What Will 2021 Look Like? (with Dr. Anthony Fauci)

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It’s the episode you’ve all been waiting for: Andy closes the year with a recap of 2020 and predictions for 2021 with Dr. Anthony Fauci. Andy brings you into the bubble with Dr. Fauci by asking some of the questions he received from you. This is a conversation you don’t want to miss.

 

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Transcription

SPEAKERS

Andy Slavitt, Dr. Tony Fauci

Andy Slavitt  00:00

For the purposes of this, is Tony okay.? Do you prefer Dr. Fauci

Dr. Tony Fauci 

No, Tony is great. Tony is great.

Andy Slavitt 

Sir Fauci after you get knighted?

Dr. Tony Fauci

How about Tony? Tony’s good.

Andy Slavitt

Welcome IN THE BUBBLE. It’s Andy Slavitt, we approaching the year end. And there’s a number of things going on. We are hitting infection levels and deaths that are just quite frankly unimaginable. And I know this is a shock to the system for everybody. So on the show today, we’re going to try to put some perspective on everything. And as you just heard, we’re going to have Anthony Fauci as our guest today to talk about really recapping what happened this year. And what’s going to happen in the coming year.

I thought that’d be a perfect capstone for this year. You know, I think our two themes are surviving and remembering. And you know, we did an episode a couple days ago with Tammy Duckworth, who, you know, I consider to be, in many respects, the ultimate survivor, her story on the battlefield, if you haven’t heard it, go back and replay it. Just remarkable. And then we’ve just got so many people who didn’t survive, that we haven’t really paid proper remembrance to.

And we’re going to do a little bit of remembering. But your questions, my questions, I think you’ll enjoy listening to Tony, I know you’ve all seen interviews with him before. But he is even more of a gracious, humble, nice person, as I think you’ll see. And by the way, he’s kind of smart, too. So I find that he was able to keep up with me. So let’s hear Tony.

Andy Slavitt

Hi there.

Dr. Tony Fauci 

Hi, how’s it going?

Andy Slavitt 

Good. How are you?

Dr. Tony Fauci

I’m very well, thank you.

Andy Slavitt 

For the purposes of this, is Tony okay? Do you prefer Dr. Fauci

Dr. Tony Fauci  02:04

No, Tony is great. Tony is great.

Andy Slavitt 

Sir Fauci after you get knighted?

Dr. Tony Fauci 

How about Tony? Tony’s good.

Andy Slavitt 

Tony, be great. Let’s get exactly how swamped you are. Maybe take me back to January, when you first got the sequence from China. Can you just walk folks through what those first steps were and how you got things moving?

Dr. Tony Fauci 

Yeah, you know, it really does. antedate the time when the sequence went up in, I believe was January 9th to January 10th. In the laboratory in the vaccine research center, my team there. And this particular component of it was led by Bonnie Graham had been working in two areas. One was in a long-standing collaboration in the arena of mRNA. vaccine was working with Moderna for some time. But something that is not as well recognize that really is important was that the protein, the spike protein of the Coronavirus, that would serve as the principal Immunogen in essentially all the vaccines that are being used.

It was very clear that if you put the protein in a certain conformation, it gives a very good immune response. And in a different conformation, the immune response isn’t as good. What Bonnie had been working on previously for like seven years when he published it with respiratory syncytial virus is that if you get the relevant protein, in a certain form, it’s referred to as the post fusion or the pre fusion. Post fusion is what happens after it binds to the cell. Pre fusion is how it looks when it’s just in the virus itself.

And Bonnie found out that if you can get it in the prefusion form, it’s much more immunogenic and leads to a much better vaccine. The only trouble is, the prefusion form is unstable it flops around. So what they had to do was induce mutations in the molecule to get the best molecule for the Immunogen, but in a stable form. And they successfully did that with RSV. So then fast forward few years, and now it’s all of a sudden it’s January 2020.

04:27

And the sequence goes up on the database, and we say spike protein, there it is, you pull the sequence out, and then you do it and you manipulate it in a way that you’re going to express a protein so that when you put it in the mRNA, it’s going to come out in exactly the right form. And it was that was done extraordinarily quickly because they had been working on it with another virus for a considerable period of time. So we went from seeing the database showing the sequence.

And then we got together the next day on the phone discussing it what we should do, let’s go ahead and start the vaccine development, I remember the discussion went because remember there was no money then at that time was, well, you want to go into vaccine development effort that’s going to cost money. And I remember telling them saying, don’t worry about the money, I’ll worry about the money, money will come later, just go ahead and do it.

And then over the next couple of days, they got together again with Moderna started the process. And something like 63 or 64 days later, we were in a phase one trial. And then we went from there to the phase two, and then the phase three started on July 27. And because of the degree of infection that was in the community, the ability to be able to get data points was truncated to a period of a few months, rather than sometimes it takes years to do that.

And here we are right now, in December, and vaccine with Pfizer has already been distributed. And very soon, likely, within the next day or two, we’ll be seeing the same thing with Moderna. So it’s extraordinary the process.

Andy Slavitt  06:10

It’s extraordinary story, and it’s a.. The lessons for our country in terms of investing in science, what sometimes you don’t know even what the benefit of that investment is, is really critical. You know, when you look at a vaccine like this, and you’d look at something that’s been much more challenging, like HIV, can you explain to the layperson what it is that made this an easier virus to attack from a vaccination standpoint?

Dr. Tony Fauci

Yeah, that’s a great question. And the answer is that the thing that would predict whether you’re going to be able to induce the body to make an adequate immune response against any given pathogen, in this case a virus, really will depend on what the body’s response to natural infection is. So if you get infected with whatever pathogen, even one that causes significant disease, and death, smallpox, polio, measles, that most of the people who get infected with those particular pathogens, wind up recovering, clearing the virus from the body, and being left with immunity.

That would prevent them from being infected, again, with the same pathogen. So the proof of concept that the body can make a good immune response when you’re dealing with those is already there. So you know, you’re going to be able to get a vaccine against polio, measles, or smallpox, with HIV, that’s a different story. Because the body does not make an adequate immune response against HIV for any of a number of reasons, which is the reason why there are really no documented cases of people who have spontaneously cleared the virus from the body once there has been established infection.

Fortunately for us, that’s not the case with SARS-CoV-2 because we know that people do recover from the virus. In fact, if you look at the number of people who’ve been affected, as well as those who’ve gotten seriously ill and died, the overwhelming majority of the people actually recover from SARS-CoV-2. So your own body, and nature has proven the concept. So therefore, it was clear that we’re going to be able to get a vaccine. But the question was, how quickly do you do it and how powerful the vaccine is. And now we’ve answered both of those questions. We’ve done it less than a year, which is historic and be it’s 94% 95% efficacious.

Andy Slavitt  08:45

There’s really no comparison in what you’ve done, and what the team has done, and in fact, and maybe just a quick acknowledgement of the of the amazing career civil servants, that I had a chance to work with that you’ve worked with your entire career. You mentioned some of the folks inside NIH. Can you recall the conversation you had early on with Peter Marks, and with Rick Bright and with others about Operation Warp Speed, and that concept, and how much the career civil servants across the various agencies collaborated? To put that together? Can you recall that for people?

Dr. Tony Fauci

Oh, yeah, it was really something wonderful. I think it was a beautiful example of public private partnerships, but of an endeavor which was named as Operation Warp Speed involving multiple agencies, so many career civil servants whose names you’re never gonna hear about, who are behind the scenes to make this happen. An enormous effort and enormous investment in money literally to the tune of hundreds of millions, if not billions of dollars, put together with the level of collaboration and cooperation. That was is really extraordinary.

10:02

It tells you a lot about the marriage, as I say, between fundamental basic science and Applied Science to get you to an intervention that is then actionable to have an impact on public health. And that’s exactly what we’re seeing right now. So if ever, there was an argument, to be able to continue to support that fundamental basic research and continue to collaborate across agencies, and then also not only across agencies, within the federal government, but the partnership between the federal government, academia and the pharmaceutical industry, I mean, you’re seeing right now, as we’re speaking, the fruits of that it truly is extraordinary.

Andy Slavitt

Yeah, I mean, people want to know what the deep state does. This is what the deep state does. And it does it all over the government, not just in science.

I’m going to read you a quote, which you might recognize, but I’m not going to make a guess who said it. “Promoting science isn’t just about providing resources. It’s about protecting free and open inquiry. It’s about ensuring that facts and evidence are never twisted or obscured by politics or ideology. It’s about listening to what our scientists have to say, even when it’s inconvenient, especially when it’s inconvenient.”

Andy Slavitt

Now, that was a quote from President Elect Barack Obama, that laid out what I think was one philosophy about how politics and science should interact. You know, you’ve served now under I think, directly serve 7 presidents going on your 8? If I think that’s right.

Dr. Tony Fauci 

No, 6 going on 7.

Andy Slavitt

Okay, you may serve as many as you as you care to, on behalf of the country. When they write about a talk about how scientists during this extraordinarily tricky period of politics and science matching, there are a number of really interesting stories ranging from Nancy Messonnier, and yourself, who, from the beginning, believe that no matter how hard your first equities were to the public, particularly without it before a vaccine, how much NPIs mattered to people who were, I think, caught up in this to people who have stuck with kind of a stance that’s been less supportive of science.

Can you talk about how you navigate that, and maybe tell folks a little bit about your first conversation with President Elect Biden, and what that feels like, I had a chance to work on the Cancer Moonshot when I was in government. So I have my own perspective, but we’d love to hear yours.

Dr. Tony Fauci  12:56

Well, you know, one of the things that you have to realize, and particularly it has come home, in shock relief here over the last year, is that you have to focus like a laser on the science that you’re doing. And that’s what I really had to do since the very beginning. We have evolved over the last 11 months with a truly historic pandemic. But it’s been in the context of a very divisive society. I mean, anybody who looks at what’s going on in the United States and doesn’t realize that there’s a substantial degree of divisiveness is not really paying attention to what’s going on.

To me, that is antithetical to a response to a global health in a domestic health crisis that we’re going through right now. So it’s really been very unfortunate, I think, we’ve been able to hold steady, to continue to focus on the science and to follow the science, which is the reason why we got to where we got and why you and I are speaking about this right now. But it has not been very, very easy, because of the degree of divisiveness in the country, which is really unfortunate where public health issues and matters, actually took on a political connotation.

Andy Slavitt  14:17

Did that surprise you?

Dr. Tony Fauci

It did, the degree of the divisiveness really surprised me, and disappointed me and quite frankly, saddened me, particularly in a situation where you see certain regions of the country in which the level of disease is so intense, that certain hospitals are on the verge of being overrun in the sense of not having enough beds or certainly not enough intensive care beds, or even trained intensive care personnel and at the same time, that that’s happening.

You have people in those regions in those towns, cities and states, who are still claiming it’s fake news, or that it’s a hoax. I mean, how could you possibly do that when the numbers are staring you right in the face when you have 303,000 deaths. And a couple of days ago, we had 3565 deaths in a single day. How can you possibly say, that’s not real? That has made it a very difficult to have a uniform type of response to this outbreak.

Andy Slavitt 

Now, I had a conversation with the head of the National Health System, who said, we have all kinds of problems and challenges in this country. But we don’t have your problem. You know, people may or may not want to wear masks, they may or may not be tired. But for nobody is it a matter of their tribal identity? And that’s a problem that I don’t think for all of the preparation, that the government’s done that you’ve done that you could possibly read to a scenario where that becomes as much of an issue.

And of course, the inability to dissent inside the government when you have an objection. Have you said it for the positive the ability to dissent is so important. And I think we just learned that lesson, and maybe speak for a second, if you wouldn’t mind just about how your initial conversation with President Elect Biden went and what’s your sense of how much things can evolve, or even you know, we because the things are still divided, even after the election of course.

Dr. Tony Fauci  16:17

I have not spoken directly to President Elect Biden about this. I’ve had considerable conversations with Ron Klain, and with Jeff Zients about this, we haven’t made the connection. And I believe it’s because President Elect Biden does not want to put me in a compromised position because I’m still part of the Coronavirus Task Force. So that was, I think, a very, very thoughtful and generous thing about not personally reaching out to me, but knowing we need to have a transition, which we’re having and doing so through Jeff, and through Ron.

Andy Slavitt

Who are two of the most capable people that certainly I’ve ever worked with. And they both have great history with you. And so I guess just It has been a simple matter. Are you encouraged by the view of the ability of science and dissent and all of those things, even if they’re inconvenient to prevail?

Dr. Tony Fauci

Yeah, absolutely. I’m very enthusiastic about that. I’m looking forward to working with them for sure.

Andy Slavitt

So let’s turn a little bit to 2021. What can the nation expect if you had to describe what 2021 will feel like for the general public?

Dr. Tony Fauci

Now, what I think we’re going to be seeing, and I’m fairly certain, we will see this as we roll out the vaccine, where more and more people get vaccinated. And I do hope that we ultimately get to a substantial proportion of the population being vaccinated. When I say substantial. I’m talking between 70% and 85%, of people getting vaccinated, we will see as we get into the beginning of the first quarter of 2021. And we get the higher priority people right now in December.

The aim is to get people in nursing homes, and extended care facilities and the first line health care workers who are taking care of individuals, as we get to that 1B and 1C level and then two and three. Hopefully, by the time we get to the middle of March, maybe middle to end of March that we will be in a position where then it becomes what I have referred to for people to understand as Open Season. Anybody doesn’t matter. Young person who has no underlying condition doesn’t have a critical job, but just every normal man and woman in the street who want to get vaccinated.

18:34

Once that starts in earnest, I believe if we do it efficiently, and we get people vaccinated quickly as we go through April, May and June, that by the time we get to the middle and end of the summer, we’ll have that proportion of the population vaccinated that we can really start thinking about returning to some form of normality. Now, I don’t think we’re gonna have to and we should not think in terms of abandoning public health measures.

While we’re getting to that point, we should think of a vaccine as complimentary to public health measures, not replacing public health measures. But there will be a time I think, this calendar year that we will begin to approach some degree of normality if we get that substantial proportion of the population vaccinated.

Andy Slavitt 

So if you had to project a month, when you would say, indoor gatherings again are likely to be safe, recognizing it’s going to be variable across the country. What does that feel like to you?

Dr. Tony Fauci 

Yeah, you know, it’s always dangerous to do that. But I’ll say it with a big caveat. That is a big, you know, guesstimate, and a lot of things would have to fall into the right place for that to happen. But I think getting back to what I said about if we get a substantial proportion, when I say substantial, I’m talking really substantial, vaccinated. I would think as we get into the full months, as we get into September, October, November, That we will be able to have indoor gatherings restaurants not feeling badly about having indoor seating. I hope it’s that.

Andy Slavitt  20:07

Great. In a sentence, what is the government need to get right? And what should the public? What does the public need to get right this coming year?

Dr. Tony Fauci

Well, first of all, what I would like to see is something that I had been asking for all along is that although I totally respect the Federalist approach towards government, where the states have a significant amount of leeway in doing things the way they would want to do, I would like to see a bit more of a uniformity respecting the differences of state where you have a consistency and a uniformity in your approach to this outbreak.

We do certain things that are standard, so that there’s no doubt about what one should be doing at any given time. That’s what I really would like to see. The other thing that I would like to see is that the testing that we’re doing of not the testing, where you’re trying to find out in identification, isolation, contact tracing, but more of a surveillance testing of asymptomatic people to be able to get a feel a good feel for the penetrants of infection is and people might be able to take it upon themselves to determine am I infected, if I am, I’m going to stay out of circulation.

And mean if obviously, I get sick, and I need a physician, I will. But if I’m just infected, I don’t want to be infecting anybody else. I want to quarantine myself for the standard amount of time, we’ve got to be able to do much more of that.

Andy Slavitt

So to close up, I asked our audience for what questions would they ask you so I crowdsource questions. And we get 250 questions. And you know what? I’m not gonna ask you all of them. And you know what? They were all really good questions. So I’m up.  if it’s okay with you, maybe I’ll pick two or three. And then we’ll let you get on your day with much much gratitude. That sounds good?

Dr. Tony Fauci  22:14

Sounds good. Let’s do it.

Andy Slavitt

Okay. Susan Williams asks:

Andy Slavitt 

“How confident are you that the vaccine will produce herd immunity when we’re hearing stories of people getting sick more than once from COVID?”

Dr. Tony Fauci

Yeah, I’m pretty confident that if we get 70% to 85%, of the population vaccinated at the level of virus will be so low in society, that we will essentially have the functional equivalent of a really good blanket of herd immunity. I’m quite confident.

Andy Slavitt 

Okay, next question:

Andy Slavitt 

“Does Tony still think COVID will be endemic in some parts of the world? Or will the vaccination campaign look more like smallpox eradication?”

Dr. Tony Fauci 

uh, I do not think we’re going to eradicate this virus. If we do, then it will be only the second human virus that we’ve ever eradicated smallpox being the first and only one, I believe that we can get good control, if not elimination. So when you think about what happens with pathogens, like viruses, you can either control it meanly, it’s still in society going along, but it’s not out of control.

Or you could eliminate it means it’s not in your country. That way we’ve done for example, with polio, or if you can eradicate it, I’m not so sure we’re going to be able to eradicate I think we could easily control and maybe eliminate it.

Andy Slavitt 

Wow. So annual perhaps vaccinations.

Dr. Tony Fauci 

Well, I hope that it’s a longer duration than annual but I think it likely is not going to be lifetime immunity.

Andy Slavitt 

“Any plan for organizing research to defeat long COVID and other disabling post viral symptoms?”

Dr. Tony Fauci

Very good question. Yes, we’re putting a considerable effort. We had a workshop on December the third and the fourth, here at the NIH virtually, but originating here at the NIH, to take a look at the support of studies, both cohort studies and studies looking at the pathogenesis, and potential treatment of this really disturbing but quite real syndrome that we’re seeing of people who recover viral logically, but have a variable time, a persistence of rather common symptoms.

Andy Slavitt  24:16

Got it. Okay, I’m gonna do two more quick ones, because I think we can answer them quickly. And then let you go. The first is it really for people who aren’t able to take the vaccine? And the question they’re asking it, I mean, what strategy is obviously ring vaccination. But the question is, what do you think of repurposed drugs is therapeutics for those of us who cannot take the vaccine? Do you know of any government funded group studying this?

Dr. Tony Fauci

Oh, yeah. I mean, the government funded group it’s the National Institute of Allergy and Infectious Disease, is investing a lot of money into looking into both repurposed drugs but also targeted antiviral delt development the way we did with hepatitis C, and the way we did with HIV.

Andy Slavitt

Got it. And are we any closer to understanding why some people have milder or no symptoms, and other people have severe reactions and other people obviously this is fatal for besides the things we know around age, and other risk factors.

Dr. Tony Fauci

Yeah, yeah, that’s the thing that troubles me the most, we do not know that. This is the big mystery of this virus. You’re right. There are factors like aging and underlying conditions, yes. But I’ve never seen a virus that can have a situation where in a large proportion of people does nothing, either no symptoms or mild symptoms, and yet in others, it kills them, we really need to find out why that happens, because we really don’t have a good explanation for that right now.

Andy Slavitt 

Well, thank you for helping us get through 2020 an extraordinary year, and for the great hope you’ve given us with all the work you’ve done to get ourselves in the position we are now to get to 21. And the place that needs to be, I can’t tell you how much gratitude people have asked me to express to you, personally. And so thank you.

Dr. Tony Fauci

Thank you, Andy. It’s great being with you. I really appreciate you having me on your show. Take care.

Andy Slavitt

Thank you, Tony Fauci for all you’ve done for the country. And thank you all for your questions. I’m sorry, I couldn’t ask all 250 questions, but a lot of them actually, I got in some other form. Let me tell you what to expect in the next few shows. That was our last live interview of the year. Hopefully, it was good one. But we’ve got some really neat things we’re going to bring you over the next couple shows. And in the beginning of January, I have selected as a kind of memory episode, we’ve selected our top 10 moments from the show.

Andy Slavitt

We’re also going to by popular demand, play a couple things that people may have missed earlier. And then in January, we’re going to kick off the year, I have asked 20 or so scientists have the best scientists in the country to answer the same four questions. And we’re gonna play show featuring all the top scientists in the country early on. And then we have an I think, a really important toolkit episode on how to stay safe when going back to work. Thank you all. It’s been a lot to me that you’ve all listened to the show this year. And I will talk to you again soon.

CREDITS

Thanks for listening IN THE BUBBLE. Hope you rate us highly. We’re a production of Lemonada Media. Kryssy Pease and Alex McOwen produced the show. Our mix is by Ivan Kuraev. My son Zach Slavitt is emeritus co-host and onsite producer improved by the much better Lana Slavitt, my wife. Jessica Cordova Kramer and Stephanie Wittels Wachs still rule our lives and executive produced the show. And our theme was composed by Dan Molad and Oliver Hill and additional music by Ivan Kuraev. You can find out more about our show on social media at @LemonadaMedia. And you can find me at @ASlavitt on Twitter or at @AndySlavitt on Instagram. If you like what you heard today, most importantly, please tell your friends to come listen, but still tell them at a distance or with a mask. And please stay safe, share some joy and we will get through this together. #stayhome

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