A Long View on the Coronavirus Problem

Interview with former HHS Secretary, EPA Administrator, and governor Mike Leavitt

Philanthropy: You’ve studied the history of pandemics, and worked closely with Dr. Fauci to create a national system for handling pandemics while you were Secretary of Health and Human Services in the Bush administration. Do you see any analogs in history to what we're experiencing today?

Leavitt: The 1918 influenza pandemic was caused by a fast-moving virus with similarities to today’s coronavirus. There are also differences—our capacity for communication, the medical advances, scientific differences. But it had a profound impact on every community, and I think we can learn from that time.

Philanthropy: What specifically? 

Leavitt: The first thing is understanding the seriousness of the situation, and the need for us to respond, and to have a willingness to change our behavior. Pandemics don't happen often. They happen every 30, 40, 50 years, but when they happen, we have to acknowledge that this is a different period than what we've lived through. So we can learn, first of all, to take the outbreak seriously.

The pandemic is going to have long-term consequences. This is not a four-to-six-month situation. In order to cause a virus to go away, to eliminate it, you have to have more than half the people achieve some level of immunity. You can gain immunity in two ways. One is by actually having and surviving the virus, and the second is to be introduced to the virus in a controlled way through a vaccine. And what we do with a vaccine is we inject a little bit of the virus into the system and it has the effect of creating immunity or an immune response.

Even if you have a vaccine, and let's say it takes another year to get it, immunity doesn't happen overnight. You've got billions of people across the world and you have to introduce vaccines in a gradual way.

My point is, we're likely to be dealing with this virus for a matter of years, not months; we're going to have to adjust the way we live. This is a new risk we have to combat. 

Philanthropy: Why do vaccines take up to a year?

Leavitt: The genetics of the virus have to be plainly identified, and then you have to identify a component of the virus that will allow the body to produce an immune response. Let’s assume that happens in a laboratory fairly quickly. We do this every year with influenza and we're very good at it, but the coronavirus is a separate class of virus from influenza. It's taking us longer to accomplish this than it would be if this were a routine influenza.

Once that labwork has occurred, then we go through Phase 1, Phase 2, and Phase 3 trials, where you're demonstrating the vaccine is both safe and effective. Those stages generally take two to three months each. So if it takes three months to identify the vaccine, and then you have to demonstrate its safety and effectiveness in three phases, you're now into ten months or a year at a minimum.

Then you have to actually put it into production. It has to be produced in sufficient doses to cover every person, distributed, and administered. If you start adding up the time, you can see this is going to be at least a year.

Philanthropy: How do you suggest donors think about the economy in light of all this? How have you thought about quarantines, shutdown, and reboot?

Leavitt: We need to acknowledge that the spread is not likely to happen in the same way in every city or region. Right now, New York City is a hot spot. In Kansas and rural Wyoming, it's nothing like that. So the question becomes: do you try to impose the same measures in both places. And the answer is, of course, no.

It's also true that, because we don't have a vaccine, our only tools to avoid the virus come from social distancing, and if we begin to move away from social distancing, we take the risk that more people will get it and it'll start spreading again. For that reason, almost every pandemic has a second or third wave before we're actually able to diminish it enough so that it goes away. We’ll likely see different levels of social distancing over time, and it's possible that we'll have to shift to more or less social distancing as the virus moves around.

I'll give you an example that illustrates this. I live in the West. I often fly to New York or Washington, D.C. Fairly regularly, I will check the weather and find that there's a storm coming in that will cancel flights. Nobody's going to work because the city's shut down by snow. Don't come. 

It is very possible that there will be, for a few years, certain locations where there will be a coronavirus hot-spot warning, and there will therefore have to be extensive social distancing in that place. We're going to have to learn to deal with that, through individual behavior changes and business changes. There may be periods when we have to close schools in certain areas during a second or third wave. It may be different in each region, but we're all going to have to learn to manage the way we interact with this virus.

Philanthropy: How do you think this could impact our elections and politics?

Leavitt: There's never been a widespread pandemic like this that didn't have profound impact on the economics, on the politics, and on the sociology. A pandemic drives change, big change, and that's just a fact of history. And you can already see it happening economically. You can see the potential for it to impact the election, not only the timing of the election but the mode. It's going to have a big impact on American politics at home, and geopolitics abroad.

Philanthropy: Do you have any suggestions on how philanthropists can play a role? 

Leavitt: Most philanthropists have established areas of interest and expertise. Bill Gates, for instance, has devoted billions of dollars over many years to vaccine development. So he's going to be able to support scientific research in that area. Not every philanthropy has that capability. But most have someplace where they can be a leader.

A lot of people are going to need help. Some with health care, many with income. There will be needs in education. Givers can bring assistance that fits within the interests of their philanthropy. I’ve observed that a lot of philanthropies view themselves as being able to take risks that taxpayers can't, and there are going to be a lot of areas that need that.

We have to look at this with a long-term lens. Just on the basis of the way viruses work, and the way vaccines work, we're looking at a three-year period. If you then recognize the economic and political impacts of this, this is fundamentally a world-changing episode.

Philanthropy: I wonder if “getting back to normal” is the wrong goal in some areas. 

Leavitt: That's a good question. In some sectors, getting us out of a rut we’ve been in for a long time could give us new options. Once you’re out of the rut, action occurs.

For instance, there have been efforts for at least 15 years to change regulations to allow telemedicine to occur more comfortably. There's been great resistance from the traditional health-care lobby. In two weeks, those taboos were swept away with emergency regulations allowing people to interact using video, text, e-mail, lots of different tools that people have wanted to use in interacting with their physician or hospitals. Those old regulations are gone, and I don't think we'll go back.