Voices of HHS
HHS Secretary Alex Azar on the Race to a Vaccine
On the inaugural episode of “Learning Curve,” Caputo shares his journey to the Department and then is joined by HHS Secretary Azar to discuss what we’ve learned about COVID-19 and the work being done to shorten the timeline to a vaccine.
Michael Caputo: Hi, welcome to Learning Curve with Michael Caputo. I'm the Assistant Secretary for Public Affairs at the Health and Human Services Department here in the United States government and the Trump Administration. I'm very, very proud to be here. Thanks a lot for listening in, this is a brand new podcast and our idea is to basically bring you along as I learn here at Health and Human Services.
There's a lot going on in this department just about everything to do with the Nation's health and well being is conducted under the, this department. There are something like 83,000 employees, everything from the Food and Drug and Administration to the National Institutes for Health to everything you've ever heard of the CDC, the Centers for Disease Control in Atlanta. Everything comes under the Health and Human Services umbrella and our Secretary here is Alex Azar I'm actually going to have him on the show today and every day, every week after we do this, we're gonna to start out weekly and every week after this we're going to pick one topic that we see people talking about and find the expert in Health and Human Services to help you learn more about that topic. I know most of America has been watching these briefings out of the White House and watching your Governor's briefings and watching your County Executive or your Mayor's briefings if you're in a big city. And we've all been sitting on the edge of our seats and it's funny because I come straight from lock down in my house right here, dropped in, parachuted in to Health and Human Services as the senior communications professional here. I've got a lot of people I work with, they're already hard at work here it's difficult to be in the public affairs arena in the United States government especially in the cabinet level, but in the middle of a pandemic, in Health and Human Services it was like being parachuted in and you know to behind the lines in a war. And I can tell you I was locked down just like you were in your house. I guess I was in, when I got back from Washington after a visit here for work in early March and I had heard about the emergence of this virus when I was in Washington and the first thing I did when I got home to my family in East Aurora, New York, by the way the nicest, little village in the world to live, work and play. A great place to live. I've lived in cities, I've lived in towns, I've lived in villages. I know all of America is experiencing the same thing that my family did. We went in the house, we locked the door and I had to convince my 18 year old that she couldn't go see her friends, that was tough. I had to convince my 7 year old and my 5 year old daughters that they couldn't even play with the neighbor kids who they've grown close to over the years we've lived on our little street in East Aurora. When we went to the grocery, I made it a once in a long while trip ,with the mask and with gloves. People in my little village East Aurora thought I was nuts, I walked in with a mask early on and I'd say mid-March. And you know, surgical gloves and they thought it was really overstating things. When I got home that 1st time from the grocery, I actually went into the mud room and stripped out of my, down off my clothes and got into fresh clothes and washed all my stuff in hot water. I did not know how far this thing was going to go. I was really nervous and when the President Trump asked us to shelter in place for 2 weeks, walking around the village of East Aurora it seemed like a free vacation, wasn't going to count against any of our vacation times. People were walking around with a beer in their hand, you know, staying a little bit of a distance between themselves. But on the street corner, you, they would end up shaking hands or high fivin'. And then about a week later the President decided that it was important for us to shelter in place for a longer time period as according to the, the advice of the scientists around him like Dr. Fauci and Dr. Birx and all the other great, public health professionals the United States government. And that really hit all of us really hard, in East Aurora. I remember seeing the faces of the people during the 1st like walk we went on as a family. Because in East Aurora we all live on little patches of land or our houses or you know it's a village, so our houses are about 25 yards from each other. And if we played in our yard with our kids it didn't really mean that they were going to be interacting with the germs and viruses of other people. So and of course in Buffalo, in March it was still winter and Buffalo we have 2 seasons winter, and July 11th I think. And it was still cold and still snowing so going out and playing, really, really wasn't on our agenda, we were in our house. We found the bottom of Netflix just like you did. And you know, we were homeschooling. My 18 year old, of course was finishing up her Senior year and high school via distance learning and my kids who went to the Catholic school across the street from us, it seemed so funny because all they had to do was go across the street to go to school but now we were locked in our houses and my little ones really couldn't understand that. I got stuck with teaching 2nd grade math and let me tell you that's really hard stuff to do. I don't, I'm not a math guy but I was having fun doing it. But after the president announced the extension of that sheltering in place; I could see the despair develop on the faces of everybody in my village. People who were chatting on the street corners were staying farther apart from each other, people who were waving across the street to each other on their walks, they weren't smiling any more they were waving. And we sat on our porch, on the front porch of our house we have one of those porch swings like you see in all the movies. In fact, in East Aurora, they actually filmed, these Christmas movies for Hallmark Channel, they've filed them there. It's like living in that film "It's a Wonderful Life." And the neighbors walking by in the 1st couple of weeks were waving and saying hi and toward the end of I'd say early April I could just see the despair developing on their face. And was right about that time I got a call from President Trump, who I've known for a lot of years. And he asked me if I wanted to be the Assistant Secretary of Public Affairs for Health and Human Services? I of course jumped at it, as a public relations professional as a you know a communications professional, a strategic communicator. I knew that a pandemic like this, something so I mean it is it's a metaphysical threat to our existence you know, I mean I thought it would be the biggest challenge of my career and it really is. I of course said yes immediately, but I watched as my village while I was filling out the paperwork and waiting out the security clearance and sitting in East Aurora waiting for my time to actually drive down to Washington, I watched as my village fell completely. All the businesses on the Main Street, we don't have a Wal-Mart we have a 5 and dime. We don't have, we don't have Starbucks, we got our own little coffee shops. And we have probably 100 businesses let's just say 100 small enterprises owned by entrepreneurs; I bet 60 percent of them don't open up again. And I watched as all of this started falling apart. Our little village is nice. I mean, It's actually middle class, upper middle class I guess. I mean Buffalo is 20 minutes away and there, you know that urban areas hit harder by the Coronavirus, but we got it too in East Aurora. When the President called I said yes. I passed through all the, the paperwork and the security background briefing and I jumped in my car, packed it all up and drove on down to Washington, it's 7 hours. I knew that when I left my family in the driveway that was the last time I was going to see them for a long time. I can't go back East Aurora and see my kids I'm back here in Washington and you know there's a lot more cases here. My kids have been really you know pristine, protected in our house in East Aurora. And I'm not going to go dip in and out of there, just get 'em sick. So to me I look at it as a military deployment. I'm an Army veteran you know and I see this is my opportunity to serve my country, to help defeat the Coronavirus, to help get America back to work. And I'm proud to be here but it's hard man. One of the things that's really hard a lot of the criticism I got from the media when I got here is I don't have health care experience and that's true, I don't. I have a lot of emergency experience, I've worked on the victims side of hurricane recovery in every hurricane since Katrina working for the victims trying to get their damages paid by insurance companies and by the, by FEMA itself. So I've been, I've spent a lot of time in Puerto Rico after Hurricane Maria, a lot of time in New York and New Jersey after Hurricane Sandy so I've seen what happens to families after a disaster. But it's usually localized. A hurricane hits one town or one region. This is the biggest hurricane I've ever experienced, the entire world. So I, you're right though, I have no healthcare experience, that's not, I mean it's not unusual the, the Assistant Secretary for Public Affairs at Treasury may not have you know financial experience, the Assistant Secretary of Public Affairs at HUD may not have housing experience. Our job is to communicate, to get people who know the answers to speak on the air. And, but I have a learning curve, I really do. Every time I talk to Dr. Fauci, Doctor Birx, Secretary Azar, I'm learning something. I'm surrounded by some of the smartest people I've ever met in my life and I feel blessed. It's a hard job, it's tiresome 24/7 in a lot of ways. But I've never been around so many brilliant people in my life and I am enjoying my learning curve. So when I told Secretary Azar I wanted to start a podcast, I had my own pod cast before I joined the government. He thought it would be interesting that I take the American people, the listeners who take the time to listen to this podcast along on as I, as I explore my own learning curve. As I learn from the best and let me tell you something the people here, in Health and Human Services are the smartest people I've ever met. And if I can tell you one thing that you should take away from Learning Curve the podcast it's hope. Because in my mind I believe deep in my heart that the scientists are going to defeat the Coronavirus. I believe it now more than ever. I've always had faith and science and faith in American America's public health system, but I now that I've been here for a month I know that we're going to defeat the virus. I see the signs and I hope you do too. I also trust President Trump who I've known for 30 years. I know he and Larry Kudlow and others they're going to restart this economy, they're going to reopen America and our economy will be restored. President Trump built the strongest economy in American history and I think he'll do it again. I think it's going to come roaring back, it's going to be difficult but I believe they'll do it. They'll defeat the virus, they'll reopen the economy but who's going to defeat the despair? The sadness I saw on the faces of my friends in East Aurora, the sadness you see on your friends faces wherever you live, Pittsburgh, Chicago, L.A., Seattle, El Paso. Everybody, we all have something that we're worried about. So I invite you to listen to Learning Curve every week from here forward I'm going to do it as long as I draw breath here at Health and Human Services. And today I'm really honored to introduce you to Health and Human Services Secretary Alex Azar. I didn't know Secretary Azar when I came here. President Trump said I would like him, I've learned to like him I think and what a team he's assembled here. So in this 1st installment of Learning Curve I'm really happy to introduce you to introduce you to my boss. Health and Human Services Secretary Alex Azar.
[12:35]: Start of Interview
Michael Caputo: So I'm here with Secretary Alex Azar from Health and Human Services with a member of the Cabinet leading all health issues for the Trump Administration. Of course in a pandemic it's a very different job isn't it Mr. Secretary?
Sec. Alex Azar: Yes, it is Michael. It really involves mobilizing just all parts of this massive department but then just extensive, extensive coordination, collaboration across the government with state and local officials but also with the private sector and internationally.
Michael Caputo: Well you know, as I came in here just a couple of weeks ago, I was locked up in my house with my kids teaching 2nd grade math to my 7 year old like most of Americans it really snuck up on us. I mean those of us who were watching this from afar going about our lives, when we understood that there was a pandemic on the horizon it really surprised all of us but you saw a little signs here and there but it in a lot of ways this was something that we could have expected is it?
Sec. Alex Azar: That's true. So while we saw early signs, we're always on the alert for any kind of adaptation of the Coronavirus and why is that?
Michael Caputo: What is the Coronavirus?
Sec. Alex Azar: So the Coronavirus is, for a lot of circumstances the common cold but the Coronavirus can be, there are different strains of the Coronavirus that can occur in the environment or that can be that can modify. So for instance, the SARS the Severe Acute Respiratory Syndrome from about 2003 which came out of China. SARS was as a Coronavirus that changed. MERS, Middle East Respiratory Syndrome, was a Coronavirus that changed. So that's why when we, when we got the word, in early January that the Chinese thought they were seeing an unidentified respiratory illness, our, our radar went up right away. Because Wuhan China, unidentified, unexplainable respiratory illness that means it's not flu, it's not, it's not something that we recognize, we get concerned. And then when they say now possible novel Coronavirus you really get alerted. But even then, so we're, we mobilized the whole government. We get very alerted to the fact that we're dealing with a novel Coronavirus. This still is unprecedented. It is unprecedent for several reasons. First, this one is a much less fatal version of Coronavirus than SARS or MERS. So that means it has the potential really to rapidly spread. Second, in really an unprecedented way this has demonstrated characteristics of asymptomatic transmission, in other words you have a disease that people can be shedding as easily as if they have complete symptoms and yet they don't even know they have the disease. So you can't just say somebody who has a cold test them for this because they may literally never show any symptoms and yet be shedding as much virus as an individual who is in the ICU
Michael Caputo: Right, and we see people like that's how it spread so quickly in nursing homes for example because staff were coming in and they didn't know they were sick.
Sec. Alex Azar: That's right that's right and so it makes this a very very unprecedented and and frankly perplexing virus to deal with which is which is why we in the world community we in the U.S. everybody is learning every day about this and it's also why I'm going to be honest with you it's so disappointing and so tragic that China was not more transparent right at the outset because this is so novel, we could have learned these things right away if they had welcomed the international community in, if they had told everybody what they knew and what they didn't know. We could have deployed teams there into China and studied this.
Michael Caputo: And you wanted to do that.
Sec. Alex Azar: I did. We offered it on January 4th we had offered to deploy…
Michael Caputo: Wow, that early.
Sec. Alex Azar: …a CDC team of experts. We then fought and fought for them to accept a World Health Organization team to get in and that didn't even get there till I think February 16th so a least a month and a half after what China has been willing to admit in terms of transmission of this disease a month and a half without gaining that critical insight knowledge.
Michael Caputo: And during that time, we're learning things the hard way that they could have told us right away.
Sec. Alex Azar: That's right, absolutely.
Michael Caputo: That’s terrible and all of us sitting in our homes like you're you know when you came to the administration from Indiana me from Buffalo, New York. You were learning things just as quickly as we were and these are things that the Chinese could have actually told us and we could have saved a lot of lives.
Sec. Alex Azar: They could have told us or we could have at least learned together by deploying the world's best epidemiological and scientific minds at this but we were excluded for the longest time.
Michael Caputo: That's crazy and I understand you know we you and I were at the White House today for one of the Coronavirus task force press briefings and it looks like you know some months later now we're kind of entering a new phase of this aren't we?
Sec. Alex Azar: I think we are so if you look at all of the epidemiological curves especially in our urban metropolitan areas where you've had large scale community spreading those seem to be very clearly on the decline coming down on the back side of that slope. If you look overall at our numbers in the United States of cases, that may not be so represented. What's going on is what we're seeing now is a large number of concentrated outbreaks so for instance at a at a meat processing plant we're all of the individuals live in community living close to each other a rapid spread, a prison with a rapid spread, nursing home with a rapid spread -- these types of either congregate living or close quarters where you get an infection that rapidly spreads throughout. So why is that a positive sign? The positive sign is those can be contained. That is literally what we do with public health tools. We surge in. We test everybody. We contain those people and it doesn't spread further, unlike say New York City or Seattle where you just have it spreading out in the community and it's so rampant you can't actually just find, isolate, track, and trace around those people. You need to bring the whole community down through what we called need mitigation social distancing to try to get control of that. So if we're seeing that community spread coming down and if it's being -- we don't want to replace by anything but if it has to be replaced by something these type of more contained outbreaks is actually a something of a positive development.
Michael Caputo: Why’s that?
Sec. Alex Azar: Again, because we can deal with them. If there's a poultry factory and there's an outbreak there we can -- it's a contained situation. We can deploy, we can test everybody, we can treat everybody, we keep them isolated from anyone else so it doesn't spread to other people. So that's - if you remember back to January and February, that’s that containment language we used to use instead of mitigation language in public health. Now, the name of the game is next going to be -- how can you even prevent those outbreaks from happening. And so that's why we're deploying testing. The CDC is out there in these critical congregate care settings to make sure that we they're using appropriate precautions to try to keep people from being able to transmit so rapidly to each other if somebody does get infected.
Michael Caputo: So as the President talks about reopening America. And rebuilding the economy, are we ready for that?
Sec. Alex Azar: We are and we have to be ready because this country has got to get back to work and what the President is saying is we don't need a single one size fits all solution across the United States in terms of this. It's going to depend on the community, it's going to depend on the setting, and it's going to depend on the individual in terms of what precautions are needed. But we can get back to work, we can get back to functioning with appropriate precautions that protect public health. The situation in you know Carmel, Indiana is going to be different than the situation in Manhattan, New York City.
Michael Caputo: No doubt, and where I'm coming from Buffalo, all my friends back in Buffalo where it's not nearly as bad as New York City are upset that the governor is treating Buffalo like New York City. The whole state of New York is being treated as one spot. It's very different from one region to another isn't it?
Sec. Alex Azar: Oh that's right -- just different county by county and that's why the President has called for this type of localized assessment to determine when it's appropriate to loosen up restrictions to get people back functioning and what the appropriate protections would be but very localized kind of determinations.
Michael Caputo: Well, I’ll tell you in my little town of East Aurora, New York we have 126 cases and one town over they've got 5. It really is that localized isn't it?
Sec. Alex Azar: That's right because it could have you know in East Aurora, it could have been a nursing home for instance that really had an outbreak and that could be the extent of the risk and situation there and that's a containment situation. You isolate, you contain within that nursing home the staff etc., and that doesn't become a major issue in the entire broad community.
Michael Caputo: So you see that it hits elderly population, people with co-morbidity, some people who have underlying issues that they're sick with anyway and children really don't get it or at least if they get it they don't have tragic consequences. So why did we keep, why did we close schools for children. I keep hearing it was to protect their grandparents right?
Sec. Alex Azar: That's right -- to protect their parents and their grandparents absolutely. You know, any of us who have kids, I know that when my kids were younger they were walking little bioterrorism experiments [laughter], basically bringing home every kind of disease known to man and I was perpetually sick from every disease they would bring home. And these schools are definitely settings for transmission of disease and this is a this is a wildly transmissible disease we now know.
Michael Caputo: Is there anything like it – transmission?
Sec. Alex Azar: Well it's not as transmissible as say measles. You know, measles -- if you put one person with measles simply walks into a room with 10 people who are unvaccinated against measles 9 of the 10 people walk out of that room with measles. That's how transmissible it is. It's not that, but this is a very very transmissible disease and so in the school setting it would spread like wildfire but the kids might do better. All of the evidence seems to suggest that kids do better with the disease but they're going to bring it home and they're going to bring it home in the communities, to their bus drivers, to anyone else they interact with and it looks as if the younger healthier might be more likely to be, we’re studying the data, more likely be asymptomatic, making them unknown carriers of the disease to other people so it puts everyone puts everybody else at risk.
Michael Caputo: So the next phase we may see where the kids go back to school but they can't visit their grandparents.
Sec. Alex Azar: Well that might be that might be a way of protecting vulnerable populations. There also are steps that one can take even in a school based setting -- you can go back to school but there are certain activities that maximize protection there. For instance, maybe you don't have auditorium sessions maybe you don't have big town halls of all of the kids together in one place -- sort of smart types of social distancing and mitigation approaches even while you get back to school.
Michael Caputo: Right. How we doing on a cure? You know, we always hear that there's no real cure for the common cold. Will there be a cure for the Coronavirus?
Sec. Alex Azar: So I feel very confident that we will have therapies to treat people with. I also believe that we will have a vaccine or vaccines eventually to take care of people. We have now given an emergency use authorization approval to Remdesivir which is an anti-viral medication which has proven to be effective in treating individuals by IV, who are in the hospital. It has reduced the length of their stay and their symptoms, and so we do have a therapeutic for this, but there are very exciting prospects in terms of in terms of treating people. One of them is very old -- I think we used this back with the 1918 flu -- that's how old it is. It's called convalescent plasma -- basically what happens is if you get this disease your body reacts and it builds antibodies. The antigen is the virus that's trying to attack your body the antibody is your body's defense mechanism that it creates, that binds to and attacks that antigen, and neutralizes it basically. So when you get this disease you build up these antibodies -- that's what kills off the disease. We can extract that from your blood in your plasma and then we can give that plasma to a sick person and that -- it's basically like a jumpstart to their immune system -- it gives them the antibodies. Or you might even be able to think of it as a as a preventative, for like say a health care worker perhaps. So this isn't actually a pretty age-old, tried and true tactic and we've got clinical trials underway. The next thing you can do is you can distill that down to -- it's called hyper immunoglobulin -- basically you get…
Michael Caputo: Gesundheit.
Sec. Alex Azar: [laughter] Yes exactly. You get that concentrated -- and that's a real burst. The next is you artificially create this -- it's called a monoclonal antibody. You basically -- it's a designer drug where you basically design that antibody, high concentration, inject that into somebody. So you can have essentially unlimited supplies of that. We are funding and doing trials, we're developing each of those steps -- the basic convalescent plasma, the hyper immunoglobulin, and then the monoclonal antibody work. We at HHS and across the government are doing that work on all of those stages of therapeutics. Now vaccines…
Michael Caputo: Let me -- I understand from the very beginning the President said that he wasn’t going to accept the, you know, 18 months minimum timeline for development of a vaccine and now he's announced -- you've announced as well -- this new initiative of yours and the Department of Defense called Operation Warp Speed. What's that about and what should people who are listening take away from that? I think it's hope, isn't it?
Sec. Alex Azar: It is hope. In short it's a Manhattan project for our vaccines as well as therapeutics and diagnostics in this space. So let's focus on vaccines, we talked about therapeutics, but vaccines -- the President simply said the timelines that are normal for developing a vaccine even accelerated are not acceptable, not acceptable.
Michael Caputo: They can’t be.
Sec. Alex Azar: We need we need vaccines to get America back to work, to get the world back to work, for people to feel safe because we can't live shelter in our homes And so we said these timelines that the big drug companies are used to, aren’t acceptable. Because here's our drug development works -- you invent a vaccine and we've now got over 70 vaccines that people have invented that they're trying out.
Michael Caputo: I mean, for the Coronavirus.
Sec. Alex Azar: For the novel Coronavirus, for COVID.
Michael Caputo: 70 different options.
Sec. Alex Azar: Yeah, everybody's at work on this. But you take it, you test it in a small number of people -- that's called Phase one, that's you're basically saying is it safe -- you look for any signs of efficacy. Then you do a Phase 2 study which is a large group of people there you're looking to find what the right doses as well as -- are you seeing -- it's called a dose ranging study -- what dose gets the effect you're looking for and is safe? Then you go to phase 3 with a larger population where you're really doing the final test in a blinded study to see is this drug safe and effective in a large number of people. And each step of the way -- a drug company -- you do Phase one, then you look at the data, you sit around, you think about it and you design phase 2. Then you do phase 2 you get the data you sit around you look at it you design a phase 3. And then you finally launch that and then you get to phase 3, you get that done and if it's a hit, if it works well then you start working with the regulator, the Food and Drug Administration, which is part of our agency here, and you start working on commercial scale up manufacturing of it. What the President is saying is compress all that. Compress all that.
Michael Caputo: All parallel.
Sec. Alex Azar: So you run, you compress that phase 1-2-3 down in sequence…
Michael Caputo: No coffee breaks.
Sec. Alex Azar: No coffee breaks -- you run right through the studying, advancing the safety and efficacy studies on the data, you combine the studies so that you're actually running these trials with multiple vaccines in your clinical trials. We did this work with Ebola in the eastern Congo -- it's called a multi arm study so instead of having to have this vaccine against a control group with these patients, this vaccine against control group with these patients, you do a single one -- one control group, multi arm, get comparative data so it gets you power of additional information. You compress phase 2 and phase 3 together as much as possible to get data and you get off to the races, driving that through. Then when you pick your big bets you figure out which platforms which vectors of the vaccine are most proven, which ones are most likely to be able to scale up on manufacturing with quality, and you place those big bets early on you, actually manufacture a commercial scale of these that vaccine as you're still studying the drug, so you might end up with a hundred million doses of a vaccine that fails clinical trial. And that's just, that's the cost will have to pay to do that, but the private pharmaceutical industry is never going to do that. We can do that at risk. We, the U.S. government have the money to and we will place those bets and we will do manufacturing scale up so that we can have hundreds of millions of doses when we get vaccines that actually function and work, and we may have multiple vaccines. It may not be just one. We're putting multiple bets down to manufacturing scale up. This is a Manhattan project for drug development because President Trump said we are going to put the full weight of the U.S. government, every part of the government that touches the science in these vaccines and combining that with the entire power of the private sector of America's world leading bio pharmaceutical industry.
Michael Caputo: And I'll tell you that's next exciting stuff and I think the American people really need to hear about it. You know, before I came here, I've told you about this, I saw a little village I came from fall into despair. I'm convinced absolutely convinced that the scientists are going to defeat the virus that the President and his men -- you and the other cabinet members are going to restart the economy and rebuild America but, how do we get people to come out of their houses? How do we defeat the despair?
Sec. Alex Azar: Well, first, we believe we're seeing very promising signs as we come into summer here that we are on the backside of the slope here in the United States. If we continue seeing that, then that gives us time we'll continue building up our personal protective equipment, our health care supplies, continue to advance the President's goals on Operation Warp Speed of getting therapeutics as well as vaccines for individuals, and then if we see a resurgence, say in the fall, we're going to be vastly vastly more prepared and ready, and…
Michael Caputo: And with a lot more knowledge.
Sec. Alex Azar: And with a lot more knowledge, and we hope, have therapeutics as well as vaccines in our arsenal, so that people can feel and be safe.
Michael Caputo: They feel like -- they should feel right now that coming out of their house is going to be safe. We're going to have our hands around this. Secretary Azar, thank you so much for spending time with us here on Learning Curve. It's a great honor to work for you, and to work for the President of the United States, and we'll have to have you back on Learning Curve soon.
Sec. Alex Azar: Thanks for having me, Michael.
Michael Caputo: Thank you sir. That's it. Secretary Azar -- our 1st guest here on The Learning Curve, the Health and Human Services official podcast. Me, Michael Caputo, proud to be here, and thanks a lot for listening. We'll catch you next week.
[32:30]: End of interview
Narrator: Produced by the U.S. Department of Health and Human Services at taxpayer expense.