Transcript: Dr. Scott Gottlieb on "Face the Nation"

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The following is a transcript of an interview with Dr. Scott Gottlieb, former FDA commissioner and a member of the Pfizer board, that aired Sunday, Aug. 7, 2022, on "Face the Nation."

MARGARET BRENNAN: We turn now to former FDA commissioner Dr. Scott Gottlieb, who is also a board member at Pfizer, and he joins us this morning from San Francisco. Dr. Gottlieb, good to have you back. You have been on this program warning for some time now that monkeypox was past the point of containment. This week, the Biden administration acknowledged it is a national public health emergency. They added two senior advisors to the White House to run point, what difference does it make now? Can they catch up?

DR. SCOTT GOTTLIEB: Well, look, I think they can still catch up. I think there's a potential to get this back in the box, but it's going to be very difficult at this point. We're continuing to look for cases in the community of men who have sex with men. It's primarily spreading in that community. But there's no question that it's spread outside that community at this point. And I think we need to start looking for cases more broadly, we're looking for cases in that community. So, we're finding them there. But we need to start looking for cases in the broader community. And that means probably testing anyone who presents with an atypical case of shingles or an atypical case of herpes for monkeypox as well, I think we need to broaden testing. And so far CDC has been reluctant to make that recommendation. I think if we're gonna contain this and make sure that it doesn't spread more broadly in the population, we need to start testing more broadly. We have the capacity to do it. Right now, CDC has the capacity to conduct about 80,000 tests a week. They're doing about 8,000. So, they can broaden this substantially by changing the case definition and--

MARGARET BRENNAN: Mm-Hmm.

DR. GOTTLIEB: --recommending that more doctors be testing more patients looking for this infection in the community.

MARGARET BRENNAN: Well, to your point about broader spread. In Illinois, a daycare worker tested positive for monkeypox and exposed children. The FDA are allowing those kids to be vaccinated. Parents about to send their kids back to be- back to school, should they be worried about this now?

DR. GOTTLIEB: Look, I don't think this is something that people need to be generally worried about, I think that probably the incidence of this infection in the broader community is still very low. So, your- your risk of coming into contact with monkeypox is exceedingly low outside of certain social networks where you see a higher case rate. But if we want to contain this, if we want to prevent this from becoming an endemic virus, we need to be looking more widely for it. And the worst case scenario is that we start testing more broadly. And we don't find it and that would be reassuring. But we should be doing that. We should also be testing wastewater for monkeypox. That's something that CDC can turn on instantly, starting to look for monkeypox in wastewater to see if it's spreading in communities and locations- geographic locations where right now we don't think it's spreading, but it could be.

MARGARET BRENNAN: We don't know what we don't know. On vaccines we know there is a national shortage. There are two doses of this vaccine that are required. HHS and the FDA said on Thursday that they're looking at a dose sparing approach to stretch out existing supply. How does that work? What- what does that mean?

DR. GOTTLIEB: Right, so this decision could come as early as this week, and the emergency use author- authorization that they could issue is it flows from the public health emergency that they declared. So, this would be the first practical effect of that public health emergency. What they would do is cut the dose by a fifth, so they only give one fifth of the dose. And instead of injecting it subcutaneously, so below the skin, they'd inject intradermally into the skin, so into the top layer of the skin. So think about a test that you get, for example, for tuberculosis, where you used to get an injection under the skin and you'd get a small welt as they injected fluid under the skin. That's an intradermal infection. We know that we inject certain things into the skin in that way, it's very immunogenic, you get a strong immune response. And there's a lot of data that FDA has looked at, that was actually collected in the context of trying to prepare for smallpox, a potential outcome with smallpox with smallpox might be used as a bioterrorist weapon, and how we would extend doses of the smallpox vaccine. What they learned from those studies is transferable to this vaccine for monkeypox. And so they feel very assured that they can- they can generate a strong immunological response by delivering this intradermally and that would allow them to stretch out the doses of the monkeypox vaccine they have by fivefold, so instead of having about 800,000 doses--

MARGARET BRENNAN: Mm-Hmm.

DR. GOTTLIEB: --they would have somewhere between four and five million doses immediately.

MARGARET BRENNAN: But this is essentially an experiment in real time?

DR. GOTTLIEB: Well, we- we've done it before. I mean, we did it for yellow fever, we've done it for Ebola. We've done these dose sparing strategies in public health emergencies. It's unfortunate we find ourselves in this position. There's decisions that could have been made earlier where we'd have more doses available, but this is a practical solution to a very immediate public health challenge.

MARGARET BRENNAN: I want to ask you about COVID now. President Biden has tested negative twice now. He's out of isolation. Pfizer makes Paxlovid, the drug that the President took, I know you're on the board of Pfizer's we say. The White House says just five to ten percent of cases have these rebounds. But this is a pretty high profile case. Dr. Fauci had a rebound too. Does this indicate anything about how someone fares long term from COVID? What- how do we understand this?

DR. GOTTLIEB: Yeah, well, look, the good news is that the President's feeling well, my understanding is that he didn't experience any new symptoms during this second bout of infectivity. So, he was testing positive but didn't in fact mount new symptoms. And that's a good sign. I don't think that he's going to have any long term implications because he had this second course of illness from- from COVID. We don't know, but I think the President's going to do quite well given what we know about his case, and the White House has been very transparent. You are seeing these cases of rebound. You're right. So far, the data seems to suggest it's about 5% of cases. You also see rebound with the other drugs and you see it in the- in the setting of natural infection. It's being studied. Pfizer right now, which as you mentioned, I'm on the board of, is talking to FDA about doing some additional studies on how to approach these cases, whether or not you recourse the therapy or extend the dose, the- the length of treatment--

MARGARET BRENNAN: Mm-Hmm.

DR. GOTTLIEB: --in certain patients. So we don't know how to--

MARGARET BRENNAN: Yeah.

DR. GOTTLIEB: --approach this fully right now. But it's a small percentage of cases where you're--

MARGARET BRENNAN: Yeah.

DR. GOTTLIEB: --seeing this phenomena.

MARGARET BRENNAN: Quickly. CDC is expected to loosen COVID guidelines for schools. Do you favor this?

DR. GOTTLIEB: Look, I think it reflects the reality that more kids are- have been exposed to this virus. They're not immunologically naive. We want to do more to keep kids in the classroom and changing attitudes about COVID. I think there are still ways we can keep kids safe in the classrooms, remain vigilant and lift some of these restrictions that have caused a lot of kids to have to miss school days. So the test to stay strategies. We've turned over a lot of infections that were asymptomatic and forced kids out of the classroom, quarantining kids who are exposed to COVID. I think they can lift those things at this point. And that seems to be where CDC is heading. But still remain vigilant, for example, notifying parents when there's a close contact so--

MARGARET BRENNAN: Yeah.

DR. GOTTLIEB: --parents can keep an eye on their children and get them tested.

MARGARET BRENNAN: All right, Dr. Gottlieb, we'll be watching that. Thank you. We'll be back in a moment. Stay with us.

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