Story at a glance
- Fauci discussed present challenges and future innovations amid the COVID-19 pandemic.
- He maintains that a vaccine will likely be ready in late 2020 or early 2021.
With rumors swirling of discontent at the White House, Anthony Fauci, the nation’s leading voice in its historic fight with COVID-19, expressed more cautious optimism today regarding a vaccine and the U.S.’s capability to flatten curves across the states experiencing outbreaks when speaking in an interview with Stanford Medical School Dean Lloyd Minor.
He first acknowledged that of all the diseases he has worked on throughout his career as a physician-scientist, COVID-19 is the worst.
“Of all the emerging infections that I’ve had to deal with...starting off on HIV in the early 80s with Ebola and Zika and the Anthrax attacks, this is clearly the most challenging,” he explained, noting that the quick rate of transmission made it capable of spiraling into a true global pandemic.
That does not make it indomitable, however.
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Fauci noted that the best way to move forward without compromising the country’s economy is to implement a gradual reopening as initially intended. He said the guidelines developed with the CDC about one month ago did not work well, citing going from a lockdown state to “throwing caution to the wind” and not implementing any of the suggested public health practices.
“We can get a handle on it...if we step back. You don't necessarily need to shut down again, but pull back a bit, and then proceed, in a very prudent way, of observing the guidelines of going step to step,” he explained. Consistent with prior interviews, he emphasizes that using masks, hand washing and social distancing are the best public health practices everyone can follow.
Looking toward the future and the release of a vaccine and other therapeutics, Fauci stuck to the estimated timeline of having a vaccine by the end of the year.
He elaborated on current vaccine trials, explaining that randomized placebo-controlled trials have yielded two intervention medicines, dexamethasone and remdesivir, that have a clear, significant benefit for patients with an advanced infection.
Despite the relative success seen with these treatments, Fauci said that a drug designed for early intervention is vital to stopping cases from overwhelming the health care system. Some of the candidates include direct antivirals, convalescent plasma, hyperimmune globulin, monoclonal antibodies and other direct antiviral agents.
He expressed optimism about monoclonal antibodies as an upfront form of treatment, to be given in single or multiple intravenous infusions, based on previous success with Ebola.
“I believe we are on a good track to get there reasonably soon,” he said. “There are multiple candidates that are in various stages of clinical trials. One or two of them will go into Phase 3 for efficacy literally at the end of this month.”
In the meantime, Minor asked Fauci about what the nation can do to improve its preparedness for another outbreak of COVID-19 or another pandemic entirely.
Fauci responded by recommending incorporating academic medical centers and professionals to help mitigate future outbreaks, citing institutions like the University of California, San Francisco, Columbia University, and Stanford University as examples of medical institutions with talent that can help in a public health crisis.
“I think if the rest of the country would leverage their academic medical centers to get involved, we’d be better off,” he said.
Outside of the realm of academia, Fauci expressed the need for a solid pandemic preparedness plan states can fall back on, in the inevitable event that another pandemic occurs.
“This is not something that is going to go away and never happens again,” he warned.
“We’ve...got to use this as a lesson to prepare for the next one.”
Some of the preparation this might entail includes developing innovative and sophisticated platform technologies to expedite vaccine development, with the ultimate goal of facilitating the transition from an unknown treatment agent to an effective vaccine.
Additionally, Fauci said rebuilding the U.S.’s health care apparatus to better withstand an influx of patients is critical.
“We have let the local public health infrastructure in our country really go into tatters,” he said. “We were so good at controlling smallpox, polio, tuberculosis, that we let the infrastructure locally, essentially go unattended, and what happened is that it attenuated and attenuated, and now when we need good local public health capability,” he explained. “It’s not optimal, it’s not as good as it should be. We’ve got to build it up again.”
The crises that erupted in multiple health care facilities across the country when the pandemic hit left medical professionals understaffed and ill-equipped to work on containing the virus and treating sick patients. The lack of personal protective equipment itself triggered President Trump to invoke the Defense Production Act in April to spur companies to manufacture medical equipment.
Fauci also recommended pouring resources into communities hit particularly hard by the virus, specifically acknowledging that people of color, including Black, Latinx and Native Americans, all have disproportionately severe rates of infection compared to their white counterparts.
“It’s striking how disproportionately they are disadvantaged,” he stated. He said that most of the essential workers unable to isolate themselves during the pandemic are Americans of color.
In light of the reckoning with how racism affects public health crises, Fauci said that the distribution of the forthcoming vaccine must be “done in an equitable way as possible,” involving committees who understand vaccinology, ethicists and community representatives.
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