--:-- Sean Rameswaram: Dr. Anthony Fauci, you're the director of the National Institute of Allergy and Infectious Diseases. It's flu season again. My boss sent out an email saying everyone go get the flu shot and I did not. I do not really want a flu shot. Is that decision going to haunt me like a house or what?
--:-- Dr. Anthony Fauci: Well, I don't think it would be hyperbole to say it's going to haunt you like a house, but that's ill-advised that decision, Sean, because it's, the flu can be a serious disease.
--:-- Sean Rameswaram: I have multiple levels of why I don't want to get it. Would you be open to hearing them?
--:-- Dr. Anthony Fauci: Sure.
--:-- Sean Rameswaram: So first and foremost, my understanding of the flu shot is I'm giving myself the flu. Am I mistaken?
--:-- Dr. Anthony Fauci: You're completely mistaken because you cannot get influenza, the infection influenza, from a flu shot. What the flu shot does is that it gets a form of influenza that is completely unable to infect you. And the body then sees that when you get the shot and makes an immune response against the virus as if it were the live virus that would infect you anyway.
--:-- Sean Rameswaram: Okay, that's good. So I'm 0 for 1 right now. But here's another one. My boss told me she used to be a flu shot skeptic, but then she got the flu really badly one year. And that's what sort of flipped it for her. And now she's a hardcore, you know, flu shot devotee. But I have never gotten the flu. And I think it might be because I'm like a generally healthy and careful person. I eat well. I drink well. I take care of myself. I dress warmly. What if I'm thinking, you know, why not just be safe and super careful instead of getting extra needles?
--:-- Dr. Anthony Fauci: Well, I mean, it's really a very benign thing. Extra needle is nothing. It's a little pinch.
--:-- Sean Rameswaram: Okay. How old are you, if I might ask, if you don't mind?
--:-- Dr. Anthony Fauci: I go by the age of 33 at this point.
--:-- Sean Rameswaram: Okay. My Jesus year. You're generally a healthy 33-year-old. Not every 33-year-old every year is going to get the flu by no means at all. But you've been relatively lucky and good that you have not gotten the flu yet. Or if you've gotten the flu, you've gotten sort of a very, very, very mild form that you did not even realize that you were infected.
--:-- Dr. Anthony Fauci: But generally, when you get the full-blown flu, you know it. You get pretty sick. It's not something that you just don't recognize.
--:-- Sean Rameswaram: But the fact that you haven't gotten it yet doesn't mean that you won't. And you might wind up getting flu and getting really ill. But also, there's another reason, Sean. There's this protection for yourself. But there's also the responsibility of protecting society.
--:-- Dr. Anthony Fauci: And let me explain what I mean. Let's say you wind up getting infected with influenza, even if you have a mild version of it, and you inadvertently expose someone who is a high risk for the complications of influenza, you might wind up inadvertently transmitting that infection to someone else.
--:-- Sean Rameswaram: And we know from a lot of experience that there are certain groups of individuals who are particularly susceptible to the complications of flu that might lead to hospitalization and in some cases death.
--:-- Dr. Anthony Fauci: And I'll give you some examples. Small children, pregnant women, the elderly, people who have chronic diseases like heart disease, lung disease, diabetes, other diseases like that who are on immunosuppressive drugs for things like cancer.
--:-- Sean Rameswaram: If they get influenza, they can wind up with serious consequences. Just last year, for example, 183 children died of influenza. The overwhelming majority of them were not vaccinated so they were not protected.
--:-- Dr. Anthony Fauci: So that's what I mean by not only to protect yourself which is an important reason to get the flu shot but also the societal responsibility for keeping the level of influenza transmissibility at its lowest possible level so that people who are particularly susceptible don't get infected.
--:-- Sean Rameswaram: What about people who get the flu shot but still get the flu? That's a thing that can happen too, right?
--:-- Dr. Anthony Fauci: Well, absolutely, because first of all, there is no vaccine that is 100% effective. Some are more effective than others. Influenza, because it's a very unusual virus, it has the capability of what we call drifting. It mutates and it changes a little, like from season to season.
--:-- Sean Rameswaram: And sometimes there isn't the absolutely perfect match between the vaccine and the flu that you get exposed to.
--:-- Dr. Anthony Fauci: We make a decision and we do this with the CDC, the FDA and WHO all working together in February or March of a particular year to anticipate based on evidence that is gathered what the flu that will be circulating the following winter.
--:-- Sean Rameswaram: Generally, you match them correctly, but sometimes that virus drifts a bit and changes over that period of time when you've been making the vaccine.
--:-- Dr. Anthony Fauci: And that's one of the reasons why the vaccine doesn't always completely match what you have in the circulation, which is the reason why not every single person is protected.
--:-- Sean Rameswaram: Some people who get vaccinated will get the flu, but you greatly increase the likelihood that you will not get influenza if you get vaccinated.
--:-- Dr. Anthony Fauci: You make some great arguments. I mean, no stronger argument than the for the good of society. That one, you got me. I'm like a big good of society guy.
--:-- Sean Rameswaram: Do you meet a lot of skeptics like me?
--:-- Dr. Anthony Fauci: You know, there are skeptics. People want the explanations. And that's why I was very willing and valued the opportunity to discuss with you what your objections were.
--:-- Sean Rameswaram: And, you know, we had a good back and forth conversation. There are some people that are just anti-vaccine for no real reason at all. They just empirically are against it. And, you know, that's tough.
--:-- Dr. Anthony Fauci: How is this doing statistically? Are the number of people who get flu shots on the rise decline? Which?
--:-- Sean Rameswaram: Well, you know, it's interesting. We need to do better. Last year, for example, there was a dip, particularly among adults, young adults like yourself, people 18 of years of age or older, has gone down in percentage by about six percentage points from the previous year.
--:-- Dr. Anthony Fauci: Which is the reason why you hear the CDC and people like me saying that we really need to make sure people get vaccinated because the fewer people get vaccinated has a twofold effect. It has that individual effect of not protecting an individual, but it also has that societal effect that we just mentioned, that the fewer people in the community that get vaccinated, the less of the community protection there is.
--:-- Sean Rameswaram: How many people die of the flu every year? Have there been particularly bad years recently?
--:-- Dr. Anthony Fauci: It's interesting that you bring that up, Sean. Last year, the winter of 2017, 2018, was essentially the worst seasonal influenza season that we've had since we've been recording the deaths and hospitalization.
--:-- Sean Rameswaram: There were 80,000 deaths last year from influenza and about 900,000 hospitalizations due to influenza. And that was in the United States alone?
--:-- Dr. Anthony Fauci: Yeah, that was in the United States alone.
--:-- Sean Rameswaram: Tonight, the flu season raging, and it's getting worse. The number of flu deaths this season is more than double what it was at the same time last year.
--:-- Dr. Anthony Fauci: The CDC says the rate of hospitalizations for the flu has doubled since December.
--:-- Sean Rameswaram: This comes as a new national survey shows some parents don't see the benefits of the flu vaccine.
--:-- Dr. Anthony Fauci: He was not vaccinated and was otherwise healthy before getting sick with the flu. The virus has been killing more than 100 people a week since mid-December.
--:-- Sean Rameswaram: From the time the whole thing started, the time we knew anything was wrong, the time he was gone was less than an hour and a half.
--:-- Sean Rameswaram: Coming up on Today Explained, where did the flu even come from and why does it want to kill us?
--:-- Sean Rameswaram: Thank you Dr. Afim Shapiro, Sean Rameswaram from Engineer at Today Explained. Yes.
--:-- Sean Rameswaram: Yesterday while working, you came up with this innovation that I thought maybe you could tell people about.
--:-- [Music starts again]
--:-- Sean Rameswaram: As I was walking up the steps from our wonderful snack room, I realized that if I just dig into these bag of chips that I'm holding in my hand, my hands will get messy, as they always do.
--:-- Sean Rameswaram: These are the delicious Zaps Voodoo chips. New Orleans style. They're fantastic, but they get all over your hands, and you have to constantly wipe.
--:-- Sean Rameswaram: So I said, hmm, I wonder if we have chopsticks in the drawer. And did we? We have a lot of chopsticks in the drawer.
--:-- Sean Rameswaram: Great. So I pulled out a set and I just sat at my desk listening to the mix and just pulling one chip at a time with chopsticks out of the bag. Really enjoying myself.
--:-- Sean Rameswaram: I was really blown away. Yeah.
--:-- Sean Rameswaram: Well, after you tweeted that photo of me, people really reacted to it in a positive way.
--:-- Sean Rameswaram: And I can see why. I mean, eating chips from a bag with chopsticks, it just makes sense.
--:-- Sean Rameswaram: And this is just a public service announcement. It's a new year. It's time to try new things like, I don't know, rating and reviewing today explained on Apple Podcasts or Stitcher or wherever you listen.
--:-- Sean Rameswaram: And maybe eating potato chips or popcorn or Cheetos with a pair of chopsticks.
--:-- Sean Rameswaram: When you fall off of your New Year's resolution for not eating potato chips, you can do so and keep your hands clean while you do.
--:-- Sean Rameswaram: Happy New Year.
--:-- Sean Rameswaram: Happy New Year, Sean.
--:-- Dr. Anthony Fauci: Dr. Fauci, where did the flu even come from? Why does it want to kill us?
--:-- Sean Rameswaram: Well, you know, if you metaphorically want to give it a mind and say it's trying to kill us, well, that's okay. But flu was not primarily a human infection. It's an infection fundamentally of wild fowl, birds, but it also infects pigs, it infects other animals.
--:-- Dr. Anthony Fauci: You know, in 2009, when we had the pandemic of 2009, that was called the swine flu because it really was a flu suited to swine, to pigs and jump species and had the characteristics to replicate very well in humans.
--:-- Sean Rameswaram: The 1918 influenza really evolved from a bird.
--:-- Dr. Anthony Fauci: So that's really where influenza viruses come from. They're not primarily a human virus. We're just about 100 years out from this epic flu.
--:-- Sean Rameswaram: What exactly happened 100 years ago?
--:-- Dr. Anthony Fauci: Well, first of all, what went down was the basis of what we call pandemics. A virus appeared, likely from a bird, jump species. We don't definitively know what it was. We know the sequence of it now, but we don't know exactly how it happened.
--:-- Sean Rameswaram: And it was a virus that had some characteristics that were clearly problematic. First of all, the human species had never before had any experience with this particular virus.
--:-- Dr. Anthony Fauci: So there was no background immunity or cross-reactivity of immunity that might help protect you. Almost everyone in society had never experienced a virus of this type.
--:-- Sean Rameswaram: You add that to the fact that this was a particularly virulent virus that really could infect someone and kill them in a relatively short period of time.
--:-- Dr. Anthony Fauci: And it was a public health catastrophe. It killed between 50 and 100 million people worldwide, and it spread worldwide. So that was one of the more catastrophic global health events that we had ever experienced.
--:-- Sean Rameswaram: And this is the Spanish flu, right? Why was it called that? Did it start in Spain?
--:-- Dr. Anthony Fauci: You know, it's ironic. It didn't start in Spain, but it was called the Spanish flu because it occurred right around the last year of World War I.
--:-- Sean Rameswaram: And it occurred in the United States and it was in Europe. And because the war was on, no country wanted to admit that they were having an infectious disease outbreak because it would signal their vulnerability.
--:-- Dr. Anthony Fauci: Spain, interestingly, Spain was neutral during the First World War. So they didn't really mind that they were considered to be vulnerable because they weren't at war with anybody.
--:-- Sean Rameswaram: So when the virus came to Spain, they publicly and openly admitted that they had this respiratory infection that was wreaking havoc in their country.
--:-- Dr. Anthony Fauci: So people started calling it the Spanish flu inappropriately because it wasn't the Spanish flu. It just as likely started in the United States for all we know.
--:-- Sean Rameswaram: And they've just been stuck with it ever since. And they've been stuck with the name Spanish flu ever since.
--:-- Dr. Anthony Fauci: And you talk about it becoming around the same time as World War I. I mean 100 million people It sounds like it killed more people than World War I
--:-- Sean Rameswaram: Well that a very important fact Influenza in 1918 killed more people than bullets and bombs did
--:-- Dr. Anthony Fauci: We haven't seen anything like that since, right?
--:-- Sean Rameswaram: No, no, no. We had two subsequent pandemics in the 20th century. In 1957 was the second pandemic of the 20th century.
--:-- Dr. Anthony Fauci: For the first time in history, we are forewarned of a possible epidemic.
--:-- Sean Rameswaram: You can help prevent the spread of Asian influenza and protect the health of your family by vaccination against Asian influenza.
--:-- Dr. Anthony Fauci: Don't wait. See your doctor or health department now.
--:-- Sean Rameswaram: In 1968, it was the third pandemic. I do hope we won't have any unseasonable cold spells. They bring on so much influenza, and the whole of our family is susceptible to it.
--:-- Dr. Anthony Fauci: And, like, for example, in 1968 was the first time we ever were exposed to our knowledge to the H3N2 version of the flu.
--:-- Sean Rameswaram: And then after that year, we had multiple H3N2s, which were not pandemic anymore, because there was background immunity and the host's body of people, the cohorts of people throughout the world had been priorly exposed to H3N2.
--:-- Dr. Anthony Fauci: So now we get H3N2 every year. Last year, it was predominantly an H3N2 year, but in 1968 was the first time that we had experienced H3N2.
--:-- Sean Rameswaram: And that's why it was a particularly bad year. And that's the reason why we called it a pandemic.
--:-- Dr. Anthony Fauci: Have we gotten considerably better at dealing with this since then?
--:-- Sean Rameswaram: You know, we have in some respects, and in some respects we have, and we have now antiviral drugs that are effective.
--:-- Dr. Anthony Fauci: We have Tamiflu, we have Rolenza. The difference between now and then is we have drugs now and we have vaccines now.
--:-- Sean Rameswaram: We have intensive care units and we have antibiotics for the bacterial complications that might occur when you get a pneumonia that's related to the influenza.
--:-- Dr. Anthony Fauci: So is that to say that we're not really at risk anymore of having a 1918-style Spanish flu kill 100 million people or anything like that?
--:-- Sean Rameswaram: Well, I see. No, I think that would be too cavalier to say that.
--:-- Dr. Anthony Fauci: It is possible, you know, unlikely but possible, that we might have a devastating pandemic sometime in the future because we know we've had pandemics in the past.
--:-- Sean Rameswaram: And that's the reason why we need to be prepared. We need to get better antiviral drugs.
--:-- Dr. Anthony Fauci: We're making a very important investment in trying to develop a universal flu vaccine.
--:-- Sean Rameswaram: So that's, again, one of the reasons why, from a research standpoint, I've made this one of the high priorities of my institute is to ultimately develop a universal flu vaccine.
--:-- Dr. Anthony Fauci: That's the aspirational goal, to have a shot that you can give once and, you know, maybe get a booster every several years, that you could have a shot that would induce a response against the influenza virus that doesn't change from season to season or strain to strain.
--:-- Sean Rameswaram: That's the ultimate aspirational goal, and that's what we're working for.
--:-- Dr. Anthony Fauci: If we reach that goal, then we will have a situation where you could essentially take the worry of influenza off the table.
--:-- Sean Rameswaram: Beautiful. Well, good luck.
--:-- Dr. Anthony Fauci: Thank you.
--:-- Sean Rameswaram: I feel like I've been rude. I haven't asked you. Dr. Fauci, have you gotten your flu shot yet?
--:-- Dr. Anthony Fauci: I sure have.
--:-- Sean Rameswaram: Well, you've convinced me. Can I come to you for my personal flu shot or do I have to go elsewhere?
--:-- Dr. Anthony Fauci: Well, you can go to many pharmacies are able to do it. Your doctor's office is able to do it, public health clinics.
--:-- Sean Rameswaram: I'm going to take that as a no, Dr. Fauci.
--:-- Dr. Anthony Fauci: But if you want to come visit us here at the NIH, I'd be happy to see you and say hi.
--:-- Sean Rameswaram: All right, great.
--:-- Bridget McCarthy: Edited this episode.
--:-- Sean Rameswaram: Unlike Sean and Luke, I did get the flu shot.
--:-- Afim Shapiro: Engineered this episode.
--:-- Sean Rameswaram: Flu shot? I got my flu shot.
--:-- Afim Shapiro: Yes, I'm a responsible adult.
--:-- Noam Hassenfeld: Noam Hassenfeld also produces here.
--:-- Sean Rameswaram: I got my flu shot, but I totally forgot to get the sticker and then I went back and there was no sticker and I was really sad.
--:-- Catherine Wheeler: Catherine Wheeler's our intern.
--:-- Sean Rameswaram: You and Luke are a danger to society. You're menaces.
--:-- Jillian Weinberger: Jillian Weinberger has been helping out this week.
--:-- Sean Rameswaram: I obviously got my flu shot.
--:-- Afim Shapiro: And the immune Breakmaster Cylinder doesn't do diseases.
--:-- Sean Rameswaram: Today Explained is produced in association with Stitcher, and we're part of the Vox Media Podcast Network.
