A Welcome Change of Course – Dr. Chelsea Clinton, Vice Chair of the Clinton Foundation

Shiv Gaglani: Hi, I'm Shiv Gaglani. Today on Raise the Line, I'm really honored to be joined by Chelsea Clinton, who is vice chair of the Clinton Foundation https://www.clintonfoundation.org. 

In that role, Dr. Clinton works alongside the foundation's leadership and partners to help create economic opportunity, improve public health and inspire civic engagement and service across the U.S. and around the world. In particular, she focuses on promoting early brain and language development through the Too Small to Fail initiative, https://www.clintonfoundation.org/our-work/too-small-fail and uplifting and empowering female entrepreneurs and women-led businesses around the world. 

She also teaches at Columbia University's Mailman School of Public Health and has written several books for young readers, including the number one New York Times best-selling "She Persisted: 13 American Women Who Changed the World." I'm really looking forward to learning more about her work at the Foundation and getting her views on the state of public health in the U.S. and abroad during the COVID pandemic. And before we get started, I'd like to really thank our advisor and investor Alan Patricof, who initially made the introduction, as well as made the connection that another Raise the Line guest, Marcus Osborne, used to work with her at the Clinton Foundation. So, Chelsea, it's truly an honor. Thanks so much for taking time to be with us today.

Chelsea Clinton:  Shiv, thanks so much for having me on today.

Shiv Gaglani: So we're recording this the day after the inauguration. It's January 21st today. I would just love to hear what you felt about yesterday. How did that come across for you?

Chelsea Clinton: I was incredibly proud and grateful and hopeful. It also was so meaningful to me in a way that I hadn't really anticipated, but I probably should have had I thought about it. To be able to share the whole experience with my children, to not have to worry about white supremacy being central or celebrated or lies kind of being a main currency of communication. Just that I didn't have to worry about that as a parent and that I could see how excited my kids were -- admittedly, to see their Grandma and Pop Pop on screen -- but to see President Biden be inaugurated and Vice President Kamala Harris be inaugurated.  To see Kamala Harris be administered the oath of office by Justice Sonia Sotomayor, who my kids know about because of the "She Persisted" book that you mentioned earlier. Just to watch their awe and their pride. 

The only real question was, "where is Major Biden?" because both Charlotte and Aidan, my two older kids, have learned about the Biden's pets in school. Aidan, my four-year-old, just kept asking "where's Major?" and I said "unfortunately, dogs don't participate in this part of the inaugural celebrations, in the formal inauguration." But after all of the many conversations we've had over the past four years about how we don't support what the president is doing, we don't support bullies, we don't support people who are demeaning to others, who don't believe that we have and deserve equal dignity...it was a profoundly moving experience for me as an American. It was an especially profoundly moving experience for me as a parent. 

Shiv Gaglani: That's wonderful. And, you know, I'm reminded of the Isaac Newton quote, "if I have seen further, it's because I've stood on the shoulders of giants." I was thinking a lot about that, knowing that this interview was coming up, that the historic Vice President Kamala Harris, obviously has seen further and is a giant in her own regard, and largely your mother paved the way for a lot of that. So, I'm sure there's a lot of pride and well-deserved pride for that. 

Chelsea Clinton: Huge pride in Kamala Harris and also in our country and what this means for our march toward a more perfect union. And also, Shiv, I don't know for you and your family, but certainly for me, I was thinking this morning I don't know which genre of photograph I now am finding most important and meaningful to me. Is it the pictures of my friends sending selfies of themselves, getting vaccinated -- my friends who are frontline health care workers?  Or my friends who are now sending me pictures, because they know it's going to mean so much to me, of their parents or their grandparents getting vaccinated? Or my friends, so many of whom sent me pictures of admittedly, their daughters -- although I like to think they were also equally excited for their sons -- watching Kamala be inaugurated? Representation is not everything. It certainly should not be the end goal. But it matters. It really, really matters. I felt like I was really lucky to see that not only in my own kids' reactions yesterday, but also in all the pictures that I got from my friends of their daughters just looking up. I could even see through those still images that they could see themselves in a really powerful way that hadn't been possible before yesterday.

Shiv Gaglani: That's wonderful. That's really exciting. So, you know, right after the inauguration, a lot of executive orders were signed, obviously, including rejoining the World Health Organization, which we are all very excited about...

Chelsea Clinton:...and this morning, when Dr. Fauci got up at four o'clock in the morning to be able to Zoom in and join the executive board meeting happening right now in Geneva. I'm just so, so thrilled that one of the first things President Biden did was to reverse that absurd, obscene, letter putting forth the one-year notice to withdraw the United States from WHO. So, I'm thrilled that we didn't have to reverse the withdrawal, we just had to reverse the intention to withdraw. And also that we committed today to pay our dues to WHO to help support and sustain the institution. Also, that we committed today to join COVAX, which is the effort to help finance the purchase and distribution of vaccines in the developing world, in the global south, something that the Trump administration had resisted doing. So, so much good news this morning. Long overdue news, but also really still very, very good news.

Shiv Gaglani: Totally. We launched this podcast in the heart of the epidemic. We ask most of our guests how we can do better, how we can "raise the line" and improve health care capacity. Now, since this is the day after the inauguration, a lot of these things are already starting to happen. I would love to hear what you're most excited about as far as the public health efforts that are starting to go. You mentioned COVAX and the WHO. But, wearing your public health hat and your Clinton Foundation hat, what are you most excited about and how are you all contributing? Because I know you do a lot around global health.

Chelsea Clinton: So Shiv, I'll talk about both what I'm excited about and what I'm really grateful to see thus far, and what I still think we need, candidly. So, you know, one of the other things that happened both last night and this morning was President Biden signing executive orders to invoke the Defense Production Act (DPA), which there had been enormous pressure for the Trump administration to do, and it always resisted doing it for reasons that were never made clear. So, what the DPA will allow is for the government to effectively work with private companies to expand their manufacturing capacity. The Trump administration resisted doing this writ large and in specific. Very quickly, the Biden administration is showing its juxtaposition because it is doing both. It is both calling for ways where the DPA could and should be invoked and soliciting suggestions to do that, while also invoking it in very specific ways. So we've already invoked it for swab production so that we can ramp up our testing capacity because still, a year into COVID, we're still not testing enough people every day. 

Not only swabs, but the other components that we need for the PCR test because one of the other things that has happened recently, Shiv, which I'm sure you probably talked about on your podcast before, is that we've moved away from the gold standard of PCR test. Increasingly the tests that we're performing are not at the PCR level and are not actually the PCR itself. Now there's growing pressure for the Biden administration to do the same around vaccines. I think that would be really important, not only to help ensure that we're doing more than just vaccinating a million people a day -- which is the initial goal the Biden administration has set here in the United States -- but also to help us meet our commitment to COVAX. Yes, building biologic production capacity is expensive, but it's certainly a lot less expensive to invest in doing that than in continuing to hemorrhage lives and economic productivity with what we're seeing today in our ongoing COVID-19 crisis. So, I hope that what the Biden administration started to do through the Defense Production Act is only a small part of what it will do, because I think we really desperately need to be scaling up our vaccine distribution capacity so that we are able to vaccinate more people here in the United States and support the vaccinating of people around the world.

Shiv Gaglani: Yes. We're very excited about that. We had a recent guest, Omar Ishrak, who's the longtime CEO and now executive chairman at Medtronic, and we talked a lot about the work that they were doing for ventilator capacity and how the Defense Production Act helped streamline some of that. 

Chelsea Clinton: It was one of the only times that it was invoked, when the Trump administration invoked for ventilators in the spring. There were some other kind of more technical things that they did. But really, that was the major example of the DPA and we saw how much it mattered. So, it will forever remain a mystery, probably, as to why they didn't use the...not only the moral, but also the logistics and the purchasing power of the U.S. Government to help better equip us and make our public health response more robust. They didn't. But thankfully, I'm confident the Biden administration will do so, and that what we're seeing last night and today is only the first step.

Shiv Gaglani: So in addition to the things that the administration is already doing, major non-profits like the Clinton Foundation, academic health centers like the Mailman School of Public Health, where you teach, are obviously doing a lot around education, around distribution and equity. What are some of the things that you're most excited about, about the work that you all are doing that raises the line and improves health care capacity?

Chelsea Clinton: So, Shiv, I'm going to separate out what I think Mailman and Columbia are doing well, and what we're doing at the Foundation, and what I think and hope we will be able to do more of. I do think one of the really good parts of Columbia's response is that it very much has drawn on every part of the institution. Whether that's working with public health experts at Mailman, or recruiting Mailman faculty to help support the vaccination efforts that are happening through Columbia Presbyterian, helping support data entry or helping support patients as they navigate booking their appointments, reminding them to show up for their appointments, booking their second dose appointments, really trying to help ensure that those who can administer the shots are administering the shots and that others are doing the other work. I point that out because I think, Shiv, that's actually been a challenge in some other institutions where the front line of the front line has been expected to do anything and everything around vaccinations, and that's not a good use or optimal use of their time or institutional capacity. So, I'm really proud to be part of an institution that I think has just done a good job there. 

On the broader Clinton Foundation, but certainly through the Clinton Health Access Initiative, we've been working with WHO over the last year to just try to help support their efforts on everything from trying to forecast the trajectory and velocity of the epidemic, to then forecast what kind of health commodities would be needed on everything from testing to now vaccines and vaccinations, to human resources that would be needed for everything from testing to contact tracing, to supporting and isolating suspected and positive COVID cases, isolating those people and patients with dignity to support the treatment once we have had real robust and not hydroxychloroquine-esque data around what really can work to improve someone's chance of survival and pace in their recovery. So, we've done all sorts of work to support WHO there, and then also with the partner governments in countries where we work to support their more national and local efforts while also still trying to support the programs that hopefully haven't been disrupted, although some have, whether that is HIV AIDS testing and treatment or routine childhood immunizations. We know that in some countries where all the routine childhood immunizations were stopped, we're trying to keep a good log of which children haven't been vaccinated against which diseases so that in a safer time, we'll be able to catch up those kids as quickly as possible. I think it would just be a tragedy on top of a tragedy if we lose progress against the deaths attributed to diarrhea, deaths attributed to pneumonia and things that we really, really do know how to prevent with good childhood inoculation coverage. 

Here in the United States, we've done everything from turn the Clinton Presidential Center into the largest feeding site in the state of Arkansas to support people who very much have been economically struggling over the last year because of our government's mismanagement of the virus -- that is not the lockdown's fault...it is the fact that we ever needed a lockdown because the Trump administration failed so abysmally to stop the trajectory and then failed to really successfully flatten and then stamp out the COVID curve -- to helping support families whose kids are now at home through more early reading and early brain development and engagement materials. And a deep passion of mine, Shiv, which is where we are now focusing more and more energy, is trying to combat vaccine misinformation and really build public trust, but also ensure that trust is connected to public knowledge and understanding of what vaccines are and what they aren't. I'm happy to talk more about that. I'm going to pause because I think that was a lot of words said altogether, but hopefully that gives you a small sense of the kind of work we're doing around the world and closer to home.

Shiv Gaglani: That's wonderful. I think there are a lot of really good threads to pull on there, but I want to be mindful of your time. So, you know, as far as vaccine education, I'd love to go deeper on that. One of the things we're most proud of at Osmosis is we work now with YouTube, which just this month announced launching YouTube Health led by a physician, Dr. Garth Graham. They've actually funded us to create a lot of vaccine education content. On Raise the Line, we've also had the CDC -- who we partner with now on vaccine education, too -- and we had on the head of Facebook Health and Amazon Alexa Health, because those tech companies obviously have massive distribution, which they can use for good or for bad, as we've seen recently. I know you all have been helping with vaccination efforts globally and vaccine education well before most of society knew what a coronavirus was, but we'd love to hear your thoughts on how we can be more effective at vaccine education. 

Chelsea Clinton: So, Shiv, why don't I start with explaining how I first even came to understand what a challenge we confront here in the United States and also increasingly around the world around misinformation and misconceptions about vaccines. I'll tell you two quick stories. I was pregnant with my first child, Charlotte, and I was coming home from work, walking from the subway station across the park to our apartment building. This woman came up to me and said, “Are you Chelsea Clinton?" I said, "Yes." And she grabbed my hands, Shiv, and she looked deep into my eyes and she said, "Please don't vaccinate your child." I was so taken aback. I said, "Thank you for your concern, but I will be vaccinating my child." And she said, "Then you will kill them." I mean, it was such a dramatic and un-nuanced response. I said, "I think, thankfully, that is not true. In fact, I think the vaccines are going to protect them, and maybe save their lives." She just looked so disappointed and she walked away. Then I had a couple of other people say nothing quite that dramatic, but also really position the question of whether or not I would vaccinate my child as if it should be a question. As if there were equally valid views on multiple sides of a debate for a question that I didn't actually think was a question, and I certainly didn't think was a debate. 

Then after I had Charlotte, she was maybe a year old, I had started to speak out about my concerns as a parent, as a public health person, as a citizen, that we were facing a growing wave -- aided and abetted by social media -- of vaccine misinformation and the correlating vaccine mistrust and parents opting out of vaccinating their kids. I was being interviewed and this woman interviewing me said, "Would you let Charlotte play with an unvaccinated child?" And I said, "No". And she said, "Isn't that judgmental?" I said, "Yes! It is! I am her parent. She is a one-year-old. It is my main job in life to make judgments on her behalf to help protect her health and safety." The person interviewing me was so taken aback. I should have also said I wouldn't have let her play in a house with an unlocked gun. I'm not going to willfully expose my kids to danger. So that then further got me interested not only as a citizen and as a parent, as an activist, but also as an academic. I got more involved in the literature and in the research and also in the various efforts -- some of which are quite long standing here in the United States -- to really educate parents, especially on vaccines and vaccination. 

So fast forward to the last year, and I think we had really started to make progress, actually, to beat back the very worrying trends that we had seen, especially on parents opting out of MMR. We were starting to see vaccination levels tick up again. Previously, WHO had warned that the U.S. could lose our measles-free status because we were having so many measles outbreaks directly related to parents not vaccinating their kids against measles. We were starting to see real progress again. States were tightening the rules for what really qualified as an exception for parents to not vaccinate their children and still be able to send their kids to school. States and cities also started to include private and parochial schools in those regulations so it became harder for parents who didn't want to vaccinate their kids to route their kids out of the public system and put them in schools where maybe vaccines weren't required. Then COVID happened and tragically, one of the main purveyors of vaccine misinformation and distrust, unfortunately, recognized a pretty great market opportunity for them. 

They have massively expanded their market share so there are groups that had hundreds of people on Facebook that now have hundreds of thousands of people on Facebook. There are groups that had hundreds of thousands of people that now have millions of people. Thankfully -- you mentioned YouTube earlier -- YouTube had already prevented the monetization of anti-vaccine content. So, they stopped Del Bigtree and Robert Kennedy Jr. and some of the, I think, great villains in this story from being able to make money off of their anti-science content. Facebook took down a lot of the most egregious information about COVID specifically, but they still have allowed a lot of equally egregious, equally unscientific misinformation to still not only exist, but really thrive on their platform. So, if you're asking what you can do, I think we have to continue to pressure not just the social media companies, but especially Facebook and especially YouTube to say, 'Well, it's great that you're preventing monetization. Maybe you can also prevent these sites or this information from showing up on top of the news feed.” We just saw, pretty powerfully, that de-platforming works, right? When Facebook removed Trump, hate speech dropped dramatically. So, we know de-platforming works and we really need their partnership right now to de-platform the big single and the big groups of anti-vaccine content. 

We also need to continue to support doctors and nurses on the front lines who are having conversations with parents, with our children or with anyone about questions we might have and to equip them with every resource they need to be able to answer everything from the question of "Is the COVID vaccine actually just a cover for Bill Gates to chip us and track us" -- which depending on the survey, more than 10 percent of Americans at least think it's a possibility -- to how you actually address something that you and I know is lunacy but is a very real concern, tragically, that people have at the moment, to much more understandable concerns that people have that this vaccine was maybe rushed because of how quickly we were able to get two fully-qualified vaccines that are being administered here in the United States and more elsewhere. 

So how do you talk about that, to how do you reassure people that while Trump tried to politicize and manipulate the process, all evidence says that the FDA was not politicized, was not manipulated in its approval process, to very real concerns that people have that this may be an extended Phase 3 trial and they're still being experimented on. Especially for Black Americans and other Americans of color who have often found their bodies to be sources of medical experimentation in our country, they have very, very, valid questions there. So, I think, Shiv, there's so much that we need to do to, in your language, "raise the line" and some of it is helping support individuals, having individual conversations, and some of it is putting pressure on the platforms and also on Amazon.  Like, why is Amazon still selling books that are full of endless lies? Why can you still watch Andrew Wakefield, who I think is one of the great mass murderers of the last two decades? Why can you still stream his documentary on Amazon? You should not be able to do that because it's not a documentary. So, there's a lot I think we have to do.

Shiv Gaglani: Those are some really insightful points. And I agree. That's something we hope to be able to contribute to as well now that we're partnering with ...

Chelsea Clinton: Let me know, if I can help, because I clearly feel very strongly about all of this. 

Shiv Gaglani: For good reason. Absolutely. I know we're at the end of our time. So, my last question for you, which is one I know our audience will appreciate is, we have an audience of millions of current and future health care professionals, people who go into public health -- from contact tracers to physicians -- what advice would you give to them about meeting the challenges of not only this pandemic, but moving forward?

Chelsea Clinton: I think, Shiv, that one of the reasons we were so vulnerable here in the United States is because we had divested, effectively, from public health over many years. We had divested at a federal level, but also at a state and local level. I think that we are living painfully in a moment where robust public health systems clearly matter, even evidenced in the questions you asked. We still don't have enough contact tracers here in the United States. It's just another example of "we still don't have enough"....fill in the blank. We still don't have enough tests. We still don't have enough people to administer those tests. We don't have enough contact tracers. We don't have enough people administering vaccinations and we don't have enough people working to make vaccines. So, we still are not doing enough. 

I hope that if we are able to do enough in this moment, then when we persist beyond this moment, we are able to maintain at least some of that capacity because we know that this is not the last time that we'll have a zoonotic virus jump into humans, especially as we continue to live and intrude upon and continue to unfortunately exploit more and more of nature. So, to answer the question "what can any of us do?"...I think we can all continue to try to meet this moment more urgently and more effectively and then ensure that when we are beyond this moment, that not only do we not forget the lessons, but that we continue to live in the lessons and that we continue to recognize that we need to have public health systems that are complementary at the local, state, federal and global levels, and that what we do now should help better prepare us for the inevitable next time.

Shiv Gaglani: Some really great advice, and hopefully as a society we won't have short term amnesia. Just this morning, I was reading again about the “Fauci Effect”, a 20 percent increase in applications to medical schools. So hopefully, there will be a lasting effect on public health and infrastructure here in the U.S. and abroad. So, Chelsea, thanks so much for taking the time to be with us today.

Chelsea Clinton: Thank you. Take care. Stay safe, everybody.

Shiv Gaglani: And with that, I'm Shiv Gaglani. Thank you to our audience for checking out today's show. Remember to do your part to flatten the curve and raise the line. We're all in this together. Take care.