David Biello: In the wake
of Dr. Anthony Fauci's announcement
that he will be retiring
as the head of the National Institute
of Allergy and Infectious Diseases
at the end of the year,
I've invited him to join me
for a conversation
on the future of the COVID-19 pandemic,
reflections on his career
and the future of public health.
Please welcome Brooklyn's own Dr. Fauci.
Anthony Fauci: Hi, David, nice to see you,
thank you for having me.
DB: Thank you for joining us.
So my first question is very simple.
Is the COVID-19 pandemic over?
AF: You know, David,
there's a lot of misinterpretation
about what the meaning
of the word "over" is,
it means different things
to different people.
I'm sure you're referring to the comment
made by the President a day or two ago.
If you're talking about the fulminant
phase of the outbreak,
when we were having anywhere from
800,000 to 900,000 infections a day
and 3,000 to 4,000 deaths per day,
that was several months ago.
We are much, much better off now
than we were then.
So in that case,
that fulminant phase
of the outbreak is behind us.
But as the President made very clear
on the second half of his sentence,
is that, which they don't seem to show,
is that he actually said
we still have a lot of work to do,
there's still a challenge ahead,
we’ve got to get people vaccinated.
We still have a number of cases,
we have 400 deaths per day.
That's an unacceptably high level.
So again, it depends on the semantics
of what your definition is.
We don't want anyone to get the impression
that we don't have a lot of work to do.
We've got to get the level of infection
considerably lower than it is.
And we've certainly got to get
the level of deaths lower than it is.
So again, it depends on the semantics
of what you mean by "end."
DB: Well, let's get
into those semantics then.
What conditions would need to exist
for the pandemic to be over?
AF: You know, that's a call
that officially is made
by the World Health Organization.
You know, my colleagues and I
oh, it must have been
more than ten years ago,
because of the lack of clarity
on what a pandemic means
to one person versus another,
we wrote a paper in the Journal
of Infectious Diseases
in which we talked about all the different
variations of interpretations.
Is it a widespread phenomenon?
Is it the widespread
nature throughout the world
that makes it officially a pandemic?
Or is it widespread and accelerating?
Or is it widespread causing
serious disease?
It means different things
to different people.
So rather than try and give a definition,
that's my definition versus another,
we should stick with what
the WHO is saying.
And as Dr. Tedros said,
that we're seeing the light
at the end of the tunnel on that.
So, again, you might interpret that,
well, if that's the case, is it over?
Well, again, what does "over" mean?
There's a lot of semantics there, David.
The easiest way not to confuse people
is to say we still have a lot of cases,
we still have 400 deaths,
we only have 67 percent
of the population vaccinated,
we've got to do better than that.
Of those, only one half
have gotten a single boost.
And as a nation,
we lag behind other developed countries
and even some low-
and middle-income countries
in the level of vaccinations
that we've been able to implement.
So if you want to look it that way,
we have a lot of work to do,
and that's exactly
what the President said.
DB: So speaking of vaccines,
what's your advice?
I know we have the bivalent available now.
What is your advice
on which vaccines to get
and when that's appropriate?
AF: Well, first, you've got
to get your primary series.
So, I mean, that's the one
where I said only 67 percent
of the country has gotten
their primary series,
which for the most part,
with some exceptions,
is an mRNA vaccine,
either Moderna or Pfizer,
given anywhere from three to four weeks
apart as the primary.
Then the issue is about giving
people booster shots.
So right now,
if you're asking a clear question,
of today,
with the bivalent BA.4-5 boosters
or updated vaccines
is a better terminology to use,
they are available now
throughout the country.
We've ordered 171 million doses.
Who should get it?
Anyone who is vaccinated
with the primary series
and has not received a shot
longer than two months ago
should get it.
So if I got my last shot,
let’s say in July -- August, September,
two months later,
you should get the bivalent.
If you were infected
three months or more ago,
you should then get the updated vaccine.
Let me give you an example
for clarity for the audience.
I was infected in the end
of June of this year,
even though I had been vaccinated.
Fortunately, because I was vaccinated,
I had a relatively mild illness.
At my age, had I not been vaccinated,
the chances are I could have had
a real severe outcome
because elderly are more prone
to get severity of disease.
So if you take the end of June,
take the end of July, the end of August,
the end of September.
I plan to get my updated BA.4-5 bivalent
at the end of September,
the first week in October.
DB: I think that’s a very useful advice,
and actually I will be doing the same.
How are you personally navigating
this stage in the pandemic?
What precautions are you taking, if any?
AF: Well, I certainly continue
to take precautions.
And I think it's important
that you ask me personally that question,
because people have different levels
of risk of severity of disease.
I am a person who is relatively healthy,
but I'm at an elderly age.
I'm 81 years old.
I'm going to be 82 in December.
So I, statistically,
would have more of a risk.
So the precautions I take,
I stay up to date
on my vaccinations, number one.
And when I go to a place
that's a congregate indoor setting
where there are a lot of people
and I don't know the status
of their infection,
their vaccination or what have you,
I would, for the most part, wear a mask.
When I'm with people
who I know what their status is,
people who are recently vaccinated
or people who come in and test
before they come in,
I could have a dinner in my home
or in the home of a friend
without any concern.
But if I go to crowded places,
certainly on an airplane,
even though it isn't required any more,
if I go on a prolonged
or even a short airplane trip,
again, because of my increased risk
as an elderly person,
I wear a mask on the plane.
DB: So switching gears a little bit,
or taking a step back,
are consecutive pandemics
kind of our new reality?
We obviously had the monkeypox outbreak.
And if that is the case,
how do we cope with consecutive pandemics?
AF: Well, you know, we have had,
probably without the general public
noticing it much,
we have had, in the history
of our civilization,
outbreaks of emerging infections,
some of which turn into pandemics.
We've had them before recorded history.
We've had them in the lifetime
of some of us, you and I.
We're going through one right now.
So given the fact that most
of the outbreaks of new infections
come from the animal-human interface,
which is sometimes
intruded upon, as it were,
where people, either by climate change
or by intruding on forests,
“uninhabited by human”
places in the world,
you’re going to get jumping of species.
Or in markets where you put
animals from the wild
in contact with humans,
which is exactly what happened
with SARS-CoV-1
and highly likely happened
with SARS-CoV-2.
We will continue to get outbreaks.
Pandemic flu generally comes
from a situation
where you have the animal species
that harbor influenza,
pigs, fowl,
birds and humans together
in that environment.
That's how you get the bird flu
that tend to challenge us a fair amount
or the swine flu.
So the short answer
to your question, David,
is that we will continue to get
outbreaks of new infections.
The critical issue is how do you prevent
them from becoming pandemics?
And that's what's called
pandemic preparedness,
which is a combination
of scientific preparedness,
like we did with the rapid development
of vaccines for COVID-19,
which was a highly successful
scientific endeavor,
matched with a public health response,
which we didn't do as well,
in the public health response,
because we had spread of infection
in a way that we could have done
better in controlling it.
DB: So speaking of that,
this is not your first epidemic,
but you've made historic contributions
to the AIDS epidemic
and now COVID-19.
But is there anything you wish
you had done differently in those cases?
AF: Well, there always is.
I mean, it's a question
of when you're involved --
Nobody is perfect, certainly not I
or any of my colleagues.
But when you're dealing with an emerging,
moving, dynamic target,
which by definition is what a pandemic is,
particularly if it's with a pathogen
that you've never had experience with,
like HIV in the very early 1980s,
or the COVID-19 pandemic
in the first months of 2020,
you could always say,
if we knew then what we know now,
and there was a lot of things
that we didn't know,
we certainly would have done
things differently.
And that's why you have to be
humble and modest
to realize if you are going
to be following the science,
the science which gives you
data and information and evidence
is going to change,
particularly in the early phases
of the outbreak.
Did we know how easily it was spread
from human to human?
No.
Did we know that it was aerosol spread?
No.
We thought in the beginning
it was like influenza,
mostly droplets from a sick person.
Did we know that 50 to 60 percent
of the transmissions
were [from] someone who had
no symptoms at all,
which clearly impacts
how you approach an outbreak?
Did we realize that instead of the typical
outbreak, where it goes up,
it comes down and then
you're done with it,
we had no concept that you'd be
seeing different waves
and different variants that came along.
So the answer to your question,
if we knew all of that from the beginning,
we certainly would have done
things differently.
But unfortunately we didn't.
And you try to be flexible enough
and humble enough
to change and modify
how you approach things
based on the recent data.
That’s not flip-flopping.
That is truly following the evidence
and following the data.
DB: Right, that's just how science works,
it's constantly updating
and especially in a real-time situation
like this pandemic.
But are there any, I don't know,
specific regrets you have,
something you would
take back if you could?
AF: Well, it depends.
Yeah, I mean, obviously in the beginning
when we were under the impression,
or didn't fully realize
that there was aerosol spread,
we were under the impression,
which was true,
because we were told that,
that there weren’t enough masks
for the health care providers.
And if we started everybody
hoarding masks,
there wouldn't be masks available
to the health care providers.
We didn't realize that out
of the health care setting,
like the hospital setting,
that masks were effective in preventing
acquisition and transmission.
We didn't know that.
We know it now for sure,
but we didn't know it then.
We didn't know that the silent spread
from people who were without symptoms.
And that meant we didn't know that,
while we were looking for sick people,
there were many, many, many more people
without symptoms that were in society
spreading the infection
in a way that was not detectable,
below the radar screen.
Had we known that,
I absolutely would have said
right from the beginning,
everybody wear a mask all the time
in an indoor setting.
But we didn't say that then.
It was only when it became obvious.
So if we had known that early on,
we would have told people to wear a mask.
However, I must say, David,
given the reluctance
of people to wear masks,
even now that we know all that stuff,
I'm wondering how well
that would have been received
if at a time when there were ten or so
documented infections,
if you told the country that everybody
should wear a mask in an indoor setting,
not so sure that would have
been broadly accepted.
DB: Yeah. And this seems
to be something that,
the United States anyway,
has been through before,
with the Spanish flu
and masking and then anti-mask protests.
And it seems to be in our, let's say,
societal immune response
to these pandemics.
Flipping it a little bit,
how do we make sure we're not caught
so, sort of, unprepared next time?
AF: Well, you know,
it's interesting, David,
what you mean by unprepared,
because the Johns Hopkins
School of Public Health
evaluated different countries'
preparedness for a pandemic.
And guess who was evaluated
to be first in the world?
The United States of America.
Guess who has the most
deaths per population?
The United States of America.
So, you know, there's preparedness,
and there's response,
there's execution
of your preparedness plans
that we did not do so well
for any of a number
of complicated reasons,
one of which was the fact,
and is, that this outbreak occurred
at a time of really profound
and deep divisiveness in our own country.
That where we had something
we hadn't seen before,
where political ideology played a role
in whether you did or did not accept
the recommended public health
countermeasures,
be it wearing a mask,
indoor settings, quarantining,
taking a vaccine, getting a boost.
If you look at the country
and look at the demography of the country
with regard to ideology,
there should never be that red states
vaccinate much less than blue states.
There's no reason for that at all
because public health risks
and public health implementation
should be uniform throughout.
And we didn't see that.
DB: Yeah, let's talk about that
a little bit more
because obviously, you've had to cope
with an incredibly polarized response
to your work
in which not just ordinary citizens,
but even politicians have called
for your resignation
and various other things.
How do you deal with that,
how do you keep your cool?
You're quite cool about this.
AF: Well, calling for your
resignation is mild
compared to having somebody arrested
who was trying to kill you.
So, I mean,
there's a big spectrum of pushing back
against public health people.
And that's one of the really
unfortunate things.
I mean, I keep my cool
because that's just the nature
of the kind of person that I am.
When you're dealing with a very,
very difficult situation,
you've got to keep your cool.
I mean, I learned that in my
early training in medicine.
When you're in the middle of emergency,
somebody is dying in front of you,
you've got to keep your cool all the time.
And that's something that's just part
of my inherent training
as a physician and as a person.
But what we faced was well beyond that.
I mean, public health officials,
not only myself, I'm a very visible one,
but many of my colleagues
are being threatened and hassled
and harassed,
themselves and their families,
the way my family is being harassed,
merely because of saying things
that are purely public health,
common sense,
tried and true principles
of how to keep people safe.
That is really extraordinary
that that's going on in our country.
DB: Yeah.
I'm also going to ascribe it
to the Brooklyn upbringing.
That gave you some cool, too.
(Laughter)
But a quick follow up,
how do you, like,
with all that going on,
with those horrifying threats,
how do you unwind from all this?
How do you, you know, keep it together
and give yourself some space to breathe?
AF: Well, I have an extraordinarily
supportive family,
my wife who's with me,
my children are grown and live
in different parts of the country.
But they are very supportive
of me with texts and calls
and knowing what I'm going through.
So I have three daughters,
which they, you know,
they try to take care of their daddy,
so it really helps.
But my wife is extremely supportive,
and we do things together.
I mean, I work a preposterous
amount of hours a day,
but every day I try to get
some exercise in
and it's usually a few mile
walk with my wife,
whether that's on the weekends
very early in the morning,
or during the week late at night
when I come home.
We try to get some form of exercise in
to diffuse the tension,
hopefully every day.
And we're pretty successful at that.
AF: Well, good for you.
So you're retiring after a very long
and distinguished career.
Congratulations.
You will have successors.
What lessons would you want to offer
your successors based on your tenure?
AF: First of all, I’m not retiring
in the classic sense.
As my wife, says, David,
I’m “rewiring,” not retiring,
because I do intend to be very active.
And that was one of the reasons
why I stepped down
at this point in time.
Because while I still have the enthusiasm,
the energy and thank goodness,
the good health
to be able to do something else
for the next few years,
I want to use the benefit
of my experience of being at the NIH
for almost 60 years,
for being the director
of the Institute for 38 years,
and for having the privilege
of advising seven presidents
of the United States
on public health issues,
to use that experience
to hopefully inspire by writing,
reading, traveling, lecturing,
inspiring the younger generation
of scientists and would-be scientists
to at least consider a career
in public service,
particularly in the arena
of public health,
and science and medicine.
Having said that,
my advice to the person
who will ultimately replace me
would be to focus on the science
and be consistent with the science
and do not get distracted
by a lot of the peripheral things,
the disinformation, the misinformation,
the attacks on medicine
and science and public health.
Focus like a laser beam
on what your job is
and don't get distracted by all
the other noise that's out there
because there is a lot more noise now
than there was a few decades ago.
And by noise, I mean misinformation
and disinformation about science.
DB: For sure.
I've definitely noticed that
as the science curator.
But pivoting a bit, let's talk about hope.
What gives you hope about the future?
Are there treatments or other things
coming down the pipeline
that you're excited about?
AF: Well, science is an absolutely
phenomenal discipline.
It's discovery.
It's ...
brand new knowledge.
Pushing back the frontiers of knowledge
that we would not have imagined
we would be in.
If you look at medicine and science,
how it's changed in a very,
very positive way
from the time I stepped
into medical school in 1962
to the time now of the things
that are available to me
as a physician and as a scientist.
I have great hope
that if we continue the investments
in basic and applied science,
that we will be able to accomplish things
in the arena of health, individual health,
and public health and global health
that were really unimaginable
just decades ago.
So I have a great deal of optimism
about what the future holds
for science and medicine.
And that's the reason why
one of the things I'm going to try and do
in my rewired post-government life
is to encourage young individuals
to consider a career in medicine,
science and public health,
because the opportunities
are really limitless.
We are at a stage now the likes of which
people who antidated us
never would have imagined
the opportunities in science that we have.
So I'm very optimistic
about where we're going.
DB: Me, too.
But you mentioned earlier how
climate change is affecting pandemics.
What worries you about the future
that we're facing?
AF: Well, just some of the things
that you mentioned.
We do have a growing element
of anti-science in society.
Disturbingly,
growing in the United States.
And when I talk to my colleagues
internationally,
depending upon the country
that they live in
to a greater or lesser degree,
there's some element of that.
The thing that bothers me
is a denial of science
and what science is showing us.
A denial of the issues of climate
and the environment,
a denial of scientific principles
and conspiracy theories about things
that push people away.
I mean, some of them are laughable,
but you would be astounded, David,
at the number of people who believe it.
That the vaccines were made
by Bill Gates and I
and we put a chip in it
so that we could follow people around
and know what they're doing
and get into their head.
The idea that there's a conspiracy,
that we’re making billions
of dollars on vaccines,
and that's why people
are promoting vaccines,
so that people like me
and others who are public figures ...
I mean, based on no data.
But once it gets into the social media,
it explodes and conspiracy
theories explode.
Even though all of the evidence
proves it wrong,
proving something wrong today
doesn't seem to matter much.
That's really strange and weird,
isn't it, David?
DB: Yeah, yeah.
Well, it's, I think, an old phenomenon.
There's a famous saying
that I'm going to mangle about
by the time the truth
gets out of the barn,
the lie is halfway around the world.
And that's definitely
the world we're living in.
I do know you have to go and, you know,
finish out your tenure
and then get ready for your rewiring,
which I'm excited about.
I'm excited to see what's next.
But do you have a last bit
of advice for the public?
One thing you hope everyone takes away
from your time as director
and your time in public health?
AF: Yeah, David, there are so many things,
but I think one thing that stands out,
particularly in the climate
and the environment
that we're in right now,
is that people need to get involved
in a proactive way
in spreading the truth
about what scientific principles are
and what they mean
and how they can be
of great benefit to society
and to try and make our population
more science literate than it is right now
by talking about things.
The truth, you know, the easiest way
to counter misinformation
and disinformation
is to be enthusiastic
about spreading correct information.
A little bit about the metaphor
that you said about the truth and lies.
Be spreaders of facts and truth.
Everybody's got to be
a contributor to that.
And that's one of the things
I think we can do better.
DB: Yeah, I would agree.
And we're definitely trying here at TED.
Well, Dr. Fauci, I know our members
are incredibly thankful,
I personally am incredibly thankful.
So thank you so much for your work
and for joining us today.
AF: My pleasure, David,
thank you so much for having me.
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