The Future Outlook with Dr. Anthony Fauci

J. Stephen Morrison: Hello. I’m J. Stephen Morrison, senior vice president here at the Center for Strategic and International Studies, CSIS, in Washington, D.C., where I direct the CSIS Global Health Policy Center.

Today I’m joined in conversation with Dr. Anthony Fauci, chief medical advisor to the President of the United States, and director since 1984 of the National Institute of Allergy and Infectious Diseases at the National Institutes of Health. Many thanks for taking time today, Dr. Fauci, to be with us. And many thanks to you for your decades of service in protecting our nation.

Anthony Fauci:

Thank you very much, Steve. As always, it’s a great pleasure to be with you.

Dr. Morrison: I want to talk this time today to reflect on where we are. What is the storyline as we approach the three-year mark in this coronavirus pandemic, as the new winter opens, as we enter a new phase of a bivalent vaccine that’s just been introduced? I’d like to take a broad view that looks at the achievements as well as the challenges. We’ll break it into those two parts. I’d like to begin with the historic achievements for which we should be proud and derive lots of hope and optimism, and which provide the foundation for the future. I’ll turn to the tough challenges after that.

We live in a wildly paradoxical moment, very mixed. Just last night, President Biden announced on “60 Minutes” that the pandemic is over for Americans while commenting also that the pandemic has imposed profound psychological impacts upon Americans, and at the same time that we know that 230,000 or more Americans will die of Covid this year and that we live with the uncertainty around what may happen next in terms of new subvariants.

We often fail to fully appreciate the magnitude of the historical achievements and the degree to which they they’ve changed our relationship with this dangerous virus over the past three years. Our attention often just turns to other pressing matters.

So these achievements are several. There’s science, and the science itself; the technical innovations therein; the people themselves, those who’ve shown remarkable courage, commitment, bravery; the citizens who’ve shown remarkable generosity and creativity; and they’re the machinery of government.

We brought $4.6 trillion of relief to various dimensions of the response through bipartisan action by Congress and through the mobilization of Operation Warp Speed under President Trump, and a massive effort at vaccinating the country and bringing therapies and other expanded testing capacities by the Biden administration in this era.

My question to Dr. Fauci, just to open this up, what’s the best way, in your view, to tell the story to Americans of the historic successes and to keep those achievements front and center as we think about the future?

Dr. Fauci:

Well, I think it’s important for our keeping – emphasizing that with all of the suffering and pain that we’ve gone through that the investments in basic and clinical biomedical research over decades, which is difficult to understand if you’re not in the field that investments that were made 20, 10, five years ago eventuated into our ability to respond from a scientific and then, ultimately, translated into a public health standpoint, an intervention that, as bad as things have occurred and what we’ve experienced, they would have been much, much worse had it not been for the unprecedented speed with which science was translated into an actionable intervention in the form of highly effective vaccines to prevent predominantly severe disease.

We need to make sure that in the realm of the complexity of this outbreak, from a public health standpoint, from a policy standpoint, from a scientific standpoint, the one thing that does stand out as a really unprecedented success story is how science has added to our capability in a very, very big way to address this outbreak. And even though it’s been terrible from the standpoint of the toll of human suffering and death both in the United States and globally, it clearly would have been much, much worse had it not been for what science has brought to the table.

Having said that in one breath, we still must be aware of how unusual this virus is and continues to be in its ability to evolve into new variants which defy the standard public health mechanisms of addressing an outbreak where you would expect it that once a certain number of people get infected and/or get vaccinated that you could, essentially, bring an end to the pandemic component of the outbreak.

And we’ve experienced at least five, and, Steve, there will be more, variants. How we respond and how we’re prepared for the evolution of these variants is going to depend on us, and that gets to the other conflicting aspect of this is the lack of a uniform acceptance of the interventions that are available to us in this country where even now, more than two years, close to three years, into the outbreak we have only 67 percent of our population vaccinated and only one-half of those have received a single boost.

Now, for sure the intensity of the outbreak now – even though it is, I believe, unacceptably high, where we’re having 400 deaths per day – when you compare it to the fulminant stages we’ve experienced over the past year or so where we used to have 800(,000) to 900,000 cases per day and over 3,000 deaths per day, we are much better off now for a number of reasons that you mentioned. But we are not where we need to be if we’re going to be able to, quote, “live with the virus” because we know we’re not going to eradicate it. We only did that with one virus, which is smallpox, and that was very different because smallpox doesn’t change from year to year, or decade to decade, or even from century to century. And we have vaccines and infection that imparts immunity that lasts for decades and possibly lifetime.

So, the next question we ask, are we going to be able to eliminate it from our country or from most of the world? And the answer is unlikely because it is highly transmissible, and the immunity that’s induced by vaccine or infection is also transient. And instead of lasting for decades and a lifetime the way it does with measles and polio, immunity – as we know from painful experience – wanes after several months requiring us to give boosters to maintain the durability and the extent of protection.

So, we’re dealing with a very, very complicated situation. The ultimate goal would be – as I mentioned, we’re not going to eradicate it; it’s unlikely we’re going to eliminate it – that we get to a level of control that’s low enough that it doesn’t disrupt our social order and essentially dominate what happens in society.

We’re heading in that direction, but we must be aware that it is likely, Steve, that with the combination of the evolution of variants as well as the seasonal aspects that as we get into this coming late fall and winter, it is likely that we will see another variant emerge. And there’s already on the horizon one that looks suspicious that it might start to evolve as another variant, and that’s the BA.2.75.2.

Dr. Morrison: Let me say a bit more about the achievements and ask you. I mean, we – it seems to me that in overcoming some of the resistance and skepticism in America about our response, we need to remind ourselves about the courage and bravery of health providers and public health officials. We need to remind people of the mobilization that happened in this nation on an unprecedented scale. We seldom seem to even reference these things today when we’re talking about the tough challenges that are on the table.

I’ll get to the tough challenges in a moment, but my question to you is, how do we get back to a point where we acknowledge the scale and the depth of the achievements that have come from the American people, health providers, that have come from Congress acting in a deliberate and strategic way at the right moment?

Dr. Fauci: Well, the answer is, the only way to do it, Steve, is to do it. It’s as simple as that. We’ve got to talk about it. We’ve got to write about it. We’ve got to make it part of the discourse.

You’re absolutely right – the courage, the bravery, the fortitude, the resilience of the healthcare providers is just astounding in a very, very positive way, and I think it showed the very best of our healthcare profession – no doubt about that. The resolve and the resiliency of the United States of America as a country – you know, as you mentioned, the very, very insightful and brave approach of an Operation Warp Speed to take those scientific advances that I mentioned, that were the result of decades of investment in biomedical research, to make them relevant in a confined, limited, restricted period of time that first year, which got us safe and effective vaccines that were available for distribution within less than a year, during the Trump administration. And then during the Biden administration, to get an extraordinary process of getting vaccines and tests and drugs available to the American public. That is an extraordinary set of accomplishments. It’s not one. It’s a constellation of accomplishments that need to be stressed to show what we can do, and what we need to continue to do.

Dr. Morrison: Thank you. Let me turn to some of these very difficult, monumental challenges. You’ve referenced some of this. If you look at the virus itself, it’s becoming endemic. We’re having to come to terms with the reality that we’re likely to face 100,000 to 250,000 [deaths] annually. At the same time, living with this uncertainty you indicated about the reality of new subvariants coming forward. And we have an urgent need for new technological innovations. For vaccines we need to stop infections, we need greater, deeper durability. We need the ability to address multiple subvariants.

We face a money impasse. We’ve had repeated impasse – repeated failures over the course of this year that put at risk our national stockpiles, our ability to accelerate the development of new tools. We’re leaving ourselves very vulnerable in this period. And we’re giving the ground over for innovation to some of our competitors, India and China in particular. We face a political and psychological impasse with the acute polarization that’s happened that’s – I think shocked everyone at the level in which that partisanship and polarization set in. And we have a shared sense of exhaustion and anger fueled by disinformation and anti-science.

And our own institutions we’ve seen afraid. We’ve seen Rochelle Walensky – Dr. Walensky step forward with admitting mistakes and beginning a process of internal reform. And the last thing that hangs over us, I think, is the uncertainty around long Covid, and what that’s going to mean. So the question to you, how do you bring these across in a coherent, clear way, this combination of threats that we face as a country right now? Despite the historic achievements, we also have these very daunting challenges that have to be better communicated, it seems to me, to the American people to understand the gravity of what we face.

Dr. Fauci: Well, it is not an easy task, but it needs to be addressed. We, as a community, both scientific, medical, public health, and even the general public who’s out there speaking about things, needs to articulate in as clear a way as possible. And that’s very difficult, because inherently we’re dealing with a very complicated situation. But unfortunately for us, the complicated situation at its best is difficult. When it is being confronted with a whole wave of misinformation and disinformation and conspiracy theories, it understandably confuses the general public.

I mean, there’s no secret that they can be, understandably, confused. So we have got to be continuing to outreach and respect the questions and the uncertainty that the American public has. Don’t blow it off. Don’t disregard it. But continue to try to reach out and explain that we are dealing with an unprecedented situation, and we’ve all got to pull together to understand it better and to address it better. That is not an easy task, but if it was easy, we would have done it already. So it’s difficult, and we’ve got to rise to the occasion and take on that task.

Dr. Morrison In closing, tell us what gives you the greatest optimism and hope at this moment in time? You’ve made some suggestions, but this is a tough phase we’re in right now. We are approaching the three-year mark. We have these monumental challenges in front of us. We’re a divided population. We’re trying to move beyond this pandemic, but that’s impossible. What gives you the greatest hope and optimism?

Dr. Fauci: My greatest hope and optimism, Steve, is what has really driven me throughout my entire professional career and my life, is to have faith in what will ultimately turn out to be the better angels in the American public. We are a good people. There’s political divisiveness now. Some of it is really rather sharp. But deep down, as a people, we are a good people. And I believe that when we realize more how we have to pull together in this unprecedented challenge, we will turn it around and we will get back to a respect for our differences as opposed to a hostility to our differences. Because, remember, it’s the differences in this country that make it a really great country. And my way of thinking of it is that I have hope that that is what will prevail.

Dr. Morrison: Thank you so much, Dr. Fauci. And thank you for your decades of service to protecting our nation. And thank you for coming today to spend time with us.

Dr. Fauci: Thank you, Steve. It’s always a pleasure to be with you.

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