Mike Leavitt interview on the response to bird flu

WASHINGTON – Mike Leavitt is part of the small club of government officials who have led the bird flu response.

The experience is still fresh in his memory almost twenty years later. When he first heard about the bird flu outbreak in 2005, he had only been Secretary of Health and Human Services in the George W. Bush administration.

The looming threat alarmed him so much that he purchased and distributed two hundred copies of a book on the 1918 flu pandemic, including one that 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 on hand, its pages covered in blue sticky notes.

An outbreak of H5N1 further afield than what the United States is currently experiencing — the disease was never detected on U.S. soil and did not spread among dairy cows — prompted Leavitt to ask Congress for billions of dollars to invest in preparedness in pandemics and vaccine technology , embark on a nationwide awareness tour with events in all 50 states and proactively engage with foreign governments.

With the cooperation of the Bush administration and Congress, HHS has established its emergency response department, invested in the production of cell-based vaccines that can produce higher volumes, and invested in diagnostic tests and antivirals.

“All of this was motivated by the idea that there might be a flu pandemic, and that if it did, it would be of great importance. And if it wasn’t, it was okay because everything we did would prepare us for other types of emergencies,” Leavitt said.

The current outbreak of H5N1 has spread among US dairy farms. Cows are a mammal that some scientists previously didn’t think could even be infected with bird flu. So far, the few human cases have caused mild illness.

In an interview with STAT, Leavitt reflected on his response to the outbreak. Leavitt also served three terms as governor of Utah and as 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 an emergency meeting scheduled with the leaders of the CDC, who would have been involved, and the topic was a possible pandemic virus. The meeting took place the next day and to be honest I did my best to understand what they were saying. I am not a scientist by training. Honestly, at that point, I’m not sure I’d ever used the word pandemic in a sentence.

I began a very intensive investigation into the level of preparation of our country. And it became clear to me that we were ill-prepared. And so the president gave us permission to start asking for money.

I spent a lot of time attending pandemic summits that we held in every state. All of this was motivated by the idea that there could possibly be a flu pandemic, and that if it did, it would be of great importance. And if it wasn’t, it was okay because everything we did would prepare us for other types of emergencies.

The most important takeaway from my experience was that we need to invest in pandemic preparedness. Every year. And if ever there was an argument to be made, it would be our experience with Covid-19. When you think about the trillions of dollars we spent in that very short time, how much less could it have been if we had been preparing all along?

You’d think that would be the case, but when you look at the dynamics of this moment, 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 only allowed public health to grow on the false confidence that this will never happen again. And they are not Democrats or Republicans. It’s just a condition that we as humans have created.

Have you ever worried about people saying you were crying even though the great flu pandemic didn’t happen?

By the time I had spent [billions], it became clear that it would not turn into a pandemic virus. I was relieved. It was clear to me that no Health Minister would emerge from this experience unscathed if it turned out to be a pandemic virus, because nothing we would have done would have been enough.

I felt good about the fact that we increased the level of preparedness. I felt particularly good when Ebola emerged four years later and the plan we had developed was used as an example. I felt particularly good when we encountered Covid-19 and realized that mRNA would be the means by which that vaccine could reach the market within a year. It wouldn’t have happened if we hadn’t invested in it ten or fifteen years ago.

What would have been your reaction if you had come to Congress and they had looked at you and said, “Sorry, we’re not giving you any money”?

Luckily they didn’t. I think it was important that I attended one meeting after another with the members of Congress, educating them all on the possibility that this existed and showing them that we had a virus that was transmitted between animals, and that we now had cases where they went from animals to humans. And to their credit, they recognized the need.

Why did you, as HHS Secretary, feel the need to get involved? Why not just leave it to CDC or other agencies?

When a risk carries this kind of potential, it was important that the President was aware of it, that the HHS Secretary was personally involved, and that we had a deliberate plan.

Do you feel like the progress you’ve made is being maintained?

I really do not know. I know I have been disappointed in some ways, but encouraged in others. I am disappointed in the sense that much of the vaccine capacity we have developed over time has proven to be unsustainable without government support. And so if you’re trying to maintain vaccine capacity, but there are no customers, it’s very difficult to do that.

On the other hand, one of the things we tried, one of the things we invested in was the production capacity for cell-based vaccines. And the reason that was so important was so that we could produce dramatically more vaccines much faster. In the past we were dealing with egg-based vaccines, which had a very low rate limiter. And therefore I think it can be said that the investment made ten to fifteen years ago was enough to create an advantage that yielded a great dividend.

I was disappointed to learn that the planning ethic we were trying to instill, not only in the federal government, but also in states, began to lose steam 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 responded 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 to emerge? It will probably be somewhere outside the United States where they raise chickens. So I went to China. I went to Vietnam. I went to Indonesia. And I felt the political dynamics that were happening in each of those countries. Because if you’re in Vietnam and you kill all the chickens, the government probably won’t reimburse them. They’re just going to kill the chickens, and so it destroyed their livelihood. Those were serious political consequences.

But probably less in our country, because when we destroy chickens, we usually take responsibility and ask for help from the government.