Meidas Health, Episode 15: Dr. Demetre Daskalakis Speaks Out After CDC Resignation

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2:36We just had Dr. Susan Krusty of the American Academy of Pediatrics on to talk about all things back to school and to really give evidence-based information. Remember, she said to go to healthychildren.org if you had questions for all the parents out there, all the confusion. If you have questions on what vaccines to get your child or basic fundamental issues that might arise when it comes to getting the flu vaccine, questions about the COVID vaccine, RSV. She went through all of that in episode 14, especially in the back half. Highly encourage you to listen to that. It's completely free. and also immunize.org.

3:14If you have questions and you're an adult or if you have a loved one that might be older, she recommended we go there to get trusted resources that are easily navigable. So please do do that. And just as a reminder, Midas Health is not just trying to be another podcast. We're trying to leverage the massive audience of the Midas Touch Network to provide you a space to interact and to hear from the nation's best healthcare leaders because unfortunately, a lot of them are no longer at the very top of the federal government. And so that's exactly why I'm so thrilled to have Dr. Dimitri Daskalakis here for episode 15.

3:51He's a big time healthcare leader for our country. I've admired him for a very long time. I really frankly consider him somebody to just emulate in terms of impact at scale. And especially as a physician trying to do or trying to have impact at scale and trying to reach as many people as possible. Dr. Dimitri Deskalakis is the very definition of that. And so you're gonna see that really shine through in our conversation. But without further ado, I really wanna maximize our time here with Dr. Dimitri. We've agreed that we're just gonna use first names here. So Dimitri, thanks so much for joining Midas Health.

4:29Thanks, man. That is an introduction that my mom would love. So thank you so much for that. Well, I so, you know, here we are Labor Day, quite literally Labor Day. So thank you for joining us on a holiday. Last week was quite the week for you. Wanted to see how you're how are you doing? I'm doing fine. I mean, I think it was quite a week. It's a whirlwind. I think going from sort of leadership at CDC to sort of trying to be a voice for, you know, raising a red flag for what's going wrong with public health in sort of a very immediate way. You know, it's been a lot, but I think I'm doing well for the most part.

5:10There's a lot of emotions, lots of feels. is do you feel safe i you know i wonder i know that you gave a really uh i just thought a series of incredible interviews on broadcast tv uh a resignation letter that i thought i mean i'm still getting sort of pinged about it really resonated but i'm wondering just in this environment uh personal safety wise uh any issues there yeah i mean i i think um you know i've i've been sort of in a national view before, talking about some very sort of complex issues that have made some folks decide that it's appropriate to target me either in digital or other sort of media.

5:56So I think that's happening now. When I wrote that resignation letter, I knew it was going to happen because it happened before. Do I feel safe? I mean, I'm looking over my shoulder a lot. I've got to tell you. But, you know, I think that this is this is the mission. I have to do it. It's it's you know, it was I decided that if I was going to resign, I could either send a letter that says I resign or say send a letter that actually says why I resigned and then really, you know, share the details. Again, the voices from the inside are different than the voices from the outside. And there's like one moment in time when you go from the inside government to out where you're able to give a very specific point of view that could potentially affect some important change.

6:41For our listeners who may not have tracked your career as closely as I have, although it's been, as you point out, Dimitri, a career filled with moments in the national spotlight in a really positive way, having incredible impact. I do want to take some time just going through your background. What led you ultimately to this high post at the CDC? Infectious disease doctor, trained at Master General Grigham for fellowship, multiple stints in public service. I was wondering if you could take our listeners through your journey. How did you end up leading the National Center for Immunizations and Respiratory Diseases?

7:17Sure, I'll take you way back. Like, everybody should get their kids a doctor's kit if you want them to be a doctor, because that's what made me want to be a doctor. So shout out to the doctor's kit. So all my life, I wanted to be a doctor. I had no idea what that meant. My parents were immigrants. They came from Greece. My dad worked in restaurants and my mom was an executive assistant. But they really helped mentor me into a place where I was able to go to undergrad to Columbia University, where I moved there in 1991 to New York City. and immediately started doing things in the HIV space. I decided to volunteer and go to high schools and talk about safer sex and all of the things.

7:59And so it became clear to me that I wanted to do something that would work in HIV space. It was punctuated by my last year at Columbia when I helped put on a large display of the AIDS Memorial quilt. I'd had friends who passed away. I used to go out in New York City and nightlife. If I was a young kid in New York, I would meet people. They would disappear into Bellevue or St. Vincent's, never to be heard from again. But I did that AIDS, the display of the AIDS Memorial quilt. And I met people who were mourning people that they lost and also people who were coming so sick. It was amazing they could walk in the door.

8:37And I had this moment on College Walk where I said, I don't want anyone to ever have this happen again. No more death and dying, no more suffering. from this, whatever I can do. So that really became like my guiding star, my North star to be able to sort of go into that and then go to med school. NYU, that was great, was mentored by some great infectious disease doctors that let me see some clinical things that became very important to me in the HIV space. Did my residency at Beth Israel Deaconess, surrounded by leaders in infectious diseases. I'm going to shout out Bob Molaring, who was one of my very early mentors, who just is a legend in infectious diseases.

9:21Then I did the unthinkable, which was to leave the Beth Israel Deaconess system. So for those in Boston knows that that's high treason, not really. And I moved over to Mass General and the Brigham where I did infectious diseases. And again, got to work with some of like the brightest and the best scientists and clinical folks. So when that happened, I was working in a lab for a while doing basic science immunology. Tom Frieden, another person you may know, came on my radio, because we had radios then. And the radio, he talked about, there was like a case of HIV, multi-drug resistant and fast progression in New York City in a gay man.

9:59And I was like, what am I still doing here? I need to go back. So I reached out to New York City to my friend, Judy Aberg, who brought me back as faculty at Bellevue. And then instantly I started doing things that were public health things. I started doing testing in commercial sex venues for HIV. I started post-exposure prophylaxis programs for taking pills after an HIV exposure to prevent it. There wasn't PrEP, so I did surveys about PrEP. And so I all of a sudden was doing public health and didn't know it. I got the opportunity to get my master's of public health at Harvard after a family donated money to NYU to build a doctor's career or some doctor's career to make sure that no one died like their son.

10:42So it resonated to my moment on college walk. So I got my MPH and then my first job out of the gate was to be the head of HIV prevention for New York City. And there, you know, I got an influx of the things that you need, political will and resources, as well as really strong science to be able to implement some really significant programming that pushed the HIV epidemic down in New York City in a rapid way, faster than expected and to a place that is, you know, enviable across the world. did a good job there enough where they made me the deputy commissioner for disease control in New York City.

11:22And, you know, I remember when I was interviewed for it, they said, you know, you're going to do all this. You'd be the chief of infectious diseases for New York City. Every now and then you'll do an emergency response. And then subsequently I was in an emergency response the entire time. So measles outbreak in Brooklyn, Legionella outbreaks all over the city, and then ultimately COVID-19, where I was incident manager of a lot of events. Stayed there and then was recruited to CDC to be the head of HIV prevention. Managed to stay in that. Well, and actually, I was hired by Robert Redfield during the first Trump administration.

12:01And I worked there for about three months and then got pulled back into the COVID space, where I worked in the vaccine task force, got back to HIV briefly, then MPOX. brought me to the White House, where I led, I think, what is considered one of the most successful infectious disease responses in the last couple of decades. And so that went great. And after that, came back to CDC to work for National Center for Immunization and Respiratory Diseases, which is the home to vaccine programs around the country, as well as a place where the smartest scientists work that the entire world looks toward for vaccine-preventable diseases.

12:43And that brings me to today where I had to resign because it was getting weaponized. You know, I want to say for our listeners, I had the first time I actually was on a call with Dimitri was during his tenure at the White House overseeing the MPOC's response. And I was saying this, you know, before we officially begin the podcast, how, as he notes, he oversaw one of the greatest public health responses to a crisis in my lifetime, certainly. But, you know, Dimitri, you'll remember this. There was moments where on those calls, you guys had to talk through the nuances of how to vaccinate and whether it was sub-Q or I, it was just even the nuances of like the angle in which - A little complicated.

13:25It was really complicated. And there was a lot of complications there, but you cut through that in a way that, you know, I try to emulate my own life when it comes to health and communication. but you did something that is, I think, incredibly hard to do. You don't necessarily get trained to do it in medical school. You either learn it or you don't. Some of it is just natural. Some of it is hard to learn. We did an amazing job. For our listeners here, everything that Dr. Dimitri just pointed out, that's a lot of hard work. And those are long days. I think you probably don't think, as you're in the midst of it, that you're going to end up where you just ended up, high post at the CDC, leading a really important center.

14:08But when you reflect back on the last week, the decision to put the resignation letter out there, take us through that because there's a lot there. And also before, I do want to do a little tee up here for that resignation letter. I encourage all our listeners to go Google Dr. Dimitri Daskalakis resignation letter to read it. It's very easily discoverable on the internet. But you talk about conflict with RFK's leadership, undermining public health, ideological bias in science, concerns for an increase in vaccine-preventable diseases, risks to our national security because of being less prepared for the next bio-crisis.

14:53There was a lot there. I'm wondering your decisions. What went into your mind before you wrote it and what made you think, gosh, I got to write it? Yeah. I mean, so I'll start by saying I'll take us back more than the week and take us back to the beginning of Secretary Kennedy's stint at HHS. I mean, I'm a government, a career government person. And, you know, what we thrive on is kind of being like AI, right? So our brains get trained on the information that we get so that we can actually like generate messaging that really is based on what that training and that input is doing. So when Kennedy came, I was like, this is great because now we have like, we're going to hear from him at his like HHS welcome talk.

15:44And that's like the first time I'm going to hear like what he actually thinks now, as opposed to my impression of him before, which was definitely influenced by my experience leading the measles outbreak in Brooklyn, where I saw some of his sentiment toward vaccine come through. So I really did that. I'm going in there open-minded. I had everyone cancel their meetings in my center so we could listen to his speech. I had note takers avidly taking notes so that we could take what he said and say, how could we train that AI brain of our own? How could we train ourselves to be able to figure out how like the things that we think are clinically and scientifically important, how we can meld that into the vision of what the secretary is expressing.

16:30So it sounds like, I mean, when I'm hearing you say this in the pre-prep for his comments, it sounds like you guys were open and sort of willing to be perhaps proven wrong. If you had pre-existing sort of a sense of what might, what he might say, it sounds like you're open to a positive outcome here that maybe he was going to surprising. A hundred percent. I was thrilled when he got on stage at that HHS meeting and said, you know, I'm not coming with preconceived notions, though you may hear that I have some. You should not come with preconceived notions either. And we were like, shazam, that's the thing.

17:05Like, that's what we need to hear. And everyone was like, OK, we can work with that. And and, you know, I think also like we heard the words, you know, gold standard science and we're like, yes, science, since we felt that folks were trying to get away from it. And we heard radical transparency and we're like, yes, all of this is a yes. So we don't have had conversations like based on that transcript and other things we saw about how we could really plug in our stuff into that vision. And, you know, we were all, we all sort of started there. And then when we saw that the words and the actions didn't really correlate, we started to feel not so good about that.

17:42So for me, as I saw that unfold, my question was always, where is my line? What's going to happen where I'm like, I can't be here anymore? Again, I'm a doctor. I took the Hippocratic Oath. I really do believe in that if I feel like I'm about to do harm, then it's really not a thing that I can do. And so I was really close and continue to be close with Dr. Deb Howery and Dr. Dan Jernigan, my letter, which has been sometimes criticized for being long, sorry I had lots to say, that letter - That's why we have AI. Yeah, right. I should have summarized.

18:30I had prepared it and really had been chronicling the things that got me close to my line. Then a couple of things happened. The first for me was when the document that sort of guides what's going to happen at the Advisory Committee for Immunization Practices, the work group, that small group that creates recommendations that go to the bigger meeting for discussion. Like we gave loads of feedback. Lawyers gave loads of feedback. And then ultimately what came back was this document that it wasn't about what they wanted to talk about in the meeting. Everyone was great with that, But it was more about the fact that they wanted to say that, you know, that they wanted to remove CDC scientific bias from the work group, which is weird because, like, I think that we have the most disimpassioned scientists who are the least biased.

19:24And they sort of made it clear that the workgroup, that the members of CDC staff weren't actually reporting to the director anymore, that they were like really beholden to a vision of the workgroup chair. the lead of the work group for COVID-19 has a pinned tweet that says, the evidence is clear. We should stop giving people COVID vaccines. So, you know, and, you know, call me crazy, but, you know, we've seen that, you know, COVID vaccine helped end the pandemic. All of the data in the world, except for sort of some sources that maybe these folks are citing that are not demonstrated to be valid sources, that the COVID vaccine is safe.

20:18There's always a risk for a vaccine. Like, nothing is zero risk. But overall, it's a safe vaccine. Definitely, there could be some side effects. And again, there's been a severe side effects of folks who had myocarditis, which is inflammation of the heart. But that hasn't really been seen for a while. And it was really related to a very sort of specific time where people were getting doses close together. Anyway, so that meant to me that there was no way that my scientists that were working within CDC were going to be able to create science that was not contaminated by the ideology since the ideologues were the ones that were driving the conversation in a way that was unprecedented.

20:59So that was my first my first line. And the second, you know, was when we started to hear that Susan was potentially Susan Menares, who is the who is the director of CDC, you know, the congressionally sort of approved director of CDC confirmed. when we heard that she was probably going to leave or be removed, you know, we were going back to the time before we had a director, months and months of having no scientific leadership, where we were just getting these top-down recommendations with no ability to input. We'd never briefed the secretary once, like not one NCIRD, no one from my center ever had briefed him, ever, ever, not me, not anyone.

21:46And so we were getting all this top-down stuff with with no evidence backing it, we were like, great, we have scientific leadership, we're gonna be okay. And then that got pushed aside, which meant that imminently we were coming to all these decisions and that there was, all that could happen from my perspective was harm, no good. And that's my line. You led the National Center for Immunization and Respiratory Diseases. That was the post that you held. And we're having this conversation on Labor Day, day after a conversation that we just had with president of the American Academy of Pediatrics, Dr.

22:22Susan Kressley. And what I find just, it's hard to keep up, but it's, you know, my wife's a pediatrician, I'm a pulmonologist, and vaccines are what we do in our clinical lives in a variety of different ways. And I was talking to Dr. Kressley, and it was amazing to me that here is an organization, the AAP, that is now stepping into this void that is seemingly being created in a very, very rapid period of time. And this just seems like this is all happening so quickly. Can you speak to what this means now for our listeners who represent a broad spot in the general public? Because we were trying to, Dr.

23:09Krusty was trying her darndest to represent 79 other medical societies and put good information out there. I linked towards the end to a few websites. And it all felt, it just felt tragic. And it felt like no one podcast or entity is going to be able to fill the shoes of what we've lost. And what we've lost here is incredible expertise and leaders, servant leadership like you and your colleagues. I'm just wondering, what do you think this all means? Like, where are we headed? Yeah, Ben, I'm going to take it from high up to low down. Please. Which is that, like, what this means is that there is going to be a clear effort to limit access to vaccines.

23:55It's not going to be about improving the ability or freedom for people to choose. It's going to be about the inability to access vaccines. There may be bottles on the shelf, right? There may be bottles, needles, whatever on the shelf that vaccine exists, But this is undermining two things. It's undermining access from the perspective of coverage. And I'll talk about that in a second. But it's also undermining trust and confidence in vaccines. Like this chaos, all of this noise creates an issue. Like folks can't process all of this. And so what happens with all the different pieces coming in and the way that it's coming is that you're like, well, I don't know who to believe.

24:36Right. So that's so I like, you know, I applaud like the medical organizations that are trying to say, look, we are your trusted providers. By the way, they are the trusted providers. I mean, the secretary said, don't take his medical advice. I agree. Don't take his medical advice. He is not an expert, nor has he listened to experts. So I trust the pediatricians. I trust the obstetrics and gynecology folks. I trust the medical doctors. You know, I imagine that there's more coming. But here's the facts. If the government, if the ACIP, if the Advisory Committee on Immunization Practices decides to somehow constrain who is able to get one vaccine or another for a reason that's not based in data, like there may be reasons, like there may be like, oh, you shouldn't give this vaccine.

25:23to X, Y, or Z because the risk and the benefit, it doesn't make sense. But for vaccines where the risk and benefit does, if there is some kind of ACIP recommendation that somehow makes it hard for someone to get vaccine or says, this vaccine shouldn't be given to a six to 12 year old, That's probably not going to happen with COVID. But if that ACIP says that, yes, AAP and all the other organizations can say, we call inaccurate. That's not right. That's a false recommendation. But if the recommendation is an ACIP recommendation that gets signed by whoever it is, I guess, you know, a speechwriter, O 'Neill or the secretary, that then gets codified as a recommendation from CDC and HHS.

26:19That recommendation triggers vaccine coverage in insurance. So if that says do not give to six to 12 year olds, that means that that that vaccine may no longer be covered by insurance. Let me give you one more very scary thing, which people don't know, but hopefully I can express it in as clear a way as possible. There is a program called Vaccines for Children. It is the program that is the safety net program that gets vaccines to kids who are uninsured or uninsurable, who can't afford it, or who are on Medicaid. Over 50 % of kids in the United States get their vaccines through the Vaccines for Children program.

27:04If the ACIP says this vaccine should not be given to six-month-old to 12-year-olds, the VFC won't buy it. I see. And that means that those kids will not get vaccine. You know, it was really, thank you for that. It was illuminating just to look at the data on six months to 23 months of age children that are those in that age group, otherwise healthy. As the AAP was pointing out, that's a high risk group still for ending up in the hospital, even if they don't have an underlying condition. And to your point, what I think gets lost, I'm wondering your view on this. I think this level of detail, all it takes is you having 60 seconds to lay it out for us and it's clear.

27:59But it strikes me that a lot of these decisions are being made with perhaps the expectation that the general public won't grok what's actually happening. um and you know i i look at some of the decisions that were made on the fda you know the fda label changes the code vaccine and many people and we did a lot of segments on broadcast for it and i i got a lot of feedback saying then i didn't realize that this means my pharmacist cannot potentially do what they've been doing for the last five and a half years and it's it's amazing that through line that there's complexity in policy that if people understood that, you know, right below the headline, what this means for them, which you're, I mean, again, this is why you're so good at what you do.