The Hill on Friday spoke with Anthony FauciAnthony FauciREAD: The Hill’s interview with Anthony Fauci On The Money: Jobless rate exceeds 20 percent in three states | Senate goes on break without passing small business loan fix | Biden pledges to not raise taxes on those making under 0K Overnight Health Care: Fauci on why a vaccine by end of year is ‘aspirational’ | Trump demands governors allow churches to open | Birx says DC metro area has highest positivity rate MORE, director of the National Institute of Allergy and Infectious Diseases and the nation’s top infectious disease expert. The following transcript is edited only to clarify The Hill’s questions.
I want to start with progress on developing a vaccine. You’ve said that, starting in January, we were 12-18 months away from a vaccine, but now we hear some people saying there may be a vaccine by the end of the year. Is that realistic?
In January, when we first began the development of one of the candidates, one of the several candidates, I had said that we would hope by carefully but nonetheless quickly going through the various steps without compromising safety or scientific integrity, I felt that within a year to a year and a half, we very well might have a vaccine that is available for deployment. I said that in January, and a year from January is December.
I think with the way things are progressing now and the fact that we’re going to be proceeding from one step to the other with risk for investment but not risk for the patients — in other words, in the standard way you develop a vaccine, you do not make major investments in the next step until you are fairly sure that the prior step works and you are satisfied with it. If you jump ahead and at least prepare and make investments, for example preparing sites for trial and even beginning to produce vaccine before you even know it’s safe and effective, that you’re taking a risk, and the risk is a financial risk, it’s not a safety risk. If you do that, you can cut down by several months the process of getting vaccines available as opposed to waiting until you’re fairly sure everything works and then beginning for example manufacturing the doses. When you start manufacturing them ahead of time, then the risk is financial, because if it works, you’ve saved a lot of time. If it doesn’t, then you’ve invested money you’re not going to recoup. I think when you put those things together, again with good attention to safety and scientific integrity, it is conceivable that if things work out right, you could have a vaccine that could be ready to be deployed by the end of the year, the beginning of 2021.
That is assuming that the vaccine works. We’re talking timetables that any time you develop a vaccine, you always remember, you always have a question that you may not get an effective vaccine. Even if you do everything right and you do everything on time, there’s no guarantee you’re going to have an effective vaccine. So when we talk about having a vaccine that might be available in December or January, that’s assuming that the vaccine is actually effective.
What does it mean to “have” a vaccine? How many doses need to be developed, distributed or administered before we can legitimately say it’s available? World Health Organization Director-General Tedros Adhanom Ghebreyesus has warned that the virus won’t be defeated until everyone in the world has access to a vaccine.
That’s the reason why you need not only multiple shots on goal with multiple companies involved is because it increases the chance that you’re going to have more than one successful vaccine, but also if you need multiple companies with all of their capabilities producing a vaccine to have vaccine that’s not only enough for us here in the United States but also for the rest of the world. We’re not alone on this planet. There are a lot of other countries and nations and regions that would need vaccines.
I’m fairly certain that the idea if you ramp up production and start months ahead of time, like this summer, instead of waiting until the late fall and early winter, which would delay the availability of doses and drugs that if you started reasonably soon as we enter into the late spring, early summer and as we get into the phase three trial, that you could have 100 million doses by the end of the year and maybe a couple of hundred million doses by the beginning of next year. I mean that’s aspirational. The companies think that they can do that with the right financial backing.
How concerned are you about the strength of the supply chain necessary to distribute a vaccine — the vials, needles, syringes, et cetera?
In this process, this rapid approach toward a vaccine — it was given the name Operation Warp Speed. I’m a little concerned by that name because it can imply by warp speed that you’re going so fast that you’re skipping over important steps and are not paying enough attention to safety, which is absolutely not the case. But in this program of hastening the development of the vaccine, it’s something that we do feel actually is feasible to get the kinds of doses that you would need.
As part of that program, we’ve employed a person, a general in the United States Army, Gustave Perna, who is really very very highly regarded in military circles for his ability to do things like supply chain and distribution and things like that.
The debate in Congress lately has been over the economic side of the recovery. What do you want to see from Congress to address the public health side of the crisis?
Congress has been extraordinarily generous in giving to the CDC and to the NIH and to the other agencies of the federal government enough resources to be able to do the job that we’re being challenged to do. The Congress, the Senate and the House, both sides of the aisle have been extremely generous from the public health standpoint, as well as the economic.
Just from observing the amount of investment to help the economy recover has been extraordinary. And similarly they’ve made major investments in having us be able to do our work in public health and biomedical research.
The Senate is in D.C., but the House is voting remotely. Should lawmakers be coming to D.C. or is that too much of a risk?
I would leave that both to their own discretion and the advice of the House and Senate physician, rather than my opining about what they should or should not do. They have good medical advice and they should follow that medical advice.
CDC did not issue guidance on reopening churches and houses of worship. How would you advise houses of worship to reopen safely?
There are guidelines in general that are given about reopening that can be applied to houses of worship. I wouldn’t say there are no guidelines there, there are some general guidelines for that, and it’s done in the same measured way that we do opening other areas where there’s congregation. You have to be careful, it depends on the particular state, city, region, county that you’re in and what the dynamics of the outbreak are. So if you’re in an area where there’s relatively little infection, as there are in certain regions of the country, versus an area where there is still a high degree of infection, how you approach what you do in houses of worship really varies. You want to make sure that you have good physical distance, wearing a mask where appropriate when you cannot separate yourself from an individual physically, all of those things are a combination of what is already in the guidelines as well as common sense.
Were you surprised to hear President TrumpDonald John TrumpREAD: The Hill’s interview with Anthony Fauci Trump’s routing number revealed as press secretary announces he’s donating quarterly salary to HHS: report Former White House aide won M contract to supply masks amid pandemic MORE is taking hydroxychloroquine?
I’m not going to comment on that.
What’s the best role for antibody testing now? Should we be relying on antibody testing as a metric for reopening?
I think we have to be careful because we want to make sure when we do antibody testing that we have tests that have been validated and that are reliable. The other thing is that we have to be careful because we do not know at this time what a positive antibody test means. It certainly does mean that you’ve been exposed and that it’s likely that you’ve recovered, particularly if you are without symptoms. The durability of the antibody response, the degree of protection that you get, the relationship between the type of antibody, and whether you are or are not protected and for how long are still things that are open questions that we are examining to see if we can add some solid science to it.
Certainly the suggestion is that if you have recovered and you have antibody positivity, that you at least for a reasonable period of time you are protected. That’s the assumption. The assumption is probably correct, but we haven’t definitively proven it yet. So I believe that antibody tests have value in getting a feel for what the penetrance of the infection was in society. You could easily figure that out by finding out how many people actually were exposed and infected by doing an antibody test. That you can determine and that would be important in giving you an idea about how much undetectable infection there was in society. Because the significant number of infections, the person remains asymptomatic. You would not know that unless you do various surveillance studies, and one of the ways to do a surveillance study is by doing screening with antibody tests.
Some states are reopening without meeting CDC’s guidelines. Does that concern you?
It is prudent for states who are at various levels of infection to follow the guidelines that have come out about reopening or opening America again. And that is to get past the gateway criteria and then go into the various phases at the rates that are prescribed by the guidelines. Obviously if some states don’t do that, there is always a risk that you may have a resurgence. Hopefully if there is the states at least have the capability of addressing that by having the manpower, the tests and the process in place to identify, isolate and contact trace. So hopefully they will have that in place to prevent significant resurgence.
Much of the federal response has been to let the states act on their own. Has that hindered the federal response? Without national guidelines, how can we be sure every state is reporting and following the same metrics?
The system in our country is that the federal government provides general guidance, general direction, and backs up with resources, where necessary, the states. But the states have the discretion of the pace at which they are going to make this attempt to reopen. There are a set of guidelines they can follow, but there’s a certain amount of discretion because it isn’t one-size-fits-all. We have a big country and we have varying degrees and dynamics of the outbreak in different parts of the country. And although the federal government does provide backup and support and guidance, ultimately the states are the ones that make that decision.
The United States is closing in on 100,000 deaths from the coronavirus. How do you assess where we are on the epidemiological curve?
One of the things that is going to be important is that as we open up and try to get back to some degree of normality and pull back on the mitigation is what is our capability? And I hope it’s intact. I believe it is in certain areas. What is our capability of being able to respond to the inevitable blips that you will see when you pull back on mitigation, and the workforce that can do it to be able to identify, isolate and contact trace. If we have that in place and it’s good, then there will not be a significantly larger number of infections. If we don’t handle that well, we could have even more infections than the models are projecting.
One of the models that I was quoting back then was saying there would between 100,000 and 240,000 deaths, and we’re very close to having 100,000 right now. Hopefully it doesn’t get significantly more than that, but that will depend on how well we respond to the inevitable rebounds that you will see as you pull back. If you respond well, you may keep that number relatively low.
When was the last time you were tested? How often are you tested?
I’ve been testing negative a lot. What’s today? Friday? Yesterday, I was negative.
Have you been surprised by the role politics is playing in this outbreak? Even a virus has become a political football in our hyperpartisan times.
I try to dissociate myself from that, and do what I’ve done all along, is to try and give the best public health advice and guidance based on data, based on science and based on evidence. I’ve always done that and I’ve successfully been able to stay out of some of the political whirlwind that happens all the time.
I’m not surprised this is a political situation. It happens, I mean it isn’t the first time that it’s happened, but I try to dissociate myself with that.
You’ve become more visible than ever, even more so than during Ebola or H1N1. Has that changed your daily life in any way?
It’s kind of transformed my daily life into 20-hour days, 18- and 19-hour days, quite intense. As it should be, because this is a very serious problem and we feel a great deal of responsibility to get this right for the health and safety of the American public.
Do you see a possibility for major pro sports leagues to play games this year, even without fans?
I think there is. Several of the major league organizations, baseball, football, soccer are all trying to do something in a way that would be safe for the players, safe if there are any spectators. Certainly the first line would be that these sports where you could televise it and the people can get the benefit of seeing the sport without necessarily congregating in a stadium or an arena. I think the various major league sports are trying to be creative keeping in mind that their first responsibility, that is the safety of the players and the personnel, and also if there are fans, the safety of the fans.
I can’t predict with any certainty what’s going to be able to be done but I can tell you that there’s a great deal of discussion to see if in fact we can get some sports events during this year.
The coronavirus has disproportionately hit African Americans and other minority communities. How do we use the crisis to address historical health disparities?
I hope that we take the lesson that we’re learning from COVID-19 to refocus on the things that we’ve known all along, that there are significant health disparities that we need to address. A bright light gets shined on that when you’re in a crisis situation the way we are now, when you see these very disturbing numbers of African Americans and other minorities again bearing the brunt of the burden of disease. And I hope that when we get this COVID-19 under control, we don’t forget about the fact that we still need to address these health disparities, which will be there unless we address them.
How long do you envision staying in your position? Have you considered retiring?
No, I haven’t thought about retiring. I’ve got too much work to do right now.