Less than three weeks into the new Biden administration, Dr. Anthony Fauci, the infectious disease expert who’s headed up the National Institute of Allergy and Infectious Diseases since 1984, is encouraged by the new president’s approach to the COVID-19 pandemic.
“It was very clear what President Biden wanted … and that is that science was going to rule,” Fauci says. “That we were going to base whatever we do, our recommendations or guidelines … on sound scientific evidence and sound scientific data.”
But there was something else that Biden promised, which Fauci found equally reassuring: “He said, ‘We’re going to make some mistakes along the way. We’re going to stumble a bit. And when that happens, we’re not going to blame anybody. We’re just going to fix it.’ “
“Boy, was that refreshing,” Fauci says.
Fauci has worked with seven presidents, from Reagan to Biden. Much of his career has been devoted to researching viruses and the immune system. During the AIDS epidemic, he made major contributions to the understanding of how HIV affects the immune system and was instrumental in developing drugs that could prolong the lives of people with HIV.
During the COVID-19 pandemic, Fauci became something of a medical celebrity as a member of the former administration’s coronavirus task force who publicly disagreed with then President Donald Trump about COVID-19 treatment, the value of masks and about the timeline for reopening. In return, Trump called Fauci an “idiot” and tweeted about firing him.
“What I think happened is that the [Trump] White House, in general — the president — was looking for people who were saying things that were compatible with what his feeling was about, where he wanted to go,” Fauci says.
Looking ahead, Fauci says the pandemic is far from over — especially as the virus mutates and new strains emerge. He says controlling the spread of the virus will help tamp down mutations. The key is to vaccinate “as many people as quickly and as efficiently as you possibly can” and “to double down on the public health measures of uniform wearing of masks, physical distancing, avoiding congregate settings — particularly indoors.”
Fauci notes that any vaccination efforts should address the needs of the larger global population.
“You’ve got to be able to get — with the help of the developed world — the entire world vaccinated,” he says. “As we allow this infection to exist to any degree in any part of the world, it will always be a threat. So we’ve got to approach this the way we approach smallpox, the way we approach polio, and the way we approach measles and other devastating global outbreaks.”
On the major new mutations in the coronavirus and how that affects our strategy to fight it
I think people need to understand something that’s very important: RNA viruses — SARS-CoV-2 is an RNA virus — will mutate, and the more the virus replicates, the more opportunity you give it to mutate. So when you have so much infection in the community, as we have had in the United States over the last few months, where you literally have hundreds of thousands of new infections per day — we were up to between 300,000 to 400,000 [cases] a day. We’re down now between 100,000 to 200,000 per day. But we still have 3,000 to 4,000 deaths per day. That means the virus has almost an open playing field to replicate, [which] means you give it an opportunity to mutate.
So even though this is a challenge, we should not be set back by this. We can meet the challenge and you meet the challenge by first getting a handle on the degree of mutations by doing good genomic surveillance, No. 1., but No. 2., by doing whatever you can to prevent the replication of the virus — by vaccinating as many people as quickly and as efficiently as you possibly can.
And also to double down on the public health measures of uniform wearing of masks, physical distancing, avoiding congregate settings, particularly indoors.
One of the things that we do know is that the vaccines that we have, although they are less effective in preventing disease, … when you look at serious disease with hospitalizations and deaths, the vaccines still have a pretty important, positive effect even on the mutants.
But we don’t want to get confident about that. We’ve got to be able to match future vaccines and upgrade them to be able to be directed specifically at these troublesome mutants that have evolved.
On the misleading idea that a good way to conquer COVID-19 might be to simply let more people get infected, and gain immunity that way
[Trump] wanted to focus on things other than the pandemic. So anyone who would come in like [coronavirus adviser] Dr. [Scott] Atlas and say, “Just let people get infected, you’ll get herd immunity and everything will be fine,” was a welcome strategy or a welcome philosophy.
But as it turns out — and we know right now very clearly — that that was an incorrect strategy, if you actually pursued a strategy of “don’t try and intervene. Don’t wear a mask. Don’t worry about congregate settings, just let the virus take its course and try and protect the vulnerable.” … We cannot effectively protect the vulnerable [that way], because they were such an important part of our population.
So if you look at the number of people right now who have died, it’s close to 450,000 people. And if you look at the seroprevalence in the country — how many people already will have gotten infected — there are certain areas where it’s high, 20-plus%. But as an average for the country, it’s probably somewhere less than 20%, which means that if you wanted to get the 70 or 85% of the people that need to be infected to give you herd immunity, a lot more people will have died. We’ve already had 430,000 [to] 450,000 people who have died, and we aren’t even anywhere close to herd immunity.
On the origin of the FDA’s “emergency use authorization,” which has been used to speed COVID-19 vaccines to market
To get a drug out as quickly as you possibly can, based on the fact that the benefit looks like it was better than the risk, and you didn’t have to fully show efficacy yet; originated way back during the years of HIV. Compassionate use of a drug — even before you get an emergency use authorization — originated way back in the days of HIV, because we didn’t have compassionate use to any great extent until we got into the situation with HIV in the early and mid 1980s. So there’s a very good connection between some of the things that we’re doing now with interventions for COVID-19 that actually originated way back when we were doing HIV in it’s very early years.
On two things he learned from the AIDS epidemic that he’s applying to the COVID-19 pandemic now
One of them is the importance of getting the community involved and dealing with the community and their special needs. … We have a disparity here that is striking and needs to be addressed — that if you look at the incidence of infection and the incidence of serious disease, including hospitalization and deaths, brown and Black people suffer disproportionately more than whites. …
So I think that shines a bright light on what we probably should have done all along and certainly must do in the future, is to address those social determinants of health that actually lead to the great disparity of suffering in COVID-19 among brown and Black people. We had the same sort of thing with the disparities of infection in certain demographic groups with HIV. So from an epidemiological standpoint, there were similarities there.
We also learned the importance of fundamental basic science in getting solutions. … Back in the early days, getting infected with HIV was a virtual death sentence for the overwhelming majority. … It was the fundamental basic science of targeted drug development that allowed us to develop combinations of drugs — first single drugs and then a couple at a time, and then triple and more combinations of drugs — that ultimately completely transformed the lives of people living with HIV, to the point where you went from a virtual death sentence to being able to lead essentially a normal life, as well as not infecting anybody else. …
We know now that something we’ve called “treatment as prevention” [works] — which means if you treat someone who’s living with HIV and suppressed the level of virus to below detectable, you make it essentially impossible for that person to infect someone else. So we got there through basic science.
On being vilified by AIDS activists early on in the AIDS crisis, who believed the government should expand access to experimental medicines, and how that compares to being vilified during the COVID-19 pandemic by people who are anti-science and anti-mask
That really is a stark contrast. The [AIDS] activists were justified in their concerns that the government (even though they weren’t doing it deliberately) were not actually giving them a seat at the table to be able to have their own input into things that would ultimately affect their lives. So, even though they were very theatrical, they were very iconoclastic, they seemed like they were threatening, … never for a single moment did I ever feel myself threatened by the AIDS activist.
In fact, one particular situation, I think, was very telling. At a time when there was a lot of pushback against the government and not listening to the valid concerns of the activists, I was invited to go down — and I went with just one of my staff at the time — to go down essentially alone to the gay and lesbian community center in the middle of Greenwich Village to meet with what must have been anywhere from 50 to 100 activists in this meeting room. Just me and one of my staff. And they were angry with the federal government because they felt the federal government was not listening to them, and they were right — I think they had a really good point.
Not for a second, did I feel physically threatened to go down there, not even close. I mean, that’s not the nature of what the protest was. And I think one of the things about it was that not only were they not threatening at all in a violent way, but ultimately they were [also] on the right side of history.
On his early research into the AIDS epidemic, visiting gay bathhouses to gain a better understanding of the then-mysterious outbreak that was killing gay men
This was the very, very early years of the outbreak. In fact, it may even have been before we even discovered that HIV was the cause. And we were seeing these large numbers of mostly gay men who were formerly otherwise well, who were being devastated by this terrible, mysterious disease. And it was so concentrated in the gay community that I really wanted to get a feel for what was going on there that would lead to this explosion of a sexually transmitted disease. So I did. I went to the Castro district [of San Francisco]. I went down to Greenwich Village and I went into the bathhouses to essentially see what was going on.
And the epidemiologist in me went, “Oh, my goodness, this is a perfect setup for an explosion of a sexually transmitted disease!” And the same thing going to the gay bars and seeing what was going on. And it gave me a great insight into the explosiveness of the outbreak of a sexually transmitted disease. So I think it was important, because it gave me a really on-the-ground feel for what was actually dynamically going on.
On whether COVID-19 will be with us forever like influenza
I don’t think we need to make that assumption. That certainly is a possibility — that you would have enough virus floating around and changing from year to year, that you would have to treat it in some respects, the way we treat seasonal influenza, where you have to upgrade the vaccine almost every year.
There is a way, if done properly, to avoid that, and that is, for example, if we successfully vaccinate 70 to 85% of the people in the United States and dramatically diminish the level of infection — if we were living in a vacuum in only the United States, then I don’t think we’d have to worry about seasonal turnover and having to match. But we live in a global community, and unless we get the rest of the world adequately vaccinated, and unless we don’t have the opportunity of this virus to mutate in a place that doesn’t have access to vaccines, we will always be threatened.
Fresh Air’s interview with Dr. Fauci was recorded as part of a WHYY Zoom event at which Fauci accepted WHYY’s annual Lifelong Learning Award. Sam Briger and Seth Kelley produced and edited this interview for broadcast. Bridget Bentz, Molly Seavy-Nesper and Deborah Franklin adapted it for the Web.