Dr. Anthony Fauci, Director of the National Institute of Allergy and Infectious Diseases in the US a member of the White House coronavirus task force, and also a world-renowned HIV/AIDS researcher, spoke at virtual WISH 2020 in a special interview with The BMJ’s Editor in Chief, Fiona Godlee.
In comparing the pandemic to the HIV/AIDs epidemic outbreak in the 1980s, he said: “Whenever you have pressure, you’ve got to make sure you act in a very measured way based on evidence and science, but at the same time being sensitive to the needs of people.
“…there are certain things about science that need to be immutable. And then there’s the regulatory process which is definitely geared towards the protection of the safety of people while getting medications to them. But one of the problems we had back then was the design of clinical trials and their accessibility. We used paradigms and models geared to diseases that were not at all like HIV/AIDS.
“It became clear that we had to have a situation where you could have the integrity of the clinical trial, but make an intervention available to people as long as they were willing to take the risk, and there was a reasonable chance they would benefit. That was just one example of my awakening to the fact that you’ve got to adhere to the fundamental principles and tenets of science but keep an open mind and be flexible when you’re dealing with real human beings.”
Discussing the reasons why the pandemic has reached current proportions in the US, Dr. Fauci said: “The US is a very large country, and heterogeneous in so many ways; demographically, geographically, but particularly in the level of infection that we have in different places. It’s a federalist society where an awful lot of responsibility can and is given to the states. What we had was not a uniform approach when we had the shutdown.
“When we decided to open up the economy, some states did it in a way that was not appropriate … jumping over stage 1 or disregarding it completely,” he said. “We have done well in some respects, but it is patchy and not uniformly well as a country… I think the lesson for [countries like] the UK is to try and have a unified approach that’s centrally mandated.”
In terms of testing asymptomatic people, he said: “We cannot ignore asymptomatic infection because that is a major component of the outbreak. And that is the reason we saw community spread and the insidious thing about that is it becomes difficult to do identification, isolation, and contact tracing.”
Dr. Fauci noted that there was not enough information to pronounce on mass testing but that the US would be implementing the 15-minute antigen tests that were more important for broad screening. “We need to be careful that we don’t let the perfect be the enemy of the good… If you really want to get a feel for the penetration of infection in your community, you may want more of a surveillance approach.”
Turning to the vaccine, he said: “A lot of things are politicized but I think people across the world and in the US should realize that there are a lot of failsafe checks. We have assurances from the FDA commissioner that science itself and not political considerations will dictate the decisions about the regulatory components of the vaccine trial.”
He added: “I don’t think the administration failed to respond to the science. Being on the task force, I have always spoken based on pure evidence and science … Whether they act on the things you tell them, that’s beyond my power. There’s always a lot in the press about a frayed relationship between the president and I, and that’s just not the case.
Dr. Fauci addressed racial disparities in health: “It’s a very unfortunate situation not only with COVID-19 but with other diseases. African Americans are about 13% of the US population but [account for] over 40-45% of new cases. This population is also hit doubly hit. The jobs they do as a broad demographic group puts them on the front line of interacting with people, so they have a greater chance to get infected to begin with. It is also clear that African Americans have a disparately larger percentage of the underlying conditions that lead to a serious outcome, diabetes, hypertension, cardiovascular disease, obesity.
“It’s the result of decades and decades of those social determinants of health. If there’s ever a silver lining, it is that it may be jolt us into realizing that we have to correct those disparities.”
Commenting on ‘long COVID’, he said: “We’re starting to see emerging information…That’s why we need to take this disease with a degree of humility and commit to preventing infection, through universal wearing of masks, avoiding crowds, distance, outdoor-better-than-indoor, washing hands, and doing everything we can to get a vaccine … because it is not to be taken in a trivial way at all.”
Dr. Fauci explained why he continues to see patients: “If you ask me what my underlying identity is that always grounds me in the reality of what we need to do and gives me insight into the kind of emphasis we need, it’s my identity as a physician. It really helps me to understand disease pathogenesis … but also to understand the impact that has on them and it inspires me.”
He concluded: “I believe the pandemic will end with an effective and safe vaccine that ultimately will be widely distributed throughout the world. But that is going to happen together with public health measures. I don’t think it’s going to be like measles where it’s 98% effective even though it’s a highly transmissible virus. But you have got to [roll out] the vaccine together with public health measures until the overall protection umbrella of protection essentially is all over the world. It’s probably going to take a year or two to happen.”
WISH, an initiative of Qatar Foundation, is dedicated to capturing and disseminating the best evidence-based ideas and practices with a mission to create a healthier world through global collaboration. Virtual WISH 2020 is featuring more than 100 sessions and 300 global speakers to discuss evidence-based content and innovations addressing some of the world’s most pressing health challenges.