A Conversation With Secretary Xavier Becerra

Secretary of Health and Human Services Xavier Becerra discusses the agency’s global footprint, including how COVID-19 exposed systemic disparities in healthcare at home and abroad, plans to prepare for future pandemics, and efforts to restore global partnerships. 

Transcript: 

COLES: Very good. Thank you. And good morning to everyone joining us today. Thank you for joining us for this conversation at the Council on Foreign Relations, and our meeting with Secretary Javier Becerra from the Department of Health and Human Services. Mr. Secretary, we’d love to welcome you. I’m Tony Coles. I’ll be your host for this moderated discussion. I’m the executive chairman and the chief executive officer of Cerevel Therapeutics, and a member of the board of directors for the Council on Foreign Relations. And I’ll be presiding over today’s discussion. Mr. Secretary, we’d love to give you an opportunity to open with some introductory comments, and then we’ll dive right into our conversation.

BECERRA: Dr. Coles, first, thank you for inviting, thank you for hosting and moderating, and I’m looking forward to the opportunity to chat with folks on the Council on Foreign Relations. And I appreciate the interest, because today health care is not just domestically important, but globally important. So I hope I can stress to you how lucky I am to be in this position at this time, when America counts for so much. I know that when I go around the world and speak to many of my health minister counterparts they are thrilled to know that America’s back. We just have to prove to them that we’re here to stay. And I hope that what I can convey to each and every one of you is how important it is that we work as a team because, if nothing else, COVID has taught us how much of a global community we really are, that it really takes a village to make things happen. And the village isn’t just America. It’s the entire world. So looking forward to the conversation. Thank you very much for inviting me.

COLES: Well, very good. Mr. Secretary, let me just provide a brief introduction. Of course, you need no introduction because we’re all quite familiar with the work of your department and we have followed your career for many years. But by way of a brief introduction, Secretary Becerra is the 25^th secretary of the Department of Health and Human Services. He is notably the first Latino to hold the office of HHS secretary, and quite a landmark for the country. He served most recently as the attorney general of California, and prior to that was a twelfth-term member of Congress. So, Mr. Secretary, you come into this conversation with a breadth of experiences, both on the legal side, on the political side, and now on the civil service and the administrative side. So this should be a great opportunity for us to chat.

Let’s set the context for the conversation, if we can. The mission for HHS is actually quite clear. It’s to provide access to health care and provide the best health care delivery services to the American public. But I know, Mr. Secretary, that you have your own personal mission. You have talked quite publicly and quite frequently about health security and health access. So, if you can, let’s start the conversation with the intersection of both your personal mission and experience in this area, and the mission of the department.

BECERRA: So great question, Dr. Coles. I would say that for me America has been a real blessing. My parents, immigrants from Mexico, who did things the way you’re supposed to. Worked very hard, never asked for anything, followed the rules, and had four children who they gave a chance to do what they never got a chance to experience. I know I owe this country a lot, and I intend to continue to give as much as I can because I know that there are people like my parents who hope that their kids will have an opportunity to do this. And you can speak to that globally as well.

And so for me being at HHS, when we talk about making health care more affordable, it first means making it more accessible to all those folks who’ve never been able to afford it, and never have had it. And so for me it’s reaching out, making sure we’re looking behind that rock, we’re not missing anyone, and we’re trying to bring everyone along. President Kennedy’s admonition of lifting all boats to me is gospel. And I think that if we do this right, we won’t just lift boats in America, but we’ll lift boats around the world. And so I’m thrilled to be here, and I very much look forward to working with others to team up and making sure we’re lifting all those boats.

COLES: Well, good. That’s a great opener for us, because of course the primary focus for Health and Human Services is a domestic both health care delivery agenda and policy agenda. But there are important global implications that I know our audience will want to explore further in this conversation. So let’s put a pin in that and we’ll come back to some of those topics as well. Also, by way of context, this was actually quite interesting to note. This is—this particular department is the largest non-military organization, 90,000 employees. And you have the responsibility for 25 percent of the federal outlay. And you actually provide more grant dollars than all other agencies put together. So we’re talking about a broad and a vast remit.

I know that the members listening will appreciate that there are eleven operating divisions of Health and Human Services, including the FDA, the CDC—and we’ll come back to the CDC and its role in the pandemic—CMS, the Center for Medicare and Medicare Services, the NIH and, importantly, something that I know is near and dear to you, the substance abuse and mental health services administration as well. So this is a vast agency with a broad remit and a broad set of responsibilities.

How do you, as you’ve been in the role for a year now, how do you go about setting the immediate priorities for the organization? I know COVID is at the top of your list, and I want to spend a lot of time on COVID because that’s of interest to all of us. But talk a little bit about how you viewed the job in the beginning and how you set the priorities for your term.

BECERRA: And so, Dr. Coles, you’re right. To some degree, our priorities were set by circumstance. COVID being upon us required us to tackle that first and foremost. So job one had to be COVID, COVID, COVID. And we believe that if we do COVID right and we address this pandemic, that we’ll be able to do a whole lot more because COVID exposed so many of the gaps, the holes that our public health system has. And if we learn from those lessons, we’ll be able to improve our system, which is already the most expensive in the world, provides some of the best care in the world, but at the same time has some of the glaringest holes in it in the world.

And so we take from COVID the rest of the work we do, making health care more affordable to more Americans. We’ve already gone a mile in that direction. We increased the number of Americans who have access to health care through insurance to a point where we’ve never been before. It’s the highest number so far in the country’s history. The Affordable Care Act helped tremendously in that regard. We know that it’s not just a matter of making it more affordable; it’s making sure it’s good quality. So we want to get rid of, for example, junk insurance plans that you can pay very little upfront for them but when you need to use them you get very little coverage. And that many times can lead to bankruptcy for you because you thought you had coverage when you really don’t.

And at the same time, everything we do, at least under my watch, will be infused with this sense of fairness and inclusion, equity, so that we really are intent when we say we want you vaccinated, and we made every effort possible to make sure that when we said we want you vaccinated, we meant everyone. We don’t care what your income, where you live, what your status—whether income status or immigration status. If you’re in this country, we thought it was important that you get vaccinated free of charge. And so far we’ve delivered fairly well on that. And so that is a goal that we have, is making health care more affordable, making it available to more people with quality. And when we say that we mean everyone.

COLES: Well, that’s certainly very encouraging to hear. And talking about meeting the moment, in a way you were—and the administration were handed a set of circumstances that has touched the life of every American, and literally every person on the globe, which is the COVID pandemic. What would you say, Mr. Secretary? You know, that’s obviously something that we’ve all been very thoughtful about. We’re all COVID experts by now. We’ve been learning in real time, we follow the latest set of guidelines, the latest missives from the various agencies under your watch. But as you—as you look back and perhaps wind the hands of time back one year, when you first took this role, what do you wish you knew then that you know today that might have been helpful in these last twelve months?

BECERRA: Probably I’d say, Dr. Coles, recognizing that it did take rocket science, in that figurative way, to get us the vaccine and help us really tackle COVID. But at the same time, it didn’t require rocket science for everything to make sure we reached all Americans. So we needed the bright minds to help us find that vaccine. And we pumped in major resources and changed authorities and regulations so that we could get that vaccine out as quickly as possible. At the same time, trying to get it to all Americans was tougher than we thought, but it didn’t require rocket science.

Two quick examples. First, when I came into the position a little bit more than a year ago I was being given updates every day. And what we found was that about a year or so ago, around this time, about two-thirds of White Americans had received at least one dose of the vaccine. Barely over 50 percent of Black Americans and Latinos—Latino Americans in this country had received one shot. Which doesn’t make sense, because COVID didn’t care what the color of your skin was, it was going to kill you one way or the other if it could get to you and really make you sick. And so we set out to try to change that disparity.

Today, I’m proud to tell you, that because we did some very aggressive work more than 80 percent of white American adults have received at least one dose of the vaccine. More than 80 percent of Black American adults have received that vaccine. And more than 80 percent of Latino Americans have received at least one dose of that vaccine as adults. And so we showed that in America you don’t have to have disparity. And we showed in America that everyone—when the president said everyone should get a vaccine, he meant it. And it’s possible to do so. So we do need rocket scientists, but we just need some, you know, basic hard work, hands-on effort to make sure we can make that happen for everyone.

COLES: So let’s pick up on that particular point because, obviously, we are living through a lifetime of firsts as we manage the pandemic. And certainly, that’s been true for the administration. This has been, I think some would say, a distributed effort, with the White House manning an important part of the leadership here. Obviously, Dr. Fauci is a good colleague and a prior—or, a prior participant in this forum with us—has played a(n) important role and a very visible role. Jeff Zients as the coordinator for the COVID response. Talk a little bit about the role of HHS now that we’re in this era of firsts, in a way. Obviously, the FDA has to approve these—the new agents for therapeutic use or provide emergency use authorization as the case may be. But talk a little bit about what that distributive effort has been like and, specifically, your role as secretary in making sure that we do exactly what you suggested we could do.

BECERRA: Sure. Let me give you the football analogy. And I hope most of you recognize football, and I mean American football not, in this case, the more popular soccer that is known around the world as football. But there’s no doubt that when the president won election, he knew he had to tackle COVID. And so he made it his number one priority. Even before he was sworn in, he had assembled a team to start working on this during the transition. The quarterback is, has been, and will be at the White House when it comes to COVID. And Jeff Zients, who you mentioned, was the coordinator from the White House. Today it’s Dr. Ashish Jha who’s the new White House coordinator.

And so the policy—the word will come down from the White House of what they’re hoping to see. HHS, because pretty much everyone who works with that White House team is from HHS—you mentioned Dr. Fauci, the CDC, NIH, FDA, all the teams that we have at HHS were there to execute. So whether we’re, in one case blocking, or in one case we’re catching that pass, or running the football, or periodically being given the ball to toss it as well. We’re going to do what we must do to execute on what the president wants to see. And HHS is indispensable in the execution and delivery of that COVID policy. And so we’re thrilled to be not only a team member but on the field when it comes to delivering to beat back COVID.

COLES: So you gave us some really impressive statistics about shots in arm a moment ago, in the last twelve months. And I think a lot of the credit, obviously, goes to the coordinated effort to the various agencies that report to you. But let’s click down on some of those agencies. Obviously, the CDC has come under fire recently for its management of the pandemic, changing guidelines, that kind of thing. The FDA I think has done what they could to expedite these therapies for use by Americans. How—if you think about this particular moment, have we done a good job in not just delivering the therapeutics to Americans, but helping Americans live with COVID, which is where I think we all expect this will go? And if not, where do think there’s room for improvement as we move forward, and this becomes an endemic as opposed to a pandemic situation?

BECERRA: So it won’t surprise you, having seen this day to day for more than a year, that I believe that, whether it’s CDC, FDA, the team at HHS, that they have done remarkable work. And you know this. Science is hard. Otherwise, everyone would have a doctor in front of their name if it wasn’t. Science is hard. COVID is complicated. And so put those two together and CDC trying to get information, guidance out to the American public is not going to be a simple ABC. And the science changes as COVID changes, as the variants come out. What we learned based on what we are able to develop, with the therapeutics, with the vaccines changes as well. And so it’s a—it’s a constant flow. It’s an evolution.

And CDC has the thankless task of trying to communicate that to the American public as best possible. I think they’ve done a remarkable job. The fact that today nearly 260 million Americans have at least one shot in arm, close to 220 million have the full vaccine, more than 90 million Americans have gotten boosted. And please, if you’re over the age of fifty, get boosted, and get boosted a second time if you’re in that range. We need to have people protected. We know what it takes. And what we have been able to communicate and achieve is a point where even the most fast-spreading of the variants that we’ve seen—B.A.2 is fast spreading—it’s still- even though we’re beginning to see rates of cases go up again, we’re not seeing the same rates of death go up the same way. And that’s probably a sign that a lot of Americans have gotten protected. And that then is a result of like the folks at the CDC doing their job and doing it well.

COLES: Good. Well, we are all anxiously watching the headlines for both the latest set of guidelines. I think many of us are anxious to return to whatever the new normal existence is. And we do have to count on clear guidance from the agencies. And you’re right, science is hard. I’ve devoted most of my life to science, and I know certainly as well as anyone that it is hard, and it can be hard to keep up with emerging evidence. But I think everyone listening would wish you well, you and the agency well, in continuing to deliver care. And really thinking about how we learn to live with COVID, in a way.

Let’s shift gears and we’ll, I’m sure, come back to some COVID-related questions. But let’s shift gears, and we’re sticking with the theme of meeting the moment, in a sense. Let’s talk a little bit about the role of HHS and the crisis at the border, if we can. That was another set of circumstances that you and the department were handed. Talk a little bit about what has happened there, and specifically how we might contemplate moving forward productively in the morass of that topic?

BECERRA: So, and we have to really peel apart what we mean by the circumstances at the border, because there has been a health circumstance that has lived at the border for a while, as it has throughout the country with COVID and the pandemic. And then, of course, there is the immigration challenge that we faced on that border for the longest time. I remember my twenty-four years in Congress I worked very hard to achieve immigration reform of a very broken immigration system. I left, and we still hadn’t passed the laws that take care of that immigration system. So you have to balance the fact that you’re got a health challenge that existed on the border as well as the rest of the country, and you have the immigration—the migration challenge that we witness at the border.

COLES: So that’s fair. Let’s talk a little bit about Title 42. I’m sorry to interrupt your comment, but I want to make sure we cover Title 42, which has been in the headlines lately.

BECERRA: Yeah. And that’s where I was heading. But I wanted to make sure I gave a foundation. So Title 42 is a law in our books that allows us to protect the health of the American people, including by using some pretty extreme measures, like quarantining Americans. Quarantine—Americans are very accustomed to their liberty. Telling me that I cannot move around is a pretty big move for government. And so quarantining Americans is a big thing. Title 42 gives us those abilities—those authorities to do some of those things. It’s based on health conditions. And Title 42 has been in place since the pandemic started because we want to make sure that we’re not spreading COVID any more than necessary.

But now the situation is changing. As you know, Americans are surviving, some folks aren’t using masks anymore. Title 42, therefore is, at this stage, under the CDC’s interpretation of the facts and the science saying we no longer need Title 42 to protect the American public based on health conditions. Now, there’s a situation at the border where people were going to say this is going to create a real problem because there are still people who are trying to come in. That could be. But you don’t use a health law to deal with a migration challenge. You use migration laws to deal with migration challenges. You can’t use the cover of health to try to deal with a migration challenge.

And so there’s where Congress—it behooves Congress to work with this administration, which presented on its first day in office—President Biden sent over to Congress his first day an immigration reform law. And it’s important that we deal with the migration challenges at the border with our laws that deal with migration, rather than trying to bootstrap a health care law to do migration work.

COLES: And as you think about the implementation of what your agency has to cover, which is obviously the care of some of the asylum seekers, children in particular, talk a little bit about where the challenge is. Is it a budgetary challenge? Is it a political challenge? Where—what’s the crux of what it is that your agency confronts on a day-to-day basis?

BECERRA: All of the above. And what we have to recognize is that there are people who, for generations, have been trying to come into the country—some the right way, some without getting the papers they need. We’ve got to deal with it. You have a broken immigration system that doesn’t let us, for example, in this particular case, deal with the request for asylum. Someone would request asylum upon entering the country, that triggers a lot of different laws that provide some protections to that individual while their asylum claim is worked through the process. If it takes four or five years to work that claim through the process, some folks will look at that and say, hey, I got in. I just had to step into the U.S., and I got in.

That’s not the case. But because you have a process that doesn’t get that person through the legal system to adjudicate that claim quickly, it sometimes leaves that impression. We have to really change that immigration system that allows someone to make a claim for asylum, rightfully or not, and not have adjudication of it right away, because it send messages, and what we don’t want to send is the wrong messages to any part of the world. We’ve got to do it the right way, follow due process, but let’s get it done. And because we haven’t been able to get it done as well as we can because the system is broken—it’s been broken for a long time; it didn’t just break last year—this is what we have, and so that challenge is real, but it’s not a health challenge directly.

COLES: We usually do think of your department as a domestic department focused on the care and delivery, as we’ve been talking about, but there are obvious implications to the ever-increasing global agenda that we all share. There’s been a lot of conversation about the role of multinationals, our collaborative efforts with those multinationals and with other countries. I know and we know that you’ve been reaching out to your G-7 counterparts and meeting on a frequent basis. Let’s talk a little bit about how you think the landscape evolves in terms of both coordinating responses for this pandemic and the next pandemic, early alert systems, the unique role the CDC can play as a particular organization that operates at a global level. Talk just a little bit about the global agenda for HHS.

BECERRA: This is one of the exciting aspects of the job, because anything that happens in America happens—at some point, it ripples throughout the world. Health care is no different; in fact, health care has become even more important. And so our role, especially now that we’re back in the game because until President Biden took office, we had essentially removed ourselves, the previous administration removed America in so many ways from being in the game, especially on health care with the World Health Organization. We’re back in and I could see how thrilled and anxious a lot of our partners around the world are that we are back in. They want to make sure that we don’t, you know, go AWOL again, and so it’s an opportunity for us to lead at this global-stage level and I think we’re ready for it, and what we want to do is be able to do it in partnership. Growing up, I saw how in many ways some of my distant relatives in Latin America would always look at the U.S. both with love and with concern because sometimes we did things great, sometimes we interjected ourselves in ways that weren’t as acceptable.

I think the world is hoping to see that better angel of America come out and we can make a difference, and that’s why I’ve engaged with my counterparts on the global stage. I think it’s crucial that we show that we’re ready, and by the way, no one has come forward when it’s come to vaccines, making them available to the world, especially those places that it’s more difficult to get them to, than America has. Several hundred million vaccines have gone out to the world from America itself. No one has come close to matching us. We need to continue to do that because we have been the leader in this regard and I think that if we show we’re going to do it, leading but at the same time as a partner, I think we’re going to get not only good results but good will.

COLES: So let’s talk a little bit about that leadership. Obviously, we lived through a more isolationist America-first perspective on the global stage. We’re now in a different moment where this collaboration and this openness towards working with counterparts around the world is the order of the day. But you talk a lot about America’s leadership, and exactly what does that look like? How do we lead and what are the things we have to navigate as we migrate from an isolationist approach to a more collaborative approach? Do other countries trust us? And do they trust that we won’t abandon them again?

BECERRA: Yeah, they want to trust us because they know they need to trust us, because if we’re not in the game it just makes everything so much more difficult for everyone, and so—you know, it’s—you’ve been jilted before, will you get jilted again, but I think they know the relationship is too important to not work on. What we have to do is show that we’re going to be leaders but the—you know, as they say, you can’t lead unless you have followers and I think what probably will hold us up best is if we show folks that we are part of a team and we’re not just simply going to tell people where to go; we’re going to work with them so we can all agree where we must be together. If we do that, if we show that we know how to work well and not just tell people what to do, I think people will not only appreciate that we’re back but really recognize that America is back.

COLES: But tangibly, what role can we play? And this is—it obviously extends beyond COVID. To the extent that you can speak to it, talk specifically about the role of leadership, America and leadership on the global stage.

BECERRA: We’re right now in the process of determining where we go in terms of global preparedness and response on what comes next after COVID, the next pandemic, whatever it might look like. We’re trying to figure out how we coalesce and do this globally, so what will be the rules? Will there be requirements? We’re now discussing how we actually finance the tools that will be needed to make real this idea of working together for preparedness and response. Who’s going to put forward what amount? Who will make the commitments? All those things we’re working on. We know, as America, people are going to expect us to do more than others. We’re ready, but we want to make sure we’re bringing everyone along to know that we have a responsibility. You may not be the richest country in the world or the biggest country in the world, but you have a responsibility as well. And so our leadership is showing we’re ready to give at the office; at the same time, we’re going to be good watchdogs to make sure everyone else recognizes they’ve got to row with the boat too.

COLES: Let’s—we’re going to open the floor for questions in just a few moments. I obviously have lots to talk to you about, but let’s again come back onshore, as it were, and I’m sure we’ll go back and forth between the domestic and the global aspects of the department.

You know, one of the things that I have thought about quite a bit is the relationship between the FDA, the Center for Medicaid and Medicare (sic; Medicare and Medicaid) Services, the interplay of those two organizations and what happens specifically across the approval of new therapies and the reimbursement or the coverage of new therapies—obviously a complicated topic, complicated subject, and this is not necessarily about pricing reimbursement, but we’ve got a living example where there’s been a new Alzheimer’s therapy that has been approved by the FDA, controversially, admittedly, and for the first time we see some interplay between the FDA, the approval regulatory body, and CMS, the paying body of the federal government. I noted that Rob Califf, the new commissioner for the FDA, and the secretary for—sorry, and the director for CMS, Chiquita Jordan-Brown, I think—

BECERRA: Brooks-LaSure.

COLES: —thank you, Brooks-LaSure—offered a joint statement recently and that was unprecedented, I think. So talk a little bit about this new era, if you will, of approving controversial drugs, connecting them to reimbursement, and what might be in store as we continue this conversation.

BECERRA: So you struck on something that’s very important, so let me briefly say this: What you saw was what a team does. It works together. Even though FDA and CMS are two separate agencies within HHS and have two different missions and responsibilities, they worked as a team to try to convey a singular message of how we’re going to try to serve the American people when it comes to health care. The particular drug that you speak of, Aduhelm, which is a drug to help those with onsets of Alzheimer, is controversial. FDA did come out and say that, on a conditional basis, it was making it available because they saw enough evidence to say that it might be safe and effective, but it’s ongoing basis to discover more. Having said that, then the question becomes, OK, who can access this? CMS, as the fiduciary responsible for protecting Medicare for sixty-plus million Americans who receive Medicare services, had to make a decision; OK, now we’ve heard from FDA that Aduhelm could be available, even though conditionally. What does that mean for the sixty-plus million Americans who have Medicare who might seek access to that drug and get reimbursement based on Medicare?

If you recall, when the Aduhelm announcement was made, the company said that the cost of that drug would be $56,000 per treatment. You can imagine if sixty-plus million Americans who started to see onsets of Alzheimer’s thought that they needed to use that drug how much it would cost us as taxpayers. So CMS had to undergo an analysis different from FDA. They have a responsibility to protect the Medicare program for the sixty-plus million Americans. They went through analysis very similar in that they looked at the science and the facts and they made a determination. Their determination was that they will allow reimbursement through Medicare for use of that drug under very limited circumstances—controversial decision, just as FDA’s decision was controversial, but they both do their work based on what their missions are and they both came out with a statement talking about how important it is to work together, because we understand this is probably not the last time we see a circumstance similar to this occur.

COLES: It certainly—for those who don’t think about this every day, as you do and as I do from different vantage points, certainly unprecedented set of decisions and we will certainly be watching the evolution in that conversation.

Operator, I think we’re ready to take our first question, so if you would provide directions as to how to do that, we will continue the conversation.

OPERATOR: Thank you.

(Gives queuing instructions.)

We’ll take our first question from Jay Markowitz.

Q: Hi, Tony.

Mr. Secretary, thank you to you and your ninety thousand colleagues at HHS who have helped us face this unprecedented acute health challenge that is the worst that any of us have seen in our lifetimes, so thank you for doing that. My question is about the lessons from COVID that we might be able to apply more broadly and proactively to support other innovations that improve health and save lives. Thank you.

BECERRA: Jay, thank you for the question and for your comments. Right off the top, I’ll tell you, telehealth, we have realized how much technology and the internet has made possible for us to not only communicate faster and more often with each other, but when it comes to medicine, all those folks who could not leave their home and were going to miss appointments, medical appointments, today telemedicine has made it possible for them to continue those appointments, to continue receiving the life-saving treatment. Here’s the difficulty: Telehealth is limited in scope because the laws—for purposes of making sure there was accountability and that we weren’t getting ripped off by shysters out there in the world, reduces the scope of how you can use telemedicine. We’ve learned from COVID how indispensable it can be, especially in rural communities throughout this country, especially in low-income portions of the country, and so now we’re talking about expanding the telehealth authorities that we have so we can make sure Americans can access that indispensable health care without the constraints of the law getting in the way. And so right now Congress is trying to tweak that a bit; they gave us a five-month extension on some of those authorities that let us have more—give providers more discretion. That’s been critical.

What else? Who knew that we would come up with a very powerful and effective vaccine in less than a year? We did. Now we’re learning a great deal from that vaccine and its mechanics on what we can do moving forward with others. Today, Dr. Coles asked the question, where do we go from here, pandemic, endemic? We’re now looking at how we take all the science that has given us great results and apply it moving forward so that we can deal faster and more effectively with what’s coming our way.

And the final thing I’ll mention, Jay, that we’ve learned is that unfortunately some people are misusing our easy access to information and communication and filling the airwaves with a lot of dis- and misinformation, which has made it difficult to reach a lot of Americans who are very concerned that if they inject themselves they will become sterile and never be able to have children, those kinds of things. And it’s unfortunate that social media has been not just our ally but also one of our worst enemies when it comes to trying to fight COVID.

COLES: Mr. Secretary, let me, before we take the next question, just extend Jay’s note to you. What will we do differently for the next pandemic? What is lined up for us? We were somewhat surprised, surveillance and otherwise, by this one. How will we respond better, faster, and more effectively for the next one? What have you done to assure Americans there?

BECERRA: I can tell you some things that I know for sure we should do; whether ultimately we’ll have the capacities, the authorities to do is another thing. But one, we need to go to Americans where they are, not wait for them to come to us, because too often, especially if you’re in, again, a rural community, a low-income community, you won’t get the information as quickly so you won’t know that you can go to a particular pharmacy and get your vaccine shot free. We need to make sure we’re going to where you are, and that’s how we were able to increase the numbers, especially in minority and low-income communities of people who were getting vaccinated. Secondly, I think we realize now that we’re going to have to deal forever with the dis- and misinformation out there. That means we’ve got to get out there. If we’re good marketers—and any marketer out there will tell you, you can’t just send a message out once, you’ve got to repeat it over and over and over, and that costs money, but we know it’s better for us to get a message across to someone about how to stay healthy than to let somebody else get a message out that sounds sexy, attractive, or scary and beat us at the punch, so we need to be out there doing that.

We’ve also learned that investments up front—we have as a federal government spent probably $4.5 trillion directly out of the federal government to tackle COVID. We know how much it costs. And by the way, that’s not all for the medical health side; that’s to keep people who are unemployed from going all the way under, going bankrupt; it was to help a lot of those folks who no longer had access to childcare services find something. There’s a lot of different things. Helping restaurateurs survive the closure of facilities—all of that, $4.5 trillion—a chunk of it, probably less than a tenth of it, on the health care side, but for the money, what we got from the investment on the health care side was an effective vaccine, effective therapeutics, and a way to get that out, and so we need to continue that effort. Right now we’re struggling to get Congress to give us additional funds so we can finish the job on COVID. That would be such a waste. It’s like taking the ball all the way to the one-yard line in football and then taking the team off the field with four downs to go. It doesn’t make sense.

COLES: Clearly, the NIH played an important role in the innovation around the vaccine. That story has been told several times. We may come back to that topic if we have time, because that could also be interesting for the next pandemic.

Operator, why don’t we take the next question?

OPERATOR: We’ll take our next question from Daniel Spiegel.

Q: Thank you, Mr. Secretary.

You mentioned the World Health Organization and it’s so good that we are back at WHO. Let me just ask you, though: The World Health Assembly (sic; Organization) is having its annual global meeting of health ministers called the World Health Assembly at the end of May. Perhaps you’ll be going.

BECERRA: I will.

Q: Good. I have two quick questions for you.

First, would you consider asking Director General Tedros to invite President Zelensky to address the World Health Assembly so that he might be able to tell the world the story of Russia’s barbarous assault on Ukrainian health infrastructure?

And the second thing, I don’t know whether you’re aware of the fact that Russia is a member of the thirty-five country executive board of WHO, and to me, the idea that this country that is bombing hospitals as we speak, taking actions inconsistent with the WHO constitution, should no longer be a member of the executive board. I would like you to comment on that.

BECERRA: Wonderful suggestions. I had an opportunity to do a sit-down—a bilateral sit-down with Director-General Tedros two weeks ago here in Washington, D.C. I will see him later in May, as well. And we have been talking about the situation in Ukraine. I think to a—almost to a person, the health ministers, including we in the U.S., have condemned some of the actions by Russia to attack health facilities and health professionals.

I don’t know for a fact, but I would presume that the conversation is going on about what this impact has on Russia’s standing within the WHO and the WHA, and I will make sure that I personally convey your thought about what we should do as far as inviting President Zelensky to the World Health Assembly, and how Russia is treated given that it is a member of World Health Assembly—all good points because I think all of us agree that what we’re watching in Ukraine is not just a devastation to the people of Ukraine; it’s a devastation to the goals of democracy. So I appreciate the comment.

COLES: Very good. Thank you, Mr. Secretary.

Operator, we’ll take the next question.

OPERATOR: We’ll take our next question from Ramanan Laxminarayan.

Q: Thank you, Secretary Becerra. My name is Ramanan Laxminararyan at Princeton University.

Anti-microbial resistance—now there’s data showing that 1.3 million people die of anti-microbial resistance, and as COVID hopefully fades away, this is going to be a big problem, not just globally but also in the United States.

How would this fit into pandemic preparedness as we think of this going forward and as it evolves?

 BECERRA: Yeah, wonderful question, and I’m glad you raised it because not enough people know about this. AMR—anti-microbial resistance—is something that I was—I was actually quite surprised and gratified to learn when I became secretary and participated in my first global health ministers meeting—is something that many of the countries, especially the more developed countries, are taking on because we see how important it is; not just for us but for the rest of the world because the overuse of anti-bacterial medication has made it more and more difficult for us to rid ourselves of some of these diseases that, really, we should be able to treat and let people get back to their lives quickly.

It’s also not a sexy subject. It’s very difficult to get manufacturers of drugs to focus on this because they don’t see it as a big dollar maker. And so it is something we absolutely have to tackle. And I will tell you, fortunately there is a great deal of interest—and I myself have made this one of the priorities on the international stage for the U.S.—to really, really advance the issue of AMR so we can get ready because we know it’s—as you mentioned, the numbers are already huge of losses of life already—it’s going to get even worse the more and more we find that we lose medicines like penicillin as effective treatments against some of these diseases.

COLES: Very good. While we’re waiting for our next question to queue up, Mr. Secretary, let’s go back to the topic of the NIH and those efforts. Obviously, there was a critical role played there in the identification of the elements of the spike protein that would be responsive to a vaccine; that the story between Moderna and Pfizer and the various collaborations broadly, again, are well known to us.

Share your perspective, if you can, on how we can further strengthen those public-private partnerships and the opportunities not with the private industry, but with NGOs as well, both here and around the world. It strikes all of us that it’s just a smart thing to do, and we’ve got a sterling example with this recent one around the COVID vaccine. But talk about some of the ongoing efforts within the department to really strengthen those external bonds and relationships.

BECERRA: Yeah, and as I said at the beginning, it really does take a village to get this done, and in this particular case, the neighborhood and the village where we have our pharmaceutical industry, those with the technology and the research capacity to help us develop these life-saving drugs and vaccines, that portion of the village really stepped up. It was, as you mentioned, a public-private partnership.

I mentioned the four-and-a-half trillion dollars that we put out as taxpayers through our government. The pharmaceutical industry got a good chunk of that, and they came out with a great product. And so that kind of partnership is absolutely indispensable, and we must promote that because we want to continue to be the place that comes out with these medicines. We were first in line to get some of these medicines because we helped make sure they were available, and I hope that what we do is continue to act like good neighbors. And I would say that as we get into this next phase—whether it’s because of a new variant or because we’re now dealing with COVID as an endemic circumstance in the country—either way—that we have good neighbors, and that requires the pharmaceutical industry to be good neighbor, to, again, be able to thrive, make enough of a profit that it thrives, but to understand that this is too important—human health is too important for someone to try to game the system and make too much money because we know we have no choice but to go to that fountain for that life-saving treatment.

So we all have to be good neighbors. We all have to be part of the family. It will take a village, and that public-private partnership has been indispensable.

COLES: Very good.

Operator, we’ll take the next question.

OPERATOR: We’ll take our next question from Thomas Bollyky.

Q: Hi, Mr. Secretary. Thank you so much for being at the Council on Foreign Relations. I’m the director of the Global Health Program here, and thank you for all the work that you and your team have been doing in this pandemic.

A(n) earlier questioner raised the issue of the World Health Assembly. One of the topics that will be discussed there is the possibility of increasing countries’ assessed contributions to the World Health Organization. Presently the World Health Organization is funded like a mid-sized hospital in the United States, but it has a global agenda and mandate to pursue.

There is presently a proposal that emerged from the Administrative and Budgetary Committee for member states to consider at the World Health Assembly on whether or not to increase WHO’s contributions. And I’m wondering whether or not the United States, your department is supportive of that proposal, and if not, what WHO needs to do to gain U.S. support for increasing assessed contributions.

BECERRA: Thomas, thank you for asking the question, and thank you for asking what is a difficult question to respond to because, as I said, we’re back in this global game. We want to think big and show that we’re big and will play big. At the same time, we want to make sure everyone does their part as well. So the answer—you know, this is where the politics comes in because now we’re talking real money and dollars.

I think President Biden has made it very clear. We’re ready to do our share—whether it has been on the issue of Ukraine, whether it was on the issue of making vaccines available throughout the world, we’re going to step up. And I don’t think we’re ever afraid to step up as a country; we just want to make sure that everyone steps up with us. And it has to be a global affair. It has to be a village that does this. And I have no doubt that what you’ll see is America will step up to the plate and do what’s right when it comes to financing the World Health Assembly and the organization, and doing our part when it comes to what’s next to prepare for pandemics or the rest. We just have to make sure that when we do that, everyone else does it as well because we’re not patsies, we’re not going to just do it because we’re the richest country in the world. We want it to succeed, but it takes a village to make it succeed, and we want everyone to be part of that process.

So, Thomas, I didn’t give you a direct answer because you’ve got to stay tuned. That’s the negotiation as I know you well know. It’s one of those processes where we all have to figure out where we’re going to end up. We want to make sure there are some clear mechanisms, accountability. But I don’t think there is any doubt. At least when we’re in—because there was a time when we were not in the game, but when we’re in, we’re going to do our share.

COLES: Very good. Thank you, Mr. Secretary.

As we are coming to the close of our time—and we are waiting to queue up some additional questions—we’ve talked a lot about COVID. I obviously talked about the transition from the pandemic state that we’ve been in the last two years to an endemic state.

What can Americans expect on the near horizon from your department, both by way of guidelines, ways to restore the normalcy of day-to-day life? What should we be thinking about? We now know that masks on airplanes are no longer required, but of course that’s being challenged by the Department of Justice. So there is some uncertainty in the moment. But give us your best sense about how we manage this next phase of the transition from pandemic to endemic?

BECERRA: So there I’d say, Dr. Coles, let’s not count our chickens too quickly. There are still Americans who are immunocompromised. There are still Americans for whom the vaccines are not fully effective. There are still Americans who are under the age of five who are not yet eligible to get vaccinated. We still are losing hundreds of Americans every day from COVID, and so we’re not around the corner. And so we still have to be careful.

It’s as—again, if you are on the one yard line with that football, you don’t just start playing loose—fast and loose with your four downs. You’ve got to get over the goal line.

Let’s get over the goal line, and so that’s the most important thing because we know we still have to deal with things on a long-term basis, the endemic state we might be in, and that’s where—talk to all those Americans who are still feeling the effects of COVID—what we call long COVID. Talk to all those Americans who lost their job. Talk to those Americans who have been going through some real mental stress. A hundred thousand Americans documented died from overdose in the last year that we had the records for, what, 2020.

It’s tough, and so we have a lot of work to do. But what we want to make sure is that we’re prepared for what might come next. Whether it’s a variant or a new form of disease, we want to learn from what COVID taught us. And that’s where I think, as we deal with something like COVID as an endemic challenge we recognize what we can do. We can get vaccines out there quicker than we thought. We can participate without making people feel like it’s going to break their bank to be able to get the vaccine. We want to make sure that people can discern the truth from the misinformation. And we want to make sure that everyone understands that no one is safe until everyone is safe, and that doesn’t mean just America; it means the world.

We have work to do, but we can to it, and that’s the great thing about this country. And why so many people count on us around the world to be in the game is because they know when America says we can do it, we will.

COLES: Very good, very good.

Mr. Secretary, we are going to give you any last words that you would like to offer. We certainly appreciate our time together.

I thank you for your leadership and for your service, for the service of the various agencies you have responsibility for. They play a very important role, and you’ve heard the gratitude expressed by the membership, but I’ll add my voice to that for that.

Share any final thoughts or comments with us that you would like.

BECERRA: Sure, and first I have to say thank you and for the very thoughtful questions as well. I hope you invite me back at some point; not because there is another pandemic but just because you invite me back.

My dad used to tell me—he was a construction worker. He never had a chance—he went to about the sixth grade. He had to work all his life, started as a farm worker. He graduated to being a construction worker out in the heyday of freeway building in California. He would tell me, if I get up in the morning, go to work, it’s a good day because that meant he’d bring money home and there could be food on the table.

I love that, and I love when I can tell people I got up in the morning, and I went to work, and it was a good day. Pandemic or not, as tough as it is to find health care insurance for everybody in America, if I can get up in the morning and go to work, it’s a good day because I have another chance to make a difference.

And the other thing I learned—and this I learned as a member of Congress, as I watched so many good ideas go into the graveyard of all those great ideas we see in Congress. Any chance I have I’m going to take it to the hilt. I always tell folks, if you get to be in a place where you can make a difference, never do mild. And I’m in a place where I hope I can make a difference. And I guarantee you I will not do mild. It may cost me my job, but I will not do mild because I know my dad just hoped he could get up and go to work. I’m getting to make a big difference. I will not do mild.

So thank you very much for letting me be here. I hope the Council on Foreign Relations and its members will never do mild.

COLES: Well, we appreciate your service and your leadership. You’re certainly in the white hot part of the flame—you and your department—on so many issues, and we wish you continued success on behalf of all Americans. And of course, the Council never does mild. It is always our objective to exceed the very best, both in conversation and in thought leadership around these critical issues.

Thank you for joining us today. It has really been a pleasure to spend some time with you.

And thank you, our membership, for joining us as well. We always appreciate the time that we have together.

Thank you, and Operator, I think we can disconnect.

(END)

This is an uncorrected transcript.