Published on Dec 23, 2020

Video Transcript

[MUSIC PLAYING] JOHN WHYTE: Welcome, everyone. You're watching Coronavirus in Context. I'm Dr. John Whyte, chief medical officer at WebMD. Today I have a very special guest, Dr. Anthony Fauci, the world's leading authority on infectious disease. Dr. Fauci, thanks for joining.

ANTHONY FAUCI: Thank you. It's good to be with you.

JOHN WHYTE: Dr. Fauci, I heard you got the vaccine today, so I wanted to ask you about your experience. How are you feeling?

ANTHONY FAUCI: I'm feeling perfectly fine, perfectly normal, nothing so far. I have no pain in my arm. I had nothing to even indicate that I had been vaccinated. I feel perfectly fine. That was about, let's say, about three, four hours ago. I'm doing great.

JOHN WHYTE: Now, people ask, does it feel cold? They know they're kept at these super frozen temperatures, but was there any tingling or--

ANTHONY FAUCI: No, no. No, you don't feel it at all really. It was even, several of us remarked because I got it together with a group of health care providers, and I'm also a health care provider, but I got it with them, and all of us agreed that it was even less of a feeling than the flu shot. You know, flu shot sometimes it hurts a little. It didn't hurt at all. It was perfectly fine.

JOHN WHYTE: I want to ask you about the vaccine because you've talked about how impressed you have been with the safety and efficacy data, 94, 95% effective for both of these vaccines. If the data is so compelling, why have it authorized under emergency use authority as opposed to full approval?

ANTHONY FAUCI: That's a very good question, John. And the reason is you want to get it out as quickly as possible. To do the full dotting the I and crossing the T's of a biological license application, the BLA, that would take several more months to do. So when you do an EUA, particularly an EUA that's granted on the strength of these data, which is really quite impressive, both of these vaccines not only were safe, but they were 94% to 95% efficacious in preventing any clinically recognizable disease and even better in preventing severe disease.

So we felt that we wanted to get it out quickly while the process of putting in for the full license approval. We didn't want to have months go by without people having the advantage of the vaccine given the extraordinary situation in our country. As you well know, we're in a very difficult situation. We're having between 200 and more thousand cases a day, anywhere between two and 3,000 deaths per day. Hospitalizations has reached a record of 118,000. Places like California are being stressed to the point they may run out of beds.

So you don't want to be delaying vaccine merely because bureaucratically you have to go through a bunch of hoops to get the official approval. The data are quite strong to grant an emergency use authorization.

JOHN WHYTE: Some people have been out there saying, just to your point, given the number of infections, the number of deaths, the scarcity of the vaccine right now, let's not focus on two doses, but there's some efficacy, some significant efficacy after the first dose. Why not just start giving more people the first dose? And one is better than none. What are your thoughts about that approach?

ANTHONY FAUCI: That has been discussed a fair amount. What people don't appreciate, even though there is some degree of efficacy after a single dose, it is really not optimal at all, and we don't know how long it lasts. We do know definitively that when you give a prime, even though you do get some degree of immunity after the prime single dose, after the second dose, it's dramatically higher, and it lasts considerably longer.

JOHN WHYTE: What about data in children? Particularly, let's say less than 12 years old. Should we be worrying about vaccination in children given we know the journey of the disease in children versus really focusing on teachers and workers and other adults?

ANTHONY FAUCI: Well, do you want to do both. So the reason we traditionally, when we make a vaccine and test a vaccine, is that you don't want to test it on children because children are vulnerable. They do not have the capability of giving informed consent, which is important. It's their life, though they're very young. It's still their life. So you've got to take extra special care in safety.

So the standard traditional thing we do is you do a vaccine study that's a phase three large study in adults. When you get good safety and good data on efficacy, then you can feel justified in taking the risk of trying it in a child. You can do a phase one, phase 2A in a child after you complete the vaccine trial in the adult and then quickly get the children to get vaccinated by what's called a bridging study.

A bridging study means you don't have to spend the entire time doing tens of thousands of children the way we did with the adult. You can do a couple of thousand, 2,000 to 3,000 or 4,000 kids, show that it's safe, and show that it induces the kind of response that's comparable to the response that protected the adult. Then you can make the assumption that it will protect children, and then you license it because you've proven safety, and you have a very good indication that it likely will protect the children. We're going to start that, John, probably the middle to the end of January.

JOHN WHYTE: Do we need to vaccinate kids before we can reopen schools?

ANTHONY FAUCI: No, I don't think that that's necessary. I think that the default position should be as best as possible to keep the children in school or get them back to school if they're not in school. We know now that when all other things being equal, children in school get infected less than the adults in the community. So if you have the capability of dealing with kids when they get infected, you have reasonably good surveillance, like maybe vaccinate the teachers to protect them in the school and prevent them from infecting the children.

JOHN WHYTE: They're on the next prioritization list as well. You know, I want to ask you about vaccine confidence, and you might have seen the data from a USA Today survey that just came out that talks about Democrats are nearly twice as willing as Republicans to receive the vaccine, and even more concerning can be that 36% of Republicans say they'll never take the vaccine. How do we get to 70, 80% herd immunity, Dr. Fauci, if we have these issues with confidence in the vaccine? What are the one or two things that we need to be doing now to inspire confidence?

ANTHONY FAUCI: Well, I think we need outreach to the communities of all people, Republican and Democrat minorities and people in the general population. The way we have approached it is to not essentially confront people who are hesitant or who have skepticism but try and reason with them and say, what are the reasons why you have skepticism. And there are a couple of well-defined reasons. If the reason is, boy, this went really quickly, was it careless and quick, and then you show that the speed of the fact that we went from a brand new virus in January to a vaccine that we're putting into people in December is not compromising safety, nor is it compromising scientific integrity. What it is a reflection of is the extraordinary scientific advances that have been made in vaccine platform technology, which have allowed us to do things in months that we normally would have taken years. There's no compromise in safety.

The next question people ask, understandably, is, well, you're saying this is safe, and you're saying that it's effective. Is that true, or is this the government putting pressure on you? Is it the pharmaceutical companies wanting to make a lot of money?

JOHN WHYTE: So tell us, what's the answer?

ANTHONY FAUCI: Actually, the answer is-- and this is important, John-- is that the decision of whether something is safe and effective, the data that gets examined is done so by a totally independent data and safety monitoring board made up of vaccinologists, virologists, immunologists, statisticians, and others, who look at the data who have no allegiance, don't answer to the federal government. They don't answer to the pharmaceutical company. They're an independent group. When they decide that the vaccine data look really good, and it's safe and effective, they then give the data to the company who presents it to the FDA, who then, the career scientist at the FDA, not political appointees, but the career scientists work with their own independent advisory committee, which they have an established committee called the Vaccine and Related Biological Products Advisory Committee, or VRBPAC. They then say, OK, it's cleared. Let's give it.

So in reality, the entire process is independent and transparent, and that's what people need to know, and when they do, I believe they will be much, much more amenable to getting vaccinated.

JOHN WHYTE: Everyone's talking about the variant, you know this, and the concern that will the vaccine be effective. What are the countermeasures that we need to be taking now? You've been talking about we don't want to overreact, and others are saying, you know, now is the time that we need to be overly cautious in a way. What's your response to assuage people's concerns about what they might be hearing on the news or reading online about the impact of these potential variants?

ANTHONY FAUCI: Well, I think they need to understand something broadly at 40,000 feet that this is an RNA virus, and RNA viruses mutate all the time. That's their occupation is mutating. The more they replicate, the more they mutate. Most of the mutations do not have any functional significance or functional relevance. The one that's being looked at now, the one that's dominant in the United Kingdom is one that appears-- we don't know for sure-- but it looks like that it has a better capability of transmitting of going from person to person. There's no evidence that it has any effect on its virulence, or namely, does it make people more sick, it doesn't.

The other important issue, is it true or not that it's evading the protection of a vaccine, and it doesn't appear that that's the case at all. So what we need to do is we need to watch it very, very carefully. We need to do surveillance in this country. And then there is discussion about if it isn't already here, which it might well be here, and we don't know it yet, what do you do? And there's been discussions-- some people, I know the European Union is banning travel from the UK. I think that may be an overreaction now. I would not be against at least seriously considering making sure that people who fly here or come here from England, the UK, to the United States, that you require they be tested before they get on the plane so that you know they're negative when they get here. That, I think's something that might be considered. I'm not saying we should do it, but we should consider it.

JOHN WHYTE: Those are all good points. You know, I always ask my colleagues, what should we ask Dr. Fauci? So I want to give them an opportunity, and you know, I have to use a crystal ball. And you don't have one there, but I have one here, Dr. Fauci. Our producer sent it. And the question was that many people have postponed their weddings from last year to March or April of this year. Do they need to postpone it again?

ANTHONY FAUCI: You know, they should have done it till June, July. And the reason is--

JOHN WHYTE: Not going to be happy to hear that.

ANTHONY FAUCI: I'm sorry, John. You know, we don't know-- I have been saying, and I think it's going to work out that way, that if we do it efficiently, and it depends on how efficient we are, if we get the priority people vaccinated, the ones that the ACIP is recommending, if we get them vaccinated between now, and let's say, March, beginning of April, and we could start in April doing what I call open season on vaccinations, namely anybody in the general population who wants to get vaccinated will get vaccinated. If that's the case, when we go through April, May, June, July, by the time we get into the middle or end of the summer, I believe we will have-- if we do it correctly, we can have 70% to 85% of the population vaccinated.

When that occurs, there will be an umbrella of protection over the entire country that the level of virus will be so low that you will essentially have been able to establish herd immunity. So I'm looking forward to as we finish the second quarter and go into the third quarter of 2021.

JOHN WHYTE: And finally, I want to ask you about the Fauci effect, the impact that you're having on young students who are saying, I want to go into medicine, I want to go into science. When you heard about the Fauci effect, how did you feel?

ANTHONY FAUCI: Well, I felt good that young people want to go into a profession that I love and that I have been in for so many years. I think it's-- well, it goes beyond me. I mean, they're calling it the Fauci effect, and I'm very flattered that that's the case. But I think it also relates to the courage of the health care providers in the emergency rooms, in the intensive care units. I think people are seeing a face of medicine that they may not have seen before, of people who are really stepping up to the plate and doing their job. I'm doing it by trying to speak truth to the country and trying to be clear in the explanation of what is going on in a way that they understand. The health care providers are risking themselves, their health and their lives every day to take care of people. So I think that the face of medicine is a much, much more attractive face now than it may have been in the past.

JOHN WHYTE: My colleagues have also wanted to ask you in terms of your professional career, you've dealt with HIV, Ebola, other pandemics around the world. Why has COVID-19 been so difficult? Is it the politics around this issue? Is it the impact of social media that didn't exist before? Why so hard now?

ANTHONY FAUCI: Well, whenever you have a public health outbreak, a really transforming outbreak the likes of which we haven't seen in 102 years, everyone has got to pull together to get a maximum impact on addressing it. Unfortunately, we are living in a very divisive society. I think anybody that looks and what's going on in the United States has to realize that there is a lot of divisiveness. That makes it much, much more difficult because simple public health measures take on a political connotation.

You said it yourself when you gave the numbers. Why should there be any difference between a Republican and a Democrat as to whether they want to take a vaccine or not? There's no reason why there should be. I mean, because it's a public health issue. I think it's just a reflection of the kind of divisiveness we see. So you're right.

That has made it difficult because it has led to mixed messaging, and when you get mixed messaging, people get confused as to what's the best thing to do. And you've really got to be uniform and consistent when you're fighting something as serious as a pandemic.

JOHN WHYTE: Dr. Fauci, I want to thank you for all the work that you've been doing for 40 plus years running the National Allergy and Infectious Disease, as well as all you are doing to keep us safe during a type of pandemic that occurs once a century.

ANTHONY FAUCI: Thank you, John. Good to be with you.