Exit Interview: C.D.C. Head Redfield Reflects on His Time on the Job

He predicted the “worst is yet to come” in the pandemic and expressed frustration with the politicization of mask-wearing and mitigation efforts.

Dr. Robert R. Redfield, the director of the Centers for Disease Control and Prevention, will leave his post at noon on Wednesday, as Joseph R. Biden Jr. is sworn in as the new president.

An infectious-disease specialist with a focus on treatments for AIDS/H.I.V., Dr. Redfield led the public health agency during one of the most tumultuous periods in its history. He was frequently criticized for moving too slowly to protect the United States from the coronavirus, especially regarding the initial rollout of coronavirus tests, while being attacked by Mr. Trump and others within the administration for contradicting their overly optimistic scenarios of the likely course of the pandemic.

On the weekend before his departure, Dr. Redfield talked in an interview about his challenges and his disappointments.

(This interview has been edited and condensed.)

It’s hard to leave at a time when the pandemic still hasn’t reached its peak and the worst days haven’t come. It would have been more rewarding to leave when the pandemic is under control, but I do feel proud.

I encourage the president-elect to focus on his pledge to get people vaccinated in 100 days. I’m glad we gave him a foundation to build on. Last week, we had two days when we vaccinated one million people a day. We laid a foundation for vaccine administration. I find it unfortunate when some people suggest that the vaccine program delivering one million a day is somehow a disaster — but it will be a model when the Biden administration does it.

I’m not trying to criticize the Biden administration at all. But he’s pledged to do 100 million people in 100 days. We’re on the verge of delivering one million a day, and yet I heard his chief of staff on the Sunday talk shows saying that our vaccine program was a disaster and they inherited a mess. I’d rather they would be thankful. That’s better dialogue than political hyperbole.

I really think it was trying to operationalize an effective public health response against the greatest pandemic that this nation has had in a century in an environment where there’s been probably more than 30 years of underinvestment in public health across this nation. The core capabilities — data analytics, laboratory resilience, the public health work force — has been chronically underinvested in. That was a real frustration.

I was. When we had the measles outbreak, I had some state health officials literally tracking it with pen and paper and fax machine.

When they’re talking about rebuilding infrastructure, the first infrastructure that they have to rebuild is the public health infrastructure in this nation. We need to be overprepared from a public health perspective rather than underprepared, particularly when it comes to challenging infectious pathogens. Because timing is everything — you know, what you can do in the first 36 hours, 48 hours? First week or two?

My greatest disappointment was the lack of consistency of public health messaging and the inconsistency of civic leaders to reinforce the public health message. You can read between the lines what that means — “civic leaders.”

Covid-19 Vaccines ›

Answers to Your Vaccine Questions

While the exact order of vaccine recipients may vary by state, most will likely put medical workers and residents of long-term care facilities first. If you want to understand how this decision is getting made, this article will help.

Life will return to normal only when society as a whole gains enough protection against the coronavirus. Once countries authorize a vaccine, they’ll only be able to vaccinate a few percent of their citizens at most in the first couple months. The unvaccinated majority will still remain vulnerable to getting infected. A growing number of coronavirus vaccines are showing robust protection against becoming sick. But it’s also possible for people to spread the virus without even knowing they’re infected because they experience only mild symptoms or none at all. Scientists don’t yet know if the vaccines also block the transmission of the coronavirus. So for the time being, even vaccinated people will need to wear masks, avoid indoor crowds, and so on. Once enough people get vaccinated, it will become very difficult for the coronavirus to find vulnerable people to infect. Depending on how quickly we as a society achieve that goal, life might start approaching something like normal by the fall 2021.

Yes, but not forever. The two vaccines that will potentially get authorized this month clearly protect people from getting sick with Covid-19. But the clinical trials that delivered these results were not designed to determine whether vaccinated people could still spread the coronavirus without developing symptoms. That remains a possibility. We know that people who are naturally infected by the coronavirus can spread it while they’re not experiencing any cough or other symptoms. Researchers will be intensely studying this question as the vaccines roll out. In the meantime, even vaccinated people will need to think of themselves as possible spreaders.

The Pfizer and BioNTech vaccine is delivered as a shot in the arm, like other typical vaccines. The injection won’t be any different from ones you’ve gotten before. Tens of thousands of people have already received the vaccines, and none of them have reported any serious health problems. But some of them have felt short-lived discomfort, including aches and flu-like symptoms that typically last a day. It’s possible that people may need to plan to take a day off work or school after the second shot. While these experiences aren’t pleasant, they are a good sign: they are the result of your own immune system encountering the vaccine and mounting a potent response that will provide long-lasting immunity.

No. The vaccines from Moderna and Pfizer use a genetic molecule to prime the immune system. That molecule, known as mRNA, is eventually destroyed by the body. The mRNA is packaged in an oily bubble that can fuse to a cell, allowing the molecule to slip in. The cell uses the mRNA to make proteins from the coronavirus, which can stimulate the immune system. At any moment, each of our cells may contain hundreds of thousands of mRNA molecules, which they produce in order to make proteins of their own. Once those proteins are made, our cells then shred the mRNA with special enzymes. The mRNA molecules our cells make can only survive a matter of minutes. The mRNA in vaccines is engineered to withstand the cell's enzymes a bit longer, so that the cells can make extra virus proteins and prompt a stronger immune response. But the mRNA can only last for a few days at most before they are destroyed.

You can see that different parts of our society have different perspectives on what needed to be done. Controlling the pandemic was always, in my view, aligned effectively with maintaining the economic health of our nation. It wasn’t an either/or — we showed that in schools. You can still keep businesses, hospitals, et cetera, open and do it in a safe and responsible way. There are some parts of our economy that will need to have some restrictions. I would argue that having people in a crowded bar, drinking three or four beers without their masks, talking louder and louder so they spray their respiratory secretions further and further, is probably something that needs to be curtailed.

But the fact that we didn’t have an alignment meant we had the private sector and public sector all wrestling with how to put it together independently. So the reality is we are in for some very difficult times, and I think I would have loved to have been proved wrong. I still believe the worst is yet to come.

First, we always said that we were going to be for some period of time — probably April, May — we were going to be in a state where demand for vaccine could outstrip vaccine availability. I look at it as an enormous accomplishment that here within, you know, six, seven months, saying we’re going to have a vaccine by the first year, basically two manufacturers are able to produce approximately 10 million doses a week.

First and foremost, I stood up for the agency at every turn. I never caved. I think you can find a number of people at the agency that would tell you that, who were actually in the arena with me.

There are people who say to me, “Well, why didn’t you tell the president this?” or, “Why do you tell the president that?” There are some people that will only be satisfied if you personally criticize the president. I’m a chain-of-command kind of guy.

But I’m very disappointed that some civic leaders decided to make this issue of mitigation a political football, rather than embracing the public health measures. It took a long time to really finally get through, I think, and have more consistency of messaging — probably not until late September.

As I said, civic leaders, both at the federal and the state level, didn’t echo the critical public health measures and mitigation messages that we were trying to put out in the spring and early summer.

I called her and congratulated her when she was appointed, and I gave her all my contacts and I told her that I’d be available for advice and questions. She’s been in regular contact with the people at C.D.C. I asked them to give her 100 percent of their attention.

You know, I believe if I wear my mask, wash my hands and social distance, I can fly safely.

In three years, I’ve kept all the conversations I’ve had with the president between me and the president. I’m going to make it all the way through.

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