Dr. Fauci on pandemic politics

Sean Rameswaram: Support for Today Explained comes from BetterHelp. Let me tell you a true story. Last weekend, I got an email from a listener who wanted to discuss their problems with me. And I said, look, I don't think that this is about me personally. At least I hope it's not. Why don't you try BetterHelp.com slash Explained? Absolute truth. As the largest online therapy provider in the world, BetterHelp can provide access to mental health professionals with a diverse variety of expertise. Find the one with BetterHelp. The one is not me, guys. Our listeners get 10% off their first month at BetterHelp.com slash explain. That's BetterHelp.com slash explained. It's Today Explained. I'm Sean Rameswaram, but my friends call me Ram. 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 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.

[Discussion of Dr. Fauci's outburst]

Sean Rameswaram: We got in touch with Dr. Fauci 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?

Dr. Anthony Fauci: 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.

Sean Rameswaram: 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 1,000 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.

Dr. Anthony Fauci: 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?

Sean Rameswaram: You know, we've really got to be careful of that, Ron, because those are models. And as I've always say 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.

Dr. Anthony Fauci: 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.

Sean Rameswaram: 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?

Dr. Anthony Fauci: 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 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 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.

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Sean Rameswaram: 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?

Dr. Anthony Fauci: I am very concerned about that. And that's the reason why we have 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.

Sean Rameswaram: I'm not. But my staff sends me these emails and say, you got to look at this, boy. No, I don't. I don't have a Twitter account, but I just, I'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 VRPAC, 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.

Dr. Anthony Fauci: 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, giving 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. If this somehow is politicized?

Sean Rameswaram: 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.

Dr. Anthony Fauci: 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?

Sean Rameswaram: 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. You know, 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.

Sean Rameswaram: 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?

Dr. Anthony Fauci: 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 a young guy that I been doing this like for 40 years. I do know that because I've read your biography. So the fact is, it is not a question of rising above the politics. I never let ever, ever let political considerations get in the way. What I became impatient with, and I do have 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, time out. You really can 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.

Sean Rameswaram: 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. Do you think we're, as we head into winter, running the risk of people, there's some 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?

Dr. Anthony Fauci: 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.

Sean Rameswaram: 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?

Dr. Anthony Fauci: 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 argument 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.

Sean Rameswaram: Dr. Anthony Fauci, he's the director of the National Institute of Allergy and Infectious Diseases. I'm Sean Rameswaram for him. The rest of the Today Explained team includes Muj Zaidie, Amina Al-Sadi, Will Reed, Halima Shah, Jillian Weinberger, and Noam Hassenfeld, who contributes music to. 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. Today Explained is part of the Vox Media Podcast Network.