NIH Director: “Our Culture Wars Are Killing People”

CHRISTIANE AMANPOUR: From the existential crisis of our times to the pandemic that we have endured for nearly two years, both of course have been mired in the toxic spread of disinformation and denial. As director of the National Institutes of Health, Dr. Francis Collins has been guiding the United States through the COVID crisis. He recently announced that he’ll step down after 12 years and three presidents. And here he tells Walter Isaacson how grappling with vaccine resistance and conspiracy theories was one of his most difficult challenges as director.

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WALTER ISAACSON: Thank you, Christiane. And Dr. Francis Collins, welcome to the show.

DR. FRANCIS COLLINS, NIH DIRECTOR: Glad to be with you, Walter.

ISAACSON: After 12 years as the director of the National Institutes of Health, you did it through Obama’s term and then stayed on through Donald Trump and then for Joe Biden as we got to the last stages of this fourth wave. But then, you decided to retire from the directorship. Tell me about making that decision.

DR. COLLINS: It was not an easy decision. You know, it took me many weeks to wrestle with it. I hope nobody thinks I just had a bad idea and said OK, I’m done with that, but no, it was not that. 12 years is a long time, Walter. No other presidentially appointed NIH director has lasted more than about half that. So, I was kind of hitting my shelf life. And I really felt that if I was not going to stay for an entire additional presidential term, I needed to give the president a chance to identify a new director and get them nominated and confirmed by the Senate, which isn’t always an easy process before it got much later in the term. So, I had to really figure out what was the right timing and how to do the right thing here in terms of what’s good for the institution, because I love the NIH and I want to do everything I can to be sure it stays in the best possible place. And it was a bit of a challenge here, because COVID has been so completely dominating of everything that NIH has been involved in, and I have been deeply into that for the last 22 months, and I didn’t want to do anything to disrupt the momentum there, which has been amazing. Science has really risen to the challenge here.

ISAACSON: One of the things you’re noted for during your tenure is your humility. A trait that’s not often found in government these days. And the coronavirus, it seems like one of its side effects is to increase our humility, because it so baffles us so many times. What is it about this coronavirus that we don’t understand that you wish we understood better?

DR. COLLINS: Well, it sure has been an evolving experience of scientific humility, just when you think you have got your mind around what this virus is capable of, another curveball comes at you. I guess the biggest curveball in the last six months has been the Delta variant with its extremely high contagiousness, which pretty much said, we’re having a different pandemic now than we did in 2020 because this virus behaves so differently. Yes, we were not really prepared for that. That kind of wrecked a little bit of our simpler ideas about getting full immunity, enough of the population immunized or having had a prior infection, that the virus would be driven away. We didn’t get there. Of course, that’s not just because the virus changed. We also failed, really, to be able to communicate apparently to about 60 million people that they would want this vaccine. Walter, I got to say, that’s been the most surprising and disheartening part of the last 22 months. Science really stepped forward here, bringing together all of the bright brains from public and private sectors with resources supplied by the government through warp speed, and came up with vaccines that are unbelievably safe and effective, better than we hardly dared to hope for. And yet, here we are, almost a year after those approvals, where there is still substantial fraction of our society, a technologically advanced society, or so we thought, who are resistant to taking advantage of this and who are dying every day by 1,000 or more in an unnecessary way.

ISAACSON: Well, the most surprising statistic along those lines I saw was that 70 percent to 75 percent of some parts of the NIH, people who work at the National Institutes of Health, only 70 percent to 75 percent are vaccinated. Why is that?

DR. COLLINS: Yes, why indeed? You know, if we look at our employees, federal employees who are indirectly engaged in research or in patient care, because we run a hospital, they’re the percentages above 90 percent, but we have a whole bunch, thousands of contractors, who take care of the grounds and the cafeterias and the maintenance of the buildings, and that’s a cross section of the U.S., pretty much like any other group you might see, and they’re afflicted by the same set of concerns, much of it based on misinformation or even disinformation, that has reflected their resistance. Now, we’re going to see what happens because they also are now required to be vaccinated by December the 8th or risk losing their jobs. And I think that probably will wake up a lot of people who have been sort of on the fence or putting it off. But there will certainly be some who are very actively resistant for various reasons, and this could be a tough few weeks.

ISAACSON: You and I are very much in favor of these vaccines. Of course, I was even in an early trial for the vaccines and have had the booster shot, but I kind of get why people may resist saying, the government is forcing me to get a vaccine. Do you understand that resistance?

DR. COLLINS: I do. And I really wish the mandates were not necessary because the logic behind the vaccination is so compelling. We never should have had to do this. But when you consider that the country is at risk when such a substantial proportion of its population is not vaccinated, the government has an interest in trying to protect its citizens going way back to 1905 and Jacobson v. Massachusetts, the Supreme Court agreed that this is a role for the government when there is a public health risk of a major sort, and that is certainly true here. So, yes, I wish it hadn’t been necessary, but I think it was the right thing to do it. And interestingly, Walter, I have heard from a few people this story that they were resistant to vaccination because it’s sort of part of the tribe that they’re involved in, and their social circle, their bubble, everybody is like no, we have to fight this off because government is invading our liberties and maybe they have embraced some of the conspiracy theories that are out there, but they weren’t really quite sure they believed all that stuff, but to actually go and voluntarily get vaccinated put them at some risk of maybe being seen as not quite with the group. And now, if they’re forced to do it, they can complain about it, but it’s not their fault. So, maybe that’s helping a little bit here in terms of getting over the resistance. I don’t want to be paternalistic about that, but I have heard that kind of motivation from a few people.

ISAACSON: Moderna said over the weekend that it needs to reassess its data for 12 to 17-year-olds with the use of its vaccine. What are they looking into, and when might they be able to figure it out?

DR. COLLINS: For the Moderna and the Pfizer mRNA vaccines, there have been rare reports of myocarditis or pericarditis in people who got the two initial doses. And it seems that the most vulnerable group for this is young males between 12 and 30. Moderna is looking again to see whether their vaccine is particularly prone to this. Nordic countries seem to think Moderna had more of this than Pfizer. I have not seen that data convincingly. And let’s be clear, this is still a very rare event, maybe 1 in 5,000 in that high-risk group, and it’s a reversible treatable condition with apparently no long-term consequences. So, if you had to choose between that kind of myocarditis and getting COVID-19, you’re better off to get the vaccine. But still, I think they want to be really careful. These are, after all, data points that everybody wants to be sure are right.

ISAACSON: Do you really feel that every parent should have, say, a five- year-old vaccinated?

DR. COLLINS: I think every parent ought to be able to look at the benefits and risks and have the information they need in front of them in a digestible way. Parents are pretty smart about this, figuring out what to do that’s going to be best for their kids. I have all that data because I have been studying it furiously ever since Pfizer submitted it, and of course, in last week’s FDA meeting and this week’s CDC meeting, there is a very public discussion by experts. And I’m convinced if I had a 5-year-old son or daughter or maybe a grandchild, I would say this is something that is worth doing. This has got a whole lot more benefits than it does risks. The risks seem to be pretty low, basically a sore arm, maybe a little fever that first 24 hours. Other than that, we don’t really see there’s much of a reason to be concerned.

ISAACSON: You’re a person of deep faith. Have you been surprised at how the faith communities have sometimes resisted both vaccines and mask mandates?

DR. COLLINS: Yes, Walter, this is a source of heartache. I’m an Evangelical Christian. And that seems to be the community where there has been particular skepticism about masks and about vaccines. Much of it gets all tangled up with politics because those are also communities that tend to be conservative and oftentimes have embraced some of the rhetoric coming from the right, which may, in some instances, really not be based on science at all but rather based upon an effort to fight back against the other party. I do think this is a serious situation. And I have done a bunch of podcasts with people like Rick Warren and Franklin Graham to try to get a message out there to pastors and to members of congregations that this is serious stuff. It’s not sufficient to just accept some argument about masks or vaccines because it came from some political voice or some right-wing media. You want to know what’s true here. After all, our faith is based upon truth. If we lose that, we have lost the whole thing. Jesus’ words, John, chapter 8, verse 32, the truth will set you free. If we are slipping away from that, and I fear that the church, in many instances, has lost that anchor, that’s a really serious concern, not just about COVID but about our future in many other ways.

ISAACSON: You talk about the conflict sometimes between science and religion. But nowadays, we have an even worse conflict, it seems, which is between science and politics. Why is politics so infected our ability to be objective when we look at science?

DR. COLLINS: Walter, I don’t know. And here again, I worry about the state of our nation, that what seems to dominate every behavior that’s chosen is not what the facts are. It’s like, OK, what kind of points can I score against the other people? We’re so divided. We’re into our tribes. And it seems as if that’s particularly malignantly present in politics. And so, I see regularly people who are representing of the people who ought to be thinking about the people and the truth that they need to hear choosing a direction that they must at some level know is not actually factual. And putting it forward to score political points.

ISAACSON: Be more specific. Who are you talking about?

DR. COLLINS: Well, I don’t want to name names. There’s plenty of people one could point to here. But just as I said about the church, we’re losing an anchor to the truth is a serious danger for our future, one could say the same about politics and about our society as a whole. If we have lost the chance to tell the difference between somebody’s opinion or somebody’s most recent political statement, or somebody’s feelings and place those as if they had the same value as scientific evidence, we’re in deep trouble.

ISAACSON: We’re facing two epidemics. An epidemic caused by a natural virus, but also an epidemic caused by electronic viruses, the spread of misinformation and purposeful disinformation. How do we fight that second pandemic, which actually is like a viral pandemic? People spreading things, the lies evolve, and they become stronger.

DR. COLLINS: I don’t fault the people who are confused and fearful right now about COVID-19 and whether the vaccines are safe. I don’t fault the people who have really not figured out whether climate change is real because they’re barraged with all this information. I do fault the people who are distributing that information, knowing it to be false. That is the kind of behavior that a human being should not embrace without having a pang of some sort of sense of having crossed a moral line. And it’s not just now that we’re having this sort of social disagreement. This is killing people, Walter, literally. You know, 100,000 people estimated to have died from COVID-19 needlessly, unvaccinated, most of them because somebody gave them information that was demonstrably false that said, you don’t want this vaccine, it’s dangerous. 100,000 deaths. Our culture wars are killing people.

ISAACSON: Are you disappointed that the Wuhan Institute hasn’t been more forthcoming and the Chinese government hasn’t been more forthcoming in looking at the origins of this pandemic?

DR. COLLINS: I am disappointed. Because we need to know how this got started. I can tell you that none of the research we have funded at the Wuhan Institute could possibly have led to SARS-CoV-2 and COVID-19. But, of course, I don’t know what else they were doing. We were funding a tiny proportion of their budget. There are people who think maybe they had actually isolated SARS-CoV-2 a few months before it all burst out, and maybe there was even a lab accident. There’s no evidence to support that at all. None. But I think it would be better if they opened their lab books and let people look at what they were up to. So yes, I think China has really stonewalled this whole effort, and they continue to. And that’s unfortunate. We need to know exactly how this started.

ISAACSON: More than 20 years ago, you were on the cover of “Time” magazine because you helped lead the teams that sequenced the human genome. In other words, find out exactly where our genes are coded in our DNA. That didn’t actually lead to as much as we thought it would. But now, with the advent of the use of RNA and messenger RNA, we’re actually being able to make use of what you did more than 20 years ago. Tell me about what’s happening now that makes what you did in sequencing the human genome so important now?

DR. COLLINS: Well, it’s involved in almost everything we’re doing in medical research. And, Walter, there’s a first law of technology, which is a major scientific advance always is overestimated in the short run and underestimated in the long run. I think that’s true of the human genome project. There were people saying, this is going to transform your medical care in the next two years, and that was fanciful and there’s no way that could happen. I will say, it has transformed aspects of medical care, like cancer, for instance, where almost everyone who gets a cancer will want to know, what’s the genome sequence of the tumor cells and how could you use that in choosing therapy. It’s transformed management of mysterious cases in the newborn ICU, where you can get that genome sequence in two days and often make a diagnosis. And certainly, in the research area, it’s transformed everything we do in the laboratory. But you’re right, when it comes to RNA, which is, after all, the message that is produced from reading out a DNA sequence, that has become the mainstay of our best protection against COVID-19 and other infectious diseases with the mRNA vaccines. That took 25 years of hard work to get there. We just announced a few days ago a public/private partnership, the Bespoke Gene Therapy Consortium to try to see if we can accelerate the process working with FDA and about 10 companies and see whether we can regularize the approach to those gene disorders that are rare enough that they don’t get much attention but collectively involve about 30 million people. I’m pretty excited about that. And none of that would happen if it had not have been for the foundation provided by the Human Genome Project.

ISAACSON: As you retire, you’re going to still need to make a living. Do you think your Affordable Rock ‘n’ Roll Act might actually be something you could take on the road?

DR. COLLINS: Well, it might be fun do that, but I don’t think I would count on that to be particularly profitable. We do have a good time. The Affordable Rock ‘n’ Roll Act is all made up of scientists who have day jobs in the clinic or the laboratory, but they’re all pretty amazing bunch of musicians and we do have a good time, 10 or 12 of us, depending on who is available. And yes, I think we make some pretty good music. And when — you know, Walter, when you’re out there with the band is really clicking and you got people, hundreds of them out dancing, it’s an experience that you don’t want to pass up. We have had to pass it up for two years because of COVID. I hope we are going to be able to get back out there soon.

ISAACSON: Dr. Francis Collins, thank you so much for joining us.

DR. COLLINS: Great to talk to you. It was a fun conversation.