Pursuing public health across the political divide

As one of the oldest public health schools in the country, Yale School of Public Health (YSPH) is entering a new era with a young spirit. For the first time in its 109-year-history, YSPH will soon transform into an independent school within Yale University.

The historic transition from a department within the Yale School of Medicine to an independent school is an opportunity to redefine what a school of public health of the future looks like, thinking beyond the boundaries of the work that has been done Dean Megan L. Ranney, MD, has said.

As part of her forward-looking vision, Ranney launched the YSPH Leaders in Public Health lecture series to engage with national and international thought leaders from public and private sectors on ways to “create the change in the world that many of us here believe in,” Ranney said, “recognizing that there is more that we agree on than disagree.”

The school’s most recent guest speaker, Alex M. Azar II, discussed how he realized his passion for public health as the 24^th U.S. Secretary of Health and Human Services (HHS) from 2018 to 2021. Previously, Azar was the president of Eli Lilly, one of the world’s largest pharmaceutical companies, from 2012 to 2017. Azar visited YSPH on April 4 to discuss how his career experiences converged during the COVID-19 pandemic, resulting in the development of safe and effective COVID-19 vaccines in record-breaking time, an effort he oversaw.

An attorney and Yale alumnus, Azar earned his law degree from Yale Law School in 1991, describing his time at Yale as “an intellectual feast.” After graduating, Azar clerked for Associate Justice Antonin Scalia of the U.S. Supreme Court. He then worked as an associate in the law firm of Kenneth Starr, the author of the Starr Report, which served as the basis of the impeachment of President Bill Clinton.

Azar was a lawyer for George W. Bush’s presidential campaign in 2000, a job he described as an unremarkable “nothing burger” – until 7 a.m. on a Wednesday in November when he got a call saying, “Alex, we need 200 lawyers in Florida by this afternoon,” he recalled, referring to the famous Florida recount involving Bush and Al Gore that ultimately decided the 2000 presidential election with a ruling by the U.S. Supreme Court. After Bush was declared the election’s winner, Azar joined the Bush administration as general counsel to HHS, led by Secretary Tommy Thompson.

“I said, ‘You know, I don’t know anything about health care,’” Azar recalled telling Thompson.

A complete video recording of Dean Ranney's chat with Alex M. Azar II can be found on the Leaders in Public Health Speaker Series website.

Today, Azar lists as his key public health achievements:

• Operation Warp Speed, the federal effort that accelerated COVID-19 vaccine development.
• Helping to end the Ebola virus outbreak in the Democratic Republic of the Congo in 2019, “the pandemic I thought we were going to face,” Azar said.
• Banning flavored e-cigarettes to help curb tobacco use by young people.

“It’s pretty obvious, I come from a certain side of the political aisle,” Azar told Ranney, during their “fireside chat” before the YSPH audience.

Ranney and Azar met during a flight to Aspen, Colorado, where they participated in a discussion at the Aspen Institute about gun violence, an issue that is among Ranney’s top public health priorities. Azar, Ranney recalled, warned her that they likely would disagree with each other.

“Not as much as you think,” she replied.

“I think that where you and I are completely aligned, regardless of which party we may affiliate with, is this belief in the power of the private sector, government, and philanthropy to advance the health of our society as the foundation of our economic and societal success – that without health you can't have the rest of it,” Ranney said.

As a conservative lawyer, Azar was brought up to believe in the “separation of powers, and war powers,” he said. “The welfare state is not high on the list.” At HHS, he realized that welfare programs compose one-seventh of the U.S. economy.

“You wake up every morning with the ability to impact the lives of millions of people here and abroad,” he said of his HHS leadership. Having an important role in something important is the key to engagement in life, and in work, Azar said. “That really got me on my journey.”

When asked what advice he has for graduating students, Azar called his career path “preposterous,” because of how it went “here and there,” rather than following a clear path. “You can have a vision of that, but you can't predict where you'll end up,” he said.

“I've sort of been struck by lightning many times in my career with the opportunities that I've gotten,” he said. “I’ve always tried to put myself in that position.”

The COVID-19 clinical trials that Azar oversaw as HHS secretary were the largest in human history.

To develop safe and effective vaccines in record-breaking time, Azar told his top leaders to “take money off the table and be guided only by the laws of science and physics.” This resulted in clinical trials being funded through phase 3 development.

“We prefunded all clinical trials up front, so when we were in phase 1, we already had our phase 3 clinical trial sites ready; we were doing clinical trial enrollment. We were able to move from phase 1 to phase 2 to phase 3 literally within hours, and scale incredibly quickly,” he said.

in June 2020, Operation Warp Speed began commercial-scale manufacturing of the vaccines, making hundreds of millions of doses before some were in phase 3 clinical trials, using purchase guarantees and other commitments from the federal government to drug companies.

Then, some of the largest clinical trials in human history took place – 30,000 clinical trials per vaccine, with logistical support provided by the U.S. Department of Defense. “We could rebuild clinical trial sites anywhere in the country. We could shift from Omaha to Seattle in hours because of the Defense Department's logistics,” Azar said.

Originally, the COVID-19 vaccine development project was called Manhattan Project 2. The name was changed after Azar attended a G-7 meeting of health ministers. “Afterwards, my very good friend, the minister from a certain country, said, ‘Is there any chance you could not call it the Manhattan project? That has sensitivities,’“ Azar said.

The name Operation Warp Speed was suggested by Dr. Peter Marks, MD, director of the Food and Drug Administration’s Center for Biologics Evaluation and Research, and a key leader of the vaccine development program. Azar called the new name, “a great act of branding. It’s remembered to this day, and I think will always be remembered.”