Dr. Deborah Birx on the Trump White House, the politics of the pandemic, retirement and more

Washington — Dr. Deborah Birx is speaking out about her tenure as coordinator of the White House's coronavirus task force under former President Donald Trump, telling "Face the Nation" new details about the 11 months she spent trying to steer the federal government's response to the pandemic.

In a wide-ranging interview, Birx spoke about her decision to join the task force in the first place after repeatedly declining to do so, her relationship with Mr. Trump and former Vice President Mike Pence, the legacy of her time in office and her upcoming retirement.

A transcript of Birx's interview moderator Margaret Brennan that aired Sunday on "Face the Nation" can be found here. A selection of highlights from the full interview appears below, lightly edited for length and clarity.

Joining the White House task force

MARGARET BRENNAN: So, we're at the end of February. CDC official gives a briefing to reporters that tanks the markets when she says that within the community there may be a virus spreading and it could cause severe disruption to daily life. Dr. Fauci goes on television a few days later and says the risk to Americans remains low. You're watching this and what are you thinking?

DR. BIRX: So I'm in South Africa. We have all of our countries in, from all over the world. We're going through — we're working 24 hours a day, but we have a break over dinner. And we're staying at a place where we can cook, and I love to cook. So, we're cooking, we're eating, we're watching CNN. And so over those two weeks of February, we're yelling at the CNN television saying, this is going to be a pandemic because the Chinese — what I saw from China, when you overwhelm your hospitals, you have to know that you have broad-based community spread before that happens. Yet they weren't seeing it. 

And that really worried me because what we were looking for is people with symptoms. And so when people were coming into the country, we were looking for people with symptoms.

MARGARET BRENNAN: When you say we, who do you mean? 

DR. BIRX: I mean the United States.

MARGARET BRENNAN: The CDC. 

DR. BIRX: Well, the United — I think it was everybody. I don't know who was on the task force at that time, but I think multiple agencies were represented at that time.

MARGARET BRENNAN: But why wasn't it obvious to them, when you're watching this on TV and saying this is so clearly a pandemic that's coming to hit us hard?

DR. BIRX: I guess because I've been in a lot of pandemics, and I've learned from the things we've missed. 

This is exactly how we missed the HIV pandemic. That's how we missed it when it started. I know that it's not a respiratory disease, but it has a large asymptomatic component. And so we didn't see it until people started getting sick. And that's true about many pandemics. 

If you're only looking for sick people, you miss a lot of what is really happening under the surface. And so I was always worried that there was a big iceberg under the surface and we were just seeing the top of it. So, when we were questioning people who came into this country about symptoms rather than testing everybody who came into the country, that's when I started to get really worried.

At the same time, there were individuals — there was a single individual in the White House that had been calling me since January.

MARGARET BRENNAN: That was Matt Pottinger —

DR. BIRX: Yes.

MARGARET BRENNAN:  — the deputy national security adviser?

DR. BIRX: Because I've known him and I've known his wife for a very long time. We've worked on pandemics together. Both of us were in Asia during SARS. And so we understood how serious this can go.

MARGARET BRENNAN: And he asked you, Matt Pottinger asks you to come from the State Department to the White House.

DR. BIRX: And I said no about 20 times. 

MARGARET BRENNAN: Why? 

DR. BIRX: Well, from the outside, everything looks very chaotic in the White House. I had spent — 

MARGARET BRENNAN: Wasn't it? 

DR. BIRX: — the first three years of this administration trying to stay out of the swirl, trying to protect the PEPFAR program. We had extraordinary cuts, obviously, every year.

MARGARET BRENNAN: This is AIDS? 

DR. BIRX: The President's Emergency Plan for AIDS Relief. It's what's changed the trajectory of the pandemic around the world, both for HIV and TB. 

I had no interest in going into a political space. I'm not a political person. I'm a civil servant. I've never been a political person. I've never worked on a campaign. I've never campaigned for any of the candidates. I take the Hatch Act very seriously. I- I just am not a political person.

So, it never occurred to me to go into the White House until I could see that we were missing pieces that I thought were very important in the response. And so after many weeks of saying, no, no, no, the president announced the new task force with the vice president in the lead. They said this would be very technical, and that I would have a very technical position. And because I thought that I could be helpful, which is the only reason I go and do anything. If I think I have something to add, I feel like it's my obligation to the American public to go in and do that. That's what a civil servant is supposed to do.

The crisis in the spring

MARGARET BRENNAN: Was that the moment, though, that moment in the spring — is that the moment you looked at the task force and you said, we have a serious problem here, this is not going according to plan?

DR. BIRX: I think everyone knew that.

MARGARET BRENNAN: When did that hit you?

DR. BIRX: Everyone knew that. Everyone knew that from, I would say, March 8 on. Because you only had to look at the slopes of the curves in these major metropolitan cities to understand what was happening and understanding if you're seeing that rate of hospitalization, how much community spread there was.

MARGARET BRENNAN: But you were trying to get Americans just to wear masks. And the president himself was undermining you. He wasn't wearing one. I mean, you would go out and talk about it can be a fashion statement from the podium. I mean, you were trying to make it light so people would accept it. But all these guidelines are getting undermined by the president himself. Is there ever a way to make that scenario work?

DR. BIRX: Well, you have to, because that's the president. So you have to figure out how to get that message out when you can't get it out from the head of the country. And that's our job. You don't give up. You don't say, well that didn't work so of course you know, everything is going to be terrible. You've got to try to make it the least terrible it can be. I mean, you can't ever in any moment when American lives are at stake, say, well, this is just too hard. I'm giving up.

MARGARET BRENNAN: But where's the vice president in all of this?

DR. BIRX: The vice president knew what I was doing.

MARGARET BRENNAN: You mean he knew that you were telling the governors privately to do things that the president publicly was making light of? When he was saying, you don't really need to wear a mask, or pushing to reopen the economy faster than your guidelines would allow, Mike Pence knew that? 

DR. BIRX: He knew what I was doing because —

MARGARET BRENNAN: And he supported it?

DR. BIRX: — I don't —I'm not a person who would go out on their own and not do, you know, I wouldn't go —

MARGARET BRENNAN: Why would you have to be sneaking around? You're the head of the COVID task force and tens of thousands of Americans are dying. Why is that a covert operation?

DR. BIRX: Because if this isn't working and you're not going to get that to work, you have to find another solution. I mean, you can't just say, well, the president is saying this so I'm going to give up on the 50 states, the District of Columbia, and the territories that we support. I couldn't do that. And others couldn't either. 

I mean, there was a team of people going out and supporting this approach. I felt all along that if we could have put 20 or 30 full-time CDC personnel in every state for long term assignments, six-month assignments, they could help states get over these barriers and understand and help support states translate their guidance.

Trump's "parallel data streams"

MARGARET BRENNAN: So you were looking at all this data. Do you think when you were in the room and briefing, even if it was with other people, do you think President Trump appreciated the gravity of the health crisis you were describing?

DR. BIRX: I think the president appreciated the gravity in March. It took awhile after I arrived in the White House to remove all of the ancillary data that was coming in. I mean, there was parallel data stream coming into the White House that were not transparently utilized. And I needed to stop that, where people were —

MARGARET BRENNAN: You mean outside advisers? 

DR. BIRX: Outside advisers, coming to inside advisers. And to this day, I mean, until the day I left, I am convinced there were parallel data streams because I —

MARGARET BRENNAN: Disinformation?

DR. BIRX: I saw the president presenting graphs that I never made. So, I know that someone out there or someone inside was creating a parallel set of data and graphics that were shown to the president. I don't know to this day who, but I know what I sent up and I know that what was in his hands was different from that. That worries me because at any moment — I've built my career on data transparency and accountability. It is very important to me that we all agree how the data is collected and how we use it. We don't cut it in pieces and say, we're only going to look at it in this six weeks because it makes us look better. Or, we're all going to look at it in these two weeks because we look better than Europe in these two weeks. You can't do that. You have to use the entire database.

MARGARET BRENNAN: Who was doing that? 

DR. BIRX:  To this day, I don't know. I know now why watching some of the tapes that certainly Scott Atlas brought in parallel data streams. I don't know who else was part of it, but I think when the record goes back and people see what I was writing on a daily basis that was sent up to White House leadership, that they will see that I was highly specific on what I was seeing and what needed to be done.

COVID deniers in the White House

MARGARET BRENNAN: What were the biggest obstacles to you communicating that, though? I mean, were there COVID deniers in the White House?

DR. BIRX: There are people in the White House and I think people around this country, because I've had the privilege to meet them and listen to them and hear them, because I wanted to hear what people were saying. There were people who definitely believed that this was a hoax.

MARGARET BRENNAN: Why?

DR. BIRX: I think because the information was confusing at the beginning. I think because we didn't talk about the spectrum of disease, because everyone interpreted on what they knew. And so they saw people get COVID and be fine. And then they had us talking about how severe the disease is and how it could cause these unbelievable fatalities of our American public. 

I mean, so every American life lost, I mean — I haven't slept in 10 months or 11 months because those were the numbers. That's someone's parent. That's someone's grandparent. My great-grandmother was lost in the pandemic flu. I know what that feels like from just listening to my grandmother. To have that others feel that same level of pain and loss when it was preventable or could be preventable was really excruciating.

MARGARET BRENNAN: So you don't blame the president's own language of calling some of this politically motivated, a hoax? It was a phrase he used at one point.

DR. BIRX: You know, when you have a pandemic where you're relying on every American to change their behavior, communication is absolutely key. And so every time a statement was made by a political leader that wasn't consistent with public health needs, that derailed our response. It is also why I went out on the road because I wasn't censored on the road.

Working with governors

DR. BIRX: I was so frustrated by the end of May going into June by the lack of reaction to what I could see in the middle of May coming, that it and that — you combine that with the gating criteria not being utilized, that I realized that the only way, if I could not get a voice internally, that I could get a voice out at the state level because I could see the governors on the governor's call weekly and I could see how deeply they were concerned about every one of their citizens. Most of them were not in the middle of an election campaign. 

And so by going out and working with the governors, two things happened. One, I got to see amazing things that are best practices and really bring those back. And what I've learned from Detroit and Chicago and Arkansas and Alabama and Texas and Arizona and up through Connecticut — I mean, it's just been amazing to be able to see really great solutions and try to bring those back. But that was the place where people would let me say what needed to be said about the pandemic, both in private with the governors and then in following up, doing press to talk to the people of that state.

It was difficult during the run-up to the election. That was the time when one of my daily reports — there was by that time 200 of them. That was when one of them was leaked, right before the election. So clearly there was some intentionality there. And I was talking about how severe the epidemic was in the Northern Plains states and saying if that epidemic gets into our populous states of California, Texas, Florida, New York, that this would be an early surge to what we expected in the winter with the expansion of this virus. 

And so I was very worried. But others were worried, too. I want to make it clear this was just not Debbie Birx. There was a coalition of four of us at the beginning, from Steve Hahn to Bob Redfield to myself to Tony Fauci, making it clear that we would make sure that we could get the information out to the public in one way or the other. It's why I sent the information to all of them every morning, because I never knew who would have the ability to do press.

No "full-time team" at the White House

DR. BIRX: I was an N of 1. So having a team at the White House that can really respond to this is going to be really, really important, because the amount of work that needs to be done not only at the White House but also at the state level to really ensure that we come out of this in some kind of normalcy by summer will be really critical.

MARGARET BRENNAN: You said you were just one. You were coordinator of the task force. What do you mean, you were just one?

DR. BIRX: There was only one full-time person in the White House working on the coronavirus response. There —

MARGARET BRENNAN: How is that possible? 

DR. BIRX: Well, that's what I was given. So what I did is, I went to my people that I've known all through the last years in government, all 41, and said, can you come and help me? And so I was able to recruit from other agencies, individuals. 

And certainly, Irum Zaidi who I brought in from PEPFAR, was my chief epidemiologist and data developer for the PEPFAR program, where we really revolutionized data to really end the- work on ending the pandemic of HIV and TB in sub-Saharan Africa. And so I would be able to wicker together a group of volunteers who really helped me. 

And I had one incredible support person, Tyler Ann McGuffee, who really helped make sure I was at meetings on time and didn't miss emails. But there was no team, full-time team in the White House working on coronavirus.

MARGARET BRENNAN: Did you ask for staff and you were denied?

DR. BIRX: I did ask for staff. I think what [the Biden administration is] doing, of bringing in an expert in testing, an expert in vaccines, an expert in data and data use, not just collecting data, but how to use it successfully, I think all of those pieces are going to be critical for their success, bringing in a full-time supply chain person. 

And so, all of these individuals existed, but they existed in different pockets of government. So as a team, you're constantly having to work outward to getting everybody on board, to making sure the response is as coordinated as it can be.

Why Birx didn't quit

MARGARET BRENNAN: Did you ever consider quitting? 

DR. BIRX: Always.

I mean, why would you want to put yourself through that everyday? Colleagues of mine that I had known for decades, decades in that one experience, because I was in the White House, decided that I had become this political person, even though they had known me forever. 

I had to ask myself every morning, is there something that I think I can do that would be helpful in responding to this pandemic? And it's something I asked myself every night. 

And when it became a point where I could — I wasn't getting anywhere and that was, like, right before the election, I wrote a very detailed communication plan of what needed to happen the day after the election and how that needed to be executed. And there was a lot of promise that that would happen.

MARGARET BRENNAN: Because you knew at that point that the election was a factor in communication about the virus?

DR. BIRX: Yes. Yes.

MARGARET BRENNAN: Did you ever withhold information yourself?

DR. BIRX: No. 

Trump's infamous "bleach" comments

MARGARET BRENNAN: When some of those colleagues were repressing you, I mean, some people felt you became an apologist for President Trump. They look at that moment in the briefing room, you know the one I'm talking about, when he came out and he talked about injecting bleach and you were sitting there and he looked at you and he asked about ultraviolet light and heat —

DR. BIRX: See, that —

MARGARET BRENNAN: — and you start talking about fevers. You didn't say no.

DR. BIRX: No, no. OK, so —

MARGARET BRENNAN: Tell me.

DR. BIRX: — so let's go back to that, because that's a really critical moment. 

He was not speaking to me. He was speaking to the DHS scientist that was two seats over from me that entire time. When he finally turned to me and said, is it a, could this be a treatment? I said, "not a treatment." You can look at the transcripts. "Not a treatment." That dialogue was between the president of the United States and a DHS scientist. 

I have always been respectful of offices, and you can see I don't criticize people specifically in public. I don't think that — I always think that you need to transcend that and you need to find a way to communicate effectively where you're not criticizing a person in public. 

So when he did turn to me at the very end of that dialogue, I said, "Not a treatment."

Now it's in the transcripts. It never got picked up by the press as, that is what actually happened.

MARGARET BRENNAN: Your answer when he said bleach, you said, not a treatment?

DR. BIRX: Not a treatment. When he turned to me and said, what do you think? Could this be a treatment? I said, not a treatment. But that moment was — that was completely lost. 

And then there's, you know, skits on Saturday Night Live. I mean, when you're a scientist who's grounded themselves in data and combating epidemics and working with communities and working with governments to change the future of people's lives for the better and then you get, this is what — when you talked about, was I prepared for that? No, I wasn't prepared for that. I didn't even know what to do in that moment. 

I think, you know, that's when you're in that, can't-let-the-floor-swallow-you-up moment. I mean, that conversation between two people was going on in front of me. And I, to this day, don't know what to do when that happens.

I think now — I think there's some people who thought that I would just stand up and take over the microphone from the president. I don't know what people's expectations were in that moment.

MARGARET BRENNAN: Well, sometimes people say, well, Tony Fauci, when that happened to- to him, he would sort of gently come back up to the podium and set the record straight if he disagreed with the president.

DR. BIRX: Well, he was given the opportunity to do that, though.

MARGARET BRENNAN: And you don't feel you were given the opportunity to respond?

DR. BIRX: Not until he turned to me and said, could this be a treatment? And I said, not a treatment. You know, in that moment, you know, people then want to define you by the moment and I understand — I, look, I understand how perceptions go. And I understand, I understood when Matt Pottinger was calling me to go into the White House and try to support a comprehensive coronavirus response by utilizing the strength of the federal government would be a terminal event for my federal career, which is part of the reason why I didn't want to do it. 

MARGARET BRENNAN: A terminal event?

DR. BIRX: A terminal event. I know that I wouldn't be allowed to really continue successfully within the federal government. You can't go into something that's that polarized and not believe that you won't be tainted by that experience or how people interpret you in that experience. 

So I knew that part of it. I didn't want that to happen.

MARGARET BRENNAN: And this will be the end of your federal career?

DR. BIRX: Yeah, I will need to retire probably within the next four to six weeks from CDC.

Her legacy

MARGARET BRENNAN: An immunologist, you were appointed by President Obama to work on AIDS relief, as you mentioned, at the State Department. Yet your name in the history books is going to be associated with President Donald Trump. How does that sit with you?

DR. BIRX: Well, you know, this is what worries me. When I see how partisan and divided the United States is that then gets played out in the civil service, and if we start looking at technical civil servants as belonging to a political party, we will lose the ability for highly qualified civil servants to come and help. 

And we have amazingly qualified civil servants. They're at the CDC. They're at HHS. They're at FDA. They're at NIH. And most of the White House personnel are civil servants detailed there from their home agencies. If we start saying if you come in and do this, you are then going to be part of the political apparatus, that is going to be very dangerous for this country.

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