Science Friday - Dr. Fauci On A Life Of Medical Research And Public Service

Episode Date: August 19, 2024

Dr. Anthony Fauci has a long history with Science Friday. Ira first met him in the early 1980s while covering the HIV/AIDS epidemic. He has been a frequent guest on the program, discussing everything from the common cold to SARS, food allergies to Ebola, and malaria to the recent COVID-19 pandemic.After leading the National Institute of Allergy and Infectious Diseases for 38 years, Fauci stepped down in December 2022. But he certainly hasn’t disappeared from the public eye. He’s been called to testify regularly before Congress and he’s written a new book, On Call: A Doctor’s Journey in Public Service. He joins Ira for a wide-ranging discussion of AIDS, COVID-19, public health vulnerabilities, and his new post-government role as a teacher.Transcript for this segment will be available after the show airs on sciencefriday.com. Subscribe to this podcast. Plus, to stay updated on all things science, sign up for Science Friday's newsletters.

Are there generational lessons to learn from health crises like COVID or HIV AIDS? There's emerging infections always, so that's a lesson to be learned. The other lesson is the investment in basic and clinical biomedical research always pays all. It's Monday, August 19th, and you're listening to Science Friday. I'm SciFri producer Charles Burgquist. In today's episode, Dr. Anthony Fauci reflects on what he learned from his decades in public service, his time at the NIH and in dealing with both HIV-AIDS and COVID-19. Plus, his life after the NIH and a new role as a teacher.

Here's Ira Flato. Joining me now is probably the person who has made more appearances on our show over the past 33 years than anyone else. He is someone I first met when I started covering the HIV-AIDS epidemic way back in the early 1980s. And over the years, we've talked about, But every disease you can name, I think, from the common cold to SARS and MERS, Ebola, to COVID, even basic research into food allergies.

And after leading the National Institute of Allergy and Infectious Diseases since 1984, he stepped down from his role at NIH in December of 2022, but he certainly hasn't disappeared from the public eye. He's been called to testify regularly before Congress, and he's written a new book, On Call, A U.S. doctor's journey in public service. Dr. Anthony Fowtie, welcome back to Science Friday. Thank you, Iris. It's always good to be with you. I think this is the first time we talk to you when not in public service. What does it feel like to be a quote-unquote private citizen now?

You know, it feels good. I think I was ready to make that transition. So it's a positive feeling. I really missed the people that I've been involved with over the years, but I'm excited about what I'm doing now, Ira. So that makes the change much less traumatic. You made a decision that while I still had a lot of energy and passion that I wanted to do something else besides what I had been doing for the previous 38 years as director, I wanted to get involved in a university and get surrounded by students, which is. is what I'm doing now at Georgetown. And that's a different experience, but a very favorable and desirable experience. Tell me a bit about that. Tell me what kind of students and what are you teaching them? Well, I'm the Distinguished University professor with a dual appointment in the

School of Medicine and in the School of Public Policy. I don't teach a course where I grade students, but I give a lot of lectures, seminars, fireside chats, and meetings with students from the various schools on campus and even some downtown off campus, the medical school, School of Arts and Science, the nursing school, even the School of Foreign Service. I've had some discussions with people in that school. So it gives me an opportunity to wide exposure of students of varied interests, not just medicine and science. Do they ask you what it's like to be a public figure for all those years and about the challenges? and do you share that knowledge with them?

That's one of the reasons I wanted to make my home base a university setting because that's what students are interested in. They're very curious about what it's like to have reached a certain state of recognition and accomplishment because that's the way I was when I was at their stage. I would look up to people who had a degree of accomplishment and just kind of want to get a feel of what was your course of life, life, what did you do? How did you get to where you were? They're deeply interested in that. And let's talk a bit about it because it's so much part of your book, COVID. You're right that if we knew in the

first few months what we knew now, many things would have been done differently. What do you mean by that? Well, for example, in the very early weeks, we had the impression from the Chinese that this virus was not spread efficiently from person to person. So there wasn't a big push to get everybody to wear a mask early on. There was a shortage of masks. There wasn't data to show that masks outside of the setting of the hospital were effective in protecting you and protecting you from spreading it. And we had no concept that 50 to 60 percent of the infections were spread from a person who had no symptoms. Wow.

That is a learning experience, is it not? Boy, that really was. So had we known that early on, there would have been a much greater push for greater ventilation, for wearing masks and indoor settings. That came later, but it could have come much earlier

had we appreciated that. You're right that of all the weaknesses in our public health response to COVID were profoundly compounded by one of the two enemies. of public health, the spread of egregious misinformation and disinformation enabled by the internet and social media that unfortunately remains with us today. Instead of looking back at the past, why does that still remain with us today? Well, because that's the nature of the free

speech in the internet. You can get up and if you have a bunch of followers and say something that's egregiously incorrect and it gets spread around enough all of a sudden to a certain segment of the population, it becomes a fact. It is amazing how much misinformation and disinformation are out there. It's just really stunning and unfortunate because misinformation costs lives. I mean, people don't get vaccinated because of misinformation. And there's an estimation that about 200,000 people died unnecessary deaths because of misinformation about vaccines who they decided not to get vaccinated. Did not realize the number was that high.

Yeah, yeah. Wow. I don't want to focus very much on the politics of the last four years of COVID, but I do want to touch on one aspect that you write about, and that is the controversy of the origin of the virus. And one side says it was a virus that escaped from a Chinese lab, another says it originated in the live animal market, and you say you have an open mind about that. Please explain what you mean by that.

Yeah. Until you definitively know what the origin is, you have to keep an open mind. But an open mind doesn't mean that you can't have an opinion based on data. So I have an open mind and with definitive data one way or the other proves one of the theories, I will embrace that. But when you look at data, there is accumulating data that's rather convincing, not definitive, but rather convincing from evolutionary virologists from all over the world. Australia, Canada, the United States, the UK, EU, strongly suggesting that it was a natural spillover from an animal reservoir to a human.

They haven't proven it, but the data are pretty compelling. Yet, there is no solid data that it's a lab lead. That doesn't mean it didn't occur. There's just no solid data. So I still have an open mind, but I lean strongly towards it being a natural occurrence. Do you think we'll ever know, will have solid data that one way or the other? I think the more time goes by, Ira, the less chance that is. And I think one of the things that happened early on that would have been much more convincing

about a natural occurrence is that the Chinese didn't come in and quickly clean out the market and get rid of all the animals that shouldn't have been there. in the first place. As soon as there was an outbreak, you know, it was so-called illegal to have these wild forest animals in a wet market. But they were there. There's photographic evidence that they were there. As soon as the outbreak occurred, the Chinese cleaned out the market. So any proof that animals were infected there is gone because the animals were removed. Let's talk about the vaccines that were developed. I mean, quicker than anybody really had thought, Right? Beyond quicker. Completely unprecedented to have the sequence of the virus in the first week

of January of 2020 and less than 11 months later to have a vaccine that has been tested in tens of thousands of people to prove and to be safe and effective to the tune of greater than 90% is beyond unprecedented. That has never happened in the history of axonology. And those vaccines largely are targeting bits of the spike protein. That's come into our language over the years. And it's been like, what, four years since we've had the original vaccine. Why is it not possible to target some other constant part of the virus? So we get a longer lasting vaccine.

And that's something that changes all the time like those proteins. You know, that's a good question, Ira. And it's one that is common to a lot of vaccines. for different viruses. The business end of that molecule is the one that binds to the human ACE2 receptor, and that's the spike protein. So that would give you the greatest chance of blocking. There may be other epitopes on the virus that if you block, you may not get infected, but it is unlikely would have the potency of blocking that epitope that directly binds to the receptor on the cell.

I was reading some research just the other day that said, you know, the best place to really stop this viral attack is in your nose and nasal spray. We don't have a nasal spray in this country, but there are other countries that do. Isn't that right? Yeah, but there's a lot of research going on now, Ira, a lot of research that's being supported by the NIH done in several medical centers throughout the country of getting exactly what you said, a nasal spray. or installation of a vaccine into the nasal passage. Is it something that's endemic, as you say, something that we're just never going to get rid of, but we just have to live with it? I think so. I don't think there's a chance we're going to eradicate it.

We've only eradicated one virus in humans and that smallpox. I don't think we're going to eliminate it the way we did measles and polio in this country. It's just too prevalent and too highly transmissible. But we can control. it at the lowest level possible. I think it is going to be with us indefinitely. I don't might not say forever, but for a definite period of time. That means we're going to be still seeing new cases of long COVID. And isn't that the dangerous part of this? I mean, so many of us tolerate this. I just got over my latest bout last week. I know so many people around us getting it.

But no one thinks about, hey, I don't want to get it because there's a possibility I could have long COVID. That is true. I got rid of my bout four weeks ago. Same thing. It was my third bout. So what about, is there any way we can do something about long COVID? What do we know about it? Well, we don't know a lot about it.

There's a lot of people working on it and a lot of money's being poured into. It looks like it's an aberrant, uncontrolled inflammatory, immunological response to what is likely fragments of virus that persist even after the acute infection. But it's not certain. I mean, there are a lot of theories. Some of them are more convincing than others. But one of the things that's a common denominator is an aberrant hyperimmune response that doesn't calm down after the acute phase of the viral infection.

But it's really interesting to see that there are some people, like my wife who's been around my grandchildren and me and my kids and everybody who has gotten it and never come down with it. I mean, is there some genetic part maybe if some people's genetic makeup makes them a little bit more immune? I'm sure there is. It hasn't been definitively identified, but Ira, like any infectious disease, there's a lot of polymorphisms in the genome of the human species. And within that, there will be some that we haven't recognized yet that protect you against one infection versus another. Or could it be that so many people get it and show no symptoms? that they may have it and really just don't know it. Exactly.

In fact, there are a lot of people who have asymptomatic infection. There are many things we have vaccines for now. And when I was telling people I was going to talk to Dr. Fauci, they said, you got to ask them this question. We get this a lot. Is it safe to get more than one vaccine at a time? Yes. Yes.

Because, you know, people worried, either my kids or I have to get the flu vaccine and the COVID vaccine at the same time, that's safe. That's safe. And the reason people question that, Ira, is that they say the antigenic load of multiple vaccines at the same time is going to overwhelm your immune system. And that is not true because a single infection from one of those pathogens has an antigenic load that overwhelms the number of vaccines that you could take. So you should be worried about an antigenic load from a vaccine. What can we learn from COVID that can be transferred to the next disease that comes along? And should we really not be surprised that a new one will be coming along?

Well, the answer to the second part of the question is that I would be astounded if another outbreak did not occur. We don't know when, maybe not in my lifetime, but history has told us that pandemics have always They've arisen during our own tenure here on this earth, and it will happen after we leave. So that answers that part. The first part is there were many lessons learned from COVID. I wrote a paper in the Journal of Infectious Diseases in 2023, about 10 lessons. Some of them are to expect the unexpected. I mentioned that to you a little bit ago when we were talking about things like COVID being transmitted,

mostly from asymptomatic people, aerosolized transmission, that kind of thing. Misinformation and disinformation of the enemies of public health. Pandemics shine a bright light on disparities of health in society as shown by minority populations who did much, much worse. Basic and clinical research investment pays off all the time. Those are the kind of, there's many, many lessons that we could learn. We should not let the experience of COVID go without teaching us things to help us better prepare and respond to the next outbreak. Do you feel that because there was so much distrust of our public health system during the pandemic that the health system has been permanently spoiled, any trust in it?

I don't think permanently, but I think significantly. I just think that there's so much misinformation. No system is perfect. The scientific community had to make changes in what their recommendations were based on evolving data. That often gets interpreted as scientists flip-flopping. But it isn't because it's the nature of the corrected nature of science that is so correct. unfortunately, that's led to a mistrust in science. I don't think it's irreparable, Ira.

Yeah. But I think it's something we have to deal with because it's serious. Les, how many spoke about, we talked about the health of the health care system. Is it healthy or does it still need to be repaired itself? Oh, it absolutely still needs to get repaired. We've got to do better than we have. We've done much better now with the Affordable Care Act. But right now, it still is not as good as in some kind.

countries that are on par with us as being developed countries, but even some developing countries do better than we do. Yeah. I mean, I'm still surprised by how many people are afraid to get vaccinated. I mean, I remember the story. You told me when you were a kid in Brooklyn, when it was a smallpox vaccine. Tell me that story again. Yeah, and I was about six years old. There was somebody who came from Mexico, I think, and entered into New York City and had smallpox and the city panicked. So they vaccinated a couple of million people in a few days lining up in New York City. And it worked. And they were able to do that because the system was set up, right? Because kids got vaccinated when they were born. Exactly. Nobody objected. They just did it.

Do you think we'll ever get back to that? I don't think so. Well, we need to take a break. We'll be back with more of my conversation with Dr. Anthony Fauci in just a minute. His new book is On Call, A Doctor's Journey in Public Health. Stay with us. This is Science Friday from WNYC Studios. This is Science Friday. I'm Irooflado.

In case you're just joining us, I'm speaking with Dr. Anthony Fauci. As you may know, he's a winner of the Presidential Medal of Freedom and the author of a new book On Call, a doctor's journey in public health, and for 38 years, was director of the National Institute of Allergy and Infectious Diseases at the National Institutes of Health, which directs the government's research response to diseases from the common cold to Ebola. Dr. Fauci stepped down from that role in December of 2022. We have spoken with him many times, over the years, but this is our first interview since he left public life. Let's talk about one of your other major focuses and one of your victories, and I'm talking about

HIV-AIDS. Where's the cutting edge in AIDS? Is it a permanent vaccine, a better prep therapy? Because I was just reading a recent issue of Science Magazine that said that they had this breakthrough headline, landmark trial may herald new era. And HIV protection, twice yearly injection provided 100% protection in study in African women. You know what I'm talking about. That's Lenna Cappavir. That's a injectable drug that is twice a year that is just incredible. They did a study in cisgender women in Southern Africa, 100% efficacy in preventing the acquisition of infection.

Amazing. How is that different than in men? Well, in men, the problem is that prep had never been as good in women as it was in men. So men have good prep. I mean, you take a pill of tramatta every day. You get 99% affected. And also injectable cavitegavere every couple of months is just as good as oral travada. So we have good prep.

We just need to implement it. We just need to implement it. So does that mean that AIDS is basically a solved problem? Well, it's not solved because it isn't 100% implemented. I mean, there are scientific hurdles that we need to get over. We need a safe and effective vaccine. We don't have it yet. It's been one of the real scientific challenges.

But if we implement it, all of the tools we have, Ira, we could probably stop this epidemic in its tracks. So, for example, if we identify everyone who is living with H.R. HIV and put them on effective antiretroviral drug and bring their level of virus to below detectable, they would not transmit the virus to anybody else. We know that. It's called U equals you. Undetectable equals untransmissible. So that's an implementation problem. Get everybody on therapy. Then if you've got everyone who was at risk for infection and put them on prep, you would never get any infection. So we have the tools to shut down this outbreak now, even in the absence of a vaccine.

Is it a problem then of compliance by the public? Not only of compliance and accessibility. So the drug is out there, but it's not getting to the right people. Right. And compliance means that the drug is available, but they don't use it. Accessibility is because they don't get access to the drug. Most people focus on the infectious disease part of your portfolio, but I know your Institute did a lot of work on the allergy part of its mandate.

How much progress have we made in understanding allergies? You know, we've made a lot of progress in some areas, and we still are not doing so well in others. I mean, one of the real advances in a very serious allergy problem is how to get people to be desensitized to peanut allergy by them early, early exposure to peanut products early on, as opposed to withholding them, and then they could get anaphylaxis later on in life when they get exposed.

Hmm. So that still needs a lot of research, is what you're saying. Yeah, yeah. Where we're falling down with regard to infectious diseases, is it a money problem, a leadership problem, a knowledge problem? You know, well, certainly it's a support problem. We've got to continue the support for basic and clinical research and infectious diseases. that's the person.

The second thing is the disparity in access to health care. I mean, people who don't get vaccinated die from vaccine preventable diseases. So it's an implementation problem, but also a discovery problem. We still need vaccines against HIV. We still need vaccines against other diseases. What do you tell your students about your different experiences in your career and how you tackle diseases, like comparing, for example, AIDS and COVID. What's the lesson that you tell them there? Well, there's many lessons, Ira.

The first is that emerging infections have always occurred long before recorded history. History has recorded it. And in our own lifetime, we have seen the emergence of two book-ended infections that are historic in their magnitude. So if you look at my own personal career of 54 years at the NIH, 38 years as the Institute Director. In the beginning, there was HIV, which we have to this day. And when I left, we had COVID. That means that there's emerging infections always. So that's a lesson to be learned. The other lesson is the investment in basic and clinical biomedical research always pays off. It paid off in spades with the COVID vaccine, work on targeted antiviral therapy, paid off in spades with HIV antiretroviral

drugs. The greatest argument for investment in basic and clinical biomedical research. Well, we've run out of time, but I'm wishing you the best of luck. Your book is called On Call, but your new calling is to be a teacher. Yeah. It looks like. I'm enjoying it. I'm enjoying it.

Yeah. And do you learn stuff from the kids that you teach? Oh, every day. Every day. Yeah. Absolutely. Take care. Dr. Anthony Fauci, former director of the National Institute of Allergy and Infectious Diseases, NIH.

He's an awardee of the Presidential Medal of Freedom. And he's author of the new book On Call, A Doctor's Journey in Public Service. Tony, it's been an honor to know you. Please stay well and stay in touch. Thank you very much, Ira. Always great to be with you. Take care. That's all the time we have for today.

A lot of folks helped make the show happen this week, including Kathleen Davis, Diana Plasker, Beth Rami, Feliceomeres, and many more. Tomorrow, research into Alzheimer's disease and whether properly timed pulses of light and sound might help clear signature plaques from the brain. But for now, I'm CyFRA producer Charles Berkwist. Thanks for listening. We'll see you soon.