Press Briefing by Senior Counselor Kellyanne Conway, ONDCP Director Jim Carroll, and Assistant Secretary of Public Health ADM Brett Giroir
James S. Brady Press Briefing Room
10:15 A.M. EST
MS. CONWAY: Good morning. Thank you for being here. We come before you bearing good news. For the first time in four years, life expectancy in the United States of America has increased. And for the first time in 29 years, the number of drug overdose deaths has decreased.
This has not happened through coincidence. It's happened through causation. It's owing in large part to a whole-of-government approach to treat the whole person, led by President Trump, First Lady Melania Trump, and really, the entire administration.
Nearly 70,000 of our fellow Americans died from an overdose last year, and 48,000 of those involved opioids. About 70 percent of those deaths also involved some type of synthetic opioid, most prominently fentanyl, which could be an instant killer. A couple of tiny grains are a lethal dose.
We've met with first responders, parents who have lost children, people in recovery, people who are running recovery centers. We've met with mothers whose babies were born chemically dependent. And we certainly have met with health professionals. All of them have shared stories of loss but, increasingly, of courage and recovery.
This is a crisis that we call the "crisis next door," because we want people to know, from the beginning, that the silence and stigma that it tends to — many people, it prevents them from seeking out the kind of treatment and help that is available to them is a very big priority for us — busting through that stigma and silence.
We also want to make clear, in this crisis next door, that it is indiscriminate. It affects all races, socioeconomic status, gender, age, and certainly other affiliations. If the crisis is indiscriminate, then the response must be indiscriminate.
And that's why, in addition to everything that the President and the First Lady and the administration have done, I wanted to share with you, as a reflection, what I consider to be the most robust and significant bipartisan accomplishment of the President's first term: H.R.6, the SUPPORT Act. The President signed it into law following overwhelmingly unanimous support from every Democrat who voted for it in the House and the Senate. This overwhelmingly bipartisan action has led to an increase in the money and awareness on the opioid and poly-drug crisis.
Features of the SUPPORT Act include the CRIB Act, where there is more money and more action for those neonatal abstinence syndrome babies that I mentioned before. Medical professionals tell us it's best to keep the mother — it's best for the mother and it's best for the baby to keep them together. And, increasingly, that is happening.
Also, the nearly $3.7 billion in new grants put forth by the administration have made a real difference in our municipalities. The STOP Act has helped us increase the number of seizures of fentanyl and other synthetic opiates coming through our mail. It's up to about 38 percent, and we have a goal, if not a mandate, of 100 percent.
Let me go through a couple of the numbers: 4.1 percent overdose death decline overall in our nation. And that is the first time in 29 years — nearly three decades. But in some of the hardest-hit states, we're off a peak of over 20 percent: 19 percent in Pennsylvania, 22 percent decline over the peak high in Ohio, 11 percent in West Virginia, 14 percent in Minnesota, 7 percent in North Carolina — just to highlight a few of them. Also, the Customs and Border Protection in the last fiscal year increased the seizures of fentanyl by 21 percent.
We also launched a targeted ad campaign geared at youth that was seen by over 1.4 billion views and over 58 percent. In fact, the longer documentary type won an Emmy.
Naloxone prescriptions have increased over 400 percent. Our Surgeon General, in April of 2018, issued the first advisory by a surgeon general in over a decade. And Dr. Adams said at the time: We need to have naloxone more available to our first responders, to our health professionals, to our school systems, libraries, YMCAs and the rest, but also to each and every one of us. The Surgeon General says, if each of us were to carry naloxone on our person, we too can be part of the solution, reversing these overdose deaths by administering this overdose-reversing medication.
Last night, Congress passed a 15-month extension of the current emergency scheduling of fentanyl analogues. This is a critical tool for law enforcement because it allows them to continue to detect, analyze, and handle safely and effectively this very lethal drug.
In our effort to focus on prevention education, treatment and recovery, law enforcement interdiction, I'm also happy to report that we have record back-to-back-to-back-to-back collections on Take Back Day. And I do want to credit our partners, like Google, who have been incredibly helpful to us in raising awareness and action among the public in understanding how to safely and broadly dispose of your unused, unneeded expired drugs.
In addition to Take Back Day, the prescriptions of high-dose opioids have fallen by over 32 percent since the President came into office. If you need the pain medication, it will be there. People are walking around with what's left from a bottle of 30, 40 pills, and that's where some of the peril begins.
In addition, we launched FindTreatment.gov — a completely overhauled tool for every American to access so that they can customize finding treatment for their needs. You can customize it by age, by geography, whether you're veteran, by LGBT, certainly by gender. And this promotes quality over quantity. When you type it in and you customize it, you can find treatment centers that are best for you. Maybe you need to be there for a short amount of time. Maybe you need to be there in-patient, out-patient. Maybe you need to be there a longer amount of time. You can customize that quite confidentially.
From 1999 to 2015, the government reported a 20 percent reduction in our workforce due to opioid and other drug abuse and addiction. A 20 percent decline over 16 years. I'm happy to report that because we've invested over $100 million in displaced worker grants across 17 states in the Cherokee Nation, those numbers are moving.
We are trying to treat the whole person, not just check in person. We got you in drug court; we got you in drug treatment. Isn't that terrific. It's really terrific if we can them help them acquire employment, education, skills, training, and certainly housing, on the way to full recovery.
There is so much more work to be done. We're very pleased that the overdose deaths have declined, but 68,000 of our fellow Americans died last year from drug overdose. That's 68,000 too many. If you look at the Super Bowl this coming Sunday, that number could be represented by every single seat with 3,000 left over at the Super Bowl this coming Sunday — just to give you the actual enormity of the problem.
We will continue to fight this every single day, and we will continue to make the investments of money, of time, of education.
And with that, I'd love to turn this over to Director Jim Carroll of the Office of National Drug Control Policy and then Admiral Giroir, the Assistant Secretary for Health of the United States of America. Thank you very much.
DIRECTOR CARROLL: Thank you, Kellyanne. A couple of years ago, when President Trump and I first talked about me taking the job as the Director of the Office of National Drug Control Policy and serving as his drug czar, he instructed me to be relentless in our efforts to save lives. And that's exactly what we've done to tackle this drug problem here in the United States.
The good news that we're announcing today is a testament to the President and his leadership on this issue. It's an example of what can happen when we come together and apply that whole-of-government approach.
The obstacles we face could not be greater, but through our efforts on prevention, treatment and recovery, and reducing availability, we've made real progress for the American people — which we not only want to sustain, we want to accelerate.
Kellyanne discussed how we got here and what these numbers mean. Admiral Giroir will discuss the incredible headway we're making with getting people into treatment.
But I want to highlight the progress that we have made with our international partners and our law enforcement who are critical in reducing the supply of these dangerous drugs.
Back at the G20 Summit in 2018, President Trump raised the issue of fentanyl production with the head of China and demanded a solution. He made it clear that the United States would not tolerate the flow of fentanyl and other deadly synthetic drugs coming into our country.
Because of this, in May 2019, China scheduled fentanyl and other similar analogues, such as controlled substances, which was a historic and significant event.
Last night, the House of the Representatives passed a 15-month extension on the ban in scheduling of fentanyl, but a long-term solution is still needed.
In September of 2019, I led a White House delegation to Beijing to ensure that China was keeping up with their commitment to President Trump. The Chinese government agreed to improve the legal framework, agreed to improve their standards for prosecution for fentanyl-related trafficking, and established law enforcement methods there that were not heard of before.
In every meeting I had with the Chinese, my counterpart said they heard the President loud and clear: that the flow of fentanyl into the United States was not tolerated. Since then, the Chinese officials have invited our U.S. counterparts back there to watch the first-ever prosecutions of Chinese nationals for trafficking drugs into the United States.
This progress, combined with President Trump's commitment to secure our southwest border — which is critical to stopping the flow of drugs into our country — brings together several lines of effort that will serve to keep Americans safe from the dangers of illicit drugs.
A wall acts as a force multiplier for our Border Patrol agents, and is one of the many tools that we are using to counter drug traffickers.
Taking the steps towards the humanitarian crisis at our southern border has also been critical to keeping those drugs out of the country. The more men and women we have in uniform, the more that we have on line, the more that are stopping these traffickers — the greater chance we have of saving lives.
The Department of Justice has played a critical role in this, as they have been cracking down in unprecedented numbers on drug traffickers.
Under President Trump, the DOJ has ramped up trafficking prosecutions — not only here domestically, but internationally.
Under this administration, the U.S. Treasury Department has made more kingpin designations against operators of distributors in foreign countries.
The High Intensity Drug Trafficking Areas that we fund out of the White House here — which provides assistance to federal, state, and local drug task forces — has received unprecedented funding from this administration, and that is beginning to show and is part of the paradigm shift that we're seeing.
These HIDTA initiatives, for example, have dismantled 3,000 drug trafficking organizations, they've removed $16.5 billion of illicit drugs off our streets, and they have made nearly 99,000 arrests of drug traffickers.
In 2018, we even added, for the first time in 17 years, the first new HIDTA to make sure that we're tackling this.
The men and women of law enforcement, whether they're in uniform or not, are playing this vital role and putting their lives on the line every day.
What this shows is the President's efforts are working and we are saving lives.
Before I turn this over to Admiral Giroir, I want to ask that when you're reporting on this issue, that when you're reporting on these numbers, that numbers are really just part of the story. Behind each of these numbers is a person, is a child, is a mom, a dad, someone whose loss has left a great mourning in a family.
I was with three parents yesterday who had lost their child to an overdose. Today, we remember Jason, Amber, and Eddie, and all of the other people that we have lost. And we continue this fight in their honor to make sure that we fulfill the President's commitment to save American lives.
And with that, I'll turn it over to my friend, Admiral Giroir.
ASSISTANT SECRETARY GIROIR: Thank you very much, Director Carroll. Again, I'm Brett Giroir. I'm the Assistant Secretary for Health at the Department of Health and Human Services. I'm also Secretary Azar's principal advisor on opioid policy, and I've been that for about two years. And I'm honored to wear the uniform of the U.S. Public Health Service Commissioned Corps.
What we see today is no accident. This is the result of an intentional whole-of-government, whole-of-society approach to overuse — to over- — to opioid use disorders and other substance use disorders.
First of all, we recognize this as the public health emergency as it is. And as such, we have focused on many different areas to yield these results.
First, as Kellyanne said, the number of opioids that have been produced — the total amount of opioids that have been prescribed since January 2017 is reduced by 30 percent nationally. And we have been able to do that while preserving and expanding options for pain control for those who truly are in chronic pain or have debilitating injuries.
Secondly, we've approached this as a public health emergency, because addiction — opioid use disorder — is a chronic brain disease. We have unprecedented numbers of individuals who are now receiving treatment. Our estimates are over 1.3 million individuals are now on medication-assisted treatment, and they're also getting the psycho-behavioral support and wrap-around services that they need.
You heard about naloxone — very, very important because everybody deserves a second chance at life. You have the power. I hope all of you in the media carry naloxone with you. It's very easy. You can save a life, give a person a second chance.
This has resulted in, as you heard, a 4.1 percent decrease in the number of deaths and a 4.6 percent decrease in the actual overdose age-adjusted mortality rate. Very important.
A couple comments on the overall longevity. I have been shocked. Everyone in the public health community has been shocked that over the three years, previously, our longevity has decreased. That really means that our children and grandchildren will live less long and less quality of lives than we have. This is shocking, and we have not seen this since the height of the AIDS epidemic in the '90s.
This has been reversed. We're now on the trajectory of increasing years of longevity, and that's associated with a number of things. What does that mean? It's only one-tenth of a year, but that's 25 million person years we just gained by this increase in longevity. And the good news is the preliminary data from quarter one into quarter two of 2019 is our mortality rates continue to drop.
Now, I want to talk about all the Health and Human Services issues like treatment, like prevention, but I do want to mention the social determinants of health that are very important.
There was a nationwide study in December, published in JAMA, that highlighted what we all know: When an auto plant closes, opioid mortality rate among the young goes up 85 percent. We have to keep our eye on those socioeconomic issues and everything that we're doing to increase employment, increase opportunity. These all directly affect the rates that we see and that we celebrate today.
And the final thing is, we are not taking our foot off the gas. We understand that this is a dynamic issue — opioid use disorder, other use disorders — and it's being fueled by transnational cartels. So we are going to keep working together. We work weekly, daily, together across the government to make sure we continue a whole-of-government, whole-of-society approach.
MS. CONWAY: Thank you. Any questions? Kristen?
Q: Kellyanne, a couple of questions. How should we think about this moment? Is this, in fact, a turning point? As you point out, the rate is still very high, but do you see this as a turning point? And I have a couple of other ones.
MS. CONWAY: Sure. I'll have my colleagues speak to that as well, Kristen.
It's a turning point and we hope it becomes a trend. So what we're doing is working, and it is a multifaceted approach. So I can't say it's just law enforcement and surveillance, or Customs and Border Protection; it's just a new treatment locator; it's just Take Back day and more education — that that tiny little bottle that bears a label of the family doc and local pharmacy that was prescribed to help someone could, in fact, be very dangerous in the wrong hands, or even in your own hands, if you're the prescribe [sic], if you use it for purposes other than why it was prescribed.
So we want to keep and redouble our efforts. We certainly hope that we can count on continued bipartisan action and agreement on this, because as I said earlier and I'll repeat here: H.R.6 had every single Democratic vote in the House and the Senate, including all the people in the House and the Senate running for President. So there is tremendous agreement and action on this issue because it affects every single district and state.
So we want — we want to see the trend line. We recognize that the mortality rate — excuse me, that the life expectancy is increasing because of strides in the drug space. We still — and
cancer, frankly. We know that suicides and flu — and flu combined with pneumonia — are keeping that rate down among other Americans. But we're going to continue, and we hope that we have — we have what I call the horizontal and vertical government approach.
Horizontally, it's across state, federal, and local. And vertically I — you know, I call it in terms of the federal government apparatus. To have 13 or 14 departments and agencies actively engaged on this — ones you would expect, like HHS and FDA and NIH and CDC; SAMHSA certainly; but also Veterans Affairs, Veterans Administration; DHS; State Department has been very helpful; Department of Justice, obviously; but also Department of Labor and Department of Education; and Department of Interior to help with rural and tribal America.
So there's much more work to be done. But we feel like we have a protocol that's helped us get to this point of progress.
Q: Let me ask you one — if you want to weigh in on that one, I do have one on the coronavirus.
ASSISTANT SECRETARY GIROIR: It is — it absolutely is a turning point, but we have to look at the complexity of the problem. Some states still have increasing rates of death. Most states have decreasing rates of death. We now know that prescription opioid overdoses that caused death are really down tremendously as a result of our work, down 13 percent in 2018, and they continue to decline.
The newest data says cocaine is starting to level off, but we still have issues with fentanyl. It used to be up 30 to 40 percent year over year. Now it's up under 10 percent, so we're making progress. But we're all worried about the next wave, which is evolving, and that is psychostimulants or methamphetamine. Those continue to increase across the nation. They're being driven all almost entirely by transnational Mexican cartels, and we have been on that problem for about a year right now.
So, yes, we're at a turning point but this is a dynamic, rapidly evolving crisis.
DIRECTOR CARROLL: To follow up, I think one of the things that can make this a turning point is for this to give hope to those people that are suffering from an addiction, for them to be able to come forward and realize that there is, in fact, lifesaving measures that they can take and that we can help them to get on the path to recovery: the prevention programs that we fund, like through our drug-free community programs, the efforts that we're making to get people the help that they need, and also while we're striking hope in the minds of people who have an addiction, we're striking fear in those who want to traffic, and will look to other legitimate opportunities instead of turning to selling drugs in our country.
Q: And just a quick question on the other big health news of the day: Has the White House ruled out stopping flights into and out of China? Can you update us on any conversations going on related to that?
MS. CONWAY: So there's a new task force that's been created. It's being led by Secretary of Health and Human Services Alex Azar. As you are probably aware, the President was briefed yesterday in the Situation Room. I've been a part of those staff-level briefings, senior staff-level briefings, and I won't make an announcement about that right now.
I will say that we're all very relieved and happy and heartened to see what happened with the flight of the 201 or so Americans who landed in Anchorage and then California. So we will continue to monitor the situation, as you know. And I think that Secretary Azar had a few interviews just this morning, maybe addressed this as well as.
Q: Is there a second flight next week?
MS. CONWAY: I don't want to comment on that.
Q: I just have sort of two — I wanted to follow up on that one. Do you know whether the President has spoken to President Xi about this situation with the coronavirus? But I also have a follow-up on fentanyl and the overdose deaths.
MS. CONWAY: Well, the President has tweeted about President Xi, I believe last week or maybe earlier this week. You can see that, obviously, we've offered assistance. And obviously, we are also monitoring the fact that other countries now have cases.
And in this kind — I think that's all I'll say right now. The CDC director and Dr. Fauci, they're all very involved. And, Admiral Giroir, maybe you want to address that –-
ASSISTANT SECRETARY GIROIR: (Shakes head.)
MS. CONWAY: — or you don't.
So we are monitoring — the President is briefed daily on this, and yesterday in the Situation Room. So I'm going to leave it at that.
Q: And my follow-up on the issue of overdose deaths: As you mentioned, fentanyl is up, and there are a number of other overdose areas involving drugs that are up as well. I'm not asking for a silver bullet, but if you were to pick out two or three pieces of policy that might bring down those numbers, what would it be?
ASSISTANT SECRETARY GIROIR: So let me say that not only does it make common sense, but the academic community has proven that there is no such thing as a silver bullet to this issue, that there has to be multimodal approaches that span prevention, that span treatment.
And again, I'm a pediatric intensive care doctor. I use fentanyl every day on suffering children in the ICU in microgram quantities. This is coming into our country in hundreds of pounds — thousands of pounds, potentially. So we have to have a law enforcement component.
Overall, I would say we have to treat this as a public health emergency, which we do. Addiction — I'd rather use "use disorders" as a more appropriate term — is a chronic brain disease. Once you have that chronic brain disease, it is very difficult but possible to treat, but it requires medication treatment and all the supporting services we have.
So a combination of prevention, stop it before it happens, get people into treatment. And that's reduction of stigma across the board. This is a disease. You need treatment. And then, again, all the kinds of follow-ups that we're doing on a national level.
Q: Kellyanne, can you speak to what the administration believes — what more the administration believes needs to be done to address this crisis? Particularly, what should we expect to see in the President's forthcoming budget in terms of any additional programs?
MS. CONWAY: Sure. Well, thank you, Zeke, for your interest in the issue. We're very happy that last night — I mean, really at the eleventh hour, because it was set to expire February 6 — but the Congress took action. It's disappointing that 86 Democrats, I think, voted against extending the fentanyl analogue scheduling that, honestly, is a no-brainer, especially when you consider that they were all on board with the larger compilation of dozens and dozens of bills that became H.R.6 that included several different focuses on fentanyl reduction, handling, analysis, and the like.
So we hope that we can — again, notwithstanding anything else that's happening — count on everyone to belly up and help.
I think we also need to — to Admiral Giroir's point, we're all obviously very concerned about what we consider to be the fourth wave now of the drug crisis, meth. And we hear from law enforcement routinely that whereas they're whacking the moles of fentanyl more and more, up pops meth more and more, and I think, to some extent, heroin as well.
One thing I would say is, in the states that have the Good Samaritan laws where if I'm driving the car and my friend is overdosing, perhaps I have also used with that friend, in the past, I basically pull up to the emergency room, and the bluing friend starts rolling out the door and I pull away because I'm afraid of being prosecuted. That doesn't happen in many of these states now where you won't be prosecuted. In fact, both people will go in and try to get some services.
So I think so much of it is education. And I think the incomplete or underwhelming coverage of this issue is probably something I would want to solve with you, in that we talk about so many things that don't affect 72,000 lost lives, and then if you draw the concentric circles around those lost lives, the dozens and dozens, or hundreds of people who are affected beyond that one lost life.
So I think it's also making sure that law enforcement, which includes Customs and Border Protection; includes local law enforcement sheriffs; includes our ports of entry; and then, between our ports of entry — where, increasingly last year, Customs and Border Protection did interdict these poisonous drug — I think respecting the fact that making sure they have more respect and better resources.
And also, I think for all the things that we're teaching our kids in the formal curricula in school today — and speaking as a mom of four school-aged children — it would be terrific if, on a volunteer basis even, educational programs like this were more incorporated into the formal curricula and/or for after-school programs or with the local law enforcement or health professionals.
This should absolutely be included because they are in — they're in the line of peril, all of them. This is indiscriminate.
And so I think the treatment and recovery — one thing I'll mention — it didn't get mentioned today because they're so much to talk about — but one of the big things that has happened in this administration is, I believe, HHS or CMS has granted — are we up to 22 or —
ASSISTANT SECRETARY GIROIR: Twenty-seven.
MS. CONWAY: Twenty-seven. I mean, it's really remarkable. Was it four when we got here?
ASSISTANT SECRETARY GIROIR: Yes.
MS. CONWAY: Four states or so. Now we're up to 27 states where this IMD 1115 exclusion has occurred. This is really helping people get into treatment because that was a ban on mental institutions keeping people too long. It's existed for 40 years, and it had a lot of merit for that reason. But it had a cruel — the cruel irony, the cruel result of it was a long waiting list for treatment and empty beds, because if you filled that 17th bed, you would risk not getting Medicaid reimbursement.
So we have granted twenty- — we now, as a government, as a nation, 27. More than half the states have a waiver so that you can treat that 17th, to 50th, to 60th person in your facility and still count on Medicaid reimbursement.
And I'd also say something about the veterans. The President took action several months ago on veteran suicides. He's always been very concerned about that. We are taking action, as a government also, on opioid and other drug misuse disorder among our veterans.
I visited the Cleveland Veterans Administration, for example — not the Cleveland Clinic, but for the veterans across the street from there — and I was really struck by how there, and other places — but by way of example, pain management may not mean pain medication. They're trying other protocols first. They're doing Reiki and swimming and yoga and other less addictive drugs to help our veterans.
So I think looking at each and every department and asking them what they're doing, it's unusual for the Department of Education, Department of Labor to be so involved, but they are. I mean Labor has all these displaced worker grants, because we know — and Dr. Giroir can speak about the factories, I think, for a moment — we know that if you lose your job because of a substance use disorder, you lose your job because you tested positively for drugs, for many Americans, you also lose your hope of recovery.
And I visited a great place called Belden — B-E-L-D-E-N — Industries — just, again, by way of example — with Second Lady Mrs. Karen Pence, and Dr. Adams, the Surgeon General, and then Secretary of Labor Alex Acosta in Indiana, where Belden's — one of many examples now where, if you fail a drug test, instead of you losing your job immediately, they hold the job for you but you agree to go into immediate treatment. And they work with the local — they work with the local hospital, they work with the local community college to make sure that you keep your skills and education up. And that job is waiting for you when you are ready to re-assimilate.
Again, I think the government far too often pats itself on the back: "Oh, look at all the numbers." And Director Carroll and Admiral Giroir said it beautifully and brilliantly that these aren't just numbers, these are people. So you want to help these people re-assimilate into society. And if they qualify for skills education or employment opportunities, housing opportunities, we want to be able to connect them with that information.
So that's a very lengthy answer because we have to — I would — I would never say just treatment recovery, which was the emphasis of the last administration; just, "Oh, we can arrest and punish our way out of it." No, we can't. That would be a ridiculous idea, and thankfully, this President agrees with that. And we can't just say to people, "Gee, don't start." What about all the people who are already there?
Weijia and then —
Q: Thank you so much.
MS. CONWAY: I'm sorry, we'll get to you.
Weijia and then Andrew.
Q: Oh. Thank you, Kellyanne. Can you walk us through the life expectancy increase? What are the numbers? What factors do you think contributed to that? And also, how do Americans fare with other people in the world?
And, Admiral, since you're going to take this, I have another question for you on corona.
ASSISTANT SECRETARY GIROIR: Okay, so the life expectancy data — again, this reverses a three- to four-year trend and a loss of life expectancy. You can look at this in many different ways. Some of the principal components that resulted in the increasing expectancy was a reduction in cancer mortality, a reduction in unintentional deaths — and that really deals with overdoses primarily, but also things like car crashes.
There was also, though, a reduction in cardiovascular mortality, a reduction in Alzheimer's mortality. So it was very broad across many causes of death. There was also a 4.8 percent decrease in homicides in 2018. So these are all positive factors.
The negative factors — the only ones that were there — were an increase in suicides, which the administration has been incredibly attentive to with many new programs rolling out, and also influenza.
Again, we talk about coronavirus, and we need to talk about that. But remember, over 8,000 Americans have died this year of influenza. There's still time to get your influenza vaccine.
How do we rate? We still don't rate very well compared to the rest of the developed world, and certainly the last few years have lowered our ratings. But as I said, we continue — our mortality rate in 2019 continues to really plummet.
And I do want to make the case — we talk about these outcomes as if it's all medical care, and medical care is very important, but about 80 percent of health outcomes in the United States are due to social determinants of health and behavior. It's really the economy, it's the jobs, it's smoking, it's alcohol and other use. So 80 percent of our outcomes are expected to be — to come from those kinds of impacts.
Q: And what is the number?
ASSISTANT SECRETARY GIROIR: Pardon me?
Q: What is the life expectancy number?
ASSISTANT SECRETARY GIROIR: The life expectancy is 78.6 years. And that's the life expectancy in the United States right now. Women live about five years longer than men, and that's been common across the board. So women, I think, are 81.2 if I'm correct, and men are five years less than that.
So again, it seems like a small increase — an increase of a 10th of a year. But when you look at it, a 10th of a year across 300 million Americans, it's really 25 million life years of increased life expectancy. And again, this is against three years of losses in life expectancy that we haven't seen since the early '90s.
Q: And on coronavirus, how confident are you that it can be contained at this point? And what is the White House's plan — contingency plan — in case it is not?
ASSISTANT SECRETARY GIROIR: Well, I will say that this is an all-hands-on-deck effort. There's tremendous leadership from the White House, Secretary Azar, and Director Redfield from the CDC, the Assistant Secretary Bob Kadlec.
Again, resources have been put to airports. We're doing screenings. The Commissioned Corps of the Public Health Service has been deployed to support the repatriation mission as well as the airport screening.
And again, this is no cause for urgent panic in any way in the United States. This is currently under control. But, really, this is a dynamic, rapidly changing event. And, you know, the news can change at any given moment.
But the resources are deployed, the government is mobilized, and we feel confident and we know the steps to take right now to contain it.
And you know everything else: We have good diagnostics now by the CDC. The NIH already has candidate vaccines as well as many other individuals. That is a result of dozens of years of medical research to get us to the point of being rapid.
Q: And, Kellyanne, I know you wear so many hats, and we're lucky to have you because you have an attorney cap as well. And I have to ask whether you agree with Alan Dershowitz's argument that every politician weaves their public — their private interest in with public interest and there's absolutely nothing wrong with that.
MS. CONWAY: I actually am not going to discuss politics from the podium. So I will tell you I was very struck by his argument that no one is above the law, including the Congress.
But just generally speaking, I think we'll leave what else is going on on Capitol Hill to Capitol Hill today and our crack group of attorneys who are doing an amazing job of not preening for the cameras and not being partisan politicians, frankly, but lawyers effectively in a courtroom speaking to the jury and speaking to the American people.
So I'll leave that there. But I'm not going to address the political aspect of that from the podium.
Q: Thank you. Admiral, I have two questions. The first: Two weeks ago, the administration announced that it was repealing a number of rules that required social service providers that receive federal funding to — that are religious in nature — to refer people who might not be interested in faith-based approaches to secular outside organizations.
Is that going — has there been any discussion or study as to whether that will make it more difficult for some people — religious minorities or other vulnerable groups — to receive drug treatment?
And the second: Last year, Attorney General Barr criticized prosecutors who, for instance, might decline to prosecute low-level drug possession crimes as social justice reformers who let criminals off the hook, and said they're demoralizing to law enforcement and dangerous to public safety. Is that disdain for declining to prosecute low-level drug crimes in favor of steering people into treatment consistent with the scientific literature?
ASSISTANT SECRETARY GIROIR: Do you want to take the prosecution question?
DIRECTOR CARROLL: Sure.
ASSISTANT SECRETARY GIROIR: But I'll just — I'll just say that I work on a regular basis with DOJ, with DEA. And at the leadership level, there is absolutely no distance between us and approaching this as a public health issue.
It doesn't make sense to put a person with a use disorder, who has been using because of their addiction, into long-term incarceration without treatment. It makes absolute sense for me to get the people who are pushing tons of methamphetamine to our youth across the country, to get them behind bars as soon as possible.
But I'll let Director Carroll, because he deals with the law enforcement. I'll come back to — I'll come back to that.
DIRECTOR CARROLL: What we know is that drug courts work for people that have an addiction. We're able to push people and hold their hand and get them into treatment if they are suffering from the disease of addiction.
What is so disheartening is that when there are prosecutors or judges out there that don't take seriously the peoples whose addiction is to greed. The only thing that they care about is lining their pockets and preying on the victims who do have a substance use disorder. Those are the people that we need to target. That's what the Department of Justice is doing. That's what our top-notch prosecutors across the country are doing. And those are the people that need to be in jail.
The people who have an addiction — we support, with record funding from the White House, National Drug Court programs across the country, and putting them in federal courts as well to make sure that people who have an addiction are not the ones that are going to jail.
ASSISTANT SECRETARY GIROIR: And just to comment, I want — I want to make it clear that this administration stands to treat all people who are in need. I have the privilege of running the ending the HIV epidemic presidential priority announced at the State of the Union last year. And we provide care to everyone regardless of who they are, where they are, what circumstances they are. And we'll continue to support that. That is the humane thing to do, and that is the position of the administration.
Q: But ending the referral requirement, wouldn't that make it more difficult for some people to seek treatment if they — if the only treatment facility in the area is a faith-based one and they won't be referred to somewhere that they might be more comfortable?
ASSISTANT SECRETARY GIROIR: So we work with all — we work with all communities. I think faith-based providers have an important component in this, particularly in wrap-around services. For opioid-use disorder, MAT is the standard of care. But MAT alone, if you don't have a job, if you don't have a place to live, if you don't have a welcoming community, is not going to be the entire solution. So all of those things are important.
We'll continue to study every policy and make sure there are no adverse events. But, again, we want everyone to be treated. That's the core administration policy.
Q: And, Kellyanne, another follow-up question on the evacuations of —
MS. CONWAY: If I could just add just one quick thing to Andrew. I just, again, would point you to FindTreatment.govalso. We worked on that for years, and it's the first overhaul. If you go back and look at it previously, we can show you the difference.
It basically just generated quantity. If you put in your ZIP code and say, "Look all of the — look at the 400 facilities you can go to within 500 miles." And people would shut it down because, like, "Well, how do I find the one right for me?" You can customize it by any number of criteria, whether you're a veteran, male or female, LGBT, in-patient, out-patient, temporary, longer term, type of insurance — if you're on Medicaid, Medicare, private insurance, no insurance, for example.
So I would also point you to that because that is a new tool for every American to access, and they are doing it.
Q: Thank you so much. This is a question for the Admiral about coronavirus again. I want to know: How high, do you think, is the risk of coronavirus spreading in the U.S.? And do you think this could be a global emergency, since we just saw the number surpass the number from SARS in 2002, 2003?
ASSISTANT SECRETARY GIROIR: Well, it's really hard to take theoreticals because it really is a rapidly emerging and a rapidly changing environment. There has been, at least of this situation — the sitrep, this morning, there's been no person-to -person transmission within the United States. There clearly has been person-to-person transmission in China, but there has been no person-to-person transmission.
There's extensive screening, appropriate quarantine and isolation that is currently going on, and we certainly hope that continues.
But to sort of project what's going to happen over the next couple of weeks — again, it's a dynamic situation; all of the resources are in place. The situation rooms are in place, the operation centers are in place. We have CDC deployed. We're working with the World Health Organization. Again, my organization, the Public Health Service, is deploying in support of the repatriation missions as well as the airport screenings.
And there'll be updates, you know, on a regular basis from Secretary Azar, my boss, who is leading the — leading the efforts.
Q: Sir, can I follow up on that coronavirus question, if you don't mind? Because you're talking about, obviously, the importance of combatting what could potentially become serious, although you don't want to get into hypotheticals. And one of the President's Cabinet members, this morning, referenced or suggested that perhaps coronavirus could be good for jobs in the United States. I'm wondering if you find that kind of rhetoric or language helpful, and what you might suggest to public officials as they talk about this.
And, Kellyanne, if you want to weigh in on that as well.
ASSISTANT SECRETARY GIROIR: I don't have any knowledge of the comments this morning.
MS. CONWAY: I didn't see that. I'm sorry.
Q: A follow-up question on the repatriation efforts?
Q: Can I just ask really quickly: In terms of the evacuations of U.S. personnel, I know it's already happened with respect to Wuhan, but will the U.S. government give diplomatic personnel throughout China the option of leaving their posts?
MS. CONWAY: I'd refer that to the State Department.
Q: Kellyanne, on the STOP Act — you mentioned the STOP Act, some numbers. Can you give us an update on how far the Post Office has gotten in compliance? I think they have to screen all packages or refuse them by the end of the year. Are they anywhere close to getting there?
MS. CONWAY: Yeah, so it's gone basically from zero — if any of you ever go to the JFK facility — I'm going to have Director Carroll address that — if you ever want to take a field trip to JFK airport, you'll see how few packages actually are screened coming in from China and elsewhere.
But the STOP Act essentially means that foreign origin packages now must have sender recipient and contents listed on them. Our third-party carriers have been doing that for a long time — your UPS, your FedEx, for example. And so, now, our own U.S. Postal Service needs to get on board with that.
So the last numbers that I saw were somewhere in the 35th percentile. And we're on our way to — it needs to be 100 percent at some point. We're really pleased — about 16 months since the STOP Act, maybe less, was signed into law — that we're already at 37 percent. But Jim can really amplify that.
DIRECTOR CARROLL: I'd love to lead a delegation if you want to go to the JFK Airport, or one of the other ones, and show you what Customs and Border Protection, as well as the USPS — U.S. Postal Service — are up against.
What we need is additional capital, additional investments from Congress, to make sure that we have the technology. But what we have seen is actually the President attacking this at the core, at the countries where it's coming from. And so we — as I said at the beginning, we do have a dramatic reduction in the amount of fentanyl that is coming in the mail from China. And so that is helping at the outset, while we continue to develop the resources, technology, to tackle it actually at the facilities themself.
Q: It seems like they're a long way off though. I mean, are they going to get there? The law says what the law says. Can they comply?
DIRECTOR CARROLL: That's our goal.
MS. CONWAY: That's our goal.
Just quickly, none of us mentioned the first-of-their-kind fentanyl advisories, which we issued as an administration in August, and that included the Department of Treasury, the departments that are here right now, and others.
Essentially, we are trying to show the private sector how easy it is to disrupt and divert their otherwise legitimate supply chain. So we gave first-of-their-kind advisories on the movement, the money, the manufacturing, and the marketing by these fentanyl traffickers who are very clever, because you could have a couple of blocks of fentanyl in your otherwise legitimate supply chain. And so we're dealing with the private sector so they're more aware of how they could be unwittingly helping us to come into the country.
Q: Do you have any — on the coronavirus again: Do you have any evidence or information about China's use for these biological weapons for coronavirus?
MS. CONWAY: I have no comment on that whatsoever.
Q: Secretary Azar said that U.S. officials should have more cooperation with China in order to get coronavirus under control. Is there any sign that China is wanting to have more cooperation? And how are those negotiations going?
ASSISTANT SECRETARY GIROIR: Well, I'd really refer you to Secretary Azar. But there's been, at least our perception, a high degree of cooperation with China. And there is ongoing request for assistance, and I would refer you to Dr. Redfield who runs the CDC for that.
Q: Kellyanne, one other question. Your former coworker, John Kelly, said he believes John Bolton. What do you make of John Kelly's statements? And — yeah, what do you make of John Kelly's statement saying that he believes John Bolton?
MS. CONWAY: Well, I respect General Kelly enormously, and like him, personally. I don't know what he's referring to, so I can't answer it. In other words, that's just a "I believe John Bolton." I have not seen —
Q: Do you believe that John Bolton —
MS. CONWAY: Well, I have not seen a manuscript. And I will tell you that —
Q: — had a conversation with President Trump where President Trump directly tied the aid to Ukraine's —
MS. CONWAY: He didn't say that.
Q: — investigation? That's what John Bolton said. He said that he believes that.
MS. CONWAY: Did John Bolton say that —
Q: Yes. He said that he believes —
MS. CONWAY: — or are we talking about an unpublished manuscript? I'm sorry. Where did John Bolton say that?
Q: John Bolton said he believes —
MS. CONWAY: Where?
Q: John Kelly says he believes John Bolton. Are you now saying that he is confused?
MS. CONWAY: Yamiche, where did John Bolton say that?
Q: He said that in front of a number of people. It's pretty clear that John —
MS. CONWAY: No, no, no.
Q: It's pretty clear that John —
MS. CONWAY: Where did Ambassador John Bolton say that?
Q: — Kelly is saying that if John Bolton said that President Trump directly tied the aid —
MS. CONWAY: No, no, no. Back up. Yamiche, where did Ambassador John Bolton say that this week?
Q: It was in front of cameras. Everybody saw it.
MS. CONWAY: John Bolton or John Kelly?
Q: John Kelly said that in front of cameras.
MS. CONWAY: Okay, Yamiche, where did John — what did Ambassador John Bolton say this week?
Q: So are you saying that John Kelly did not understand what he was saying when he said "I believe John Bolton"?
MS. CONWAY: I'm not saying that. But you're not answering my question. I can't answer your question unless I understand it.
Q: But it's a very clear question.
MS. CONWAY: It's not clear at all because I'm asking you —
Q: It is a very clear question.
Q: John Bolton said in his book that he had a conversation —
MS. CONWAY: Is that what you're talking about? An unpublished manuscript? Are you talking about a leak of an unpublished manuscript, as reported by the New York Times?
Q: John Kelly was talking about that manuscript.
MS. CONWAY: No, I'm asking you what he is referring to.
Q: I'm talking about that, and John Kelly was talking about that as well.
MS. CONWAY: Okay. Because I don't know that to be true and neither do you. In other words, I don't know what John Kelly was referring to. And I'm asking you, what exactly did Ambassador John Bolton say this week, in advance of John — General Kelly's comments? What did he say? I didn't see him say anything. I hear about unpublished manuscripts that I, frankly, haven't seen and I bet you haven't either.
Q: Well, what do you make of John Kelly making that statement?
MS. CONWAY: So you want me to — you want me to answer a hypothetical wrapped up in a conundrum.
Q: Well, yeah. But why don't you just answer: What do you make of John Kelly commenting that, if the manuscript is true, that he believes John Bolton?
MS. CONWAY: If the manuscript is true? You want me to —
Q: Yeah. What do you make of John Kelly making that statement?
MS. CONWAY: You want me to answer a hypothetical wrapped up in —
Q: No, it's not a hypothetical.
MS. CONWAY: It is a hypothetical.
Q: John Kelly commented and said, "I believe John Bolton." What do you make of John Kelly saying those words?
MS. CONWAY: I don't make anything of it. I don't make anything of it.
Q: You don't make anything of it?
MS. CONWAY: No. But I will tell you, particularly by NBC and MSNBC, you guys couldn't stop day after —
Q: I work for PBS NewsHour.
MS. CONWAY: I know where you work. Day after day — you appear there plenty, and I think you're paid by them. But day after day after day — day after day after day, you know what you talked about with John Kelly? That he was on his way out. He was going to be the next one to be fired. He was on his way out.
He started doing that — there was — first, it was the Politico article in October of 2017, about six weeks after he took the job. That person has moved on to a different outlet now, but it was still a ridiculous article. So for a year and a half, while he was on the job, the main story about General Kelly was that he was going to be on his way out.
Now you want me to answer a question — I haven't talked to General Kelly about this or Ambassador Bolton about this. And I'm not going to comment, particularly from the podium, in the press briefing room, on a hypothetical — on a leaked unpublished manuscript that I haven't seen.
I hope it doesn't — I hope it doesn't include classified information. And I know there's always this rush to imbue credibility on whomever you think is against the President at that moment. If it's not Michael Cohen, it's Michael Avenatti. If it's not them, it's Lev Parnas — who couldn't even get into the Senate chamber yesterday because he's wearing a tracking device because he's been charged with crimes. So that's not a hypothetical.
Q: But my question was about what do you think —
MS. CONWAY: You're asking me to answer —
Q: — of John Kelly's comments?
MS .CONWAY: I already told you what I think of General Kelly.
Q: You don't make anything of that?
MS. CONWAY: I respect him and I like him. And you're asking me to comment on — he said, "I believe John Bolton." I don't know what he is referring to when he says that and neither do you.
Q: Kellyanne, on the President's State of the Union Address next week, the President —
Q: Can I follow up on a question about — just this question now?
MS. CONWAY: Probably not.
Q: Has the White House responded to Mr. Bolton's attorney's urgent request that you at least review the chapter on Ukraine —
MS. CONWAY: It has nothing to do with me.
Q: — so that he can use it, if he's called as soon as next week to give evidence?
MS. CONWAY: Well, I'll tell you what the President of the United States is doing. In addition to eliminating from the face of the Earth dangerous terrorists; completing two trade deals; continuing to reshape the federal judiciary — we're close to 200 judges and we'll get there soon enough; keeping this unbelievable economy going — and that's why his approval rating is at its highest point ever in his presidency, according to some polls — including by your outlets, if not reported by your outlets; he is helping to bring the overdose death rate down and to improve the life expectancy.
He's focused on those types of things. He will go to Michigan today to — and I believe an auto manufacturing plant, and then to do Moines, Iowa. That's what he's doing. The idea that we should stop what we're doing to review somebody's book strikes me as not a big priority, in my view, for the President.
And so —
Q: He could be a key witness in the trial if witnesses are called next week.
MS. CONWAY: You would hope so, wouldn't you?
But anyway, I — again, "if," "if," "if," "if" — hypotheticals — I'm not answering that here.
Here's what I know to be real: Sixty-eight thousand Americans died last year of a drug overdose. That's why we're here, and I'm always happy to answer all of your questions as you full well know. But I got to stick to — I got to stick to reality and not hypotheticals and frankly — and, frankly, wishful thinking.
Q: Are you confident you have the votes, Kellyanne, to prevent witnesses? Are you confident you have the votes, Kellyanne?
Q: Admiral, can I ask you a question on a different health topic? The Pentagon announced this week that the number of victims — U.S. service members with traumatic brain injuries — went up to 50, from 34, from a dozen (inaudible) before that. The President said recently that he considers that to be not very serious injuries. You, as a health professional, do you agree with that assessment?
DIRECTOR CARROLL: I really can't comment. I really do not know any of the details of the traumatic brain injuries on the DOD side. We know that traumatic brain injury can be from mild to very serious. It really depends. And I just don't know what the DOD injuries are. I have not seen those.
MS. CONWAY: Last question?
Q: On the President's State of the Union address next week, obviously there's a big issue for you. You know, the issue of opioid abuse, opioid addiction, it's a priority for the President. Will he make this a part of the State of Union address next week?
MS. CONWAY: He will. And I'd have to go back and check for sure, but I think that'll make it the third consecutive year that he has. We've even had guests in the First Lady's box, like little baby Hope two years ago, who was adopted by a police officer and his wife in Arizona after said police officer saw this woman using drugs visibly pregnant. I think it was behind a shopping center. And he said to her, "You're hurting — you're hurting yourself and you're hurting your baby." And he and his wife adopted baby Hope.
They were in — also, I would just remind you that this is a huge part of the First Lady's BE BEST initiative and the work that she does. I think she has single handedly helped raise awareness and funding for NAS babies, neonatal abstinence syndrome.
And happy to report — while we're talking about a decline in overdose deaths, we also see a decline in some counties in the state of Maine and across Appalachia in the number of neonatal abstinence syndrome babies either being born or, in fact, getting into treatment right away.
While we're on the topic, I think what we're talking about today is really part of the President's overall healthcare vision, because he's done things like improve kidney health initiative, surprise medical billing, transparency. We're also going to be doing maternal mortality, which is way up in this country; the highest — one of the highest in developed countries, and increasing. We're working on rural care.
I don't think the country wants to have another protracted conversation or argument about health insurance. I think healthcare — we want to put the healthcare back in healthcare, which means improving health outcomes and preventing and curing disease. And that is precisely why we're here before you today. Thank you.
11:11 A.M. EST
Donald J. Trump, Press Briefing by Senior Counselor Kellyanne Conway, ONDCP Director Jim Carroll, and Assistant Secretary of Public Health ADM Brett Giroir Online by Gerhard Peters and John T. Woolley, The American Presidency Project https://www.presidency.ucsb.edu/node/335334