¹National Institute of Allergy and Infectious Diseases Director Dr. Anthony Fauci participated in a discussion at Washington National Cathedral on the fall spike in COVID cases, the overall coronavirus response and the promise of a vaccine by the end of the year. Fauci discussed the politicization of science and the need to continue to reach out to people to convince them to vaccinate while at the same time keeping up other public health measures like wearing a mask and social distancing. Fauci also talked about strengthening the Global Health Security Network to help in managing global pandemics.

Dr. Anthony Fauci: My job as the director of the NAH Institute and as a public health official is to focus entirely on what my mission and goal is, to use science and health to preserve the health, safety, and welfare of the American people regardless of what the administration is. You know, and many people know, that I have had the privilege of serving six presidents since I became director of the NIAID in 1984. That is what we focus on as scientists. I know we are living in a charged political environment, but that is not primary for us. We continue to do our job to foster public health, but also to do the science that leads to the things like the vaccine. . . . That is what I focus on. When you hear those things in the newspapers, many people think I get shook back and forth by that. To be honest with you, I don’t.

[The politicization of science] is what we have seen a lot in the United States, but not just restricted to the United States, because we are also seeing it with my colleagues in the U.K. and in Europe and in other regions of the world. I don’t think there is a simple explanation for it, but I think there has been an anti-authority component to this. We had anti-vax, people don’t like to be told to be vaccinated. Scientists are often perceived as authoritarian. And sometimes they made that perception themselves by the way they act also. I think we can improve on that. But right now it has been just lumped into the politics of what is going on. We live in a divisive society, and even if we didn’t have a pandemic, it would be a divisive society. And the fact that we do have a pandemic, and a pandemic is a public health issue and public health is intimately related to science, . . . all of a sudden science gets caught in a lot of this divisiveness. That is unfortunate. What we as the scientists hope . . . that when we get past this, science will resume its rightful place in being something that is for everyone without divisions. . . .

When we get out of the charged nature of the stress and strain put upon us by an outbreak, people will realize the importance of science. Data speaks for itself. We are in a very difficult situation. It is quite problematic. I have said that many times not to scare people, but to bring a reality check to where we are. If you look at it, we have 10 million infections in the United States, almost 250,000 deaths. We have had 60,000 hospitalizations. Now last count we had 143,000 infections in a single day. When I testified—143,000 infections in a single day. When I testified before Congress, people thought I was being hyperbolic. Now look what is happening. That is the bad news. I think . . . the encouraging news that people need to understand, public health measures—not knocked out of the country, but public health measures that are simple and easy to understand, the universal [mask] wearing, physical distancing, avoiding crowded places, outdoors better than indoors, washing hands, it sounds simple in the context of this ominous outbreak, but it can turn it around, and that is what we need to do.

I wouldn’t say [the country’s response] is horribly wrong. I think what we have not done, and it is not just the United States—if you look at what is going on in Europe and the U.K. now, they are, in many respects, in the same boat as we are with major surges. But when you look at what happened in our own country, we did not act in a unified way. I always say one of the wonderful things about our country, that I love so much, is that we are the United States of America. And we are a federalist country, and we have states that are independent, and . . . in some respects [it is] important that they are that way. However, when you are dealing with an infectious disease, the infectious disease does not know the difference of the border between Mississippi and Louisiana, or between Florida and Georgia and South Carolina. An infectious disease means the entire country. We did not approach it that way. We had too much individual approaches towards how we are going to handle the outbreak. Our baseline never came down to the local level that we wanted it to be, so when community spread came in as we tried to open the country, it just soared right out. It is a self-propagating issue because the more community spread we get, the more difficult it is to contain it by identification, isolation, and contact tracing, because there is so much of it going on that it becomes very difficult. That is the problem we are in right now. We have an enormous amount of community spread.

Models are as good as the assumption we put into the model. I have been one to challenge models—not challenge the validity of the modeling process, but to challenge the assumptions that are put into it. If we all literally pushed together as a group and did it in a uniform way, we do not necessarily need to see the 1,000 to 1,300 desperate day. We don’t need to see the 140,000 infections per day. We can turn it around. If we stay the way we are, you do the civil math. 1,000 deaths a day and 140,000 cases a day. You multiply it by 31 days in December, two weeks left in November. By the time you get to January 1, we have a really bad situation. So what I am saying as a public health official, and as my colleagues say, we don’t need to accept that. I want to make one point that is important. . . . One of the things about a vaccine which is really important, not only in and of itself as being a tool that is essential to end this outbreak. When people know that help is on the way—and what I mean by help is on the way is we will start giving vaccines in December, and then as we get into January, February, March, we get the prioritization of the people who need it the most—that there is light at the end of the tunnel, I hope we can get over what we call COVID fatigue, where people are so exhausted with the public health measures that they really feel like they want to either give up and say let’s do what you want to do, which is not the time to do that now. Now we need to double down on the public health measures as we are waiting for the vaccine to come and help us out.

I think it is pretty clear when you see congregate settings where people are gathered indoors without a mask, there is no doubt that—we have seen that with the Sturgis Rally, [a] number of other situations. We have seen it in clear-cut examples of people getting together in a congregate away, particularly indoors, where you trace after that, there is clear outbreaks.

If you look at infectious diseases in general, what you need to get society protected, you need a certain number of people who are protected because they are immune to the virus. There are a couple of ways to do that. One way is very painful, that everybody gets infected. That leads to a lot of deaths. That is an unacceptable way to get this fire under control. The other way is to have a highly effective vaccine that the vast majority of the population takes. So in other words, if you have a 50%, 60% effective vaccine, even if the majority take it, there is a large segment of the population that is not immune. But we are fortunate, because the first one out of the gate is more than 90%, probably close to 95% effective. What we are hoping is that those who have vaccine hesitancy, who are skeptical about a vaccine, will see that the efficacy of this is so high that they may change their mind about wanting to get vaccinated. The other part of the good news is that there are other vaccines, some that are almost identical, such as the Moderna product, which will be evaluated in the next week to a few days, that we anticipate, though you never want to get ahead of yourself, that it will be as good or close to that. That is the case, we have two of them. We have the capability—what science has done in an unprecedented way—if this were 15 or 20 years ago, it would have taken a few years to get to where we are now. The idea that you went from a recognition of the virus on July 9 with the sequence to a phase-one trial literally 60-some-odd days later to a phase-three trial a few months later to a vaccine that will be getting to people next month is extraordinary. I have been doing this for 40 years, and this is really extraordinary. But as extraordinary as it is, what we don’t want people to do is to say, “Oh, we have a vaccine out, we are done.” We are not done. We still need to implement public health measures in a very intense way.

The standard thing that happens when you have a vaccine that is not readily available to everyone at once is . . . prioritization. That is the responsibility of the Centers for Disease Control and Prevention, the CDC. They rely heavily on an Advisory Committee on Immunization Practices, ACIP. The CDC makes the ultimate—this year we complemented that by asking the National Academy of Medicine to also weigh in. I’m not going to get ahead of their decision, but likely it will be frontline workers like health-care workers who are taking care of individuals, people who have underlying conditions that make them susceptible to a severe outcome were they to get infected, people in nursing homes, people with underlying conditions, . . . then children in schools, adults, teachers in schools, fundamental people who are responsible for making society run in an orderly way. That is the kind of prioritization you get. We hope by the time we get into the second quarter of 2021, we will have enough vaccine that we will progressively vaccinate people so that when we get to April, May, June, we will get people in the general population starting to get vaccines.

You have to continually outreach . . . and do what we call community engagement. There will be a core of people who will not take a vaccine [no] matter what you do. I don’t think you should give up on them, but I don’t think you should necessarily expect. But there was a larger group of people who probably just have misinformation and don’t understand the process. And what we have been trying to do—myself, Dr. [Francis] Collins, and others—we have been trying to explain clearly what the process is of making a decision that a vaccine is safe and effective. It is an orderly process, it is done by independent groups that have no allegiance to an administration or a company or to anyone. They make that decision. They look at the data and determine, is it safe and effective. Then there are letters of advisory committees, the career scientists at the FDA that I trust, the scientists like myself and Dr. Collins who will be looking at the data. There will be a very transparent process. I don’t think people who are anti-vax fully appreciate how transparent the process is. They think there is something hidden and people are trying to put something over on them. We need to reach out to them and make them realize that is not the case, and it is to their benefit and the benefit of society to get vaccinated.

I think that would be quite problematic, and it would not be good for the country in general, because if you really want to essentially crush, that word they use, an outbreak, to get the level of transmission so low that it is no longer a public health problem, if you have 50% of the people who don’t get vaccinated, there is a lot of infection that is going to be going around the community. If you get a 90, 95% effective vaccine, and 80% of the population get vaccinated, you have an umbrella of protection already that the virus has no place to go. It would be looking for vulnerable people and not finding it. That is when it goes way down and it is no longer a threat. If 50% of the people don’t want to get vaccinated, it is going to take quite a while to get to that point.

There is a lot we don’t know, and we have to be humble that we have learned an extraordinary amount in the last 10 months, but there is a lot we do not know. That is the reason why the study, the cohorts, the research we are doing is going to be going on for quite a while even after we have the outbreak under control.

At this point in time we don’t know the durability of infection. If you get infected and recover, it is likely that for a finite period of time you are protected. You have seen that is the case for what we have seen [in] specific instances of reinfection—people who got infected, recovered, and got infected with another SARS COV-2. We don’t know how extensive that is going to be. Even though antibodies are in a lot of people who recover, . . . we don’t know what is related to production and how long that lasts. We don’t want to scare people to think, “Oh my god, I got infected and I will get infected again.” Unlikely. But what we have a lot to learn is what the durability of protection is. The one thing I can say as an infectious disease person is it is very unlikely it will be like measles. I got infected by measles as a child. I’m sure you did also. The fact is you are protected essentially for life. It likely is not of that magnitude, because what we know about the common cold coronavirus is, that keeps reinfecting people. We feel like that it is measured in several months to a year or more, but it doesn’t look like it is going to be 20, 30 years. Which means people need to get vaccinated even if they have been infected before, which we think is going to happen, and it is conceivable but not absolute that you may need to boost people every once in a while after the vaccine, which is fine. . . .

Pandemic outbreaks over history have occurred before even recorded history, before understanding what a pathogen is. They have occurred in our own lifetime. Within the memory of some people, 1918 was a disaster for the world with the flu pandemic. You have seen outbreaks, some of which have been trivial, some of which have had a major impact. Right now this is the most serious outbreak that we have had on this planet in 102 years. Will it happen again? Yes. Will it happen 10, 15, 20 years from now? We don’t know. The thing about outbreaks are they are unpredictable. As scientists . . . you likely cannot prevent the emergence of a new microbe, but you can prevent that emergence from becoming a catastrophic pandemic. That is what we mean by pandemic preparedness, to prevent the inevitable emergence of microbes. As long as we have an interface with the animal world, 75% of all the new pathogens that emerged have jumped from an animal species to a human—they were zoonotic and they jumped to a human. That will continue to happen. The question and the challenge for us is, are we prepared enough so it doesn’t become a catastrophic outbreak. . . .

There are a number of things we can do. We have got to think globally. Pandemics are global, so we have to pull together globally. There is a thing called the Global Health Security Network or agenda that was established several years ago. We need to strengthen that. We need to strengthen our international collaborations. We need to have people speaking to each other. It has got to be open and transparent. When you do that, you can detect it early and respond early. Scientific approaches, technologies, are going to allow us to do what we did with this outbreak and rapidly make a vaccine. We can do even better than that, but you can’t do science alone. It has got to be public health and classic science. . . .

Right now it seems like every country is suffering. We are often compared with countries that are not comparable to us. We are not a little island of 5 million people that we can shut off. We are not a country that would accept if a ruler tells us “You must do this.” I was talking with our U.K. colleagues just today who were saying the U.K. is similar to where we are now in outbreak because each of our countries have an independent spirit, we don’t want to be told what to do. Well, I understand that, but now is the time to do what you are told. [laughter] . . .

I believe you have to be sensitive to distress and restraint of lockdowns. The economic and psychological consequences. I do not believe at this point that we do need to lock down. We have to leave that on the table. We are not going to just push it off the table. I don’t think we need to do it, because my experience is that when you as a group, as a nation, implement the public health measures I mentioned to you, we can turn this around without locking the country down. . . .

No, [herd immunity is not a viable strategy]. . . . It just is not. I don’t want to disrespect any of those who feel that way from that is their opinion, but it is just not the case. If you look now, 25% will say some of the people of this country [that] got hit badly in New York are immune. 10% of the country as a whole. The CDC did a very good study and said 10% of the people in the country have gotten infected and are therefore protected. We have 245,000 to 250,000 deaths and 10 million infections. You were not going to get to herd immunity until you get to 70 or so percent. Now, if you want to go from 10 to 70, multiply that by seven and look at the number of people who will have to have died to get to natural herd immunity. It is not feasible and it is not acceptable.