Francis Collins on trust in science and how Covid communications failed

Former NIH director and current White House science adviser Francis Collins told a group of journalists late last week about his passion for both the Cancer Moonshot and the new biomedical research agency known as ARPA-H. But he also revealed his pain at seeing people spurn mRNA Covid vaccines developed with breathtaking speed and lamented that he and other health officials failed to communicate the ever-changing science behind Covid recommendations.

“The big thing that I know I didn’t do, and I don’t think a lot of the communicators did, was to say this is an evolving crisis, this is going to change every time we made a recommendation, whether it was about social distancing or mask wearing or vaccines,” Collins told journalists gathered on Sept. 16 for the 21st Health Coverage Fellowship held at Babson College in Wellesley, Mass. “And we lost their confidence as a result of that.”

Collins, who stepped down after 12 years as NIH director, was on a glide path back to his lab to study diabetes epigenomics and the accelerated-aging disorder progeria before President Biden tapped him to become his science adviser — a turn he called “not part of my life plan” — after Eric Lander’s sudden resignation amid a workplace-abuse scandal. He will remain in that role until his successor is confirmed (“It’s up to the U.S. Senate. What could go wrong?”).

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Here are some of his remarks, including his “current obsession” with the country’s failure to end hepatitis C by using the cure we have on hand, condensed for clarity:

On what went right and wrong with pandemic response:

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During 2020, 2021, as the Covid pandemic was raging and spreading across the world, I don’t think I ever felt a greater sense of the unanimity of the scientific community to come together, to come up with strategies to battle this worst pandemic in more than a century. Many of us were working 100 hours a week. I certainly was, trying to make sure that no stone was unturned to come up with vaccines and therapeutics and diagnostic tests that might save the lives that we were losing every day. And it felt that way, like every day I’ve got to make the right decision, or it’s going to be potentially the cost of somebody’s life.

Then we had that remarkable experience with the mRNA vaccines where you went from knowing the sequence of the virus to designing the mRNA vaccine in 48 hours to 63 days later, having the first patient injected in a Phase 1 trial — just breathtaking in its speed. And I never dreamed that six months later, when anybody who wanted the vaccine could get it, that 50 million people weren’t and still aren’t [vaccinated]. The Kaiser Family Foundation estimates well over 300,000 Americans are in graveyards today because of the misinformation, the doubt, the suspicion, the distrust that caused them to say, that vaccine is not safe for me. How did that happen? I never saw that coming. And the consequences of that are all around us now. And it continues. We’re still losing 400 people a day, many of them still unvaccinated.

How did we all fail? We failed to convey scientific information in a fashion that was compelling. We were basically outgunned dramatically by lies and conspiracies in social media. We should have had our own version of flooding the system with truth instead of having the system completely flooded with lies. Some people I’ve talked to have said, you know, every lie, every conspiracy about Covid, whether it’s the chips in the syringes or whether it’s going to make you sterile, every one of those were predictable. We should have immunized people against that ahead of time, because that’s exactly what is going to happen in a situation like that.

On a possible solution:

Maybe we need a Communication Corps for the United States. I’m deeply concerned that science trust has taken a significant downward turn, and that is really putting us in a very bad position for whatever is coming up next: the next pandemic, polio, certainly climate change.

On faith leaders and Covid vaccines:

This is one of the things that breaks my heart the most about what happened in the last couple of years. There certainly is a source of trusted information that maybe could have been a big help in this, but we discovered how flimsy our science-faith connection was at the pulpit and also how really divided our country was.

On the goals of the Cancer Moonshot:

The way in which the moonshot has been phrased, is that we’re going to reduce cancer deaths by 50% in 25 years. There’s none of this, “OK, we’re going to end cancer forever.” Those are not, unfortunately, things that we can put out there and feel confident that you can deliver. I think we could do a combination of preventions and treatments to achieve this 50% reduction, but that’s not 100%. This is a really hard problem, and I think that’s what we’re learning over and over again.

On how cancer and hepatitis C are connected:

A personal obsession right now, with regards to cancer prevention, [is] the most common cause of liver cancer. What would that be? Hepatitis C, a virus that is acquired by blood exchange from an infected person to another, so these days, often because of the opioid crisis, it’s because of dirty needles. Two and a half million people, at least in the United States, are infected chronically with hepatitis C. Forty percent of them don’t even know it because we have not done a very good job in doing the kind of screening that would ideally be necessary. But guess what? There’s a cure for this.

It’s one of the most exciting developments in medical research in the last 15 years, and most people haven’t heard about it. It’s because of our health care system and the fact that most of the people who have this are not those who have gold-plated insurance policies to cover what was initially a $90,000 cost for the treatment.

On supplying clean needles:

Bring it on. I don’t have to convince the president of the value of that, but you probably know that in the current political climate, anything that’s going to involve that as a requirement is going to immediately be in a lightning rod. Much of the Republican Party does not believe that that is something that’s justifiable with public money and are worried that it, in fact, may encourage more people to abuse intravenous drugs. The evidence for that, of course, as you know and as I know, is not there, but the thought process is still here.

On ARPA-H, basic science developments, and clinical application:

We’ve got mRNA vaccines that have been fantastically effective at Covid. It completely revamps the way that we start thinking about what we could do with vaccines, including cancer. That would be a pretty good project. How would that happen right now? Not so easy to see. ARPA-H, which is now a reality, is designed to do things like that.

On the next NIH director:

That, of course, requires Senate confirmation also, in these current times where there is so much political tension about virtually everything. And certainly that relates now to whoever is chosen for this circumstance, whether it’s questions that are going to come about human fetal tissue research or whether it’s going to be about Wuhan and how did that virus really start. So it’s not going to be an easy confirmation process.