Now, President Trump's second term has heralded division and uncertainty for many in the medical research community, with cuts to research funding and scrutiny of the health secretary's approach to vaccine policy.

When Dr. Jay Bhattacharya was appointed as director of the National Institute of Health, he pledged to address what he calls the American chronic disease crisis.

And he tells Walter Isaacson how he plans to do so and the challenges ahead.

Thank you, Chris John and Jay Bhattacharya.

Welcome to the show.

Thanks for having me.

You're a trained physician.

You spent your life studying things like population and chronic diseases.

Why did you want to take over the National Institutes of Health, which is basically a science medical research institute?

One of the things that I studied as a PhD in economics, as well as an MD, one of the things I studied in my former life was science policy.

And I had found a number of things about the way that science worked that made it maybe less productive than it ought to be.

So when I got the opportunity to be the NIH director, maybe we can talk about some of these ideas, but the idea that the science is facing a replicability crisis, that the science that's published often when independent teams look at it don't find the same answer.

Science, although it's incredibly productive, produced incredible results over the past century, decades, millennia, in some ways the investments we make have not translated over to actually improving population health in ways that maybe it ought to.

So to me, that's the main reason to take it, to make science really work better and translate into improved health for the population at large.

Back in November, you wrote an opinion piece endorsing RFK Jr. to be Secretary of Health and Human Services.

And you referred to a rot, I think was the word, that had accumulated at the NIH, the place you now lead.

And you wrote, "The National Institutes of Health, whose annual budget is $45 billion, orchestrated under the leadership of Francis Collins and Anthony Fauci, a massive suppression of scientific debate and research."

What in your opinion was suppressed, and is it as bad as you said back then?

I mean, I think, I mean, I probably would be a little kinder in writing it now than I do, but I do still stand by the idea.

Let me pause by, why would you be kinder?

I've had now an opportunity to meet one-on-one with Francis Collins, and we've forgiven each other for, you know, whatever has happened.

And he famously wrote, and this is an answer to your first question, he famously wrote, in an email to Tony Fauci on October 2020, right after I'd written this document called the Great Barrington Declaration in October 2020, calling for opening schools, lifting lockdowns, but protecting older people better.

He called me, you know, a Stanford professor, and my colleagues who wrote it, the Harvard professor and an Oxford professor, he called us fringe epidemiologists, and he called for a devastating takedown of the premises of the declaration, which then led to like death threats and all this kind of nasty stuff.

That was an abuse of power.

That was an abuse, it was an attempt to essentially end the debate about the lockdowns from above.

And you know, I've forgiven him, and I don't want to dwell on it, but I think that that just, that led then to a whole host of sort of dominoes falling where, you know, you couldn't have a conversation on social media about the lockdowns or about then subsequently about the vaccine mandates and a whole host of other things without getting suppressed.

You could, you essentially, and scientists would call me and tell me that they agreed with me, but they were afraid to speak up because they were afraid that their, you know, metaphorically their heads would get chopped off.

It made it difficult to have a scientific debate.

Well, let me, let me unpack what you just said, which is now that you've talked to him and you understand you're both forgiving each other, why did it become so divisive?

Do you think people like Anthony Fauci, Francis Collins made mistakes, or do you think they were intentionally for some ulterior motive trying to mislead people?

I don't think that my philosophy about interacting with people is I assume the best is about whenever I meet people.

And I don't say that I have some ulterior motives that I don't know about, but what I can say, and I entirely agree with the characterization, maybe you don't agree with the characterization, but the characterization that they made mistakes, right?

So and those mistakes were consequential mistakes, right?

Leading back to even before the pandemic, approving in my view, a research line aimed at potentially prevent, they were saying to prevent pandemics, but that many people believe may have caused the pandemic, this sort of dangerous gain of function research that people talk about.

You're talking about the Wuhan lab in China.

Yeah, I mean, they supported that research, even though many members of the scientific community were saying that that's not kind of wise to do this research.

You know, it's like Enrico Fermi, when he put the nuclear reaction that launched the nuclear age in the squash court at the University of Chicago, he did a calculation asking what's the probability that this nuclear reaction I've caused is going to spread around the world unstoppably?

And he found that it was zero.

They supported an agenda, a research agenda aimed at predicting which pandemics would happen, but carrying the risk of causing a pandemic.

And they said that the risk was worth it.

This is before the pandemic.

During the pandemic, Tony Fauci worked very hard, I think, to -- I mean, in many ways, I think in good faith.

I don't know him personally, so it's hard for me to say about his motives.

But what he came across as is conveying certainty about things that he didn't -- should never have had certainty about.

The school closures, the risk of COVID to children, underplaying essentially the evidence of the harms of the lockdown, and then later with the vaccine, overconfidence about the ability of the vaccine to stop you from getting and spreading COVID.

All of that led to policies that -- I mean, we can talk about this in sum, but it led to many, many policies that harmed children, it harmed the working class, it harmed the poor at scale.

And I don't blame just Tony Fauci alone.

He was part of a public health community that embraced this.

But the key thing there, to me, is that we needed to have a discussion, a debate, an honest conversation with each other about this.

And that was denied to the American people and the world at large.

There were many scientists that agreed with me that kept their heads down because they didn't want their careers destroyed and damaged.

I would love to see a return to a science that -- like, where we respect each other's opinions, even though we disagree, may disagree.

We may -- we'll bring evidence to it.

We can discuss whether the evidence is right.

I mean, that's the kind of scientific community I grew up in.

And I'd love to, as the head of the NIH, help the scientific community get back to that.

Do you think it would be useful to have a commission, a nonpartisan expert commission, to say, what did we get right and what did we get wrong during COVID?

And is it possible in this age to have such a commission appointed?

Who would you put on it?

Yeah.

I mean, I naively, I guess, wrote a Wall Street Journal article in 2021 calling for such a commission.

And then in 2022, I wrote a piece called the Norfolk Group document, where we laid out an agenda for the commission, with the hope that other people would add more elements to that agenda.

There have been a number of commissions already.

Like, in the U.K., they spent a crazy amount of money trying to do a commission.

But the problem is that commissions have been, as your question hints at, really one-sided.

They've allowed the people who led the pandemic response to essentially grade their own homework.

The only way forward with this is to let people -- you know, let people who -- let a wide variety of views have their say.

Right before I became NIH director, I ran a conference at Stanford where I invited Marty McCary, the current FDA director, as well as some colleagues of mine at Stanford who disagreed with me about the lockdowns.

And it was a really productive conversation.

I think that's the only way forward.

So I guess I'll just continue to be naive about this, but also hopeful.

I think it's possible, Walter.

We just need to come at it in the right spirit.

>> Well, wait, could you just do it?

Could you just announce one?

>> I could, but it's -- there's a lot of -- okay, so let me just tell you the philosophy I've had.

I have a problem that a large part of the country no longer trusts science or public health.

That's a problem for me and for the NIH.

That's just a fact.

Whether you disagree or agree with them or not, that's the fact that I have to face.

At the same time, a large part of the country believes that science was ignored or anti-science forces led to the issues that happened during the pandemic.

And they blame, you know, President Trump or Bobby Kennedy or others for this.

My job as the NIH director is to essentially bridge the gap between those two groups.

I believe very fundamentally that science should not be partisan.

There's no such thing as Democratic science or Republican science.

Science should be something that is for all the people.

And science can't work for the people if basically everyone distrusts it.

So we have to figure out a way to solve the gap, to solve this divide that we have in this country.

Like, we shouldn't be using the NIH as a cudgel to paint Bobby Kennedy or President Trump as anti-science when they're not anti-science.

They care deeply about science.

I've had conversations with the President.

I've had conversations with Bobby Kennedy.

And they want the scientific knowledge to be translated into better health for people.

You can see it in every conversation I have with them.

And at the same time, I understand why there's this deep distrust.

A lot happened during the pandemic where regular people look and say, well, why do I have to put a mask on when I walk into a restaurant?

Then I sit down, I can take it off.

How does that prevent the disease?

Why is it that children as young as two in the United States are recommended to get masks, but in Europe the recommendation is people over 12?

The NIH, for a long storied history, is supposed to fund scientific research that would be difficult to do in the private sector because it doesn't lead immediately to patents and making money.

And now we've been cutting, it seems to me, some of the NIH funding.

Are you worried about those cuts?

And do you think we should be basically doing a lot more in fundamental science?

Right.

So, Walter, there have not yet been any cuts.

And when I've gone around Congress and talked to folks, what I see, again, from -- I mean, I've had the privilege of talking to dozens and dozens of folks on both sides of the aisle.

I see basically universal support for the NIH's mission.

And what I see is that even from President Trump, a commitment to making sure that the U.S. is the leading nation in biomedicine for the 21st century.

I don't believe that the cuts that have been proposed will happen.

I just -- just as a matter of like objectively looking at the pattern of what support there is in Congress and even within the administration -- I think that you're not totally in favor of those proposed cuts.

You don't want to deal with Congress and -- Well, I mean, I'm not supposed -- I'm not to be supposed to -- I'm saying this as a matter of like analytically.

I'm not saying my personal opinion.

I'm just saying that -- and I will say is that the NIH, when it's doing the things it's supposed to do, it has huge benefits for the American people in terms of advanced knowledge that helps cure cancer.

I was just talking actually today, this morning, with some of the folks who were behind the advances in -- that have led to essentially a cure for sickle cell anemia, something that affects a lot of -- especially African-American kids, that is seen as -- when I was a med student, the idea that you could cure it seemed inconceivable.

You're talking about genetic editing using CRISPR.

For instance, yeah, exactly.

And so, the cell-based therapies -- and now, I was hearing about it, you don't even need cell-based therapies.

You can just do it with essentially with an injection.

I mean, it's really, really, really promising.

And that's why you have this bipartisan support for the NIH, is because if you can make the NIH focus on its mission, its mission is advancing research that improves the health and longevity of the American people.

Nobody's against that.

Nobody's against that.

And if we actually achieve it, it'll -- and I believe it's possible we can -- it'll secure Americans' health and also biosecurity into the 21st century.

>> You know, last month, about 300 staffers in your NIH signed something called a Bethesda Declaration -- I'd love you to be able to respond to it -- in which they decried some things happening at the NIH, including politicizing research, they said, interrupting global collaboration, saying we're compelled to speak up when our leadership prioritizes political momentum over human safety and faithful stewardship of public resources.

I mean, these are people who work in your building, work for you.

What have you done to address that, and is there anything that made you think or change from that?

>> Yeah, so just a couple of points about that.

So, one, I'm going to meet with them, actually, I think early next week.

I'm going to have them in a roundtable, and what we can -- I mean, I really value this kind of collaborative back and forth.

And they're my colleagues.

So, I'm going to meet with them, we're going to talk with them to see what they're, you know, in person, we can talk through some of the issues.

Just substantively, I think they're just flatly wrong about the international collaboration.

So, what I've done as an NIH director, what I learned was that we had a kind of accounting structure for foreign collaborations where we put universities, domestic universities, in charge of checking whether the collaborators were, like, meeting basic accounting standards.

And often, the people that we put in charge of checking this didn't actually have a lot of control over their foreign collaborators.

Probably most famously, the Wuhan lab, where the NIH funded a domestic group called the EcoHealth Alliance, had this relationship with the Wuhan lab.

The NIH had no auditing capacity over the Wuhan lab.

There were several -- the way we structured these foreign collaborations prevent -- essentially cut the NIH out of the ability to say, "Well, can you hand us your lab notebooks?

Can we see where you spent the money?"

I put in a system that allows foreign collaboration where the foreign collaborators directly connect with the NIH.

And so, they have the same kind of auditing -- we have the same kind of auditing capacity over the foreign collaborators as we do over domestic grantees.

That's going to allow more firm -- more foreign collaboration and more effective collaboration in a way that I can look the American people in the eye and say, "We're spending your money in a safe -- in a -- we're stewarding your money in the right way.

We're checking to make sure that those collaborations are productive and we can audit them in the ways that we audit domestic researchers."

So, I'm going to -- I'll tell them about that because I think they just didn't understand some of the changes.

As far as politicization, I've worked hard -- you know, I think -- and probably tell the story in terms of the USAID, where it was really cleanest.

The USAID had these programs like PEPFAR.

PEPFAR was this program to bring HIV medications to Africa.

I'd written a paper in 2010 or '11 estimating that PEPFAR had saved over a million lives by -- at that point in Africa.

I think it's a great program.

The USAID also had this program to add a third gender to the Bangladeshi census.

Now, Walter, Bangladesh has tremendous problems.

It has arsenic in the drinking water.

It has hundreds of thousands of children dying of viral illnesses.

It has all kinds of issues.

Adding a third gender to the Bangladesh census looks to me like a politicization of the USAID rather than something that's really within the USAID's mission.

There were elements of the NIH portfolio that are also like that, essentially trying to use the NIH as a weapon in a political war that we're really poorly equipped to fight.

The DEI, for instance, I think that's something that the NIH -- I really strongly believe in we should invest in minority health.

Minority populations have worse health outcomes and have bad health outcomes.

We the NIH, as part of our mission, should invest in improving the health of minority populations.

100% believe in that.

But what did those DEI investments actually do?

Did they actually improve minority health?

No.

Minority health has lagged behind just as it has the health of many, many other American groups.

We have to like use the NIH to improve health rather than use the NIH in the part of an ideological political war.

So I think removing that, which they're calling political, is actually depoliticizing the NIH.

It leaves the NIH portfolio in a place where every party can look at this and say, "We are doing the right thing for the American people.

We're advancing -- we're investing in science that will improve your health, improve your outcomes.

We're not trying to fight a political war that we're poorly equipped to fight.

We just should never be fighting.

We should be scrupulously apolitical in that."

And that's really -- the transition to that, I think, has made a lot of people uncomfortable, because that's really what it was before.

We had this, if you will, this third-gendered Robonganeshi census problem, although that's the USID.

We had a version of that in the NIH.

Dr. Jay Bhattacharya, thank you so much for joining us.

Appreciate it.