WASHINGTON — Mike Leavitt is in the small club of government officials who’ve led an avian flu response.
The experience is still fresh in his mind nearly two decades later. When he first heard about the avian flu outbreak in 2005, he had been secretary of health and human services in George W. Bush’s administration for just a couple of months.
The looming threat alarmed him so much that he bought and distributed 200 copies of a book on the 1918 influenza pandemic, including one he personally delivered to the president.
“To his credit, he read it,” Leavitt said. In an interview with STAT on Monday, Leavitt still had a copy handy, its pages layered with blue sticky notes.
An outbreak of H5N1 further from home than the one the United States faces now — it was never detected on American soil, and wasn’t spreading among dairy cows — prompted Leavitt to ask Congress for billions of dollars to invest in pandemic preparedness and vaccine technology, embark on a nationwide awareness tour with events in all 50 states, and proactively engage with foreign governments.
With cooperation from the Bush administration and Congress, HHS created its emergency response division, invested in cell-based vaccine production that allows greater volumes to be produced, and invested in diagnostic tests and antivirals.
“All of this was driven by the idea that we might have an influenza pandemic, and that if we did, it would be profoundly important. And if it didn’t, it was OK, because everything we were doing would prepare us for other kinds of emergencies,” Leavitt said.
The current outbreak of H5N1 has spread among U.S. dairy farms. Cows are a mammal that some scientists didn’t previously think could even be infected with the bird flu. So far, the few human cases detected have caused mild illness.
In an interview with STAT, Leavitt reflected on his response to the outbreak. Leavitt also served three terms as the governor of Utah, and as the administrator of the Environmental Protection Agency during the George W. Bush administration. This interview has been edited for length and clarity.
Let’s hear your H5N1 story.
I had been secretary of health for two or three months, and I had appear on my schedule an emergency meeting with the leaders of CDC, who would have been involved in it, and the subject was a potential pandemic virus. The meeting took place the next day, and, candidly, I did the best I could to understand what they were saying. I’m not a scientist by training. Truthfully, I’m not sure at that point if I had ever used the word pandemic in a sentence.
I began a very intensive exploration as to the degree of our preparation as a country. And it became clear to me that we were poorly prepared. And so the president authorized us to go ask for money.
I spent a lot of time going to pandemic summits we held in every state. All of this was driven by the idea that we might have an influenza pandemic, and that if we did, it would be profoundly important. And if it didn’t, it was OK, because everything we were doing would prepare us for other kinds of emergencies.
The big takeaway from my experience was that we need to be investing in pandemic preparedness. Every year. And if there was ever a case to be made, it would be our experience with Covid-19. When you think of the trillions of dollars that we spent in that very short period of time, how much less could that have been if we had been preparing all the way along?
You’d think that would be the case, but if you look at the dynamics right now, it’s almost the opposite.
We always forget and think, “Well, we’ve had our pandemic, and therefore, it can’t happen again. I can pay for other things. I don’t have to do this.” And so we’ve just allowed public health to continue to go to seed out of a false confidence that it will never happen again. And it’s not Democrats or Republicans. It’s just a condition that we as human beings have created.
Were you ever worried about people who said you were crying wolf, when the big influenza pandemic didn’t materialize?
By the time I had spent [billions], it became evident that it wasn’t going to turn into a pandemic virus. I was relieved. It was clear to me that no secretary of health was going to come out of this experience unscathed if it turned out to be a pandemic virus because nothing we would have done would have been adequate.
I felt good about the fact that we raised the level of preparedness. I felt particularly good when Ebola came around four years later, and the plan we had developed was used as the template. I felt particularly good when we got into Covid-19 and realized that mRNA was going to be the means by which that vaccine could come to market in a year. It would not have happened had we not been investing in it 10 or 15 years ago, as we went along.
What would your response have been if you had gotten to Congress and they would have looked at you and said, “Sorry, we’re not giving you any money”?
Gratefully, they did not. I think it was important that I sat with members of Congress in meeting after meeting educating them all on the potential that this was out there and showing them we had a virus that was transmitting between animals, and that we now had cases where they’ve gone from animals to people. And to their credit, they recognized the need.
As an HHS secretary, why did you feel the need to get involved? Why not just leave it to CDC, or to other agencies?
When a risk bears this kind of potential, it was important that the president know about it, and that the HHS secretary was personally involved in it and that we had a deliberate plan.
Do you feel like the progress that you made has been maintained?
I really don’t know. I know I’ve been disappointed in some ways and then heartened in others. I’ve been disappointed in the sense that much of the vaccine capability that we develop over time proved not to be sustainable without government support. And so when you are trying to maintain vaccine capacity, but there are no customers, it’s very difficult to do it.
On the other hand, one of the things that we attempted, one of the things we were investing in was cell-based vaccine manufacturing capacity. And the reason that was so important was we could manufacture dramatically more vaccine much more quickly. In the past, we were dealing with egg-based vaccines, which had a rate limiter that’s very low. And therefore, I think it can be said that the investment made 10 to 15 years ago was enough to create an advantage that paid a big dividend.
I was disappointed to know that the planning ethic that we tried to imbue on not just the federal government but states, I think that began to lose momentum over time. But it’s not the first time and we’re not the first culture to do this. This is human nature.
Was there any political consideration when you were responding to this outbreak?
I literally went all over the world. Our first strategy was to say, let’s keep this virus at bay. Where is it most likely going to turn up? It’s probably going to be in someplace outside the United States where they grow chickens. So I went to China. I went to Vietnam. I went to Indonesia. And I felt the political dynamic playing out in every one of those countries. Because when you’re in Vietnam, and you go through and kill all the chickens, that government’s probably not going to reimburse them. They’re just going to kill the chickens, and so it destroyed their livelihood. Those were serious political ramifications.
But in our country, probably less so because when we do destroy chickens, we typically take responsibility and have the government help out.