we have the openness to these ideas. We have the openness to the research, to -- openness to decide how to move when we need to move and that's great.

It's great to be here, yes, to be helping as part of -- as, you know, the chief operating officer here to be able to facilitate that, to be able to kind of build the structure that enables those decisions when they happen to go forward, to be able to move and be able eventually result in the benefits for the American people that are going to happen as a result of this ferment that's happening right now. That may be to many people looking at it and going like, "Why don't we have the answer yet?" Well, we're going to have a real answer when we have it because these powerhouses are having honest conversations with each other.

MC: It's true. Are you optimistic?

EH: Yes, I'm very optimistic, but it --

MC: In general, or in specific on the virus?

EH: Well, I would say, I'm an optimistic person in general.

MC: I think you're probably the -- I got to tell you, I would consider you the happiest warrior here. I mean, we can always count on you bringing a smile to the table.

EH: Yeah.

MC: And I think -- and that comes with the experience of having to fight these battles whether it's a hurricane or a pandemic. But are we going to get there?

EH: Yes, we are. I mean, it's not a matter of if, it's a matter of when. And I think that a lot of the creativity that has been put here, not just on the scientific side but on the technological side, on distribution, on the way that a lot of the creativity has been enabled, frankly from the top, from the President on down, a lot of that sort of entrepreneurial spirit I think has been kind of sort of as leavened the overall government response.

A lot of the freedom to move and not have all top-down solutions I think has been enabled by that leadership. When you see that there will be a -- there will be an effective response to this. I think the thing that we're doing now between the R&D moving forward on its track, the manufacturing happening at the same time, the manufacturing bill that's happening at the same time.

MC: We're talking about the Operation Warp Speed, yeah.

EH: Warp speed and the distribution system being worked on at the same time means that you're working in parallel instead of just one after another, you know. One thing after another, you work in parallel. That is an innovative approach to this from a systems point of view. That's going to enable us to really truncate that time frame at the back end and move from one to the other as quickly as possible.

And that's a systems innovation. That's an administrative innovation, a contracting way of doing things that's different, that openness to dealing with the private sector instead of trying to maintain everything in house the entire time, nope. Pretty quickly, not right away, but pretty quickly moved out the door to the private sector to say, how can we collaborate and that happened very quickly. And now you're seeing the fruits of that. Just a few months down the line, you're seeing the fruits of that happening right now. Now, science and nature doesn't always cooperate with government fiat, right?

MC: Right.

EH: We can sort of --

MC: We can agree on that.

EH: Yeah, exactly. We can have another committee meeting and suddenly the science -- basic science changes.

MC: Right.

EH: That's not how it works. But you know, the more we can enable those things, the more sort of you know chips we can lay down, the better we're going to be. And that means that we have to be open not just to one right solution, but to that profusion of ideas that we're enabling right now that something's going to -- because it always has. So, something will work, something always has. This isn't different in kind from what we faced before. What we face all the time with every infectious disease outbreak that we had. This isn't something completely unknown. It's a family of viruses we've seen before.

And so, we can have some confidence. We will have something that solves this problem eventually. It's a matter of how quickly we're going to get it and we want it to happen very quickly. That's what we're all earnestly working towards hoping and praying for.

MC: A battle of ideas in a lot of ways.

EH: Yeah. That's what produces this.

MC: And it takes money -- you know, you're responsible for the budget in a lot of ways here.

EH: Right.

MC: We have to put a lot of money at risk. As the secretary says place bets on certain vaccines in the hopes that it'll pay off for the American people and all that comes out of the deputy secretary's office.

EH: The key outcome is that that's my job --

MC: Right.

EH: -- is to facilitate that, is to make sure that those resources are there, that those vehicles are there when they want to do them. In many ways like I -- the way they articulate this to me at one time is that you know part of the job is building in a basement. There's a row of houses on the same street, and you have to have a common basement.

MC: Right.

EH: That's where everything is actually been done. Everybody goes into different houses, they're all disagreeing with each other about what happened, but they've all got to be able to work together. There has to be some connection --

MC: Right.

EH: -- between all of those different houses on the street. All those different points of view have to be able to no matter what decision has been made, or no matter what decisions have been made that we can carry that out in a -- as quick, efficient, useful manner to produce what we need to produce for the American people. And that's building that and facilitating that and making it so that no matter what happens in the scientific debates, or how many decision or decisions are made, we can make that happen. That's part of what I love.

MC: But it also puts a target on you, doesn't it?

EH: Yeah.

MC: It does -- I mean, every one of the leaders that I've talked to here one way or another has, you know, they've got a target on their back.

EH: Yeah.

MC: Because you, for example, are responsible for this huge budget and making sure the American people get what they've invested in.

EH: Right.

MC: And then people, you know -- I've watched the people take potshots at the secretary, at the doctors, at the scientist, at their families.

EH: Yes.

MC: And it's a -- it's hard for me to understand until I got here, and I wore my own target that you have to have a real devotion of service. I got to tell you, I don't know if I have that in my soul. Once a week, I feel like I had it. I'm going home to my family and buffalo again. But you're back for a second tour of duty.

EH: Right.

MC: That target doesn't bother you?

EH: No, it doesn't. Not in my heart. It always bothers you, you know, on the surface. It has to, right, because otherwise, you're just like a block of wood.

MC: Right.

EH: You know what I mean, everybody's a human. And so, things will bother you but it doesn't in my heart because, you know, when you know what you're doing is going to be of use and of hopefully great use, and you're in -- you're part of a -- an endeavor, part of a group that is going to achieve I think great things in an unprecedented pressure-filled situation. I don't see how you can't be invigorated by that, by just the basics of what you're doing as opposed to, you know, the surface, the froth on the surface, right?

MC: Right.

EH: Deep underneath there, great things are moving. Great things are being done under the surface. And there's always going to be, you know, sort of winds blowing across whipping up waves, but underneath, everything's moving. And that's the great thing. That's what I have confidence in.

MC: Deputy Secretary Eric Hargan, thank you so much for your time today.

EH: Yeah.

MC: It's -- I've gotten to know you a little bit, I got -- before this. I've gotten to know you a lot better now. And I think the American people can be proud of the work you're doing and the people in your office on the hard work that all of us at HHS are doing under your leadership.

This is Michael Caputo. I'm assistant secretary for Public Affairs here at Health and Human Services learning something new every day and that's why I bring you the listener along on my learning curve. Deputy Secretary, thank you very much.

EH: Thank you. Thanks very much.

MC: Catch us next week here on Learning Curve. Have a great day.

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