Six months into the US response to the Covid-19 pandemic, Dr. Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases, remains one of the most visible and steadfast defenders of science in an increasingly politicized environment.
On Thursday, Vox and Today, Explained host Sean Rameswaram spoke to Fauci about calling out Sen. Rand Paul at a Wednesday Senate hearing; his projections for when vaccines may be ready to distribute; his concerns about public mistrust in the vaccine approval process; and telling political appointees at the Centers for Disease Control and Prevention to “take a walk.” He also detailed who the real enemy is and what he would ask for if he could wave a magic wand right now.
“The public health response and the public health activities, in fact, have become politicized, which is so unfortunate,” he told Rameswaram.
The transcript has been edited for clarity and length.
The University of Washington’s Covid-19 model is now saying we may see nearly 400,000 deaths by the end of the year. Is that a realistic estimate?
We really have got to be careful because those are models. Models are based on the assumptions that you make to put into the model. Certainly if things go poorly — if, in fact, we do not get control and people do not cooperate in some of the public health measures — that could happen.
Hopefully, as we get toward the end of the year, we’ll know that we have a vaccine, or more than one vaccine, that’s safe and effective. So if we could start vaccinating at least the high-risk people, as well as the front-line responders, by the end of this calendar year and into 2021, we could prevent that surge that everyone is concerned about.
But we can’t just rely on a vaccine. We’ve got to rely on [people’s adherence] to the simple recommended public health measures, particularly mask-wearing when you’re inside and may not be able to keep the physical distance that we’d like to see.
What is the latest on a vaccine being available in the United States? What do you think the timeline is?
We don’t know. So when you hear people make projections, they are merely projections. The vaccines that are currently in advanced trials — the Pfizer, Moderna, and now the JNJ Janssen products — are in play. (A fourth [AstraZeneca] is on hold because of an adverse event that took place.)
They have anywhere from 30,000 to 60,000 people [enrolled] per trial. And given the enrollment and the number of infections, I would project ... that by the end of the year, let’s say November or December, we will know whether the vaccines, plural, are safe and effective.
It could be earlier. I mean, if there are enough infections in the trial and you could distinguish between the placebo and the vaccine limb of the trial, you may be able to make a determination early. But let’s assume that it’s November and December.
You could ask, what do you think the chances are of it being safe and effective? The first honest thing to say is that you don’t know. But based on the preliminary data that we’ve seen in animal studies, as well as in the phase 1 studies, the vaccines appear to induce a response that’s comparable to a good response to natural infection, which traditionally is always a good sign that you’re going in the right direction.
But the proof of the pudding is going to be the result of the [phase 3] trials. Now, if, in fact, it shows to be safe and effective and you start vaccinating people, you could do that as early as the end of this year.
We’ve taken a major financial risk of producing vaccines even before we know that they work, which means if they do work, you saved a lot of months. If they don’t work, the only thing you’ve lost is money. And right now, we feel that the investment is really worth the risk financially, because we want to do things as safely but as quickly as possible.
Once we have a vaccine in the United States, do we have a plan for how it will be distributed across the country?
Yes, yes. Traditionally, the final decision on that is with the CDC ... and they rely heavily on the advice of a committee called the Advisory Committee on Immunization Practices. With regard to Covid-19 vaccines, we’ve added an extra layer to that. The National Academy of Medicine is putting together a group of scientists, ethicists, and others to map out what we think is the most appropriate, fair, and ethical way to distribute vaccines in a greater fashion.
Traditionally, you start off vaccinating the health care providers and front-line individuals who are putting themselves at risk to take care of sick patients. The other [group] is those at high risk, such as the elderly, those who have underlying conditions and people like that. The final determination has not been made, but that will be coming very soon.
How worried are you about faith in the vaccine? Are you concerned that people might not trust a vaccine produced in this country?
I am very concerned about that. And that’s the reason why I’m right here talking with you. I’m trying to make sure that we can reach out to the community and explain the process,
Because when you look at the decisions about whether a vaccine is safe and effective — we spoke about this in detail at the Senate hearing yesterday that many people tuned in to — at least I gathered that from a lot of the tweets following that hearing ...
I thought you weren’t on Twitter?
I’m not. But my staff sends me these emails that say, you got to look at this.
The situation is that people need to understand that an independent body, the Data and Safety Monitoring Board [DSMB], is beholden to no one, not to the president, not to the vaccine companies, not to the FDA [Food and Drug Administration]. Not to me.
They are an independent group of established scientists, ethicists, and statisticians. They are the only ones that have access to the data because it’s a double-blind study. And a vaccine has a predetermined set of criteria to determine if it works or not. And the DSMB intermittently looks at that.
When they feel it’s reached that point, they will then notify the company. Then the company has the option, which they will certainly do, of presenting it to the FDA either for an emergency use authorization or directly for what we call a BLA, or a biological license application, which essentially is a license.
FDA scientists will look at that. Then they will consult with another advisory committee called the Vaccines and Related Biological Products Advisory Committee [VRBPAC], who are, again, advisory to the FDA. Those data will become public so that scientists like myself and my colleagues will have access.
Everybody’s worrying that someone is going to make an end run around that and try to get a vaccine out for political reasons. Well, that will not happen, but if it does ... it will be really transparent. Because the scientists will see the data.
The FDA has pledged publicly multiple times that they will not approve a vaccine unless they’ve established that nonpolitical scientists agree that it’s safe and effective. And we’ve got to keep getting that message out because it’s totally understandable giving the mixed messages that are coming out that the public might be skeptical about vaccines.
And if it turns out somebody tries to force it out, I tell you, I will be one of the first ones that will object to that.
So you’ll be out there saying this is not the vaccine we should trust?
Yeah, I would say that the process is not the right process to do this, and we really need to go back to the right process.
Are you worried about how this whole coronavirus pandemic has shaken faith in these institutions that previously had this sort of bulletproof reputation?
Institutions like the CDC.
Yes, that is unfortunate. There have been some unfortunate things that have happened. There have been people within agencies that have tried unsuccessfully to influence the CDC.
In one situation, not to mention any names, one of those individuals tried to influence what I said, which is really a fool’s errand, because I essentially told them to go take a walk. Those people are not there anymore.
I can tell you, quite frankly, that I have been in intensive discussions with the director of the CDC and the director of FDA and I really, truly believe that you can trust them. And besides the core people, the career scientists at the CDC and the FDA — they do this for a living. They are apolitical and completely devoted to the health of our nation. And those are the people that will speak out.
"You misconstrued that, Senator. And you've done that repetitively in the past." -- Fauci is out of patience with Rand Paul pic.twitter.com/6xRoO19ZYL— Aaron Rupar (@atrupar) September 23, 2020
Your Wednesday appearance before the Senate sort of blew up on Twitter. Was it that people finally saw you lose your patience with Sen. Rand Paul? I know from watching you over the past six or seven months how hard you’ve tried to remain above the political fray. And I wonder, six, seven months into it, isn’t it wearing on you?
Well, the answer is it is certainly possible, and I have been doing this not only over the last six months, but, like, for 40 years.
I do have a great deal of respect for the institution of the Senate, and I do have respect for Sen. Rand Paul. But he was saying things that were not true. And, well, I just couldn’t let that stand because there we were on national TV with a lot of cameras. And I just had to call him on that.
I think people are giving him information. It is what’s called cherry-picking information out there. He was saying things that were not compatible with the scientific data. So what the audience saw me do was say, “Whoa, wait a minute, time out. You really can’t say that.”
I wasn’t disrespectful at all. I think I was quite respectful. But it isn’t a question of politics because he was saying what he thought was the right thing. And I disagreed with that.
Is it impossible to remain above the politics when this pandemic has been so politicized?
We’re in a highly charged political season with big-time, high-stakes elections. The public health response and the public health activities, in fact, have become politicized, which is so unfortunate. We’ve lost sight of the fact that the bad guy here is the virus. The bad guy is not one side or the other.
Public health measures should be the gateway and the vehicle to getting the country’s economy back and opening up the country. And yet there are some who interpret that as an obstacle. It isn’t the obstacle. It’s the solution.
So we’ve got to keep hammering that message home: We’re all in this together. And when you have some groups of society who make it a political issue, it makes it very complicated to get a uniform, consistent approach in our country.
If you could wave a magic wand over the United States and change one thing tomorrow to improve the trajectory of this pandemic, what would it be?
I think apart from a vaccine, which we’ll have to wait a few months for, if I were to wave a wand now, it would be to get the entire country uniformly pulling together in a public health way to get these cases down. A couple of days after 9/11, we didn’t have any political arguing about what we needed to do, or, you know, December 1941 after Pearl Harbor. Everybody was in it together.
That’s really what we’re dealing with. I don’t want to get too melodramatic, but we are at war with a virus. We are not at war with each other. So my magic wand would be ... a spirit of pulling together.