- When politics and public health collide.

This week on "Firing Line."

- [Speaker] Mr. Kennedy, congratulations on your nomination.

- [Margaret] The nomination of Robert F. Kennedy Jr. to head the Department of Health and Human Services created a firestorm.

- Buckle up, because vaccines are going to become more expensive and less available.

- He's re-litigating and churning settled science.

- He has done more than just about anybody to undermine people's trust in vaccines.

- News reports have claimed that I am anti-vaccine or anti-industry.

I am neither.

(protestor shouts) I am pro safety.

- Where's your heart?

(gavel banging) - [Margaret] Vaccines are not our only public health challenge.

Bird flu, obesity, opioid addiction.

These are just some of the crises facing America and the world.

- This is a failure of meritocracy when people can get into positions of very senior leadership that really have the responsibility of our destiny in their job description.

- Dr. Richard Carmona, U.S.

Surgeon General under President George W. Bush, is a veteran of the battle between politics and public health.

Do you think lives are on the line, Dr. Carmona?

- Absolutely, lives are on the line.

- [Margaret] With RFK Jr. likely to be in charge of the institutions that keep Americans healthy, what does Dr. Richard Carmona say now?

- [Announcer] "Firing Line with Margaret Hoover" is made possible in part by: Robert Granieri, Vanessa and Henry Cornell, The Fairweather Foundation, Peter and Mary Kalikow, Cliff and Laurel Asness, The Meadowlark Foundation, and by the following.

Corporate funding is provided by Stephens Inc. - Dr. Richard Carmona, welcome to "Firing Line."

- Thank you, Margaret.

Happy to be with you.

- In November of this last year, you co-authored an op ed with four other past surgeons general who served under the Trump, Obama, Bush, and Clinton administrations.

And in this op ed, you implored the new Trump administration to, quote, "prioritize global health security and vaccine confidence as critical national security concerns."

What is your degree of confidence that the administration is heeding your advice?

- Well, I'm concerned because there's so much chaos going on now in the administration that we just kind of shift from one topic to another and there doesn't seem to be a cohesive, strategic plan as it relates to issues of global health.

And because of these misinformation, disinformation, confusion, the public is not sure who they can trust anymore.

- Well, the Senate Finance Committee just this week has voted to advance Robert F. Kennedy Jr.'s nomination to run the Department of Health and Human Services.

Now, Robert F. Kennedy Jr. has spent decades advocating against vaccines and spreading misinformation.

He has called the COVID-19 vaccine, quote, "the deadliest vaccine ever made."

He suggested the pandemic was, quote, "ethnically targeted to attack Caucasians and Black people."

He has said he believes that, quote, "autism comes from vaccines," and he has linked school shootings to antidepressants.

What would it mean for American public health if Robert F. Kennedy Jr. is confirmed to run the Health and Human Services Department as it seems is likely to be the case?

- Well, Margaret, I'm extremely concerned because having lived in that world and know the complexity of that organization, which has about a $1.7 trillion budget, 62,000 people, and not only in the United States, but our reach is globally because it is important that we work with our allies to perpetuate peace and stability and health.

So I would be very concerned.

And as I look at the nominee, and this is an apolitical, nonpartisan statement, I look first, what are the competencies of this person to do the job?

What has been the scope and scale of their leadership positions?

Have they managed a large budget?

Have they managed a large, complex organization that has to deliver to the American people and to our allies, at times?

And the answer is no.

So this is really about competency.

I sit on public boards where I deal with this with nominating and governance committees.

You earn the right because it's a meritocracy.

This is a failure of meritocracy when people can get into positions of very senior leadership that really have the responsibility of our destiny in their job description.

- Senator Bill Cassidy, a Republican senator from Louisiana who is also a medical doctor, cast a key vote in support of Kennedy after wavering for several days.

Cassidy defended his support by insisting that RFK Jr would work closely with him, maintain existing CDC advisory panels on vaccines, and preserve research showing that vaccines do not cause autism.

Cassidy vowed to, quote, "watch carefully for any effort to wrongfully sow public fear about vaccines."

Does his change of heart, or his new confidence in Kennedy's ability to run HHS, settle any of your concerns?

- No, none whatsoever.

Often we say, you know, listen to what a candidate running for office or a senior position has done in their life, not what they tell you when they're looking to get the job.

The fact of the matter is, most of the statements he's made in the past in any other administration, Republican or Democrat, would be immediately disqualifying as it relates to being considered for a position like this.

So, no, I am not feeling calm about this.

I'm quite concerned, because, again, the competencies are not there based purely on his background, training, education, and leadership experience.

- What, in your estimation, Dr. Carmona, could be the most severe or concerning consequences of his possible tenure at the head of the Health and Human Services Department?

- Well, I think you look through many lenses.

First of all, can he lead an organization that's so large that has national responsibility as well as global responsibility?

Does he have an understanding and appreciation of evolving science, which should drive his decisions?

The fact is that vaccines arguably are probably the most significant advancement in science in the history of mankind.

We don't have the plagues anymore.

We don't see epidemics of whooping cough and measles and mumps and rubella because vaccines work and they keep us safe, and the rest of the world benefits from our vaccinology that we share.

So that's just one of many things that I would be concerned with, and that if you enter that position with bias, that you want to be a disruptor, that you don't think government is doing a good job, and so that can be very detrimental to the health, safety, and security of our nation as well as our national security.

- Do you think lives are on the line, Dr. Carmona?

- Absolutely, lives are on the line.

If people don't get vaccinated, if mis- and disinformation has been spreading and it continues to spread, and a lot of it from Mr. Kennedy, who is looking to get this job, then all of our lives are in jeopardy, as well as our allies and the rest of the world, depending on what the catastrophic event is that we're dealing with.

- You know, your view, I think it's safe to say, Dr. Carmona, is widely held amongst the medical community.

It is not as widely held amongst everyday Americans and politicians, particularly those who are in the majority in the House of Representatives and the Senate right now.

How do you manage this disconnect with the public?

- Well, often people would ask me as surgeon general, "What was the most difficult challenge you had?"

And I said, "Well, that's pretty easy.

It is telling inconvenient truths to politicians."

However, when given those inconvenient truths, a leader who is in a political position, who leads with integrity, will make the appropriate decisions by not worrying about how it's going to affect them or their fundraising, but really serving selflessly to do something for the greater good of our nation, the people that we serve, and the world.

- Are you surprised, Dr. Carmona, that more medical professionals and, frankly, the pharmaceutical industry have not been more outspoken in this national conversation we've had around the nomination of Robert Kennedy Jr.?

- Well, I would say not only the pharmaceutical industry, but I think across the board with knowledgeable people.

And I've been in some of those conversations.

People are fearful for their own safety.

They are fearful that there'll be retaliation or retribution, as the president has said in some of his remarks.

You know, "I am the person that will provide the retribution."

You know, he said that publicly.

And I think people are fearful because we see what's happening now.

An FBI that's being dismantled, governmental organizations are being put aside.

We're seeing the very machinery of this nation being dismantled and all the power given to a single leader who is amalgamating power as quickly as he can.

- Let me ask you about something that happened just before the Senate Finance Committee voted on Kennedy's nomination this past week.

President Trump posted on social media, quote, "20 years ago, autism in children was one in 10,000.

Now it is one in 34.

Wow.

Something's really wrong.

We need Bobby."

In a recent Kaiser Family Foundation poll, 20% of Americans said it is probably true that vaccines cause autism.

This is not true.

Vaccines do not cause autism.

According to the CDC, there is no link between vaccines and autism.

Would directing research towards understanding the causes of autism be a worthy redirection of this energy?

And do you think that's a possible upside or outcome, a glass half full solution here?

- Well, of course research in any unanswered question is important.

The fact of the matter is there is no evidence whatsoever that there's any link.

Numerous studies have been done over the last 20 years to show there is no relationship whatsoever.

And yet research needs to continue as to how and why we have autism and why it's increasing.

But we know it's not from vaccines.

- Over the last few months, Dr. Carmona, there has been a movement, the MAHA movement, Make America Healthy Again movement.

Some of their grievances about vaccines and seed oils are scientifically baseless.

But medical experts agree that there are other legitimate concerns over ultra-processed foods, pollutants, microplastics.

Are there some aspects of the Make America Healthy agenda that are plausible to you and that you agree with?

- Yes, absolutely they are plausible.

So can we make America healthy again if we start changing the way we eat, recreate, relate to one another, mindfulness, meditation?

We have a better understanding of the brain now.

All of those things are important because, actually, we all try, or would like to live longer, younger, happier, healthier, and cheaper.

That's the goal, no matter who, you could call it MAHA, you could call it anything you want.

But this is nothing new.

They, you know, branded it differently.

But if you look at all my colleagues, surgeon generals, going back, all of us dealt with the same issues.

We recognize that this is an increasingly preventable disease and economic burden, that if we take some steps, literally take some steps, live a healthier life, have access to whole foods, eat farm-to-table, de-stress in our life, that we can live longer, younger, happier, healthier and cheaper, and thusly reduce the cost of care and improve the quality of care and improve access to all because we won't be spending so much money on treating things that we actually cause by our bad behaviors.

- One of Robert F. Kennedy Jr.'s complaints has been that the federal health agencies are too focused on fighting infectious disease and not doing enough to confront chronic illnesses.

The prevalence of many chronic illnesses is on the rise.

Adult diabetes diagnoses, obesity rates, deaths due to Alzheimer's, have all increased over recent decades.

Is the federal government doing enough to confront chronic diseases?

- I do think that the agenda has changed significantly over the years, and we recognize that non-infectious, non-communicable diseases caused by lifestyle are ones that are significant.

But to suggest that we are going to marginalize infectious disease and only focus on that would be catastrophic.

Let's talk about COVID over the last four or five years.

Had we not spent time in understanding how a virus evolves, how can we make a vaccine quickly, how can we protect the people, we would have had many more deaths than the million-plus we've had already.

So the science has to continue with infectious disease as well.

But that doesn't mean you subordinate the programs that would help people to change behaviors so that they can optimize their health and wellness and reduce the cost of care.

They have to go hand in hand.

It all has to be part of a strategic plan as we move forward as a nation, because not only for us, but our science fuels the world.

Many of our allies and even our adversaries look at what we do so that they can take our best practices and make their communities safer, healthier, and more secure.

- You just said, let's talk about COVID.

So let's talk about COVID.

- Okay.

- I think it's safe to say Robert F. Kennedy Jr.'s rise in popularity with certain segments of the American public coincided with a decline in trust in public health- - Yes.

- And the public health establishment in the wake of the COVID-19 pandemic.

Measures that both the Trump and Biden administrations pursued, like lockdowns, school closures, has created repercussions that are still being felt today.

What lessons can public health officials take from the COVID-19 pandemic?

- Great question, Margaret.

And I'm working with some of my colleagues now on an after action report on that very issue.

So first and foremost, let's put it in context.

This was the first pandemic in over a century.

So the institutional memory was not there.

The knowledge wasn't there.

People were surprised because it was a new pandemic.

And in the beginning, there was a lot of questions about keeping people home, letting them go out.

And I think it wasn't done maliciously, but there were people that were experts but did not have the depth and breadth of knowledge of a pandemic because we hadn't seen one for 100 years.

We learned a lot.

We know now that probably letting young, healthy people stay in the environment, keep our stores and schools open, get them vaccinated quickly, is a good thing, and keeping the vulnerable away because those are the ones that will have the highest morbidity and mortality.

We learned how to get a vaccine quickly.

President Trump was actually behind Operation Warp Speed to get the vaccine done very quickly.

So there's a lot of good things that happened, and there are a lot of things that are still challenging.

But probably the most important I see, we have to communicate better.

Tony Fauci is probably the premier virologist in the world, and he was vilified by mis- and disinformation.

The fact of the matter is, when I was responsible as incident commander at the University of Arizona, where I am now, one of the things we decided, we need to have one person that the public trusts communicating.

More or less like Franklin Roosevelt with his fireside chats, and would give information from a trusted source.

Instead, so many people were speaking, many of them politicians who had no subject-matter expertise.

People didn't know who to believe and it divided us even more.

So communication is key.

When and if something like this happens again, subject matter experts should be there communicating.

They should be in coordination with the political leaders so we make sure we are all aligned, and the public sees a clearly focused, scientifically-driven message that will reduce their morbidity and mortality.

That's probably the best thing that we've learned from the last four years with COVID.

- I mean, I want to ask you about that, though, because Dr. Fauci was highly communicative.

I mean, there was hardly a television program, a cable news show, a radio show, a podcast, that he wasn't on.

Some of the challenges, at least in his case, is that he at first said, "Don't use masks," partly because we learned he didn't want masks to be taken away from medical professionals against the backdrop of a shortage.

But then masks became a must-do.

So there was also, there was hyper communication, but there was also a changing in the communication that it seemed to me sowed distrust amongst the public.

- Yes, I would agree with you.

And it falls back on what I mentioned, that first pandemic in a hundred years.

And the technology we have today is much different than we had in 1918.

Masks are an issue now that we have to deal with.

And so the communication could have been crisper and clearer and delivered through trusted individuals, not on political platforms.

So there are a lot of, you know, as you unpack this, Margaret, it becomes quite complex.

But your point is very good about the masks.

There was a shortage of masks.

Let's keep it for the health professionals.

There could have been better communication to the public, so, on that particular issue, but on many other issues too, as far as closing schools, keeping people home.

At the time, think about it, nobody was sure how this virus was going to affect us.

Is it going to die off pretty quickly?

Is it going to cause more death and disability?

A lot of questions were being asked, so it was kind of like we were at 35,000 feet in the proverbial plane and we were learning how to fly it.

- It occurs to me, as we were talking about the confidence people have in our public officials, experts like Dr. Fauci were dismissive of the theory that COVID-19 originated in the lab in Wuhan.

The CIA recently changed its assessment to support the lab leak theory.

Was the certainty with which public health officials spoke about matters that were, and in some cases still are, unsettled unnecessarily damaging to the public's confidence in what public health officials were telling us?

- Margaret, again, another terrific question.

I think that it added to the fuel of uncertainty where people wanted to know, "Well, where did this come from?

You should tell me right now."

The problem was it was quite complex.

Was it bats coming out of a mine that went to that outdoor food area and then spread the disease there?

Or was there a leak in the lab that the Chinese didn't tell us about?

From my standpoint as a provider of preparedness services, that was less important to me than stopping the spread of the disease.

The intelligence network looked, the scientists looked, the virologists, the geneticists looked.

And there's still some uncertainty there.

The more important thing was how do we protect the American public and the world from the first pandemic in a century?

That's where I spent my time.

To this day, there are still very smart people in the intelligence world and the science world that debate.

Could it have been both?

Could it have been one or the other?

There could have been spillage in the lab, or it could have been from that bat that flew in from a remote area and dropped his dropping on foodstuff.

Maybe it was both.

But more important to us today as a nation is how do we prevent the spread of this disease?

How do we get a vaccine quickly to prevent it from spreading?

How do we care for people who are sick?

Where are our resources?

Where's our logistical support?

That's where I spent my time.

But I do agree with you that that early uncertainty of where it came from added fuel to the mistrust.

- Let me ask you about vaccine skepticism, which really has soared since the beginning of the pandemic.

A Gallup poll found last summer that 40% of Americans think it is extremely important to have children vaccinated.

That's down from 58% in 2019.

- Right.

- Did vaccine mandates correlate, in your view, to an increase in vaccine hesitancy?

- I would say that there may have been some relationship because where people might have wanted the vaccine, but they didn't like being told what to do.

You know, the independents.

"Don't tell me what to do."

And I heard it personally from people.

But in giving them an education, you also give them informed consent.

Be advised that if you don't get the vaccine and you get the disease and you're living with your 90-year-old grandmother or your 80-year-old grandfather, you can pass the disease to them and it could be lethal because they are infirm, elderly, they're taking medications, et cetera.

So it's not only about the individual person.

It is about the ramifications to the society around you when you become a vector for disease, which makes this discussion very complicated.

- If the goal is to achieve a high amount of vaccine compliance, do you believe, as a public health official, that is possible without mandates?

- It probably is not possible.

But we can probably close that delta a bit by better education, that people having trust in the vaccine, that it doesn't cause disease, that the government is not experimenting on you.

All of that mis- and disinformation that was promulgated by Mr. Kennedy and others.

We need to align on our communications, make sure that we gain and earn the public's trust, so that in times of national emergency, catastrophe, the public turns that screen on and hears one message and trusts us because we've done all the vetting ahead of time and have an infrastructure in place that is to serve them and reduce morbidity and mortality.

- On the original "Firing Line" in 1974, Dr. Russell Roth, president of the American Medical Association, discussed challenges facing the healthcare system beyond just the cost of care.

Take a look at what he said then.

- Ignorance, fear, patient neglect, faith in substitutes for good medical care, the quackeries, the frauds, and so on, these are barriers that are now becoming more important than the dollar barrier.

- 50 years later, with the rise of social media, ignorance, quackeries, the frauds, seem to be an even bigger obstacle.

How can public health officials confront the spread of misinformation in our current media climate?

- It's an interesting clip.

And there is a lot of similarities and there are some differences.

Clearly, he's not using the term mis- or disinformation, but it is a driver today of people not wanting to expose themselves because they don't know who to trust.

So I think it's important.

But the other point is the value of prevention.

So we focus a lot more now on the noninfectious, non-communicable disease that are largely driven by our behaviors: sedentary activity, weight gain, type-two diabetes, living in a stressful environment, not eating healthy food.

All of those things have a significant toll.

And so prevention is in the forefront today.

But my strongest message on this would be to the public: do everything you can to get into a system that values prevention.

See a healthcare provider, whether it's a nurse practitioner, a physician's assistant, somebody in the field, check you out, understand what your risk factors are, understand what you can do to change behaviors to lower those risk factors, and in doing so, being able to live longer, younger, happier, healthier, and cheaper.

- Dr. Carmona, the threat of COVID-19 is not entirely gone.

More than 2,000 Americans died from the virus in the last month.

And that's not the only public health threat that officials are facing.

Kansas is currently dealing with one of the largest recorded tuberculosis outbreaks in U.S. history.

- We've already seen other viruses like the bird flu and monkeypox emerge.

How well-prepared is the United States today to deal with the next deadly virus?

And what do you advise the Trump administration to do in preparation?

- Okay, first and foremost, I think we are better prepared today.

As I mentioned to you early on, the institutional memory of how to deal with the pandemic was gone.

There were few people alive in a leadership position that remember 1918.

But we've built on that.

There is a guidebook that the federal government has that you can get at FEMA.gov or DHS.gov, and it's called a national response framework.

And it's an outline that how our nation deals with any and all threats to the health, safety, and security of the nation where a community's resources may be spent.

So I think we're better prepared.

If I was going to recommend to the new president that we should be testing these systems at a local, state, national, and global level to make sure that when and if we are threatened with any and all hazards that can threaten the health, safety, or security of our nation, we understand how this rolls out, how we surge, how we get together, what the communication networks are, what is our logistical supply?

All of those things are important.

And if you don't test them once in a while, you won't remember how to use them when an emergency occurs.

- Dr. Richard Carmona, for your service to this country and for your expertise here on "Firing Line," thank you for joining me.

- Margaret, thank you so much for being the portal that the public needs so we can educate them as to these challenges and hopefully get rid of a lot of the mis- and disinformation which is scaring people today.

(bright music) - [Announcer] "Firing Line with Margaret Hoover" is made possible in part by: Robert Granieri, Vanessa and Henry Cornell, The Fairweather Foundation, Peter and Mary Kalikow, Cliff and Laurel Asness, The Meadowlark Foundation, and by the following.

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