Dr. Ezekiel J. Emanuel is the vice provost for global initiatives and a professor at the University of Pennsylvania.

He’s also a special adviser to the director-general of the World Health Organization (WHO) as well as a senior fellow at the Center for American Progress.

Emanuel was the founding chair of the department of bioethics at the National Institutes of Health and held that position until August 2011.

Until January 2011, he also served as a special adviser on health policy to the director of the Office of Management and Budget and National Economic Council.

He’s also a breast oncologist and author.

Currently serving on a coronavirus task force created by Democratic presidential candidate Joe Biden, Emanuel sat down with Healthline to talk about what a Biden pandemic plan may look like, what we may need to get past this outbreak, and how the pandemic has affected him in a personal way.

You’re serving on Joe Biden’s coronavirus task force. Do you feel your team can have a plan in place that actually moves the needle correctly should a Biden administration take over?

Yes. The short answer is yes. We’ve created checklists of things that have to be done in a transition. Look, without being political about it: This (current) administration is not known for implementation skills and taking an idea and getting it out there.

If anyone has any doubt, look at testing. If anything, we’re lower, not higher than we were, and we’re certainly not anywhere near the 5 million tests per day we need.

We have thought through the whole process of implementation. One of the problems I think the public needs to be well aware of and sensitive to is the fact that some of the things for, say, a smooth implementation for a vaccine or testing or PPE [personal protective equipment], there’s a lot of it that should have been started literally months ago.

I’ll give you an example: fill finish. Fill finish is the process by which you put the vaccine you’ve created into a sterile glass vial in a facility that’s 100 times more sterile than a hospital operating room. Then you put the plug in and freeze it.

At least the initial vaccines will be freezing… Those facilities take a long time to build. We need more of them. Every manufacturer we talked to, and we talked to a number of them, said we need more of those facilities.

We’re already running very close to the limits, not just in the U.S. but worldwide. So, we need to have started 4 or 5 months ago expanding these facilities, and yet this administration, to the best of our knowledge, has not aggressively done that.

The Biden team knows the need and has this as part of the checklist, and it’s going to be critical and implemented.

And then take the international stage — the whole issue of getting the vaccine out to not just the U.S. but also other countries. I think that Biden will quickly reverse the decision on the WHO, and this will facilitate distribution not just in the U.S. but worldwide. This is absolutely necessary if the whole world is going to get back to normalcy. 

What three steps would you have insisted the current administration take on the pandemic early and often, had you the power to demand it?

One of the important things for all your readers to look at is Italy. You know, early on Italy was not a model. Italy got hit really hard when none of us really knew how to handle the virus, what was happening and what the real health consequences were.

It skyrocketed: number of cases, number of deaths, etc. But then Italy did a nationwide lockdown — initially the north but then the whole country the next day — and you can see very, very clearly over the next 8 weeks you go from the peak, plateaus, and then comes down to a very, very low number per 100,000 people.

We’ve never gotten as low as Italy is today and even before. Some parts of our country, like New York, who followed a similar path, did that. We needed that kind of process nationwide, and we did not have that.

So that’s one thing: a nationwide lockdown that lasts 8 weeks until we have a number of new cases in the 2 to 3 per 100,000 level. To reiterate: We have never, ever, gotten that low and sort of stuck it out nationwide.

Second: We need to have a mask mandate decision, and we just haven’t been able to get that as the norm. The president has been terrible, literally terrible. With one mouth he says “Yeah, yeah, we should all be wearing a mask,” and yet he never wears a mask. He never wears a mask.

And he had people sitting around him when he accepted the nomination at the White House on the lawn, right next to each other, no distancing, not wearing masks. I mean, the model is atrocious.

We need not only to have a mask mandate, we need it to be followed. We need people to walk the walk and talk the talk, as they say. And it’s key to have the president in that effort. And this administration? Just not doing it.

The third thing is we needed to not rush the reopenings. One of my big worries is we needed to not reopen indoor bars and restaurants. That has been well documented as a disaster.

You reopen them and 2 to 4 weeks later you get these big bumps in cases. Just terrible. And the reason you get that is because indoors, big crowds for prolonged periods of time exhaling. Yelling at football games on the TV or what have you. That’s how you spread the virus, that’s what indoor dining and indoor bars lead to. I think it’s a serious, serious problem. 

Those [are] three tangible items that would make a huge difference right out of the box.

Talk to me about the political aspects of this pandemic. Have you ever seen anything like it in America before? Or anywhere?

Let me be clear: I haven’t seen it. Some of the reading of the history of the great flu pandemic was not that dissimilar in the following sense: Different cities did different things and there was hodgepodge.

You know, frankly, the president at the time, [Woodrow] Wilson, decided not to talk about it, and then he went off to Europe for a couple of months. It was not a well-coordinated national response.

Is it the same as what we’ve got now? No. In part because now we have tools. We know better about public health, we know better about viruses. We’ve got interventions like masks. So, it’s a little different than it was 100 years ago.

But by the way: Whatever happened 100 years ago, it wasn’t politicized in a sense that people were calling people who did something different terrible names and saying they were violating liberty and irresponsible. You know, as Joe Biden was saying last night, look — our lives are constrained and our liberty is limited.

But the reason it is limited is because we haven’t instituted these public health measures. The places that have, have been able to open up better and, you know, had more liberty.

It’s a trade-off. Limit ourselves for 8 weeks so we can get the cases very low actually allows you to open up and have more liberty after, and for a prolonged period of time.

Vaccinations are the big hope. Is there any chance a vaccine could be the singular solution to COVID-19? Or is our solution going to need to go beyond that? Is testing equally important?

If we have a highly effective vaccine, you know, 80 to 90 percent, that’s going to be critical.

But if you don’t, you’re still going to need to have some measures. A 60 percent effective vaccine means you still need to have some protections instituted. You cannot just say “vaccine” and that’s it. We’ve got more to learn there.

Flu season is almost here. Could the public exposure to the fear, worry, and deaths around COVID-19 amp up their willingness to vaccinate for flu early and without doubt?

More people are going to get the flu vaccine. And frankly, with more people adhering to masking and no handshaking and things like that, we could actually have a low flu season.

How has the pandemic impacted you personally?

Pre-March 11, I flew almost every week and often twice a week. I literally have not been on a flight in over 6 months, so that’s certainly a change.

I love cooking, so we have a lot of dinner parties with a lot of friends over. Haven’t had that. I’ve got a very nice long table that can seat 10, and we haven’t filled that table.

Simple stuff. My mom is in Chicago. Haven’t seen my mom and she’s not young. She’s going to be 87 in November. I’ve had a new granddaughter and I haven’t had a chance to hold my new granddaughter.

So, you know, there’s a lot. Everything from the mundane like vacations to the very, very personal, like being able to see my mother and being able to touch and play with my new granddaughter. Very hard and painful.

And I will tell you, tonight is Rosh Hashanah, and there’s no in-person — there’s a Zoom. It doesn’t feel like a real holiday.

I understand there are people who are very upset about religious services. I feel it. I haven’t gone to synagogue in 6 months, and it’s very painful. It’s like there’s a hole in my week when I cannot go there and enjoy the religious service and participate in our discussions. These are the kind of disruptions we all have.

As a professor, I’m teaching online. You know, it’s pretty good, but it’s not like teaching in person. I’m much better in person than I am online.

Who are your heroes out there through all of this?

I think that we’re all dependent upon invisible people. Whether they are agricultural workers who are still picking our food because they’re not being paid a lot of money and they’re taking big risks. People who process meats, same situation.

People running public transportation at this moment — big heroes. The people who just keep our lives going. The people who keep the internet going. All of these people are essential to our lives.

If asked to put a chip on the betting calendar as to when we return to at least a “new normal,” where are you willing to place yours?

I’ve been saying this for months and I’ll continue to say it: November 2021. Even if we get a vaccine and have to play out getting it out there, it’s November 2021. I’m sticking with it.

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