Today we're talking with my friend Dr. Jay Bhattacharya. Dr. Jay Bhattacharya is a physician. He also was on faculty in medicine at Stanford University. He's an epidemiologist and a healthcare economist, and he's the newly appointed director of the National Institutes of Health research in the United States. So warm welcome, Jay.
Thank you for having me on, David. It's a delight to be able to come back and talk with you.
Well, Jay, it's been a number of years since we've known each other and it's been quite a journey. And I guess I want to start off by just congratulating you on your appointment as the director of the NIH. Were you surprised by the offer to join the administration?
In one sense, yes. That's not a job I ever sought or went after. I was perfectly happy being a professor at Stanford University. Until 2020, I guess I was perfectly happy. The four years of the pandemic were a little bit crazy. But when President Trump won, I had been working in the summer before to think through how I might reform the public health institutions of the United States. I wrote a white paper, circulated it to some people, and wrote it with some friends. And somehow it got into the hands of Bobby Kennedy, who then had his folks reach out to me. I was, you know, I guess I'd been preparing for it, but also never expecting it. So it's been such a great honor. The National Institutes of Health, as troubled as it was, I think, during the pandemic, is still an amazing institution. Still the single biggest public funding agency for biomedical research in the world, and has had a history of so many great accomplishments. So the ability, or the honor to be able to lead it, is amazing, especially at this time when so many people have lost trust in science and public health.
Well, congratulations. And I know that you care deeply about that very mandate of renewing trust in public health, to be able to renew great institutions such as the NIH. So just tell us briefly, what do you see as your mandate at this juncture?
Well, I think there's the problems caused by the pandemic, a breach of trust that's led, I think it's one in four Americans in late 2024 told the Pew folks that they do not trust that the work the scientists do has the well-being of the American people at heart. We have to fix that. One in four think that scientists are working against regular people. That's not sustainable, especially since most of the work scientists do by medicine is to help heal people, to cure people, to treat disease. And so I think that at the same time, there are very real reasons why so many people feel this way. David, you and I know what happened during the pandemic. The assertions that we had to mask toddlers, that happened in the United States. Schools closed; kids are still suffering, years behind in schooling as a result. Churches closed. There were assertions about the COVID vaccine that turned out not to be true about whether if you get it, it can stop you from spreading the disease. There were mandates. In Canada, in some provinces, you couldn't even leave the house if you were unvaccinated, almost, right? You couldn't travel on public travel. And so you can understand why a lot of people lost trust. At the same time, it's still important that science really does produce advances that have the capacity to really make people better and make their lives better. So I need to bridge that divide. That's really my mandate.
Exactly. Well, it's a very exciting, critical mandate more than ever. And I think part of your mandate is illustrated by your own personal story. I mean, you were one of the co-authors of the Great Barrington Declaration with Dr. Martin Kulldorff—and I had the pleasure of just talking with him yesterday—and, of course, Dr. Sunetra Gupta from Oxford. And it is remarkable that you basically asserted in the Great Barrington Declaration at the time, going back to what was it, 2021, basic best practices of public health, and for which you were attacked. I mean, this is, I think, part of the paradox: that you had all kinds of parties viciously go after you personally in so many ways after things that were just basically common sense, things like asserting natural immunity.
Yes, it was October 2020. But you're absolutely right, David, that it was just common sense. The idea of the Great Barrington Declaration was the risk of COVID in 2020, and even now, were so much greater for old people than for young people. So the Great Barrington Declaration said: protect old people better, and for young people, let them live their lives. Let them go to school. Let them play with their friends. Let them do what young people do. And to me, as someone who's been working in infectious disease epidemiology and in health policy for a long time, that didn't strike me as particularly novel. That's how we dealt with all other respiratory virus pandemics. But it came across as shocking in the context of October 2020. And the various parts of public health that dominated public health at the time, the leaders of public health, abused their power to suppress any conversation about it. Like, I remember it being discussed by the CBC in October 2020, accusing me of being a fringe figure, that I wanted to let the virus rip and kill people. It literally said to help protect the lives of older people better; that was the key plank of it. So the whole thing was just heartbreaking. And I think public health authorities who were in charge then really did abuse their power and bear considerable responsibility for the situation we're currently in.
I really agree. And so if you look back at the story of COVID-19, are there obvious lessons that come out of that beyond all the need for healthy discussion that focuses on what is the best scientific decision here that serves people rather than just politicizing it?
Absolutely. In fact, that's my central lesson. You absolutely nailed it right on the head. And it's the idea that you can have science without free speech is ridiculous. The whole Enlightenment involved essentially dethroning authority from the power to say what's true and false in science. Science emerges out of discussion and debate and logic, data—all that. It comes out of contention, people talking to each other, basically. And if we'd had that debate, if the governments like Canada, the United States, a whole bunch of Europe, had not worked to suppress that debate from happening with their fingers on the scale, a lot of what went wrong might have been avoided. We might have had much better results. It was really hard to tell people, for instance, about what was happening in Sweden during the pandemic. Sweden, of course, never locked down, never closed schools for kids under 16, and yet they had vastly better outcomes for everybody—the lowest all-cause excess deaths in the world. They protected human life better than Canada, protected human life certainly way better than the United States, without lockdowns.
Okay, so that's pretty clear in your mind that Sweden did it right and we could actually learn from that example.
It's incontrovertible, right? If you look at excess mortality, Canada still has high excess mortality relative to Sweden. Since 2020, Sweden has actually had negative excess mortality. Negative. They reduced mortality rates during the pandemic, whereas Canada and the United States have higher mortality, positive excess mortality relative to what you would have expected based on baseline from 2015 to 2019. It's just not debatable. And Swedish kids suffered no learning loss. My kids were out of school for two years in California. The harms from the lockdown we're still seeing to this day: high levels of suicidality, high rates of overdoses, depression. A lot of the hangovers from the lockdowns, a lot of the economic fights that we've been having the last couple years, are lingering effects of all the inflation. If you print trillions of dollars to pay for locking the world down, what do you think is going to happen? Yeah, I think a lot of the harms could have been avoided had we followed the Swedish strategy.
Well, it's truly a remarkable case study. If we can just deal with a key question here, it would be: why does this matter? Often in conversation with Canadians, they're either in disbelief because they listen to a lot of legacy media like our state broadcaster, the CBC, and you don't hear any of this. It's very discouraging, the lack of information regarding these basic facts now that lead us to believe that we could have done a much better job, to put it mildly, managing COVID-19. And there are people who just kind of want to move on; this is a really bad memory. So why is this so important as we look to the future and right now when we look at healthcare policy?
Well, first, the obvious point would be that this won't be the last pandemic, right? And lockdowns in many countries—I'm sorry to say, David, in Canada—are now the default strategy. If you expect to be able to send your kids to school for their entire childhood, well, if there's another pandemic, it's very likely that we will have the same policy in place in Canada and elsewhere. In the United States, the advantage of having President Trump and now Secretary Kennedy in office is that we can start to change the pandemic plans and start to change the conversation. In so many other countries, like in Canada, doctors lost their practice license literally for posting against lockdowns on the web, on Twitter. You have now a situation in Canada of a control of the media environment that is directly opposed to telling the honest truth about the data, about the efficacy of the Canadian COVID response, and a suppression of all of the voices in ways that have made it very difficult for people to speak up. I mean, you're incredibly brave for just having me on a podcast. That's been true for years, David. I quite admire that.
So there's a risk of the thing repeating again. Second, it's a missed opportunity. You really have a chance now to address some of the fundamental problems in science that led to the bad outcomes. Why was it that the scientists landed on things that turned out to be false, and then gave advice—essentially a kind of hubris in science about knowledge that they didn't actually have? We can use the opportunity to reform science so that it actually works better for the people of the world. So that's the second thing. And the third, I think it revealed problems in our governance structures, right? The rights that we thought were inviolable: right to speech, the right to assembly, the right to even visit your loved ones in a hospital when they're dying, the right to gather with your family at Thanksgiving, the right against being discriminated against based on your medical decisions—all these basic fundamental rights that we thought we had, turns out they're disposable. And so again, it's an opportunity to reform our government structures so that those rights that we always thought of as inviolable actually become inviolable in practice.
Right on. So you're really making eloquently again the case that without freedom of speech, without vigorous debate, you can't have, frankly, science, nor can you really ultimately have public health.
That's absolutely accurate. Because, you know, David, I do believe I was right about the Great Barrington Declaration. I don't want to downplay that. But as you said, it was obvious. It was clear. It was just common sense, right? So it's not surprising that that turned out to be right. But there are lots of things—I'm a scientist, and it's very often that I will have a scientific idea that turns out to be wrong. I'll have a hypothesis, I'll go read the literature, or I'll do some experiment, and it turns out I'm wrong. That's normal in science.
And you know what? My friends are the ones who tell me I'm wrong vigorously. It's just great fun to have them—well, it's fun for them for a little while, and then I learn. But that's how science works, is by these kinds of conversations that people have with each other where they share different ideas. Science advances if we have an environment where that kind of vigorous contention—where data and experiment and logic guide who wins, replication of scientific ideas guides who wins in the argument. And you know what? We all win. Because the easiest way to be right all the time, as soon as you're wrong, just change your mind. I mean, that's simple.
Right. Well said. Part of this context that I find kind of frustrating, quite frankly, is that you'd think we would come together now in light of everything that's happened with COVID-19 and say yes, amen to more discussion and vigorous debate. And yet it's a mixed bag. You have a lot of people that say either we can't talk about this because there's a consensus, or we just follow the science and you're a bunch of kooks. So it devolves into ridiculous name-calling instead of a sincere objective of saying, how do we have a real discussion so we can serve the people? Are you frustrated by that dynamic? I just listened to some of the hearings this morning at the US Senate with Secretary Kennedy and I was shocked. There were so many persons who weren't asking questions; they didn't even allow him to give a response. It devolved into absurdity. Is that what we're getting into, just that hyper-politicization that we can't even have a conversation?
It's been that way for several years. And it's been quite frustrating during the pandemic because the whole strategy of so much of public health was to silence anyone who criticized them. And you saw that play out in the hearing today that Secretary Kennedy did in front of the US Senate. I think just psychologically, imagine that you thought that you needed to spray down your groceries, that you needed to mask when you walked around at home, or you needed to shun your unvaccinated family, that it was okay to take away the rights of people to gather, to worship, to send their kids to school, and so on. Suppose you thought all that was really necessary.
