Dr. Anthony Fauci Interview Transcript September 8

Derek: (00:00) With that then I'm going to turn it over to Judy. Thank you very much. Judy: (00:06) Thank you Derek. I'm very glad to be here and to have this opportunity to talk to Dr. Fauci under the auspices of Research America. So thank you for having me, and Dr. Fauci, you're there so I'm going to plunge right in. I don't see you yet on the screen, but I know you're there. Dr. Fauci: (00:23) I'm here Judy. Good to be with you. Judy: (00:24) You're there. Okay. Let's just start with the basics. Where are we right now as a country in the battle against COVID-19? If you were asked for a status report, what would you say? Dr. Fauci: (00:39) I would say it's a mixed bag Judy. I mean, obviously if you look at the numbers, they are very serious and very concerning. We've had now over 185,000 deaths, six plus million infections. If you look at the country, a large heterogeneous country, there are some areas that are doing really very well right now, particularly those that got hit badly early on. For example, the New York City metropolitan area, has for at least a month now, been less than 1% test positivity. In contrast, in other parts of the country, particularly what we saw in some of the Southern states that had big surges when they tried to open up the economy, that brought our baseline number of daily infections up from 20,000 a day up to as high as 70,000. We're back down now to between 30 and 40,000, and just as those states are starting to level off and come down, which is a really good sign, we're starting to see the beginning of surges in place like Montana, the Dakotas, Michigan, Minnesota, Iowa. Dr. Fauci: (01:53) So it's really a mixed bag Judy. Some areas are doing really well and some are still threatening to have surges. So it's not an easy situation for us. Judy: (02:05) So if someone were to say, "We're rounding the final curve on this," what would you say? Dr. Fauci: (02:10) Well, it depends if you pick the location of the country and saying that it could be true, but if you look at the country as a whole, we need to be doing much better than we're doing. That's for sure. Judy: (02:23) This month, Dr. Fauci, as you know, this is on the mind of so many families, students returning to school. People are worried about their children, and I want to start by asking you about colleges, because there's been a lot of focus on those. You advised last week that schools not send students back home if they test positive. What are you concerned about with colleges? Why did you make that recommendation? Dr. Fauci: (02:49) Well, Judy, I made that recommendation because when you bring in college and university students in, if they get infected, you really should try as best as you can have to have a capability, a facility, to sequester them from the rest of the student body so they don't infect other students. But you shouldn't send them home because if you send them home, I mean, just the nature of universities and colleges, you're getting kids from all over the country. If you send them back to their community, you will, in essence, be reseeding with individuals who are capable of transmitting infection, many communities throughout the country. So it's much, much better to have the capability to put them in a place where they could comfortably recover. Hopefully that could be a floor of a dorm or some colleges are doing an entire dorm that's dedicated to people who you want to segregate from the rest of the student body. Judy: (03:50) All in all, how are American colleges and university [inaudible 00:03:54] handling this? Dr. Fauci: (03:56) Well, they're handling it in different ways. Some are going virtual and online completely, but several that I've had the opportunity to speak with are doing testing on everybody that comes in to the campus the first time once, to start off with a baseline that's essentially zero. And then do two surveillance testing at various intervals. The ones who were doing that, and who have the capability of handling students who ultimately get infected, seemed to be successfully being able to open. Unfortunately, some colleges don't have that capability of being able to sequester people and they are tending much more to doing virtual or online teaching. Judy: (04:43) What about in the public schools? K through 12? What is your concern there? How worried should parents be right now? Dr. Fauci: (04:52) Well, in contrast to what I just mentioned regarding colleges and universities where young people are coming in from all parts of the country, when you're dealing with K through 12, it's a local issue. So being a local issue, what I and others have said, and I think it's prudent to take this approach, is that since in this country, we have green, yellow, and red zones, where in the green zone, there's very little infection activity, I think that in those cases you can open up the schools in real person to person teaching with relative impunity so long as you are able to identify students who get infected and make the appropriate accommodations for them. When you get into the yellow zone and you have a degree of infection in the community, you've got to be able to adjust and adapt to that. You've got to be prepared. You look at the CDC guidelines, but you might want to modify your schedule. Morning versus afternoon, every other day, separating of the desks, if physically you can do that. Dr. Fauci: (05:59) And then finally, if you're in the red zone, you really better be very careful before you bring the children back because you don't want to create a situation where you have a hyper-spreading event, as you might have in the school. Judy: (06:13) Let's turn to the big question, the vaccine. As you know, there's a lot of speculation about when we're going to have a safe and effective vaccine that's available to everyone who needs it. What do you know about it right now? Dr. Fauci: (06:27) Well, right now there are six or seven candidates that the US government is helping to facilitate either by developing with them, or by pre-purchasing of doses, or allowing our clinical trial network to be available to them. Three of those candidates are already in phase three trial which means you're going to enroll tens of thousands of people, volunteers, to determine if it's safe and effective. The phase three trials that got started, the first two got started on July 27th. It's a prime and a boost dose. You prime and then 28 days later you give a boost. Right now, the trials are about two thirds enrolled. We project that by the end of September, they will be fully enrolled. Then you add another month, a month and a half to get that second dose. So that's the reason why I have been projecting Judy, that by the end of the year, by November or December, we will know whether we have a safe and effective vaccine. Dr. Fauci: (07:34) I feel cautiously optimistic that we will given the preliminary data that we've seen. And then there are a couple of other vaccines that are going to go into phase three trial at the end of September and then October. So sequentially, you have a lot of the candidates in play, which really is the reason why we're optimistic that we will be successful with one or more, and that will likely start taking place by the end of the calendar year 2020. Judy: (08:03) But the idea that- Dr. Fauci: (08:03) ... end of the calendar year 2020. Judy: (08:03) But the idea that we're going to have a vaccine by November 3rd, how realistic? Dr. Fauci: (08:09) Well, I think that's unlikely. I mean, the only way you can see that scenario come true is if that there are so many infections in the clinical trial sites that you get a efficacy answer sooner than you would have projected. Like I said, it's not impossible, Judy, but it's unlikely that we'll have a definitive answer at that time. More likely by the end of the year. Judy: (08:37) We know with regard to the public's confidence in the vaccine, Dr. Fauci, polls are showing that perhaps a third of Americans are not confident enough and they're saying, they're not going to take the vaccine at first. That's a pretty high percentage. At what point does this become a problem? Dr. Fauci: (08:58) Well, I think it already is a looming problem. One of the ways that we can mitigate against that, Judy, is by being very transparent in our outreach to the community about what the data are, what they show, and what criteria that we're using in order to make a decision about the vaccine being safe and effective and making it available. Dr. Fauci: (09:23) We've got to regain the trust of the community about, when we say something is safe and effective, they can be confident that it is safe and effective. That's the reason why we have to be very transparent with the data, as well as, what it is that goes into the decision making process about approving a vaccine. Judy: (09:44) Are we on track to do that right now? To be transparent? In your opinion. Dr. Fauci: (09:50) Yeah. We are Judy, one of the things that I think we need to do better on, we've got to get a higher percentage of minorities into the clinical trial so that when we get the data, we can say that it applies equally to the minority communities. African-American, Latinx, native Americans and others because we want to make sure that when we say that something is safe and effective, we mean it's safe and effective for everyone. That we need to do a little bit better on. Judy: (10:25) Come the fall, with the onset of flu season, Dr. Fauci, you and others have raised concerns about the convergence of the flu.And COVID, we've seen in the Southern hemisphere, somewhat milder flu outbreaks than there might've been. Does that give you more hope for the fall here or not? Dr. Fauci: (10:49) Well, it does. I mean, I never take anything for granted, Judy. That's dangerous, at least particularly when you're dealing with public health. So one of the things we could say is that we continue to encourage people to get vaccinated with the influenza vaccine. But if what happened in the Southern hemisphere happens here, that would be a very good and favorable thing. Dr. Fauci: (11:12) So what we think has happened, we think because people have done public health measures to avoid infection with the coronavirus, namely masks, distancing, avoiding crowds, washing hands, we've had the secondary effect that there are less influenza infections. In fact, in Australia this year for their influenza season, which goes from April to September, they've had one of the lowest rates of influenza infection in memory. So if we can do that, I think that would be very favorable. Judy: (11:53) What do you know about the coexistence, if that's the right word, of flu and COVID, that is the concern? What exactly, what is it about having the two, or being exposed to the two that's a concern? Dr. Fauci: (12:07) Well, there are several issues. Number one, it's the winter time. So when you have winter and indoors, you can expect an uptick of any type of respiratory illnesses. If we do have a full blown flu season, which I hope we don't, and we do not get control over the coronavirus, you could have several challenges. One is differentiating between COVID and flu because they're are medications for flu and we're getting more and more medications for COVID. Dr. Fauci: (12:43) Number two, we wouldn't want to see an overwhelming of the healthcare delivery system, for example, hospital beds and intensive care unit beds, and even healthcare personnel. That would be really a very serious issue if we begin to see any overwhelming of that. That's the reason why, when you have two coexisting infections during the winter months, it becomes problematic. Judy: (13:11) Do you already know Dr. Fauci, how effective the flu vaccine will be this year? Or do you just have to watch that play out? Dr. Fauci: (13:18) No, you definitely have to watch that play out. You don't know from year to year how effective it's going to be. Judy: (13:26) Is there a sufficient supply of the flu vaccine? There's been so much focus on COVID. Dr. Fauci: (13:30) Oh, yes. I mean, we have been vaccinating more and more people with the influenza vaccine as the years go by. Like last year, I believe it was something like 170 million doses were distributed. We want to do at least that amount and hopefully more this year. Judy: (13:49) Do you have concern about the public's reluctance to have the flu vaccine this year simply because COVID is out there and there's just worry, apprehension, about any kind of vaccine. Dr. Fauci: (14:02) Well, Judy, obviously that's something that bothers me continually, is the people who have reluctance to get vaccinated, particularly when you know a vaccine would be of such considerable benefit. You know, we have to fight the classic anti-vax group. Whenever there's any doubt in anybody's mind about the efficacy or the safety, which is what we're seeing with COVID, then you've got to do an extra special effort to engage the community and outreach to them, to give them the data that they can make an informed decision. Judy: (14:37) You mentioned a moment ago, Dr. Fauci, that you want to make sure, of course, that racial minorities are addressed in, whether it's the manufacturer or the distribution of the COVID vaccine. How do you do that? I mean, how do you actually go about making sure that this is distributed equitably? Dr. Fauci: (15:04) Well, again, it's all community outreach and we've done that back in the day with HIV, with prevention and treatment measures. You've got to engage the community, both getting the appropriate demographic groups involved in the clinical trial. So you prove that it's safe and effective in them. Dr. Fauci: (15:25) Then once you do that, you engage the community in an active way. That's with PSAs, that's with getting out into the community, yourself, boots on the ground, speaking to people, getting them involved. It is not an easy process, but it is definitely worthwhile. Judy: (15:43) Are there strategies in place to do that right now? Dr. Fauci: (15:46) Oh, absolutely. In fact, we've been planning for this for a few months right now. Yes. Judy: (15:52) And so that's underway. I also want to ask you Dr. Fauci, this is Research America. I want to ask you about the effect that COVID has had on other health threats, and frankly ... Judy: (16:03) Has had on other health threats, and frankly, on our research infrastructure in this country. Dr. Fauci: (16:08) Judy, unfortunately, it's been disruptive across the board, not only in the United States, but globally, because of the shutdown and the divergence of resources and attention away from other diseases and to COVID. For example, the typical type of screening for things that you need to pay attention to, screening for breast cancer, screening for prostate cancer, getting people following up on things that were suggestive of an issue, but you were asked to come and follow up. When the followup is delayed by months, you can wind up getting into a situation where diseases that have nothing to do with COVID, diseases of different types, infection, cancer, autoimmune, inflammatory, they might get neglected, and routine checkups that you would need tend to get neglected. We know in the HIV community, the disruption of services and the disruption of availability of drugs can actually really be a problem. Bottom line is it's quite disruptive and has deleterious effects on how we handle other diseases. Judy: (17:25) Is there already evidence that that's happened? Dr. Fauci: (17:28) Oh, absolutely. You're starting to see upticks and things that you would not have had if you had the appropriate screening and the appropriate followup. Judy: (17:37) And how important is it, and maybe this is a self-answering question. We know there's been a holdup in congressional funding on some of what we're talking about. How important is it that that funding continue? Dr. Fauci: (17:51) Yeah, it's extremely important. We, fortunately, being a health science-based institution have been treated with a considerable degree of generosity by the Congress. They have given us the kinds of funds that we need to be able to do our duty and our mandate with regard, particularly, to COVID. Judy: (18:15) I know you're not involved in the direct or maybe you are, in lobbying for funds, but is it your sense that that funding is going to be forthcoming that's necessary to bolster the research infrastructure? Dr. Fauci: (18:29) Yes. We have gotten a considerable amount already and we have not been disappointed every time that we have asked, and they do. They ask us what it is that we actually need. We give them an honest assessment of our needs, and thus far, they have been met. Judy: (18:46) How do you, Dr. Fauci ... People talk about pandemic fatigue, if you will. We've been at this, the country's been at this now for more than six months. How do you ensure that the American people stay vigilant, stay mindful of this? Because the numbers are mind-numbing. We're at 190,000 Americans dead. We're, as you know, millions have been infected. The numbers just keep coming at us. People are still gathering, sometimes wearing masks, sometimes not. How do you keep people vigilant? Dr. Fauci: (19:27) Well, you've got to keep reminding them of the importance of being vigilant. It is clearly a risk when you've been exhaustingly involved in something now for eight months. One of the things that I do, and I believe it can be effective, is to remind people that there will be an end to this. We will end this crisis that we are in right now, both from a public health standpoint and from a scientific standpoint, for example, with vaccines and treatments. When people know there's an end in sight, they can hang on a bit longer. It's when they throw their hands up in exasperation and say, "This is never going to end, and so to heck with it. Why don't we just get on with our lives and do what we want to do?" That can be a very dangerous conclusion to arrive at because it leads to carelessness and even more infections and the propagation of the pandemic. But when people see that if they just hang in there a little bit more, we will come to a natural end to this, and that's what I try to emphasize to people when I speak. Judy: (20:42) What do you worry most about at this point? Is it the vaccine? Is it something else? Dr. Fauci: (20:47) I don't worry about it, Judy, but I'm cautiously optimistic that we will get a vaccine. I think we will not really return with ease to a degree of normality that we all seek until we do get a safe and effective vaccine. And as I mentioned, I believe we will have that by the end of this year, the beginning of next calendar year, 2021. So let's hope that I'm correct, and it will be available. And I think that's going to really be a game changer for us. Judy: (21:19) I'm looking at a couple of audience questions, Dr. Fauci. One of them is, if there's a choice of vaccines for people to have access to, and I don't know if, is that possible, that there will be several vaccines available to people? Will people be able to make a decision about which one to choose? Dr. Fauci: (21:41) I think it's eminently possible, if not likely, Judy, that we will have more than one candidate. Like I mentioned, there are six or seven that we ourselves in the United States are directly or indirectly involved with. That's not even counting the vaccines that are being made by countries like Russia and China and the UK and others. I would be surprised if we only had one vaccine. I think there are going to be more than one that are going to be available. Judy: (22:08) How do people make the decision about which one is the right one for them? Dr. Fauci: (22:14) The companies are going to be advertising as to what the specifics and the specifications of their product. I think it's going to be more or less, Judy, something less sophisticated than this one happens to be available in the supply place where you're getting your vaccines, as opposed to you pick the one you want. It may be, if a certain pharmacy chain buys out and they become the ones that distribute it, fine, or if there's another mechanism of distribution that the government is more deeply involved with, then that's the one you're going to get. I don't think you're going to be able to pick and choose like you would in a candy store. Judy: (22:55) And coming back to a question I know you've been asked a lot, but in terms of political influence, rushing a vaccine. How can you reassure Americans that there won't be a political thumb on the scale? Dr. Fauci: (23:10) Because there are several issues that I think will mitigate against that. The data, as they come in, go to an independent data and safety monitoring board who then make the recommendations as to whether or not the vaccine is effective or not, whether it's harmful or not. And then when that data is available, it would ultimately become public. The FDA has publicly promised that they would not allow political considerations to get involved in their decision. And in addition, when they do make a decision, they get input from an outside advisory group called VERPAC, who will be involved in looking at the data and making recommendations about a decision, so there are going to be a couple of levels of control of that decision. Judy: (24:00) You mentioned the FDA, Dr. Fauci, and I know we only have a few minutes- Judy: (24:03) You mentioned the FDA, Dr. Fauci, and I know we only have a few minutes left, but it was the FDA that rolled out original information about the so-called convalescent plasma, where they came back and said later that it had been overstated. When you have something like that happen, isn't it natural that people may be skeptical? Dr. Fauci: (24:23) Oh, you're right. Judy, I don't want to deny that that's reality, they likely will be skeptical. What we're trying to do now is correct that, and get them to understand there're going to be multiple layers of checkpoints before this type of decision is made. And there are a lot of people looking at this, Judy, a lot of people in the scientific community, myself included, who are looking at this to try and make sure it gets done in a way that's scientifically sound. Judy: (24:49) And I should say not just the FDA, but there've been some back and forth, if you will, at the CDC where there's been guidance, and then it's been pulled back and questions raised. I have to ask the question again, how can the American people be sure they're getting straight science from these government agencies? Dr. Fauci: (25:10) Again, it's not going to be easy given what's gone on before. We just have to keep being quite transparent. I have been, right from the beginning, always quite clear in how I feel about the importance of the integrity of the science and the integrity of the decision-making process. And I, and many of my scientific colleagues will continue to be very vigilant about that. Judy: (25:38) Someone asks, just before we wrap up, Dr. Fauci, I mentioned convalescent plasma and the original recommendation from the FDA. It was reported in the New York Times that at NIH they did not support that recommendation. Can you shed any light on what happened inside the administration, the government? Dr. Fauci: (25:59) Well, yeah, I mean, we looked at the data and it wasn't really very clear-cut whether or not this was effective, but the rules for EUA are really quite loose in the sense of being able to say there has to be a chance of efficacy. So, there was a bit of a ... with discussion back and forth about how tight those data were to indicate that. At the end of the day, Judy, when the randomized placebo-controlled trials come out with the results, we're going to know what the right answer was. Judy: (26:29) And finally, Dr. Fauci, I know we just have a couple of minutes, when we think about Americans who are going to most need a vaccine first, clearly frontline workers, people with compromised immune systems, perhaps the elderly, how do you think about that? And, is that all decided right now about what groups of Americans need to get the vaccine first? Dr. Fauci: (26:56) Yeah, I mean, that is decided by an advisory committee on immunization practices, which reports to the CDC. Ultimately, the CDC is involved in the finer responsibility of distribution. This year, the National Academy of Medicine, whose recommendations I think came out literally a day or two ago, is called in to complement that decision-making process. Dr. Fauci: (27:23) And as you said, I think you called it correctly, it's not unexpected that frontline workers, healthcare workers are those who get it first, those with essential jobs, those who would benefit most, namely those with underlying conditions, including the elderly. So, it looks like it's going to play out that way with the COVID vaccine. Judy: (27:44) Any final message you want to give to this community, Dr. Fauci? Dr. Fauci: (27:49) Judy, it's what I said before, to really essentially get people through the frustration of having been in this for so many months, that we need to hang in there together. This will end, and it will end even sooner if we continue to go by the public health measures that have been recommended time and again for so many months. Judy: (28:16) Dr. Fauci, thank you so much. I'm going to turn the program back over to Derek. Thank you. Dr. Fauci: (28:21) Thank you, Judy. Good to be with you, as always. Derek: (28:23) Thank you, Dr. Fauci, thank you, Judy. This morning, we had a survey where people were asked, "What's the most important thing that will lead to success in the advancement of science?" And trust in science was what far and away came through as the most selected answer, and the two of you with your work today and throughout the last several months, and of course, many years for you, Dr. Fauci, are doing just that, so thank you very, very much. Dr. Fauci: (28:47) Thank you. Judy: (28:47) Thank you very much. Derek: (28:51) Speaking of inspirational visionary leaders, we return now to the format of the 20/3/1 segments, this time featuring ... We have three segments in a row, the first one featuring Congresswoman Nita Lowey, and then former Senate Majority Leader, Dr. William Frist, and then finally, internationally-known vaccinologist, Dr. Peter Hotez from Baylor College of Medicine. Congresswoman Nita Lowey: (29:26) As a member of the committee that funds medical research for my entire career, I remember touring a research lab with a young Francis Collins, as he told me his plans to map the human genome. It seemed like science fiction then, but he achieved it. And because of that breakthrough, we are understanding causes and treatments to genetic conditions that allow so many Americans to lead longer, healthier, more-