The Daily - An Interview With Dr. Anthony Fauci

Episode Date: November 12, 2021

Dr. Anthony S. Fauci, the nation’s top infectious disease expert, described the current status of the pandemic in the United States as a “mixed bag” that is leaning more toward the positive than the negative.But, he said, there is still more work to do.In our conversation, he weighs in on vaccine mandates, booster shots and the end of the pandemic.Guest: Dr. Anthony Fauci, the nation’s leading expert on infectious diseases. Sign up here to get The Daily in your inbox each morning. And for an exclusive look at how the biggest stories on our show come together, subscribe to our newsletter. Background reading: In a turnaround, the Food and Drug Administration is expected to grant Pfizer’s request to expand booster shot eligibility to all adults before the winter holiday season.This week, the Biden administration argued that the federal government had all the power it needed to require large employers to mandate vaccination of their workers against the virus — or to require those who refuse the shots to wear masks and submit to weekly testing.For more information on today’s episode, visit nytimes.com/thedaily. Transcripts of each episode will be made available by the next workday. 

From The New York Times, I'm Michael Barbaro. This is The Daily. On yesterday's show, we explored the profound challenges facing local public health officials as they try to fight COVID-19. Today, we speak with the nation's leading public health official, Dr. Anthony Fauci, about how he sees this moment, both for the pandemic and his profession. It's Friday, November 12th. Dr. Fauci, hey, it's Michael Barbaro. How are you?

I'm good, Michael. Hold on. You just blew me out of my seat. Oh, I'm sorry. No, that's not your fault. I turned it down. All right. We're good. Michael, say a few more words to see if it's good. Okay. A few more words, Dr. Fauci. How's the volume?

The volume's good now. Okay. Yeah. Well, you're not being thrown back into your seat, so that's a good sign. Right. Okay. Good. Thanks. Well, thank you for making time for us. My pleasure.

Dr. Fauci, it's very useful when we talk about COVID-19 to orient ourselves in where we are. So just to start things, in the simplest terms, where are we right now in this pandemic in the U.S.? What words would you use to describe that? Well, probably it would be a mixed bag leaning towards the positive as opposed to the negative. Why towards the positive? Well, because we have had a major surge that we have peaked and are starting to come down positive. Positive is that we have a vaccine implementation program

that has done generally quite well, though I'd be happy to get into more details about why it is not exactly where I would like to see it. Number three, we have now approval for vaccines for children, which are an important component of all of this. We've shown that boosters are safe and effective in dramatically increasing the response, in dramatically increasing the response, not only immunologically, but also when you look at the clinical data from Israel, it's very clear that it reverses some of the waning effect that you see in people who've been vaccinated six months or more. Now, the thing that's a bit sobering is that when you look at the deflection of the curve, it's starting to plateau. And what do you mean by deflection of the curve, just so I understand? Yeah. When you get to a peak and you get a top, it starts to come down.

And the sharpness and the steepness with which it comes down, the steeper, the better. The lower it goes, the better. When it starts to not get so steep and then plateau, then you might find yourself in the uncomfortable situation where you plateau where we are right now, which is at about 70 to 73,000 cases a day, which is obviously not optimal, but also is a setup to have a resurgence upon that very high baseline. Well, can we talk about where the data and the curve is? Because you're calling it sobering, and the reason it does feel sobering is because when you check these charts, and we do it on the Times website, I'm sure you do it every day on your own system, the infection rates, the hospitalization rates, even the death rates for this moment are

more or less the same as they were last November, despite the widespread availability of vaccines, and despite the fact that two-thirds of Americans have been vaccinated. So you're calling it sobering. I think for many looking at those numbers, it's a little bit baffling. Why is the situation at 75,000 infections a day or a seven-day running average when we're in these conditions that should be much better a year later? Well, Michael, it's a complicated issue and there are other factors in play that were not in play back in the previous spikes and surges. Like what? Let me go through a couple of them. First of all, what you have right now is a Delta variant, what is really, really a different species here. This variant has an extraordinary capability of spreading from person to person. You have that as a factor, a formidable enemy

that you're dealing with if you want to get metaphorical about it. Number two, you have about 60 plus million people in the country who are unvaccinated, although they are eligible to be vaccinated. Point number three, we are seeing something that is really interesting, and I'd like to get a little bit more unpacking of it with you in a bit. And that is we're starting to see waning immunity against infection and waning immunity in the beginning aspect against hospitalization. And if you look at Israel, which has always been a month to a month and a half ahead of us in the dynamics of the outbreak, in their vaccine response, and in every other element of the outbreak, they are seeing a waning of immunity, not only against infection, but against hospitalizations and to some extent death, which is starting to now involve all age groups. It isn't just the elderly. So if one looks back at this, one can say, do you know, it isn't as if a booster is a bonus, but a booster might actually

be an essential part of the primary regimen that people should have. That's interesting. Is that what you're saying? It shouldn't be seen as a bonus. It should be seen based on this waning immunity as part of how we think of basic vaccinations? I think when all is said and done, as we get through boosting the overwhelming majority of the people who've been primarily vaccinated, we're going to say, just like other vaccines that require multiple doses, like hepatitis B, like some of the childhood vaccinations, that it is likely, and I'm making my own personal projection as an immunologist and infectious disease person, we don't have the proof yet. The proof of the pudding will be after you get people vaccinated and boosted, and we have a

greater durability of protection that doesn't wane as easily, we may realize that we did a prime and a boost because we were in a medical emergency, a public health emergency. We didn't have the time to do an extensive phase 2A, phase 2B study to see whether two doses were better than three, whether a six months was better than eight months. We just did with what we had. And quite frankly, it was life-saving for millions of people. So that's why I think if we continue to get as many people vaccinated who are not yet vaccinated at all, and aggressively boost the people who have been vaccinated, I think you're going to see a different pattern than what we saw with the other surges over the past multiple months. So what you're describing is a two-pronged strategy here.

So what you're describing is a two-pronged strategy here. Of course, getting more and more people vaccinated and boosting as many people who have been vaccinated as possible. I think, Michael, that the boosting is going to be an absolutely essential component of our response. Not a bonus, not a luxury, but an absolute essential part of the program. But you know that many people you work with, especially at the FDA, have said that they are skeptical of boosting. I've listened to some of this audio of the panels and the battling over this. It's not a consensus in that world at all that boosting is going to become essential. Do you want it to be, or are you making that case to people? It isn't what I want and what I don't want. It's what it is. So it has nothing to do with my desires. It's just looking at what I think are going to turn out to be the facts in that if you look at what has happened in countries that have been more ahead of us temporally, you see that it wanes.

Right. And it's waning to the point where you're seeing more and more people getting breakthrough infections and more and more of those people who are getting breakthrough infections are winding up in the hospital. And more and more of those people who are getting breakthrough infections are winding up in the hospital. So I think it would be a misrepresentation, Michael, to say that the vaccines don't work. I don't think we've given that the full reign to that boosters will be an essential part of the protection. Where does this conversation about boosting fit in with the conversation that we've all been having for a long time about the unvaccinated. Well, you know, it makes the unvaccinated situation even more problematic.

Why? Well, because if you have a population of individuals who are vulnerable to infection, with no protection from a vaccine, you give the virus ample opportunity to circulate, to infect, even through breakthrough infections, vaccinated people, and you give it the opportunity to mutate to possibly develop into a new problematic variant. Got it. Now, if you just think a moment about the dynamics of virus in the community, when you have people who are protected by a vaccine, you know that no vaccine is 100% by a vaccine, you know that no vaccine is 100% protective. So the least amount of virus you have in the community, the less likely even vaccinated people are going to get a breakthrough infection.

But when you flood the community with 73,000 new infections every day, that puts even the vaccinated people at risk. Right. Let me just summarize this. Unvaccinated people threaten infection to those with waning immunity from full vaccination, which is why you're suggesting they need boosters. But what are the tools you have at this point, as the nation's leading infectious disease expert, to lower the number of the unvaccinated? It feels, and please correct me if I'm wrong, that the most effective tool so far for that group are mandates. Is that right?

Well, I want to make sure I say this, because unless you're not following what goes on with things that I say, that often people will take it out of context. Not us. I know you don't, but people who read and hear what you say take it out of context. So I'm not saying you do. I would absolutely prefer that we do not have to do mandates because I think we should get people to do things on their own accord. However, one thing we do know that mandates work. They've worked for United Airlines. Right. They've worked for Houston Methodist Hospital System. They've worked for any of a number of organizations that have mandates. They do work. Number two, in accordance with my preference to have people do things voluntarily,

when you think about the emergency nature of a pandemic, you as an individual are more than somebody that's just in a vacuum. You are part of a community. And sometimes when you're dealing with a situation in which you have a very unusual situation, you have to go to unusual measures. And sometimes unusual measures mean you have to sacrifice your own feeling that you have absolute control over what happens to you with what the good of society is. I think mandates fall under that category. But right now, as you know, mandates fall under that category. But right now, as you know, there's a patchwork of mandates. It's complicated. So if you're a police officer in New York, you're mandated to be vaccinated. If you're a police officer in Dallas, you don't. If you're a public school kid of a certain age in LA, you have to be vaccinated, but not if you're in Chicago, on and on. So given the success

of mandates so far, you started to hint at them. Ideally, shouldn't the goal be to have mandates in as many places and jobs and walks of life as possible right now? So why isn't it the case that there are more mandates? Well, because of the sensitive nature of mandates, there has been a reluctance to centrally from the federal government do mandates. So it always been left at the local level. As you know, the federal government, what the president has said, he can mandate that federal employees need to be vaccinated. Right. He can mandate that those who are getting money for Medicare and Medicaid can be mandated to be vaccinated. He can say, according to OSHA rules, which have

the capability of making certain actions when there is clear and present danger to the workforce, to tell organizations that have 100 or more employees that they either get mandated or they get tested regularly. But the one thing that is clear is that the mandates, I believe, would have less pushback on a broad sense if they are done at the local level. And there's a lot of that, for example, among universities and colleges, which are saying, you want to come to class in person, you've got to get vaccinated. There are some employment organizations that are doing the same things. Again, I want to make sure people understand that's not the preferable route to go. But I guess I want to make sure I understand why

it's not your preference to use mandates. In the case studies that have been done so far, Tyson Foods, United, municipal police departments, they go from rates that are pretty paltry to rates that are in the mid-80s, 90%. So why is it your personal preference that there not be mandates? I guess I don't quite understand. No, I'm an idealist. I would like to see people do things for the common good on their own accord. But Dr. Fauci. I mean, the pragmatist case would be that. Right.

I'm an idealist, but I'm also quite a realist. And that's the reason why I support mandates. So make sure you get me right, Michael. Get me correct if you want to not distort what I'm saying. Of course. I would prefer that people do this on their own accord because of their realization of their responsibility to themselves, their families, and society. If that doesn't work, I am all in favor of mandates. We'll be right back.

Okay, so just to lay out the next step in the mandates story, what ends up happening if the mandates don't work? For example, the president's large company mandate, that's now been paused by courts. And there are governors around the country, particularly Republican, who are battling these mandates or have passed laws against mandates. So that local level mandate you're talking about is not happening in those places. So if the mandates don't do the job in reaching the unvaccinated population in the country, What tools do you have left then? There aren't very many. There really aren't very many tools left. And that's really very, very difficult and painful as a public health official to see that if we don't do what is clearly and unambiguously the right thing to do is to use a tool that is highly effective to prevent the suffering and the death that goes on, then that would be very bad for us as a nation. We've lost 750,000 Americans thus far. We have 46 million infections, likely more since many go undetected. And we know what we can do. I've been involved in public health for over 40 years, and there have been diseases that I've

had to deal with in which you don't have any intervention. That's very frustrated because you say, if only I had an intervention, I could do something about this disease. Now we have a historic pandemic, the likes of which we have not seen in over 100 years, and we have highly effective, safe tools to end it. It would be really, I think, a terrible tragedy if we let more Americans and more people throughout the world, because I believe that we need to pay attention to goes on in the rest of the world, if we let more people die and more people get very, very ill by not using the tools that we are lucky enough to have.

Mm-hmm. that we are lucky enough to have. So let's spin out this scenario of the mandates not working and something like a third of Americans not getting vaccinated. What does that lead to in your experience? I mean, it seems like it starts to lead to things like more variants and more ups and downs of that curve. And how does that end? Well, I mean, ultimately, all pandemics burn themselves out. In the modern age of biomedical research and public health interventions, you can mitigate the ultimate negative impact of outbreaks in 1918 we had the

pandemic flu it burned itself out ultimately so you have a choice do you want it to burn itself out and kill a lot more people and make a lot more people sick Or do you want to do something about it to prevent further deaths and further illness? At the end of the day, Michael, this is going to end one way or another. The preferable way, if you just think about it for a moment, is to do whatever we can to minimize the suffering and the death. And we have within our power to do it. If we don't utilize it, then bad things are going to happen. I don't pretend that you have a secret chart that tells you this, but maybe you do. I mean, if this is just going to burn itself out, how long does that take? And what does it look like? You know, I don't know.

But we can use experience from the past. It likely would, you know, go through another season or so, and then it'll pitter out and go down. But a season or so, do you mean a year or so? No, you know, Michael, my computer in my cerebrum is clicking away. Here comes an out-of- of context quote from Fauci. Boy, you have had a heck of a pandemic. I can sense your anxiety around everything being taken out of context, but I appreciate

what you're saying. No, no. If you got attacked by the crazy press, far right press the way I have, you would feel as sensitive as I do. They will take it out of context. Okay. I do not know how long this would go on. It likely will burn itself out.

We can help it burn itself out greatly by getting more people vaccinated. And I can't tell you whether it's going to be next spring, next summer, or what have you. trust problem there is in the entire world of public health. And in particular, we focused on the idea that local public health officials, because of their experience in this pandemic, because of the anger and the threats coming their way, I know you're familiar with this, many of them don't feel like they can do their job anymore. with this, many of them don't feel like they can do their job anymore. And now there's a new set of laws that have come into play that have literally restricted their ability to function in their roles. And their argument is that that has perversely left them and you all in the position of being less prepared to do the work of public health now than before the pandemic, even though we've learned all these lessons about public health from the pandemic.

So as somebody who has devoted your entire life to public health, I wonder how you think about that. Well, I think it's a sad state of affairs where you have public health officials who are clearly doing things that have no other objective but to preserve and protect the health of the American public, who get attacked for that, whose lives get threatened, whose families get harassed. I mean, I'm experiencing it on steroids here for the last, you know, well over a year. Where else and what other historical situation have you seen where a public health official who is merely trying to get people vaccinated to mitigate against the outbreak by wearing a mask, by following very clear and standard public health measures, who continually gets his life

threatened, gets his family harassed, his children harassed. This is you you're talking about. This is me. Yes. I'm talking about me. So tell me what's wrong with society when a public health official who's a civil servant and not a politician gets that kind of threat. I think we have a real problem in society. It sounds painful. It sounds like this has been a pretty wounding and bruising experience. Well, I focus on what my job is, and my job is to do what I can do to end the outbreak. My job as a scientist is to do what I think we've done very well. We have played a major role in the development of the vaccines that have now saved millions of lives. We've played a major role in the development of better diagnostics, and we've played a major role

in the development of antivirals that are now going to have a significant effect. the development of antivirals that are now going to have a significant effect. So when I focus on my job and what my mission is, all that other stuff, as painful as it is, is nothing but noise. But you know what, Dr. Fauci? All that other stuff affects whether people will use those drugs that you're talking about and will have faith in everything that you just talked about. And so I guess I have to wonder, do you feel like you're less trusted now than when this pandemic began?

Well, it depends on what you mean. Trusted by whom? I mean, if you talk about the people who look at this in a rational way and don't live by what I would call a lack of facts, who don't live by conspiracy theories, who don't live by disinformation and misinformation. Those are the people who clearly don't trust us, not only me, but us in the public health sector. The people who look at this realistically and try to get correct information, I believe do trust us very, very much. Is there any part of you that gets why people don't trust public health officials, or is it just impossible for you to kind of identify with? You know, I think it's just too complicated, Michael, to, you know, unpack that psychologically in the few minutes that we have.

Sure, sure, sure. So let's talk about what the next couple of weeks look like in this pandemic, because we are, of course, headed for a period of a lot of travel for many people, the holidays, and colder weather, which has traditionally led to spikes in this pandemic. And we're already starting to see some pretty significant spikes in Europe and places like Germany. And I wonder if you think that is in store for us here in the United States as the holiday season begins and how bad you think that spike might be. Well, again, if you look at the comparison between unvaccinated people and vaccinated people, between unvaccinated people and vaccinated people. It is very, very clear that the overwhelming burden of infection, hospitalization, and death is weighted towards the unvaccinated.

Even though, and I'll say that clearly have hospitalizations among vaccinated people, that clearly have hospitalizations among vaccinated people, particularly in the era of waning immunity, which gets me back to the time we spent in discussing how I feel about boosters. So if you're a vaccinated person, your family is vaccinated, and you are in a situation where the people that you interact with are vaccinated, you can have a very good holiday. You can enjoy the warmth and the companionship of your family in Thanksgiving. You could do the same thing over Christmas. However, if you are among the unvaccinated and you get into winter, then you're going to have a tough time. And I think there is a possibility that you will see an uptick in cases that will be disproportionately born as a burden among the unvaccinated.

However, as we've said before, as that uptick occurs and you get more infections and more dynamics of infection spread in the community, that would put even the vaccinated at more risk. Right. Because the more dynamic of infection, the greater likelihood that a vaccinated person whose immunity might be waning, the greater likelihood that that person will come into contact with someone who's spreading the infection. Right. So final question. Should anyone be traveling this year, even with unvaccinated children, to see other members of their family? I know last year, you didn't get to see your

daughters because you didn't feel that that kind of travel made sense, was safe. You guys were being cautious. Are you going to be able to do it this year? And should anybody else? Yeah, of course, it's a different situation this year. First of all, I'm vaccinated. One of the reasons my children did not want to come and visit because I'm of an age that's of a higher likelihood of getting a severe outcome if I get infected. It seems like everybody knows my age now. I'm 80 years old. So I'm in that age group. And number two, they're all vaccinated right now. And getting on a plane is not really that much of a risk. It's the whole process of the traveling and interacting and mingling with people. But on a plane, it's not

necessarily a high risk at all. So I believe that people who are vaccinated, who when they go into the airport in a congregate indoor setting, they follow the CDC recommendations and wear a mask. I believe that people can and should travel during the holidays. Even if they have unvaccinated grandchildren in their midst? Well, again, when you have unvaccinated grandchildren, the best way to protect unvaccinated grandchildren is to surround them with vaccinated people. Hmm. Who are unlikely to spread it to them Who are unlikely to spread it to them. Very unlikely to spread it to them. Okay. So just so I'm clear, are you getting your family together here for Thanksgiving?

Well, Thanksgiving, they're not getting together because they live all over the country and it's not worth to come in for a day or two, but all of my daughters, all three are going to be coming and joining us on Christmas. Well, I'm glad to hear that. I wish you all the best for both holidays. And as always, Dr. Fauci, thank you very much for making time for us. We really appreciate it.

Thank you. It's good to be with you. Thank you for having me. Be well. You don't look 80. You still don't look 80. Yeah, they keep bouncing all these things off me. I'm going to start looking 80. All right. Have a great day.

Yeah, you too. Thanks a lot. Take care. Bye. Bye. We'll be right back. Here's what else you need to know today. Attention, attention.

Crossing the border is legal only on border crossing. A crisis over migrants at the border of Poland and Belarus deepened on Thursday after a 14-year-old migrant reportedly froze to death and the leaders of the two countries traded threats. The standoff began after the leader of Belarus, the dictator, Alexander Lukashenko, allowed thousands of migrants, many of them from Iraq, to approach the Polish border. In response, Poland's prime minister has dispatched soldiers to keep the migrants out. Poland and the rest of the European Union have accused Lukashenko of engineering the crisis out of anger at the EU's decision to impose economic sanctions against Belarus

over Lukashenko's conduct, including violence against his own people. And during a closed-door meeting, China's Communist Party secured the political future of the country's current leader, Xi Jinping, by elevating his place within Chinese history. The party approved a plan to enshrine Xi as an era-defining leader, putting him on the same level as Mao Zedong, the founder of China's communist rule, and Deng Xiaoping, the architect of its modern economy.

That move makes it increasingly likely that Xi will remain China's leader for a third term. Today's episode was produced by Robert Jimison and Diana Nguyen. It was edited by Paige Cowett and Lisa Chow, with help from Dave Shaw. Contains original music by Dan Powell and engineered by Chris Wood. Our theme music is by Jim Brunberg and Ben Landsberg of Wonderly. That's it for The Daily. I'm Michael Barbaro. See you on Monday.