Public Health

Vinay Prasad: Public Health in This Country Is So Broken

Vinay Prasad discusses his departure from the FDA, Fauci's diaries, and how working for the government made him more libertarian.

Zach Weissmueller | 8.26.2026 11:00 AM

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Vinay Prasad: Public Health in This Country Is So Broken

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Vinay Prasad rose to fame as a COVID-era public health establishment critic. Then he became part of the public health establishment. Now he's back on the outside following his controversial tenure at the Food and Drug Administration (FDA) as director of the Center for Biologics Evaluation and Research (CBER), which is responsible for approving vaccines and gene therapies.

In this interview with Reason's Zach Weissmueller, Prasad, a physician, author, and professor at the University of California, San Francisco, responds to the array of intense criticism he received during his tenure, ranging from agency insiders complaining about his management style to Wall Street Journal editorial writers branding him a "Bernie Sanders acolyte in MAHA drag" to conservative influencers such as Laura Loomer deriding him as a progressive-left "saboteur."

He defends his decision to reject Moderna's mRNA flu vaccine application, which the agency has since approved following his departure, and explains a controversial internal memo in which he wrote that "at least 10 children have died after and because of receiving COVID-19 vaccination" and that "for the first time, the US FDA will acknowledge that COVID-19 vaccines have killed American children." The official FDA report made public after Prasad left identified zero "certain" childhood deaths linked to the vaccine, with five classified as "possibly" and two as "probably."

"They changed the report. I had a draft report with 10 [likely deaths]. They changed it after the media publicity of my letter," says Prasad, who believes the data were altered for "political or professional" reasons.

While he entered the job with the intention to raise the standards for drug approvals, Prasad says his firsthand experience witnessing just how entrenched the political and bureaucratic problems at the FDA are has made him "a bit more libertarian" and open to the idea of "Consumer Reports–style agencies" competing with the government on drug approvals, which would offer "people in America greater flexibility in what kind of products they can try."

Prasad also reacts to the recent publication of top COVID adviser Anthony Fauci's diaries, whom he says is likely guilty of criminal conduct for his role in funding gain-of-function research.

"I can't think of a single policy [Fauci] actually got right when he was running the federal health policy," says Prasad.

Watch the full interview above. The transcript below has been edited for style and clarity.

0:00—Teaser

0:48—Transitioning from FDA critic to insider

2:39—Fauci's diaries

7:40—The origins of COVID-19

9:11—Did Fauci commit any crimes?

11:53—Aspirations for public health reform

13:22—Vaccine skepticism and criticisms

20:10—Moderna mRNA flu vaccine

26:35—COVID-19 vaccines and children

34:00—The Trump administration and deregulation

37:51—Drug approval barriers at the FDA

42:01—Wall Street Journal criticism

46:45—Has Prasad become more libertarian?

53:36—Anthropic CEO Dario Amodei's criticisms of the FDA

57:46—Peptides

59:45—Why did Prasad leave the FDA?

1:02:43—Is true government reform possible?

1:05:45—How can public health regain public trust?

Producer: Paul Alexander

Director of photography: Kevin Alexander

Audio mixer: Ian Keyser

Transcript

This is an AI-generated transcript. Check all quotes against the audio for accuracy.

Zach Weissmueller: Vinay Prasad went from COVID-era public health establishment critic to public health establishment insider and back out again. He is a physician, an author, a professor at the University of California, San Francisco, and former director of the Center for Biologics Evaluation and Research at the FDA. Vinay Prasad, thank you for talking to Reason today. 

Vinay Prasad: It's good to be back with you. 

So, we had this clearing out of the old guard, the Walenskys and Faucis and Collinses, and this replacement with the new guard, the COVID dissidents such as yourself, Marty Makary, Jay Bhattacharya. What was it like, and did you have any misgivings about stepping away from the role of academia and sort of outside critic and into the public health bureaucracy?

So, I guess one thing to point out is that maybe we changed 4 percent, 2 percent of the FDA. I mean, the FDA is an 18,000-person agency. There's tens of thousands of people still there. Before Marty, the commissioner, and I got there, DOGE had just struck, and maybe they got rid of a couple thousand people. But I think one thing to point out is the system is largely the same as it's always been. And then I think the next thing I'd point out is there are critics of the COVID pandemic response, and then there are critics. And although Marty, Jay, and I are critics of many aspects of the response, I think we don't go as far as some of the most extreme critics out there. So am I glad I did it? Yes, I think I'm glad I did it. It was an adventure. It was a learning experience. I feel like I learned more in one year than I've learned in the prior decade about how the world works. And I'm glad to have improved, I think, some aspects of government, which I think will be enduring, and at least tried to improve other aspects of government, which may not be enduring.

And yeah, I want to ask you a little bit about—or actually quite a bit about—what you learned from that experience. But first, let's stay on the context of that era, that transition. And I think the person who personified kind of the old guard was Anthony Fauci, and he's recently been in the news because he appeared in front of Congress, yet again pleading the Fifth, as Rand Paul kind of exposed or published his diaries. What did those diary entries reveal to you about Fauci's character, the way he was operating through that time?

I think that Fauci has made a lot of serious errors. And I think probably the greatest news story is that the mainstream media, I think, refuses to be honest about his legacy. Anthony Fauci was in his late 70s when the pandemic began. And had he retired, you know, at a ripe old age of 75, I think he would be leaving behind a stellar legacy. But he continued. He pushed it. He stayed through the whole pandemic, and he was the face of many things that I think his diaries get into: what he privately thought while he was publicly saying different things.

Where to begin? The origins of the pandemic. Fauci has not only been a proponent that the only answer to where the virus came from is a natural spillover event. He's gone further than that. He orchestrated a paper published in Nature Medicine called "The Proximal Origin Paper," written by a bunch of people who bolstered that point of view. He, of course, edited that paper before it was published. Then in public, he pretended like he didn't know those people. It was an independent group that validated what he was saying, whereas, in many respects, he sort of puppeted that paper. The people who wrote that paper—Rand Paul has released their Slack channel messages—showing they don't really even believe what they were writing. I mean, their messages reveal considerable ambiguity about lab leak versus natural spillover event.

So in terms of the origin, he also funded EcoHealth Alliance, of course, which had a subcontract to Wuhan. He had a huge role in the origins and sort of at least trying to frame the narrative, making lab leak—you couldn't even discuss it. You know, Facebook put a ban on even talking about the topic.

All right, that's just one thing. Then masking, masking 2-year-olds. I mean, he played a huge role in that. Lockdowns, school closure. He said he didn't close any schools. In his own diary, he says, "I told Bill de Blasio, you need to close schools in New York City." At some point, the man's got to take ownership over the decisions he did make and advocated for. When DeSantis in Florida reopened schools in the spring of 2020, he went on every television show to say what a bad idea that was. Of course, now I think it's very clear. Many of us said so at the time. School reopening was always the right decision. You know, maybe it could have been closed for a week or two, but certainly not beyond that. Fauci kept it closed much longer.

Vaccines. I think vaccines make a lot of sense. COVID vaccines for elderly people who had not yet had COVID. But do they need to be given to a 4-year-old, a 7-year-old, a 12-year-old, a 22-year-old who'd also already had COVID? This is where considerable ambiguity exists. But Fauci, the answer was clear: You need all the shots. You need the initial series. You need a yearly booster. It doesn't matter how young you are or how many times you've had COVID.

Then, of course, Fauci was wrong about—I think he's wrong about almost every single pandemic policy he advanced. Some of his defenders say to me, "Well, at least he didn't tell people to drink bleach." And I said, "Well, is that the bar for a guy who's a doctor and a scientist?" I mean, of course, yeah, drinking bleach is not a good idea. But that's not the bar for an Anthony Fauci-level figure. He should be saying things that are correct, and if they're not correct, he should be collecting evidence to weigh in. He did none of that.

Why do you think that there was such a large disconnect between his public and private thoughts on the virus throughout this? Just as someone whose job it is to communicate science to the public, why wasn't he communicating what he actually knew at the time? For instance, about the origins of the virus.

In the case of the origins, I think he doesn't want to communicate, then or now, because he looks a little bit culpable.

Is it 2011? He writes a Washington Post op-ed called—the title of the paper is "A Flu Virus Risk Worth Taking"—about why we ought to fund gain-of-function research, or research to manipulate the genomes of viruses to perhaps make them more transmissible or lethal, in an effort to get ahead of that and cure it. But that's a gamble. Is that a sound strategy? I think it's pretty clear to say that it has not led to any cures and may have led to one of the worst pandemics in the last 50 years. You know, so that was a bad idea. He's on record as saying that. He's on record as having funded the EcoHealth Alliance group in 2014, despite an Obama-era sort of prohibition on that funding, and he has a presidential pardon that extends so far back that it covers his potential funding of EcoHealth Alliance. So, boy, nobody would rather you think it comes from a natural origin than this guy. He's conflicted. That's the bottom line on that issue.

This is why Rand Paul is pursuing this, because he seems to be wanting to uncover what the origins of the virus are, which somehow we still don't know. It's unclear if we ever will. Do you have any sense, based on what we know now, what's your inclination as to where this came from?

So I use an analogy, and an analogy is you can look at biology or you can look at intelligence. So imagine somebody comes out of the kitchen and they say, "You know what? That waiter peed in the soup." You're going to say, as a biologist, "How can I prove he peed in the soup?" You can sample the soup. You can look for urine metabolites and cells from the bladder. And you could try to figure it out that way. Or you could interview three people in the kitchen who say, "I saw the guy pee in the soup." OK. 

And my point is that we have the Central Intelligence Agency, the Department of Energy, the FBI, and they have made an intelligence assessment that they believe it to be a lab leak. In Fauci's own diary, he says he was pulled into the SCIF, which is sort of a confidential room, and he was given information by the CIA where they intercepted some transmissions from China that make them sort of suspicious that it was, in fact, a lab leak incident.

To me, I think the public may never have the full evidence, but I suspect that many intelligence people do, in fact, know the answer. And that answer is probably lab leak. Whether it's malicious or unintentional, I think people can wonder about that. Fauci's own diary admits that the Wuhan wet market, which he went on TV and said was the origin—in his own diary, he writes, at best, it was an amplifying event. He doesn't believe it to be the origin.

You mentioned this pardon that stretches back to 2014, this era when the funding was—when he was authorizing funding in contravention to current U.S. policy, which is we're not going to do gain-of-function research. Do you think he actually committed a crime?

Yes. I mean, I think funding—I think the other thing about it is people will say, "Did that money go directly for this research?" The money went for viral genomic research at a Chinese institute, very similar to the sorts of things we would be worried about. I think that was a crime for which he's been pardoned. I think it's not just my assessment. That's what Joe Biden's autopen thought when he signed—or whoever signed the pardon—that he committed a crime. That's why he has a pardon that goes that far back. I think it was a crime. Now that he's been pardoned for it, I don't know what you can do about it.

How do you think history will remember, or should remember, Anthony Fauci?

I think very poorly. I think this is where the media is completely enraptured by the guy. Put aside the origin. This is a guy who went on TV and told you that you should make your 2-year-old wear a cloth mask. He told you, "Stand 6 feet apart." Later he says, "Oh, the 6 feet, we just made that number up." He told you you should lock down schools. He called Bill de Blasio in his own diary and told him to close schools. Later he says, "Who started this whole school closure thing?"

He said you've got to get a shot, even if you've had COVID and even if you're 20 years old and living in a dorm, even if you had myocarditis. He actually told Rochelle Walensky in his diary to downplay the evidence…

So let's go back to 2021. In 2021, we learned that even if you've been vaccinated, you can contract and spread the virus. I think initially we didn't think that to be true, but certainly by the summer, with different escape variants, we thought that to be true. The decision to mandate a vaccine was not until the fall of 2021, long after we knew vaccinated people could get the virus and spread the virus.

The moment you knew they could get and spread the virus, it doesn't make sense to have a mandate. The whole prerequisite for a mandate is there's got to be enough benefit to a third party that it justifies taking away your autonomy about your body. But he knew that you couldn't justify the benefit if you can still spread it. But he writes in his own diary, "We can't have Rochelle Walensky telling people that fact because it will undermine DOJ's efforts for a mandate." So he knowingly is hiding scientific truths to facilitate a policy preference of a Democratic president with whom he aligns himself. And he does that over and over.

Finally, if you've had and recovered from the COVID virus, we've never had any evidence that you need any additional shots. And yet he never made that an exemption. I think that's a very damning thing. So I can't think of a single policy he actually got right when he was running the federal health policy.

And you kind of rode in on this wave of anti-Fauciism, in a way. At the head of that would be someone like RFK Jr., who's the head of HHS. What was your big hope? We'll get into the specifics of what you were doing at the FDA, but what was your biggest hope as to what the kind of new version of public health might look like or changes that might be made?

Well, I had a very narrow mandate because I was just in charge of biologics at the FDA, and the hope continues, which is that public health could aspire to be honest, to use its powers proportionately and judiciously, to exercise humility. Public health is far from these things. Public health could actually aspire to be bipartisan. Public health does not. It's becoming an increasingly entrenched left-wing discipline run by left-wing ideologues, reaching even more and more absurd conclusions. So what public health can be and what it is are still light-years apart.

So you don't think that has changed very much?

Not much at all. No. I mean, I think changing an entrenched organization with tens of thousands of people is very difficult. There have been some changes. I suspect that there's sort of been a catalyst. The pandemic has been a catalyst. But I don't think a real reform is possible. I suspect it'll splinter into different sort of public health groups and senses of that.

And your role was at CBER, which is the part of the FDA that oversees what they call biologics. So that would be things like vaccines or gene therapies. Vaccines obviously became an increasingly polarized and politicized issue during COVID. What was your goal going in there pertaining specifically to vaccines?

You know, people ask me, like, they say, "Vaccines save lives." I say, "Drugs save lives." Like, the right drug given to the right person at the right time is life-saving, but the wrong drug given to the wrong person at the wrong time can be harmful. Vaccines are the same way. You can't say anything about all vaccines, just like you can't say anything about Tylenol, aspirin, and Plavix all in the same breath. They're all very different drugs.

And yet I think there is a mentality in the mainstream media that vaccines are perfect. They're always perfect. More of them is always better than less of them. There are no problems in the current system. They can never be questioned. And I think that dogma has to go away. But that dogma continues. I mean, you want a recent example? This miscarriage argument. Fauci, in his diary, he says, "Boy, you know, that COVID shot's very reactogenic. People get fevers and they feel terrible. Possible that it will increase the rate of miscarriage."

Now I read people say, "We know for sure it doesn't." Really? You know for sure it doesn't? Well, that's the part where I call it into question. I'm happy to concede that the best available evidence excludes a very large risk of miscarriage. There are some people on the right who said it was an 80 percent risk of miscarriage. That's ridiculous. This is not even possible. 80 percent miscarriages, you'd see that from a mile away. It's not an 80 percent risk of a miscarriage. But neither do we know it's a 0 percent risk. And science has to be very careful to say what we do know and what we don't know.

Pfizer was actually asked to do a randomized study of pregnant women. They were randomizing 4,000 pregnant women in the course of that randomized study to learn whether or not the vaccine is safe and effective and whether it causes birth defects or miscarriage. They're going to look at 4,000 women being randomized. During the course of that study, the American College of Obstetricians and Gynecologists said all women should just get it. And they stopped their study with 300-some women randomized, and the study is inconclusive. It was never run to conclusion.........

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