Before he stepped down on Dec. 19, Dr. Francis Collins was the longest-serving director of the National Institutes of Health since presidents began to appoint them. Installed by President Obama in 2009, he served under three administrations and during his tenure the budget of the NIH, the leading funder of research related to the health of Americans, grew from $30 billion to $43 billion. He is that rare bureaucrat who is also a career scientist; he was instrumental in decoding the genome and will continue to work at the National Human Genome Research Institute lab at the NIH, which has already had some success in the search for genetically-informed solutions to such health issues as cystic fibrosis, type 2 diabetes and progeria. He is also that rare scientist who is a devout Christian; he describes DNA as the ‘language of God.’
This interview has been condensed and edited.
Is the fact that you’re willing to leave the National Institutes of Health a sign that the COVID-19 crisis is over?
Oh, I only wish. Science has been amazingly responsive to that challenge. But we’ve had other problems that got in the way, some induced by this virus’s remarkable ability to develop new variants and a lot of it induced by our failure to convince everybody to take advantage of the tools that could have helped them.
One of the reasons that President Trump was not reelected, some said, was because of his handling of COVID-19. Did you see many differences with the current administration?
Yeah, it was clear that [the current administration] was going to be a circumstance where everything that got done about COVID would be based on what the science suggested was going to give the best outcome. That had not necessarily been the case in the preceding administration. It felt very much like the doors were wide open to the exchange of information.
Yet polls suggest that a majority of Americans believe that the information coming from public health officials currently is confusing. Why do you think it’s been a bit of a mess?
There are two reasons. The most significant one is that the science is changing. You wouldn’t complain to your stockbrokers if they gave you a different recommendation about a stock from two weeks ago; you’d say, ‘Oh, this person is really on top of what’s happening.’ But I will say there have been instances where the communication has not been ideal.
During most of the last four or five months I was in the NIH director’s role, the Surgeon General Vivek Murthy convened the ‘White House docs,’ as we called ourselves, once a week, and we’re trying to identify areas where we don’t quite think we know the answer, but we’re getting asked about it, let’s figure out what we think we ought to be saying. And then for any of us who were on the Sunday morning news shows, the White House would convene a one hour long conversation, and we would make sure that we were all going to be giving the same message. I gotta say, I think it’s disheartening at a time of a pandemic where we’re all really trying to get past this by making the right decisions to have such a strong focus on criticizing the public health communicators when something doesn’t go quite right. It’s almost as if they’re being blamed for the pandemic.
Indeed, you have drawn a lot of criticism, with major media outlets essentially saying that you shut down debate and censored public health approaches other than the official one. How do you respond?
When you look back at that issue, The Great Barrington Declaration [Ed. note: a fall 2020 proposal that those at lower risk of death from COVID-19 be allowed to avoid restrictions and “build up immunity to the virus through natural infection”] was scientifically very indefensible and, public health wise, irresponsible. This is a proposal that will kill people. So how could I possibly stay silent? I will not apologize for saying that this needs to be addressed. Maybe I could have used a better word than “taken down” or whatever in my emails. I was not expecting, of course, that they would become a topic of [Senator] Rand Paul’s latest hearing. It was my job as the leader of the world’s largest supporter of biomedical research to call [terrible ideas] out.
Looking back over the last two years, would you’ve done anything differently, communication-wise?
Yeah, I underestimated the degree to which vaccine hesitancy was always going to be resistant to evidence, and I wish we had initiated more intense research and the basis of this kind of decision making and what interventions might actually work. Clearly lecturing people has not done a lot of good.
What has been your darkest hour?
The resistance of more than 50 million Americans to take advantage of life saving safe and effective vaccines. That is so heartbreaking. Estimates are more than 100,000 people have died because of misinformation. It’s just shocking to contemplate; 100,000 deaths based on rumors, conspiracies, trust polarization, the way in which we’ve all slipped into our various tribes and become blinded to information that doesn’t fit that particular tribe’s perspective. This is horrifying. That’s about as dark as it gets. I really thought as we got to the point of more than 100 million people being vaccinated, and when 95 plus percent of the people dying were unvaccinated, it seemed like a conclusion that you couldn’t ignore. The misinformation is so deeply written into the consciousness of those 50 million people, that even the most incredibly compelling evidence to save yourself and your loved ones is not enough to overrule it. That’s frightening. It tells you how far down the road we have gone.
Many of the people who distrust the vaccine are people who go to church or call themselves Christians. Why do you think that is?
I identify as a white evangelical Christian and that is the very group where the vaccine hesitancy is at the highest level. I don’t want to blame any of those people who have been somehow seduced by misinformation into a position that is not good for them. I want to blame the people who are spreading the misinformation especially those who know it’s not true and are doing so anyway.
Well, who’s that? Do you think Rand Paul knows it’s not true? Or is he just saying there’s reasonable doubt?
That would be a good question. Does Rand Paul know that what he’s spreading around, while it might be good for his political career and his fundraising, is actually untrue? Do the people who say for political reasons that the 2020 election was stolen know that they’re defending a position that is demonstrably false? People are pretty good, I guess, at fooling themselves. I look at what happens in social media, at the top 12 distributors of false information on Facebook. And some of them are doctors who are making a lot of money on this. They’re the people who I have the hardest time forgiving, physicians who have given an oath to do no harm and are now saying ‘These vaccines are dangerous.’ And ‘Here is an alternative approach and that if you buy from me, you’ll be fine.’ Look at Dr. Joseph Mercola from Florida.
The one who claims to be the inventor of mRNA?
No that’s Dr. Robert Malone and, yes, he has now said it’s dangerous. But coming back to those people in the pews on Sunday morning, I’m not blaming them. I just am heartbroken that they have been somehow brought into this place of distrust, denial of factual information, called upon to do so in many instances by these tribal alliances which are driven a lot more by politics than they are by faith. Young people looking at this are like, ‘I don’t want to be here anymore.’ Look at what’s happened to membership in the church. So that’s another deep tragedy, that it’s gotten caught up in our societal malaise.
Are you tempted to lay blame on anyone?
I don’t like to do that because then I’m practicing some of the same behaviors that I’m decrying here, but I do think elected public officials have a responsibility when they’re putting out information to know whether it’s true or not. You almost feel like sometimes political parties want the public health efforts to fail if they’re being produced by their enemies.
Polls suggest most people believe that the virus leaked from a lab. Do you still believe it didn’t?
I don’t have any new information. Neither does anybody else because China has refused to cooperate with the only way that we might really try to find this out, which is to look at their lab notebooks from back then. And then the other records about people who fell ill in November of 2019, they refuse to share that. But the evidence so far that this was the result of a lab leak is entirely conjectural. On the other hand, looking back over all previous pandemics, they came about because of an animal-to-human transmission without requirement of a laboratory screw up in the middle to make it happen. Why are we jumping into a less common explanation when a much more common one is right in front of us? I can only conclude it’s because of politics.
Is there any country that got COVID-19 management right?
I don’t know if you can say anybody has absolutely nailed it. We all like to look at New Zealand and how effective they were in their time, but I think what we are now learning with Omicron is the idea that you could actually keep this virus out is really hard. I certainly wouldn’t say the United States can claim that.
What can we do to prepare for the next pandemic to avoid the same mistakes?
A lot of plans have already been put in place, although the budget to support them is not as solid as I wish it was. We can make a pretty good guess about which virus is likely to be the next culprit. We should start now to have the early steps of vaccine development, therapeutic development, and diagnostic development already done. We hope we won’t need them. But we would be that much further ahead with the response if we need it. I think we’ve also learned our surveillance worldwide has got to get better. And that’s a heavy lift, but I think everybody including Congress agrees our public health system has been so strapped by this; it has revealed all the ways in which it has been underfunded.
A lot of science graduates are going into tech or finance, because it’s more lucrative. Are you worried about a brain drain from medicine?
I’m not worried so far. I think it should be clear to people looking around that biomedical research is on an incredibly steep exponential curve of discovery and application. This is the best time in the history of the planet to be part of this adventure. This is the golden era.
Finally, I noticed that you have been made quite a lot of fun or for your singing. Does it bother you?
No, I love it. And they’re supposed to make fun of it. It’s not supposed to be serious. If people are laughing, then I win because I want them to laugh.
Correction Feb. 4.
The original version of this story misstated which doctor helped discover mRNA and then deemed it dangerous. He is Dr. Robert Malone, not Dr. Joseph Mercola.
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