Today, Explained - Dr. Fauci on pandemic politics

Episode Date: September 24, 2020

With mounting concerns over the politicization of federal health agencies, Dr. Anthony Fauci explains why Americans should still trust the vaccine approval process. Transcript at vox.com/todayexplained. Learn more about your ad choices. Visit podcastchoices.com/adchoices

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This coronavirus has been politicized from the jump in the United States, but this week's pandemic politics have been particularly jarring. It started on Monday. The CDC pulled guidance from its website that said that this virus mainly spreads by air. Guidance that they'd only posted Friday. Guidance widely accepted as fact in the scientific community, but the CDC pulled it and said it had been posted in error. Not a great look. Lots of unanswered questions. Then on Wednesday, Dr. Stephen Hahn, commissioner of the Food and Drug Administration, appeared before the Senate to reassure the nation that the vaccine approval process would not be politicized,

that a host of experts outside the organization would weigh in before any approvals were granted. Almost immediately after that happened, President Trump said in a briefing that may or may not happen, and that the whole thing sounded, quote, like a political move. At that same Senate hearing Wednesday, we saw something rare. Dr. Anthony Fauci, the country's top infectious diseases expert, seemed to lose his cool with Senator Rand Paul. You've been a big fan of Cuomo and the shutdown in New York. You've lauded New York for their policy. New York had the highest death rate in the world.

How could we possibly be jumping up and down and saying, oh, Governor Cuomo did a great job. He had the worst death rate in the world. No, you misconstrued that, Senator. And you've done that repetitively in the past. They got hit very badly. They've made some mistakes. Right now, if you look at what's going on right now,

the things that are going on in New York to get their test positivity 1% or less is because they are looking at the guidelines that we have put together from the task force of the four or five things of masks, social distancing, outdoors more than indoors, avoiding crowds, and washing hands. Or they've developed enough community immunity that they're no longer having the pandemic because they have enough immunity in New York City to actually stop. I challenge that, Senator. I'm afraid. Please, sir, I would like to be able to do this because this happens with Senator Rand all the time.

You were not listening to what the director of the CDC said, that in New York, it's about 22%. If you believe 22% is herd immunity, I believe you're alone in that. We're used to seeing heated exchanges in Congress, but this one felt different because Dr. Fauci has been a paragon of patience during this entire pandemic. We got in touch with him earlier today to ask if his patience was running out. But we started with what's to come with this pandemic as we head into winter. Good morning, Dr. Fauci. Good morning. How are you today? I'm doing well. Great to have you back on the show. Welcome to my closet.

Okay, get good ventilation in there and I'll be careful. We don't want you fainting on me. Happy equinox. A new season is upon us. And of course, winter is coming. What's in store for the United States as the seasons change during this pandemic? Well, you know, it's going to be complicated because what we really need to appreciate is that as we enter into the fall and the winter, a lot of things that we would have done outdoors, which is part of the public health program and the protocol, are now going to have to be done indoors, which means it'll be an extra special challenge. You know, we often say the four or five things that really do work if everybody implements them is wearing masks, keeping a distance, avoiding crowds, outdoors more than indoors, washing hands. If everyone had done that diligently, we would not have seen some of the surges that we've seen that have given us what I

would consider is an unacceptably high background. And by background, I mean is the number of cases per day, which even when they're in young people, most of whom are without symptoms or minimal symptoms, nonetheless, it propagates the outbreak. And you've got to get that down. Remember, when we resurged trying to open the economy and the country a couple of months ago, a month and a half ago, the Southern states literally metaphorically caught fire. And the number of daily cases were around 70,000

with about a thousand deaths per day. Now we're back down to between 30 and 40. But like a day ago yesterday was 40 some odd thousand cases. That's unacceptable as you enter the winter. If you want to go into the fall in the winter and have to have the extra challenge of a potential flu season, which we'll have, hopefully we can mitigate it, together with the fact that most people will be indoors in most climates in this country, it's an extra challenge. So I would like to get that

baseline way down, way down in a few thousand, not 30 or 40,000. Right. I mean, we're still seeing something like a thousand deaths a day. I think it may be lower, close to 800, but it's been as high as nearly 3,000 a day at one point. Could it get worse in the winter? People are now saying we may see 400,000 deaths by the end of the year. I saw that in a recent University of Washington study. Is that a realistic estimate? You know, we've really got to be careful of that, Ron, because those are models. And as I've always said, you know, models are based on the assumptions that you make to put into the model. Certainly, if things go poorly, if in fact we do not get control and people do not cooperate in some of the public

health measures, that could happen. I've argued throughout that that doesn't necessarily mean we have to accept that, because that's within our power to mitigate against. In addition to that, hopefully we'll begin, and these are just things that I have cautious optimism about, although there's no guarantee, hopefully as we get towards the end of the year, we'll know that we have a vaccine or more than one vaccine that's safe and effective. So if we could start vaccinating at least the high risk people, as well as the frontline responders by the end of this calendar year and into 2021, we could prevent that surge that everyone is concerned about. But we've got to do two things.

We can't just rely on a vaccine. We've got to rely on the emergence of a vaccine with more and more people getting vaccinated together with an adherence to the simple recommended public health measures, particularly mask wearing when you're inside and may not be able to keep the physical distance that we'd like to see. Yeah, and on the vaccine, what is the latest on a vaccine being available in the United States?

What do you think the timeline is? Well, again, we don't know. So when you hear people make projections, they are merely projections. They are based on the assumption that the vaccines that are currently in advanced trials, and we had three, and then yesterday we had a fourth one. Of that, one is on hold because of an adverse event that took place in the UK, but three of them are going. And that's the Pfizer product, the Moderna product, and now the J&J or Janssen product. These are now in play. They have anywhere from 30,000 to 60,000 people per trial. And we feel, looking ahead, that given the enrollment that we've seen and the number of infections, I would project, and this is merely a projection, that by the enrollment that we've seen and the number of infections, I would project, and this is merely a projection, that by the end of the year, let's say November or December,

we will know whether the vaccine, plural, are safe and effective. It could be earlier. I mean, if there are enough infections in the trial and you could distinguish between the placebo and the vaccine limb of the trial, you may be able to make a determination earlier. But let's assume that it's November and December. You could ask, well, what do you think the chances are of it being safe and effective? The first honest thing to say is that you don't know. But based on the preliminary data that we've seen in animal studies, as well as in the phase one study, the vaccines appear to induce a response that's comparable to a good response to natural infection, which traditionally is always a good sign that you're going in the right direction. But the proof of the pudding is going to be the result of the trial.

Now, if in fact it shows to be safe and effective and you start vaccinating people, you could do that as early as the end of this year because simultaneously with the vaccine trials, we've taken a major financial risk of producing vaccines even before we know that they work, which means if they do work, you saved a lot of months. If they don't work, the only thing you've lost is money. And right now, we feel that the money investment is really worth the risk financially because we want to do things as safely, but as quickly as possible. Once we have a vaccine in the United States, do we have a plan for how it will be distributed across the country? Yes. Yes. Traditionally, the final decision on that is with the CDC, which they've done well traditionally throughout the years when you have a vaccine that you're others to map out what we think is the most appropriate, fair, and ethical way to distribute vaccines in a graded fashion. Traditionally, I might say, that usually means you start off

vaccinating the healthcare providers and frontline individuals who are putting themselves at risk to take care of sick patients. The other is those at high risk, such as the elderly, those who have underlying conditions, and people like that.

The final determination has not been made, but that will be coming very soon. Quick break, then I'll ask Dr. Fauci if he's worried about the politics of the vaccine, the pandemic, the CDC, the FDA, all of it. Support for Today Explained comes from Aura. Aura believes that sharing pictures is a great way to keep up with family. And Aura says it's never been easier thanks to their digital picture frames. They were named the number one digital photo frame by Wirecutter. Aura frames make it easy to share unlimited photos and videos directly from your phone to the frame.

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And because she's a little bit older, it was just easier for us to source all the images together and have them uploaded to the frame itself. And because we're all connected over text message, it was just so easy to send a link to everybody. You can save on the perfect gift by visiting AuraFrames.com to get $35 off Aura's best-selling Carvermat frames with promo code EXPLAINED at checkout. That's A-U-R-A frames dot com promo code EXPLAINED. This deal is exclusive to listeners and available just in time for the holidays. Terms and conditions do apply. Dr. Fauci, how worried are you about faith in the vaccine as well as faith in the CDC? I mean,

even before COVID-19, this country had this sort of anti-vaxxer sentiment going. That's why we spoke to you about the flu shot a few years ago. And now we've got confusion about leadership at the CDC. Last Friday, the CDC posted information to its website about airborne transmission, then took it down on Monday. And a lot of scientists were concerned about that. Are you concerned that people might not trust a vaccine produced in the United States? got to, and I try to do this, and that's why I'm right here talking with you. I'm trying to make sure that we can reach out to the community and explain the process. Because when you look at the decisions about whether a vaccine is safe and effective, and we spoke about this in detail at the Senate hearing yesterday that many people tuned into, At least I gathered that from a lot of the tweets that went by following that hearing. I thought you weren't on Twitter.

I'm not. But my staff sends me these emails that say, you got to look at this, boy. No, I don't. I don't have a Twitter account. I just'm so busy, I don't do that. But the situation is that people need to understand that an independent body who is beholden to no one, not to the president, not to the vaccine companies, not to the FDA, not to me, an independent group of established scientists, ethicists, and statisticians. They are called a data and safety monitoring board. Intermittently, they are the only ones that have access to the data because it's a double-blind study. The only one that can look at it is the unblinded statistician from the data and Safety Monitoring Board. And a vaccine has a predetermined set of criteria to determine if it works or not. And the Data and Safety

Monitoring Board intermittently looks at that. And when they feel it's reached that point, they will then notify the company. Then the company has the option, which they will certainly do, of presenting it to the FDA either for an emergency use authorization or directly for what we call a BLA or a biological license application, which essentially is a license. The FDA's independent scientists will look at that. Then they will consult with another advisory committee called VRBPAC, who are, again, advisory to the FDA. Those data will become public so that scientists like myself and my colleagues will have access to the data. So everybody's worrying that someone's going to make an end run around that and try to get a vaccine out for political reasons. Well, that will not happen. But if it does, all possibility, it will be really transparent what is going on because the scientists will see the data. The FDA has pledged publicly

multiple times that they will not approve a vaccine unless their established non-political scientists agree that it's safe and effective. And we've got to keep getting that message out because it's totally understandable, given the mixed messages that are coming out, that the public might be skeptical about vaccines. So we've really got to regain the trust and reach out to the community that we're not going to let anything out. And if it turns out somebody tries to force it out, I tell you, I will be one of the first ones that will object to that. So you'll be out there saying this is not the vaccine we should trust? Or I would say... If this somehow is politicized?

Yeah, I would say that the process is not the right process to do this, and we really need to go back to the right process. Are you worried about long term how this whole coronavirus pandemic has maybe shaken faith in these institutions that previously had this sort of bulletproof reputation, institutions like the CDC. Yes, that is unfortunate. There have been some unfortunate things that have happened, that there have been people within agencies that have tried, unsuccessfully but tried, to influence the CDC. In one situation, not to mention any names, one of those individuals tried to influence

what I said, which is really a fool's errand because I essentially told them to go take a walk. But the fact is that that has happened, but that's gone now. Those people are not there anymore. So I can tell you quite frankly, that I have been in intensive discussions with the director of the CDC and the director of FDA. And I really truly believe that you can trust them. But besides the core people, the career scientists at the CDC and the FDA, they do this for a living. They are apolitical and completely devoted to the health of our nation. And those are the people that will

speak out if you see anything that doesn't look right. You know, you mentioned your appearance before the Senate yesterday and how it sort of blew up on Twitter. I have to ask, I mean, since you brought it up, what blew up was that people finally saw you, it seemed, lose your patience with Senator Rand Paul. I know how hard you've tried from watching you over the past six or seven months to sort of remain above the political fray. And I wonder, six, seven months into it, is it wearing on you? Is it impossible to sort of remain above the politics and the way this pandemic has been politicized? Well, the answer is, it is certainly possible. And I have done that not only over the last six months, but as you know, well, you don't know because you're a young guy, that I've been doing this like for 40 years.

I do know a great deal of respect for the institution of the Senate, and I do have respect for Senator Rand Paul, but he was saying things that were not true. And I just couldn't let that stand because there we were on national TV with a lot of cameras floating in, And I just had to call him on that. And I think people who are giving him information, it is what's called cherry picking information out there. I think he's fundamentally a good person. But what he did is he was saying things that were not compatible with what the scientific data. So what the audience saw me do was say, whoa, wait a minute, timeout. You really can't

say that. So I didn't mean to be, I wasn't disrespectful at all. I think I was quite respectful. But it isn't a question of politics because he was saying what he thought was the right thing. And I disagreed with that. On the subject of the politicization, as we move away from particular conflicts or anything like that, I just wonder, because this has been politicized, of course, something like wearing a mask is controversial, is divisive. surveys out there that suggest mask wearing is decreasing in some parts of the United States. And of course, with the winter coming and more people spending time indoors, of course, the risk of transmission of aerosols is increasing, right? Are we at risk now of sort of losing the thread here and losing the urgency that people used to have? Yeah, what we really need to do, and it gets back to your question about politics, the problem is that it isn't my interpretation. It's that you have to be asleep to not realize

that we are operating in a very divisive society. It is unfortunate, but it is true. Superposed upon that, we're in a highly charged political season with big time stakes at hand elections. When that happens, what has unfortunately happened is that the public health response and the public health activities, in fact, have become politicized, which is so unfortunate. We've lost sight of the fact that the bad guy here is the virus. The bad guy is not one side or the other. So when you're doing public health things, you've got to integrate yourself into the concept that public health measures should be the gateway and the vehicle to getting the country's economy back and opening up

the country. It should not be an obstacle. And yet there are some who interpret that as an obstacle. It isn't the obstacle. It's the solution. So we've got to keep hammering that message home that that's what the issue is. We're all in this together. And when you have some groups of society who make it a political issue, it completely, you know, I think, I wouldn't

say destroys, but makes it very complicated to get a uniform, consistent approach in our country. The holiday season is coming and it's a time for miracles, Dr. Fauci. I wonder if you could wave a magic wand over the United States and change one thing tomorrow to improve the trajectory of this pandemic, what would it be? Yeah, I think apart from a vaccine, which will have to wait a few months, if I were to wave a wand now, it would be to get the entire country uniformly pulling together in a public health way to get these cases down. In other words, let's make out, you know, this is a couple of days after 9-11.

We didn't have any political arguing about what we needed to do. Or, you know, December 1941 after Pearl Harbor. You know, everybody was in it together. That's really what we're dealing with. You know, we are, I don't want to get too melodramatic, but we are at war with a virus. We are not at war with each other. So that's what my magic wand would have,

would be that kind of a spirit of pulling together. Dr. Fauci, thank you so much for your time. I really appreciate it. Thank you for all your work. Always good to be with you. Thanks a lot. Dr. Anthony Fauci, he's the director of the National Institute of Allergy and Infectious Diseases. I'm Sean Ramos for him.

The rest of the Today Explained team includes Muj Zaydi, Amina Al-Sadi, Will Reed, Halima Shah, Jillian Weinberger, and Noam Hassenfeld, who contributes music too. More music from the mysterious Breakmaster Cylinder. Extra help this week from Bird Pinkerton. Cecilia Lay is our fact checker. Afim Shapiro is our engineer. Golda Arthur is the supervising producer. And Liz Kelly Nelson is Vox's editorial director of podcasts.

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