June 8, 2021 • 28 mins
Outbreaks are inevitable; pandemics are not. This week, Chelsea is sitting down with Director of the National Institute of Allergy and Infectious Diseases at the U.S. National Institutes of Health, Dr. Anthony Fauci, to discuss just how unprecedented this past year has been, what we’ve learned from past crises, what we can learn from COVID-19, and how to prepare -- personally, nationally and globally -- for what’s next.
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Episode Transcript
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Speaker 1 (00:00):
Hi, I'm Chelsea Clinton, and this is in fact a
podcast about why public health matters after so much grief, fear,
and uncertainty. I know many people are eager to put
COVID nineteen behind us, but we're not out of the
woods yet, and there are so many lessons that we
(00:22):
must learn from this pandemic to be better prepared for
the next one. COVID nineteen isn't the first pandemic that
has swept the globe. The nineteen eighteen flu pandemic infected
one third of the world's population, and more recent history,
the Obama administration created a pandemic playbook for how to
address quote a high consequence emerging disease threat anywhere in
(00:43):
the world because public health officials have long worried that
there could be another global pandemic. So just how unprecedented
has this last year been, What have we learned from
past crises, what can we learn from this one? And
how prepared is our country and our world for the
next pandemic. We're talking about all of this with someone
who has become for many the public base of our
(01:05):
government's response to COVID nineteen, Dr Anthony Faucci, Dr Fauci
was appointed director of the National Institute of Allergy and
Infectious Diseases back in during a hugely consequential moment in
the HIV AIDS pandemic. His research was crucial to understanding
how the virus works, and he was one of the
leading architects of the President's Emergency Plan for AIDS Relief
(01:27):
or pet FAR, which has helped saved millions of lives
around the world. He's advised seven presidents on how to prevent, diagnose,
and treat a long list of infectious diseases, including HIV AIDS,
respiratory infections, diarrheal diseases, tuberculosis, malaria, ebola, and zica. He's
been leading the U. S government's efforts to combat this pandemic,
working non stock with his team and communicating consistently and
(01:51):
honestly with Americans every step of the way. I was
honored to welcome to the podcast. So, Dr Arouchy, it's
become almost a cliche to say this is an unprecedented time,
and I'm just curious, given that you have lived through
other pandemics, worked in other pandemics, how much of this
(02:13):
feels unprecedented and how much of it feels eerily familiar. Well, Chelsea,
the only eerily familiar thing about it is the unpredictable
nature of outbreaks where you're just going along and then
all of a sudden something comes up. It could be
subtle the way HIV This month. In the next few
(02:33):
days where commemorating the forty anniversary of the realization that
we were dealing with a new syndrome. We didn't know
what the microbe, the pathogen was. We didn't even have
a name for it back in June and July. Having
had I guess I would call it the privilege in
some respects, but also the painful experience of being involved
(02:55):
in that from the very first day, that's sort of
snuck up on you. It was level below the radar screen.
Then as we learned more and more about it, we
found out we were dealing with just the tip of
the iceberg when we saw people who were very, very sick,
not knowing until we had a test that we were
dealing with something where they were literally millions of people infected.
(03:17):
So the fact that outbreaks are unpredictable, they come in
strange ways, that's the common denominated the difference with this
that validates the statement it's unprecedented is that when you're
dealing with something as explosive as this, which has a
couple of characteristics that I have often referred to, almost
(03:41):
ironically years ago, is what is your worst nightmare? Dr Fauci.
People would ask me that five years ago, ten years ago,
fifteen years ago, and longer. I would always say it
was the emergence of a new virus generally jumping species
from an animal host to a human that had two
character ristics, one that is extraordinarily efficient in spreading from
(04:05):
human to human, and two that it has the capability
of a great degree of morbidity and mortality. And when
you put those two things together, that's when you get
my worst nightmare. And that's exactly what we're experienced because
we have not had anything like this in well over
a hundred years, since the historic influenza pandemic of nineteen eighteen.
(04:27):
So there is a very strong true element of this
being unprecedented, at least in over a hundred years, you know,
and Dr Patty, there's an adage in public health that
outbreaks are inevitable, but epidemics aren't. Now, with the benefit
of both hindsight and your decades of experience in pandemics.
(04:48):
What do you think we could have done differently in
January or February to help save American lives and save
lives across the globe. Yeah, in some respects it is
not answerable, because you could certainly have done things differently
if you knew things differently, So you could say to
(05:09):
yourself in this country, what could we have done if
we knew back in January? What we know right now
is the characteristics that I'm telling you. It's extraordinary ability
to efficiently spread from human to human, the fact that
fifty to sixty percent of the transmissions occur from someone
(05:31):
who is infected but has no symptoms at all. We
know anywhere from a third of the people who get
infected never develop any significant symptoms at all that would
bring attention to any medical intervention. So back then, if
we knew that we were dealing with in this country
something as extraordinary as this in its ability to spread,
(05:54):
we would have done something that likely would have not
been acceptable to the American public. When we had the
first case, and I think it was January one, to
say Okay, it's here, and then a few days later
or a week or two later, it became clear that
there was community spread. It just there, which means someone
(06:15):
infected someone and you don't have the chain of transmission
locked in, you don't know where the person got it from.
That being the case, that means it's spreading in society
beneath the radar screen. If we had known its capability
of spreading, we could have said, let's shut the country
down right now to prevent it. I think there would
have been such extraordinary pushback to say, well, wait a minute,
(06:38):
what are you talking about. We have one or two cases.
You want to shut the country down. That's crazy. So
when you asked me a question, what could we have
done differently, Well, now that we have five and ninety
thousand deaths, you go back and say, wow, look what
this is done. We maybe could have prevented some of
(06:59):
those had we shut down earlier and prevented the spread.
But you know, if you look throughout the world, Chelsea,
even countries that appear to have done well early on,
every country has gotten hit really badly. Even some of
the Asian countries now that we pointed to as models
(07:19):
of their response are now starting to get into trouble,
including places like Taiwan and Singapore and Vietnam and places
like that, who seemed to have done very well in
the first waves. You made a comment that resonates with
me is how do you prevent an outbreak from becoming
a pandemic? So I don't think we're necessarily going to
(07:40):
be able to prevent the emergence of new microbes. They've
occurred historically for as long as and before history even
recorded it. History is full of them. But in answer
to your question, how do you prevent that from becoming
a pandemic? And that's when we talk about lessons learned?
What can we learn having gone through this where the
(08:03):
United States was ranked by public health agencies as being
the best prepared country in the world for a pandemic
and we got hit among the top three, with Brazil
and India as the three worst in the sense of
numbers of cases and deaths and dr bout You do
you think that that is because we were prepared for
(08:26):
previous pandemics and not future ones. I mean, were we
ready to fight the last war and not the next war?
I think it's partially that, not completely. I think it
was there were things that went wrong early on, and
that was the issue with the testing that we didn't
have a good testing system for a considerable period of time,
and we were testing only symptomatic people because we're not
(08:50):
fully aware that asymptomatic spread was really, really, very important.
So those are the things that I think could have
been done differently. And then, you know, I don't want
to read litigate what went on last year, but there
were things that I think could have been done better.
Although I live in New York now, I grew up
in Arkansas and then moved when I was twelve to
(09:11):
d C. And it is heartbreaking to me Dr Facci
that Arkansas, Louisiana, Tennessee, Mississippi, so much of the South
have vaccination rates that are half of what we see
in the Northeast. Since you've had to communicate now over
so many decades, so many different public health challenges and
(09:33):
also imperatives, how do you think we rebuild trust in
science and especially trust in in vaccines and vaccinations. That
is something that is not going to happen easily, Chelsea.
I think that we may have to find ways, and
that's a complicated issue. As you will know, probably better
than I do, it's a complicated issue of how you
(09:56):
heal the differences and the hostility. I mean, I've been
the object myself of a phenomenal amount of hostility merely
because I'm promoting what a really fundamental, simple public health
principles that seems astounding that that would generate a considerable
degree of hostility, But it is. It is. So I
(10:18):
don't think the answer is intensifying the hostility and pointing figures.
I think the approach is to outreach to try and
understand each other better and realize that we have differences.
But those differences should be the source of strength in
some respects and not the source of chaos. So I
(10:38):
don't I don't know the answer to your question. It's
a seemingly simple question with a complicated answer. We've got
to reach out to people and get them to understand
that this is for their own safety, their own health,
and also what I refer to as communal responsibility, your
responsibility to society. Because there is a thing called the
(10:59):
chain of transmission of an outbreak, and one of the
very interesting and I must say quite unique aspects of
saws COVID two and COVID nineteen is that the same
virus that has killed almost six hundred thousand Americans makes
many many people have no symptoms at all. It just
(11:20):
doesn't bother them. I mean, there's the people getting no
symptoms at all. So that is in many respects unprecedented
to have that situation. Usually, when you have something as
potentially deadly as this, it makes just about everybody a
little bit sick. This is something where there were people
who were saying, why should I get vaccinated? The chances
(11:43):
of my getting into trouble are very very low, and
they're correct. If you look at the rate of hospitalizations
of young people, it's a non zero. It's small compared
to the rate among elderly people and among people with
underlying conditions. But there are a couple of things there
that people don't fully understand. You're not completely exempt, because
(12:03):
a lot of young people wind up getting into trouble statistically,
not nearly as many as the elderly and those with
underlying conditions. But there's another aspect of it. Let's say
you get infected and you don't get any symptoms at all,
and you could say that, see, I got infected, big deal,
what's the difference. The difference is that it is conceivable
(12:27):
and maybe likely that even though you've got no symptoms,
that you would inadvertently and innocently I'll use that word
pass it on to someone else who would then pass
it on to someone else who would then get a
serious consequence. So there is a degree that have to
consider of what is my societal responsibility of not being
(12:49):
part of the chain of transmission as opposed to being
a dead end for the virus. So do you want
to be a dead end for the virus or do
you want to be situation where you're part of the
transmission chain which would get other people in trouble. But
that's tough to get that concept. I mean, Dr pot
I never thought I would say I wanted to be
(13:10):
a dead end, but yes here I am very happy
to be fully vaccinated in a In a dead end,
we'll be right back to stay with us. I don't
(13:32):
want to ask about preparedness because I think probably a
lot of people are now as we are vaccinating the country.
I know a lot of people want to put COVID
in the rear view mirror, leave it in, not worry
about it again. But we know that the virus is
not done with us until we have everyone vaccinated and
(13:53):
we know we need to learn lessons from this to
help better prepare us going forward. So what less since
do you think we need to learn, And how do
you think your work at the NIH has to adapt.
How do you think the Biden administration has to adapt?
What concrete things have to happen to ensure we are
better prepared for the inevitable next time? Okay, so two
(14:16):
components to my answer to Chelsea. The first is that
when you're dealing with a global pandemic, you have to
have a global response. We're not going to be safe
on this planet until the pandemic is controlled globally, so
right away it is not necessarily a lesson, but almost
a mandate that we really need to help the rest
(14:39):
of the world, as as a rich country, get this
under control, because if there's still viral dynamics somewhere, even
if we get this on the very good control here,
there's always the danger of the generation of variance, which
then would make our protection somewhat tenuous even with the vaccines.
That's the first thing when you look at the future,
(15:02):
what lessons learned for the future, we need to also
prepare in a global way. There was a thing called
the Global Health Security Network or the Global Health Security Agenda,
where you have interconnectivity among countries of the world, good
modern up to date communications, sharing of re agents, sharing
(15:23):
of of specimens, continued good collaboration and communication, building up
in the local areas, the public health infrastructure that would
allow them to respond and quench something when it breaks
out in any given country, because outbreaks generally don't start
(15:44):
spontaneously in twenty five countries. They generally start as a
jumping of species, usually not always from an animal reservoir
to a human and then it spreads to the rest
of the world. That doesn't mean that you've got to
blame the country where it happens. It just so happens,
but you've got to have those countries prepared to be
able to contain it. So that's the thing with preparedness.
(16:06):
The other thing from a scientific standpoint is that we
are very fortunate that we have made decades and decades
of investment in basic and clinical biomedical research, which has
allowed us to do something that's unprecedented, to get a
vaccine in which a virus was first identified in January
(16:28):
of and then in December of that same year, eleven
months later to be putting vaccine into people's arms. That's efficacious.
If we were having this conversation ten years ago, you
would have told me I was completely crazy thinking that
that would happen. It usually takes years and years. And
(16:49):
the speed was not because we were reckless in doing
things and cutting corners. The speed was related to the
extraordinary amount of in u stament that was made of
the previous decades in clinical and basic research. So there
are another component of lessons learned. We need to continue
(17:10):
to make the investments in research that will allow us
to have the scientific component of the response be optimal.
And fortunately for us, that's what happened with regard to
the vaccines. Dr P. You you mentioned earlier the Global
Health Security Agenda, which while it had antecedents over many years,
(17:32):
really got codified in the aftermath of a Bola and
of the United States saying what has happened in Western
Africa is clearly a tragedy for people there, but it
is a danger to us here too, and we do
need to have more robust public health architecture everywhere. And
then that wasn't a priority for the Trump administration, but
(17:56):
it wasn't really a priority for the world. I do
admittedly have a little bit of a concern that once
we are through COVID nineteen, I worry we might lose
focus on the need to build robust global architecture to
help protect public health everywhere. Well, Chelsea, I definitely share
your concern, and the reason I do is from my
(18:19):
experience in that corporate memory for things that I've been
very very difficult in the sense of responding and preparing
is often short lived, and when you put this behind us,
we will be dealing with problems that are real and present.
Yet it's difficult to get people to understand that the
(18:41):
threat of an outbreak is perpetually a real and present danger.
So what we've got to do as a globe, as
as a planet, as a community of nations is to
just make sure we tell ourselves that when we get
this under control, that we've got to say never again
and need it, and never again means to really put
(19:03):
the effort into the kind of preparation that will require
considerable resources. And even though it's tough to convince people
to give resources to something that isn't happening. Now, we've
got to call back the memory of two thousand nine
(19:23):
one because as we started off in the beginning of
this podcast, the fact is that this is really what
happened to us. It just came out of nowhere, and
it just immobilized us for such an extraordinary period of time.
And we're in our second year now. The economy has
been wrecked by this for sure, not only here in
(19:46):
the United States. Thank goodness, we're recovering now, but it's
still a lot of people out of work. I think
those kinds of memories should spur us on to make
sure we are adequately prepared next time around. Well, and
hope we will spur us on. Returning to a comment
that you made earlier that I am in vigorous agreement
with that we have responsibility to help vaccinate the world.
(20:08):
And while I certainly appreciate President Biden's commitment to donate
seventy million doses by July four, we know we can't
effectively donate our way out of this. So I am
curious Dr about you if we think about the architecture
that we really need to help protect public health globally.
While often the focus is on surveillance and specimen collecting, testing,
(20:32):
what do you think it should be for vaccine research
and development, for example, or the actual ability to manufacture
and to guarantee the quality of vaccines in the next generation.
I'm with you on that, and that is referring to
building up the capacity and the ability to do technology
(20:53):
transfer so that when you have an outbreak, it isn't
only companies in Switzerland, the United States and the UK,
but you have plants and companies and technology and the
knowledge to do it in Senegal and Ethiopia and South
Africa and Indonesia and Brazil and Chile, so that when
(21:15):
you have an outbreak, you do have the capability. And
that is building up not only the infrastructure of public
health to do surveillance and monitoring, but also the ability
to respond at a global level. To rely on donations
is a quick, immediate, partial fix, but the real durable,
(21:39):
sustainable fix now in the future is to allow other
countries that generally don't have that capacity to be able
to make vaccine in a timely fashion and not depend
completely on donations from the rich country. The rich country
should donate if they have to, but the real ultimate
solution is to have a world where it's evenly distributed,
(22:02):
with his equity and opportunity to make your own countermeshes.
In this case, it would be vaccines and therapeutics. We're
taking a quick break, stay with us, Dr pot You
(22:26):
mentioned earlier that you've been under quite a bit of
personal attack for talking about things that should be I
would argue like fairly non controversial, like the importance of vaccines,
of vaccinations. And we know that so many of our
public health officials have been under in noorminate stress, working
day after day without rest to try to help protect
(22:48):
public health over the last year and a half. And
we know that many public health officials have also received
horrific abuse, and that the mental health toll has been
really immense. What do you think we need to do
to try to help support everyone who's really been on
the front lines to recover from this horrifically stressful time
(23:09):
is hopefully we recover as a country. Yeah, well, you're
pointing out something that I think everyone hopefully will ultimately
recognize is the extraordinary courage and effort that has been
put in by our frontline health care workers. I mean,
they truly are the heroes and the heroines of this
the physical risk that they took are taking to take
(23:32):
care of people. The physical and mental strain of seeing
people every single day dying right in front of you
with very little that you can do, particularly when you're
dealing with people who have underlying conditions in which when
they get hospitalized, there and very very difficult straits. It's
a reality. We've lost close to five nine people in
(23:54):
this country. That's terrible for the losses of those people
and their families. But what people don't a pre cate
because I've been there. I've been there, and I know
what what it means, the terrible strain and stress when
you're trying your best to save someone's life and they
just lose. You lose them person after person at the person.
We've got to pay attention to the stress and probably
(24:17):
a good degree of post traumatic stress that those people have.
So I think attention to mental health issues is something
we really absolutely have a responsibility to do for people
who have given it everything and yet have exhausted themselves
in the process. Your dr pot, I want to be
respectful your time. I also want to end on an
optimistic note. We spoke earlier about how the COVID nineteen
(24:41):
vaccines were accelerated through just extraordinary amounts of attention and
investment and collaboration really across the globe, and so I
just I'm curious what else that is being worked on
currently at the n I H. Do you think is
close to a breakthrough and that could similarly really help
(25:02):
save and protect a lot of lives soon. Yeah, and
it's in multiple fields of medicine, not just infectious disease.
But one of the things that we're having a lot
of optimism now. You know, we've done spectacularly well in
the development of life saving drugs for persons living with HIV,
to the point now if you're infected, you get put
(25:23):
on one pill that contains three drugs and you can
go essentially lead to almost a normal lifespan. So we've
done well there. The thing that has been the challenge
is a vaccine for HIV. But I believe some of
the technologies that have been developed and shown to be
highly successful, like the MR and a vaccine platform technology
(25:45):
for COVID nineteen is now being actively pursued in the
field of HIV and in other areas of medicine, including
can serve and other infectious diseases. That's what I think
is perched for breakthroughs. Also when the field of immunotherapy
for cancer. I mean, the more we learn about how
we can control the regulation of the immune system, they're
(26:08):
going to be cancers that have been beyond the reach
of cures that likely will now for the first time
see that you can actually marshal the immune system's response.
Cancer immunotherapy has been in some areas quite successful, but
in some areas still very frustrating. I think you're gonna
see a lot of that frustration turned to good results
(26:29):
within a reasonable period of time. So there's never been
a time more exciting in the field of biomedical research
then now, and and that's the reason why we are
so grateful for the support that we continue to get
from the Congress and from multiple administrations, because it's certainly
has given us an extraordinary tool for COVID nineteen. If
(26:54):
it were not for that, we would be in much
much more dire straits than we are right now with
regard to this pandemic. Dr Facci, thank you so much
for your leadership and for your time today for giving
me kind of things to be optimistic about, but also
of course thanks to still worry about and work on.
So thank you so very much. Thank you very much. Chelseae.
I appreciate you're having me on your show. Thank you.
(27:18):
Dr Anthony Facci is the director of the National Institute
of Allergy and Infectious Diseases at the U S National
Institutes of Health or the n AGE. If you're not
yet vaccinated, go to vaccines dot gov to find a
vaccine site near you and anyone can visit. We can
do this dot HHS dot gov to join in a
month of action to help get as many people vaccinated
(27:38):
as possible. And volunteers, even if you're vaccinated, who take
at least five actions may be invited to the White
House in July. And as we reflect on what our
country has been through, let's keep listening to scientists and
experts like Dr Faucci and is Tea. Let's keep asking
hard and important questions so that we can learn from
what's worked and what hasn't so we are better prepared
(27:58):
for the inevitable next time. And to any of our
listeners who have been on the front lines of this
crisis as a nurse, doctor, researcher, or anyone else in
the world of public health, thank you. Our country owes
you a huge debt of gratitude, and I hope that
you're taking care of your own health to physically and mentally.
In Fact is brought to you by I Heart Radio.
(28:20):
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with additional support from Lindsay Hoffman. Original music is by
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(28:43):
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see you next week.
Hi, I'm Chelsea Clinton, and this is in fact a
podcast about why public health matters after so much grief, fear,
and uncertainty. I know many people are eager to put
COVID nineteen behind us, but we're not out of the
woods yet, and there are so many lessons that we
(00:22):
must learn from this pandemic to be better prepared for
the next one. COVID nineteen isn't the first pandemic that
has swept the globe. The nineteen eighteen flu pandemic infected
one third of the world's population, and more recent history,
the Obama administration created a pandemic playbook for how to
address quote a high consequence emerging disease threat anywhere in
(00:43):
the world because public health officials have long worried that
there could be another global pandemic. So just how unprecedented
has this last year been, What have we learned from
past crises, what can we learn from this one? And
how prepared is our country and our world for the
next pandemic. We're talking about all of this with someone
who has become for many the public base of our
(01:05):
government's response to COVID nineteen, Dr Anthony Faucci, Dr Fauci
was appointed director of the National Institute of Allergy and
Infectious Diseases back in during a hugely consequential moment in
the HIV AIDS pandemic. His research was crucial to understanding
how the virus works, and he was one of the
leading architects of the President's Emergency Plan for AIDS Relief
(01:27):
or pet FAR, which has helped saved millions of lives
around the world. He's advised seven presidents on how to prevent, diagnose,
and treat a long list of infectious diseases, including HIV AIDS,
respiratory infections, diarrheal diseases, tuberculosis, malaria, ebola, and zica. He's
been leading the U. S government's efforts to combat this pandemic,
working non stock with his team and communicating consistently and
(01:51):
honestly with Americans every step of the way. I was
honored to welcome to the podcast. So, Dr Arouchy, it's
become almost a cliche to say this is an unprecedented time,
and I'm just curious, given that you have lived through
other pandemics, worked in other pandemics, how much of this
(02:13):
feels unprecedented and how much of it feels eerily familiar. Well, Chelsea,
the only eerily familiar thing about it is the unpredictable
nature of outbreaks where you're just going along and then
all of a sudden something comes up. It could be
subtle the way HIV This month. In the next few
(02:33):
days where commemorating the forty anniversary of the realization that
we were dealing with a new syndrome. We didn't know
what the microbe, the pathogen was. We didn't even have
a name for it back in June and July. Having
had I guess I would call it the privilege in
some respects, but also the painful experience of being involved
(02:55):
in that from the very first day, that's sort of
snuck up on you. It was level below the radar screen.
Then as we learned more and more about it, we
found out we were dealing with just the tip of
the iceberg when we saw people who were very, very sick,
not knowing until we had a test that we were
dealing with something where they were literally millions of people infected.
(03:17):
So the fact that outbreaks are unpredictable, they come in
strange ways, that's the common denominated the difference with this
that validates the statement it's unprecedented is that when you're
dealing with something as explosive as this, which has a
couple of characteristics that I have often referred to, almost
(03:41):
ironically years ago, is what is your worst nightmare? Dr Fauci.
People would ask me that five years ago, ten years ago,
fifteen years ago, and longer. I would always say it
was the emergence of a new virus generally jumping species
from an animal host to a human that had two
character ristics, one that is extraordinarily efficient in spreading from
(04:05):
human to human, and two that it has the capability
of a great degree of morbidity and mortality. And when
you put those two things together, that's when you get
my worst nightmare. And that's exactly what we're experienced because
we have not had anything like this in well over
a hundred years, since the historic influenza pandemic of nineteen eighteen.
(04:27):
So there is a very strong true element of this
being unprecedented, at least in over a hundred years, you know,
and Dr Patty, there's an adage in public health that
outbreaks are inevitable, but epidemics aren't. Now, with the benefit
of both hindsight and your decades of experience in pandemics.
(04:48):
What do you think we could have done differently in
January or February to help save American lives and save
lives across the globe. Yeah, in some respects it is
not answerable, because you could certainly have done things differently
if you knew things differently, So you could say to
(05:09):
yourself in this country, what could we have done if
we knew back in January? What we know right now
is the characteristics that I'm telling you. It's extraordinary ability
to efficiently spread from human to human, the fact that
fifty to sixty percent of the transmissions occur from someone
(05:31):
who is infected but has no symptoms at all. We
know anywhere from a third of the people who get
infected never develop any significant symptoms at all that would
bring attention to any medical intervention. So back then, if
we knew that we were dealing with in this country
something as extraordinary as this in its ability to spread,
(05:54):
we would have done something that likely would have not
been acceptable to the American public. When we had the
first case, and I think it was January one, to
say Okay, it's here, and then a few days later
or a week or two later, it became clear that
there was community spread. It just there, which means someone
(06:15):
infected someone and you don't have the chain of transmission
locked in, you don't know where the person got it from.
That being the case, that means it's spreading in society
beneath the radar screen. If we had known its capability
of spreading, we could have said, let's shut the country
down right now to prevent it. I think there would
have been such extraordinary pushback to say, well, wait a minute,
(06:38):
what are you talking about. We have one or two cases.
You want to shut the country down. That's crazy. So
when you asked me a question, what could we have
done differently, Well, now that we have five and ninety
thousand deaths, you go back and say, wow, look what
this is done. We maybe could have prevented some of
(06:59):
those had we shut down earlier and prevented the spread.
But you know, if you look throughout the world, Chelsea,
even countries that appear to have done well early on,
every country has gotten hit really badly. Even some of
the Asian countries now that we pointed to as models
(07:19):
of their response are now starting to get into trouble,
including places like Taiwan and Singapore and Vietnam and places
like that, who seemed to have done very well in
the first waves. You made a comment that resonates with
me is how do you prevent an outbreak from becoming
a pandemic? So I don't think we're necessarily going to
(07:40):
be able to prevent the emergence of new microbes. They've
occurred historically for as long as and before history even
recorded it. History is full of them. But in answer
to your question, how do you prevent that from becoming
a pandemic? And that's when we talk about lessons learned?
What can we learn having gone through this where the
(08:03):
United States was ranked by public health agencies as being
the best prepared country in the world for a pandemic
and we got hit among the top three, with Brazil
and India as the three worst in the sense of
numbers of cases and deaths and dr bout You do
you think that that is because we were prepared for
(08:26):
previous pandemics and not future ones. I mean, were we
ready to fight the last war and not the next war?
I think it's partially that, not completely. I think it
was there were things that went wrong early on, and
that was the issue with the testing that we didn't
have a good testing system for a considerable period of time,
and we were testing only symptomatic people because we're not
(08:50):
fully aware that asymptomatic spread was really, really, very important.
So those are the things that I think could have
been done differently. And then, you know, I don't want
to read litigate what went on last year, but there
were things that I think could have been done better.
Although I live in New York now, I grew up
in Arkansas and then moved when I was twelve to
(09:11):
d C. And it is heartbreaking to me Dr Facci
that Arkansas, Louisiana, Tennessee, Mississippi, so much of the South
have vaccination rates that are half of what we see
in the Northeast. Since you've had to communicate now over
so many decades, so many different public health challenges and
(09:33):
also imperatives, how do you think we rebuild trust in
science and especially trust in in vaccines and vaccinations. That
is something that is not going to happen easily, Chelsea.
I think that we may have to find ways, and
that's a complicated issue. As you will know, probably better
than I do, it's a complicated issue of how you
(09:56):
heal the differences and the hostility. I mean, I've been
the object myself of a phenomenal amount of hostility merely
because I'm promoting what a really fundamental, simple public health
principles that seems astounding that that would generate a considerable
degree of hostility, But it is. It is. So I
(10:18):
don't think the answer is intensifying the hostility and pointing figures.
I think the approach is to outreach to try and
understand each other better and realize that we have differences.
But those differences should be the source of strength in
some respects and not the source of chaos. So I
(10:38):
don't I don't know the answer to your question. It's
a seemingly simple question with a complicated answer. We've got
to reach out to people and get them to understand
that this is for their own safety, their own health,
and also what I refer to as communal responsibility, your
responsibility to society. Because there is a thing called the
(10:59):
chain of transmission of an outbreak, and one of the
very interesting and I must say quite unique aspects of
saws COVID two and COVID nineteen is that the same
virus that has killed almost six hundred thousand Americans makes
many many people have no symptoms at all. It just
(11:20):
doesn't bother them. I mean, there's the people getting no
symptoms at all. So that is in many respects unprecedented
to have that situation. Usually, when you have something as
potentially deadly as this, it makes just about everybody a
little bit sick. This is something where there were people
who were saying, why should I get vaccinated? The chances
(11:43):
of my getting into trouble are very very low, and
they're correct. If you look at the rate of hospitalizations
of young people, it's a non zero. It's small compared
to the rate among elderly people and among people with
underlying conditions. But there are a couple of things there
that people don't fully understand. You're not completely exempt, because
(12:03):
a lot of young people wind up getting into trouble statistically,
not nearly as many as the elderly and those with
underlying conditions. But there's another aspect of it. Let's say
you get infected and you don't get any symptoms at all,
and you could say that, see, I got infected, big deal,
what's the difference. The difference is that it is conceivable
(12:27):
and maybe likely that even though you've got no symptoms,
that you would inadvertently and innocently I'll use that word
pass it on to someone else who would then pass
it on to someone else who would then get a
serious consequence. So there is a degree that have to
consider of what is my societal responsibility of not being
(12:49):
part of the chain of transmission as opposed to being
a dead end for the virus. So do you want
to be a dead end for the virus or do
you want to be situation where you're part of the
transmission chain which would get other people in trouble. But
that's tough to get that concept. I mean, Dr pot
I never thought I would say I wanted to be
(13:10):
a dead end, but yes here I am very happy
to be fully vaccinated in a In a dead end,
we'll be right back to stay with us. I don't
(13:32):
want to ask about preparedness because I think probably a
lot of people are now as we are vaccinating the country.
I know a lot of people want to put COVID
in the rear view mirror, leave it in, not worry
about it again. But we know that the virus is
not done with us until we have everyone vaccinated and
(13:53):
we know we need to learn lessons from this to
help better prepare us going forward. So what less since
do you think we need to learn, And how do
you think your work at the NIH has to adapt.
How do you think the Biden administration has to adapt?
What concrete things have to happen to ensure we are
better prepared for the inevitable next time? Okay, so two
(14:16):
components to my answer to Chelsea. The first is that
when you're dealing with a global pandemic, you have to
have a global response. We're not going to be safe
on this planet until the pandemic is controlled globally, so
right away it is not necessarily a lesson, but almost
a mandate that we really need to help the rest
(14:39):
of the world, as as a rich country, get this
under control, because if there's still viral dynamics somewhere, even
if we get this on the very good control here,
there's always the danger of the generation of variance, which
then would make our protection somewhat tenuous even with the vaccines.
That's the first thing when you look at the future,
(15:02):
what lessons learned for the future, we need to also
prepare in a global way. There was a thing called
the Global Health Security Network or the Global Health Security Agenda,
where you have interconnectivity among countries of the world, good
modern up to date communications, sharing of re agents, sharing
(15:23):
of of specimens, continued good collaboration and communication, building up
in the local areas, the public health infrastructure that would
allow them to respond and quench something when it breaks
out in any given country, because outbreaks generally don't start
(15:44):
spontaneously in twenty five countries. They generally start as a
jumping of species, usually not always from an animal reservoir
to a human and then it spreads to the rest
of the world. That doesn't mean that you've got to
blame the country where it happens. It just so happens,
but you've got to have those countries prepared to be
able to contain it. So that's the thing with preparedness.
(16:06):
The other thing from a scientific standpoint is that we
are very fortunate that we have made decades and decades
of investment in basic and clinical biomedical research, which has
allowed us to do something that's unprecedented, to get a
vaccine in which a virus was first identified in January
(16:28):
of and then in December of that same year, eleven
months later to be putting vaccine into people's arms. That's efficacious.
If we were having this conversation ten years ago, you
would have told me I was completely crazy thinking that
that would happen. It usually takes years and years. And
(16:49):
the speed was not because we were reckless in doing
things and cutting corners. The speed was related to the
extraordinary amount of in u stament that was made of
the previous decades in clinical and basic research. So there
are another component of lessons learned. We need to continue
(17:10):
to make the investments in research that will allow us
to have the scientific component of the response be optimal.
And fortunately for us, that's what happened with regard to
the vaccines. Dr P. You you mentioned earlier the Global
Health Security Agenda, which while it had antecedents over many years,
(17:32):
really got codified in the aftermath of a Bola and
of the United States saying what has happened in Western
Africa is clearly a tragedy for people there, but it
is a danger to us here too, and we do
need to have more robust public health architecture everywhere. And
then that wasn't a priority for the Trump administration, but
(17:56):
it wasn't really a priority for the world. I do
admittedly have a little bit of a concern that once
we are through COVID nineteen, I worry we might lose
focus on the need to build robust global architecture to
help protect public health everywhere. Well, Chelsea, I definitely share
your concern, and the reason I do is from my
(18:19):
experience in that corporate memory for things that I've been
very very difficult in the sense of responding and preparing
is often short lived, and when you put this behind us,
we will be dealing with problems that are real and present.
Yet it's difficult to get people to understand that the
(18:41):
threat of an outbreak is perpetually a real and present danger.
So what we've got to do as a globe, as
as a planet, as a community of nations is to
just make sure we tell ourselves that when we get
this under control, that we've got to say never again
and need it, and never again means to really put
(19:03):
the effort into the kind of preparation that will require
considerable resources. And even though it's tough to convince people
to give resources to something that isn't happening. Now, we've
got to call back the memory of two thousand nine
(19:23):
one because as we started off in the beginning of
this podcast, the fact is that this is really what
happened to us. It just came out of nowhere, and
it just immobilized us for such an extraordinary period of time.
And we're in our second year now. The economy has
been wrecked by this for sure, not only here in
(19:46):
the United States. Thank goodness, we're recovering now, but it's
still a lot of people out of work. I think
those kinds of memories should spur us on to make
sure we are adequately prepared next time around. Well, and
hope we will spur us on. Returning to a comment
that you made earlier that I am in vigorous agreement
with that we have responsibility to help vaccinate the world.
(20:08):
And while I certainly appreciate President Biden's commitment to donate
seventy million doses by July four, we know we can't
effectively donate our way out of this. So I am
curious Dr about you if we think about the architecture
that we really need to help protect public health globally.
While often the focus is on surveillance and specimen collecting, testing,
(20:32):
what do you think it should be for vaccine research
and development, for example, or the actual ability to manufacture
and to guarantee the quality of vaccines in the next generation.
I'm with you on that, and that is referring to
building up the capacity and the ability to do technology
(20:53):
transfer so that when you have an outbreak, it isn't
only companies in Switzerland, the United States and the UK,
but you have plants and companies and technology and the
knowledge to do it in Senegal and Ethiopia and South
Africa and Indonesia and Brazil and Chile, so that when
(21:15):
you have an outbreak, you do have the capability. And
that is building up not only the infrastructure of public
health to do surveillance and monitoring, but also the ability
to respond at a global level. To rely on donations
is a quick, immediate, partial fix, but the real durable,
(21:39):
sustainable fix now in the future is to allow other
countries that generally don't have that capacity to be able
to make vaccine in a timely fashion and not depend
completely on donations from the rich country. The rich country
should donate if they have to, but the real ultimate
solution is to have a world where it's evenly distributed,
(22:02):
with his equity and opportunity to make your own countermeshes.
In this case, it would be vaccines and therapeutics. We're
taking a quick break, stay with us, Dr pot You
(22:26):
mentioned earlier that you've been under quite a bit of
personal attack for talking about things that should be I
would argue like fairly non controversial, like the importance of vaccines,
of vaccinations. And we know that so many of our
public health officials have been under in noorminate stress, working
day after day without rest to try to help protect
(22:48):
public health over the last year and a half. And
we know that many public health officials have also received
horrific abuse, and that the mental health toll has been
really immense. What do you think we need to do
to try to help support everyone who's really been on
the front lines to recover from this horrifically stressful time
(23:09):
is hopefully we recover as a country. Yeah, well, you're
pointing out something that I think everyone hopefully will ultimately
recognize is the extraordinary courage and effort that has been
put in by our frontline health care workers. I mean,
they truly are the heroes and the heroines of this
the physical risk that they took are taking to take
(23:32):
care of people. The physical and mental strain of seeing
people every single day dying right in front of you
with very little that you can do, particularly when you're
dealing with people who have underlying conditions in which when
they get hospitalized, there and very very difficult straits. It's
a reality. We've lost close to five nine people in
(23:54):
this country. That's terrible for the losses of those people
and their families. But what people don't a pre cate
because I've been there. I've been there, and I know
what what it means, the terrible strain and stress when
you're trying your best to save someone's life and they
just lose. You lose them person after person at the person.
We've got to pay attention to the stress and probably
(24:17):
a good degree of post traumatic stress that those people have.
So I think attention to mental health issues is something
we really absolutely have a responsibility to do for people
who have given it everything and yet have exhausted themselves
in the process. Your dr pot, I want to be
respectful your time. I also want to end on an
optimistic note. We spoke earlier about how the COVID nineteen
(24:41):
vaccines were accelerated through just extraordinary amounts of attention and
investment and collaboration really across the globe, and so I
just I'm curious what else that is being worked on
currently at the n I H. Do you think is
close to a breakthrough and that could similarly really help
(25:02):
save and protect a lot of lives soon. Yeah, and
it's in multiple fields of medicine, not just infectious disease.
But one of the things that we're having a lot
of optimism now. You know, we've done spectacularly well in
the development of life saving drugs for persons living with HIV,
to the point now if you're infected, you get put
(25:23):
on one pill that contains three drugs and you can
go essentially lead to almost a normal lifespan. So we've
done well there. The thing that has been the challenge
is a vaccine for HIV. But I believe some of
the technologies that have been developed and shown to be
highly successful, like the MR and a vaccine platform technology
(25:45):
for COVID nineteen is now being actively pursued in the
field of HIV and in other areas of medicine, including
can serve and other infectious diseases. That's what I think
is perched for breakthroughs. Also when the field of immunotherapy
for cancer. I mean, the more we learn about how
we can control the regulation of the immune system, they're
(26:08):
going to be cancers that have been beyond the reach
of cures that likely will now for the first time
see that you can actually marshal the immune system's response.
Cancer immunotherapy has been in some areas quite successful, but
in some areas still very frustrating. I think you're gonna
see a lot of that frustration turned to good results
(26:29):
within a reasonable period of time. So there's never been
a time more exciting in the field of biomedical research
then now, and and that's the reason why we are
so grateful for the support that we continue to get
from the Congress and from multiple administrations, because it's certainly
has given us an extraordinary tool for COVID nineteen. If
(26:54):
it were not for that, we would be in much
much more dire straits than we are right now with
regard to this pandemic. Dr Facci, thank you so much
for your leadership and for your time today for giving
me kind of things to be optimistic about, but also
of course thanks to still worry about and work on.
So thank you so very much. Thank you very much. Chelseae.
I appreciate you're having me on your show. Thank you.
(27:18):
Dr Anthony Facci is the director of the National Institute
of Allergy and Infectious Diseases at the U S National
Institutes of Health or the n AGE. If you're not
yet vaccinated, go to vaccines dot gov to find a
vaccine site near you and anyone can visit. We can
do this dot HHS dot gov to join in a
month of action to help get as many people vaccinated
(27:38):
as possible. And volunteers, even if you're vaccinated, who take
at least five actions may be invited to the White
House in July. And as we reflect on what our
country has been through, let's keep listening to scientists and
experts like Dr Faucci and is Tea. Let's keep asking
hard and important questions so that we can learn from
what's worked and what hasn't so we are better prepared
(27:58):
for the inevitable next time. And to any of our
listeners who have been on the front lines of this
crisis as a nurse, doctor, researcher, or anyone else in
the world of public health, thank you. Our country owes
you a huge debt of gratitude, and I hope that
you're taking care of your own health to physically and mentally.
In Fact is brought to you by I Heart Radio.
(28:20):
We're produced by Erica Goodmanson, Lauren Peterson, Cathy Russo, Julie Subrian,
and Justin Wright, with help from the Hidden Light team
of Barry Lurry, Sarah Horowitz, Nikki Huggett, Emily Young and Humanity,
with additional support from Lindsay Hoffman. Original music is by
Justin Wright. If you liked this episode of In Fact,
please make sure to subscribe so you never miss an episode,
(28:43):
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If you really want to help us out, leave us
a review on Apple Podcasts. Thanks again for listening, and
see you next week.
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