DR TEENA CHOPRA:
Hello, I am Dr Teena Chopra, professor of infectious diseases and this is for faculty
development at Wayne State University. Today you're going to spend the next 40 minutes
with one of the greatest minds in medicine. He is the face of public health and public
policy in the world. I distinguish professor at Georgetown University,
he also holds an additional appointment at the University school of public policy. Previously, he served as a director of national
Institute of allergy and infectious diseases at the NIH, from 1984 to 2022. He was a key advisor to seven presidents and
also served as a chief medical advisor to Pres. Joe Biden. He has received numerous awards including
the presidential Medal of Freedom, National Medal of Science, and the award for public
service. He has been awarded 62 honorary doctorate
degrees from universities in the US and throughout the world. He has authored more than 1400 scientific
publications. Some fun facts about our speaker today, he
was the captain of his basketball team, and also a great speller. He participated in the citywide spelling bee
when he was in school. Above all, he is an incredibly kind, modest
and giving person and in his own world, the code of public services doing something that
is beyond your own self, beyond your own potentially selfish motivations. Ladies and gentlemen, please welcome Dr. Anthony
Fauci. Hi, how are you? DR ANTHONY FAUCI:
Thank you, it is a pleasure to be with you, thank you for having me, looking forward to
our discussion. DR TEENA CHOPRA:
I welcome you today, on behalf of faculty, students and staff. We have more than 400 people joining in today
and before I start asking questions, the one big team today, from everybody was, make sure
you take Dr Fauci for his service, during the pandemic and beyond. Some of them did not have question for you,
but they wanted to thank you. DR ANTHONY FAUCI:
Thank you, I appreciate that, thank you. DR TEENA CHOPRA:
Dr Fauci to begin, we have had more than 1.1 million deaths in America, and we are still
counting. We clearly fell short in our public health
response. As you know, we are located in Detroit, Wayne
State University is of one of the largest in Detroit, and what is the role of academia
in public health? As you know, we are moving towards establishing
centers for emerging infectious diseases, schools of public health. What kind of teaching should we include the
that our younger generations can better understand public health? How do you plan to include public health in
various curriculum at Georgetown University? DR ANTHONY FAUCI:
That is a great question, and I can answer it by breaking this into two fundamental buckets. One is the fundamental science, basic and
clinical science bucket, and the other is a public health bucket. Academia, you have fundamental translational
research, the single success story of the pandemic. By that, I mean that the support, mostly but
not exclusively by the NIH of scientists over the previous 15 to 20 years, in the arena
of the development of platform technology including mRNA, which was such a successful
vaccine platform, the many years of work that was done on structure based immunogen design
develop the optimal stabilized immunogen of the spike protein, which was so successful. And then the investment, particularly in operations
like operations work speed, to do something that has never been imagined to be done is
to go from the availability of a genomic sequence of a virus, on January 10, to develop a phase
1 trial in 65 days, phase 3 in 125 days, and to have a vaccine that is proven in a clinical
trial involving tens of thousands of people to be safe, effective and going into the arms
of individuals in 11 months, the end of November, the beginning of December. That was a combination of the synergy between
academia, and pharmaceutical companies. That is unprecedented. That is beyond any precedent to do it. And then you ask another question, what about
the public health role? Of academia. I think that even though most people do not
fully appreciate the importance of the role of academia, public health, it is for the
academic people in infectious diseases like yourself, and your team, in Detroit, teams
in other cities like New York and San Francisco, and LA, and all of the cities that caught
and even some of the community places, to analyze the data of what we did right, and
what we did wrong. And the best way to do that is to go to the
people who are in the trenches, and I think the city of Detroit, in many respects, was
the Midwest epidemic epicenter of the trenches. What you learned about what should be done,
what is needed, what you did not have and needed, so that -- when you prepare for the
next pandemic, you can see that these are the things that worked well, these are the
things we had that did not work well, and these are the things we do not have, that
we should have had. So, all of that has to spring from the bottom
up it cannot be from the White House or the CDC or the NIH down, it has got to be from
the bottom up. The short answer to your question, academia
clearly has played a successful role in the science, and the development of interventions
like vaccines, and therapeutics, but they also have a very underappreciated role in
getting the data and the correct science associated with public health. So, bottom line, it is an important role. DR TEENA CHOPRA:
Thank you, this was a very nice summary of academia and public health, and I'm sure our
medical students are listening to this, as well, and how they can be involved in public
health, not only during pandemics, but also otherwise. You rightly pointed out about Detroit being
the epicenter. We have major health disparities in Detroit. The social vulnerability index is one of the
highest in the nation. The pandemic only made it worse. As scientists, we were communicating information
which was changing so rapidly. How do you establish trust with your community
in such a dynamic situation? DR ANTHONY FAUCI:
Well, let's look at the problem first. Then we can see how we are going to connect
with the community. One of the things that have been becoming
very clear in most outbreaks, including HIV, is the inequities in health access are very
important determinants of the negative impact of an outbreak. This was dramatically emphasized and apparent
with COVID. Detroit, as you mentioned correctly, Teena,
has a great deal of health disparities. Particularly, and Brown and Black people which
occurs not only to the lack of access to health, but the decades if not centuries old Social
Determinants of Health. Which make it more likely for an individual
of a minority population, if they do and when they do get infected, to have a more serious
outcome. And what we are learning is that that is not
genetically racially determined, it is determined by the social determinants of health. The fact that because of lack of access to
healthcare, because of economic considerations and lack of accessibility of a good diet,
for lack of a number of things, that throughout the country, but particularly emphasized in
cities like Detroit, New York, and right here in my own city, Washington, DC, that take
African-American, for example. They have a much higher degree of obesity,
diabetes, hypertension, chronic renal disease, chronic obstructive pulmonary disease those
issues, when you look at the likelihood of progressing to severe COVID, when you get
infected. We are not going to change those social determinants
overnight. It took decades and centuries, based predominantly
on racism, and discrimination, but we have to make a commitment now, that we have 1.14
million deaths in our country. The worst outbreak since 1918, pandemic of
flu. I would hope that the corporate memory of
the fact that Social Determinants of Health played a role in that, that we need to have
a decades long commitment to do something about that. Let's talk about what we can do tomorrow. I think that if you want to prepare for the
next pandemic, you've got to look for the accessibility and the access to health, in
the form of testing to have clinics that are available to people, as opposed to just tertiary
hospital. You've got to get out into the community,
so anything we learned in COVID is that it is at the community level, the disparity is
at the community level. Once you get a person who suffered from health
disparity, into a tertiary hospital, once you get into what of your hospitals, then
everybody's equal there. It is what happens before you get into the
hospital and that is something we have to pay attention to in the next way we prepare
for a pandemic. DR TEENA CHOPRA:
Absolutely. You said it very greatly, about going out
in the community, and initially in the beginning nobody expected that this is going to happen,
but after it took us a while, it took us a few months to get ready, and go out to the
nursing homes, go out to people, and offer support in the form of testing. Testing was obviously one of the biggest limiting
factors here in Detroit but it took us a while because we never expected, in your own words,
expect the unexpected. That is where we want to be next time. This is a nice segue into talking for a few
minutes about public health response, in nursing homes, across the nation. I feel like we really feel it on so many levels,
when we were in the midst of the surge, like I was talking to you backstage, patients coming
to the ER, from nursing homes, mortality rate was 80%. We did not test them and they were gone. Very unfortunate. It is not like COVID-19 did this, it is COVID-19
expose the inadequacies of the nursing home. What we learn here in Detroit was that not
all nursing homes were equal. There are some good ones, but they're only
available to the wealthy and to the insured. For example, today, if we have a nursing home
patient and they develop fever, what will happen to them? They will be sent to the ER, and this patient,
who is already partly demented will be exposed to more trauma, more infections. My real question to you is, do you think that
in the future, our nursing homes better prepared administratively, financially and legislatively,
for any kind of public health crisis? DR ANTHONY FAUCI:
Right now, the answer is no. (Laughs) we have a task in front of us, I
think. You just described it better than I possibly
could have described the problems, the question is, what about the solutions? I think would happen in nursing homes, some
of which are unavoidable just on the basis of what a nursing home is, and just what the
structure of the nursing home is. The other things that we have got to learn
to have done, administratively and otherwise. For example, when you have an outbreak that
is highly contagious as SARS-CoV-2 is, the idea of the staff being the individuals who
are spreading it among the occupants of the nursing home was something that we did not
fully appreciate, thinking that it was one nursing home inhabitant spreading to another. I'm not saying this happened in Detroit, but
broadly, at 40,000 feet, in general, we need to pay more attention to do we let visitors
into the nursing home to outbreak? If so, we cannot say that you're going to
get these old people and shut them off completely, from the people who love them. But you got to be very careful in who comes
in. Are they vaccinated? Do they have a good N-95 or KN-95 mask? Do they stay away if they are a systematic? Do they test themselves before coming in? Those are lessons learned within the nursing
homes. We got to do better. I had a lot of contact with the head of CMS,
and she was very good and understood those problems, right from the beginning, and did
everything she could to try to alleviate them. I think there is still a lot of work to be
done, and you pointed out yourself some of the really important issues. I, myself, had a personal experience because
my wife's mother was in a nursing home, who was demented, not totally, but partially demented. The same thing happened she had a fever, and
a typical 90+-year-old person, who has a fever and a woman, you think urinary tract infection,
for it away. You bring her to the emergency room, and it
was a terrible experience. She was there for hours and hours, before
we could do anything. And they treated her, and bring her back,
and thank goodness, she did not have COVID but she did, it really would have been a real
difficult situation. There's a lot of work that needs to be done
at the level of nursing homes. DR TEENA CHOPRA:
Involving the nursing homes, in public health, educating them about public health, like our
team from Wayne State University wanted to nursing homes and drop we were doing because
it was a hole in the bucket that we needed to patch, we were doing patchwork. We went to nursing homes, physically went
there, myself included. Started swabbing everybody, and then cohort
in patients, and there was no room to cohort them so we created a nursing home where we
put all of our patients who were negative in one nursing home because the other thing
is the logistical challenges. They are not equipped with private rooms,
so there are so many other challenges which I think even at this point, if we have a disease
X we are not prepared. DR ANTHONY FAUCI:
I totally agree. It is remarkable you were able to cohort individual
nursing homes, and do that. That must have been a logistical challenge,
to the likes of which very few people could handle. That would be a very logistic challenge to
do that. DR TEENA CHOPRA:
Absolutely. We have a very good team, which you very -- rightly
point out in the article that you've written that we had to channel all of their resources
that we could, whether it was making our own hand sanitizer, making mobile unit clinics,
and going into people and giving them vaccines and doing testing and whatnot. Dr Fauci, the other big worry, as an epidemiologist
practicing in Detroit, that I have is our low vaccination rates in Detroit. Childhood vaccination rates have fallen before
40% in Detroit, and I'm not just talking about the COVID booster rates which are low, but
tomorrow, if we have a measles outbreak or even a polio outbreak, I will not be surprised. What can we do to increase our vaccination
rates? One. I want to share a little story with you. Like I was mentioning, I did my med school
in India, and I was on the front lines with a polio vaccination. They made us rotate in rural India, during
the vaccination campaign, so I would go door-to-door with my colleagues, and talk to families,
knock at the door, have a cup of tea with them, and give the kids two polio vaccines,
it was fun and easy and no resistance. Now coming into COVID, and two other vaccines,
there's so much misinformation, the question is, how do we overcome this hesitance? DR ANTHONY FAUCI:
This is one of the most difficult problems we are facing and what we all face in the
future, there has always been a small element in the country of anti-vaccine, and antiscience,
and with the political divisiveness, in which public health has taken a political intonation
to it, where we note that if you look demographically at the country, it is less likely for a red
state to get vaccinated against COVID, then it is for a blue state, and deaths among COVID
are more in red states than they are in blue states. That is terribly tragic. A political ideology is going to be responsible
for whether or not you are healthy or not, sick or not, or dead or not. The only thing that we can hopefully do is
separate the ideological considerations from public health and get people to realize that
historically vaccines speak for themselves. The only trouble is, in the disinformation,
and misinformation associated with the social media, it becomes very difficult, if not impossible,
for people to look at facts, evaluate them and say, "Take a look at the curve. The people who were vaccinated, their hospitalization
and mortality is like this. The people who are on vaccinated, it is like
that." Data come out and hit you like a Mack truck,
and there are people that feel beyond public-health rationality, that they don't want to get vaccinated. That is bad enough for COVID, but the thing
that you are referring to, that worries me, as much, outside of the realm of COVID, is
what that means for normal childhood vaccinations. Our mothers and fathers really going to have
their children not get me both, mumps, rubella, hepatitis and so on, that would be a terrible
tragedy. If you look at facts, not tweets, not social
media, but fact is that every time that you get a level of vaccine in a community, below
a certain level, particularly with measles because measles is always the -- canary in
the coal mine, because it's highly transmissible. When you get below a certain level in the
community into the 80s are lower, you get the measles outbreak. We see it in pockets, we saw it in Disneyland,
we saw in upstate New York, in Rockland County, where you have a certain religious sect did
not want to get vaccinated and someone came from the outside into the community, you had
a massive measles outbreak. You have to keep pushing with correct information. There is is freedom of speech in this country,
that has taken to its extreme, can really lead to a problem. That is, you cannot suppress somebody from
spreading misinformation. But, you can counter it by aggressively spreading
correct information. That is all of our responsibility, I try to
do it as much as I possibly can. I know, you do, a lot. But everybody has to do it. Medical students have to do it, interns, residents,
fellows, how to articulate the correct information with vaccines. DR TEENA CHOPRA:
I was having a discussion with (unknown name), and American healthcare is focused on specials
in a primary care physician. He believes is the primary care physicians
responsibility to educate patients, and he things we need to empower them more, and if
you look at America, if you look at the number of urgent care centers we have, our healthcare
is really building more urgent care centers, but are they empowering primary care physicians? That's the real questions. What are your thoughts on this? DR ANTHONY FAUCI:
He is absolute correct, that is a place where you can get education done right, at the point
that Jack was saying. We got to pay more attention to that, so he
hit the nail on the head. That is where you have to do it. DR TEENA CHOPRA:
That is very reassuring to know. I'm going to switch gears a little bit here,
and talk about lockdowns. Why do we have lockdowns? So we can harness resources, testing, ventilators,
vaccines. But the fact that we needed such long lockdowns
here in the US, what does this say about our preparation for the next unprecedented pandemic? The question I have is do we need to build
more negative pressure rooms or beds or even hospitals? If we have another pandemic disease X, let's
say, are we prepared to manage it without shutting down schools and businesses? Are you aware of any state-by-state legislative
or financial commitments that are directed towards these resources so that we do not
have such long lockdowns? DR ANTHONY FAUCI:
Yes, I think, Teena, you have to separate the advisability of lockdowns and the duration
of lockdowns, versus the need for better facilities like negative. I think we do need more negative pressure
beds and rooms, but I would not overdo it, because that is not the answer in itself. I think if we think what we will do, every
city will get two or three new hospitals, and first of all, financially, it will never
happen. You will not be able to do it. I don't think that is the solution, but getting
back to the important part of the first question, and I think you enter the question partially
-- with your question and you said, lockdowns have to have an endgame. You have to have a reason to lockdown, for
example, in New York City, when Elmhurst Hospital was overrun and they were having cooler trucks
outside, because they had no places to put the bodies, you had to have something to immediately
shut down the tsunami of infection. That lockdown was absolutely justified. The real critical question is what do you
do during the lockdown? When do you stop looking down? Lockdown has a purpose. One of the purposes, if you do not have a
vaccine, it is to get more ventilators, get the hospitals better prepared, get more people
involved in the healthcare sector to do it, until you decompress the pressure on the hospitals,
that you can open up. If you have a vaccine available, you might
want to lockdown temporarily so you can get everybody vaccinated. That was, I think, one of the problems in
China. They locked down for a long time, but they
did not effectively vaccinate all of their older people so when they opened up again,
all of the elderly, not all, but many of the elderly people, got infected. So, lockdowns with a purpose work. It saves lives. You get into a problem if you prolong the
lockdown and you do not do what you need to do to reopen. I have always said, right from the beginning,
people who are, I think, of ill intent have said the opposite, of me. I have said from the beginning, once you lockdown,
you have to start planning about how you're going to reopen. You do not lockdown and say, "See you around,
come back whenever." You say you are locking down, now how do you
plan to be open? Reopen the schools, reopen the places of business,
and the way you do that is to have a plan about how you are going to protect. For example, in schools we need better ventilation,
absolutely. One of the things we have not paid attention
to is ventilation. We got to be able to get work schedules and
to get people to stay at work, and work the schedules so you don't have overcrowding in
a place. Those are the things we need to do, and it
gets confused because some people think that lockdowns are bad, or lockdowns are good. No. Lockdowns have a place, but they are not the
permanent solution. DR TEENA CHOPRA:
Nicely said, I love the piece about more ventilations in schools. I have a 9.5-year-old, and it is not easy
for them to be home, but having more ventilation in schools, and having work schedules, I think
is a great lesson that you point out, too. Let's talk a little bit about climate change,
Dr Fauci. We are seeing the wildfires in Hawaii, and
climate change is real, it is affecting all aspects of our lives on our planet. Do you think that do not expel over is also
indirectly aided by climate change and what measures are organizations look like NIH and
CDC taking to help tackle this problem? DR ANTHONY FAUCI:
The answer to the first question is an absolutely yes. I was reading this morning, there is clear
indication that with the increase in warming that the range of vectors including mosquitoes
and ticks are leading to pick booms in areas of the country where you do not have tickborne. We are seeing malaria in the United States
and dengue fever spilling out into the United States. Zoonotic diseases, those are directly or indirectly
involved with vectors like -- insect vectors, without a doubt, play a role, and climate
change plays a role in that. The answer to the question is, and unequivocal
yes. You are saying, what measures of organizations
like NIH and CDC doing to tackle the problem? Nothing (Laughs) and the reason is that it
is not the mandate of the CDC and NIH to counter climate change. There are other organizations and commitment
on the part of society. What the CDC and NIH can do, and actually
does, is to study those diseases, and get better vaccines against dengue fever, against
malaria, against Zika out, against tickborne diseases so that when climate change does
cause a greater spillover in zoonotic diseases, we will have the tools. The climate change countering has to come
from an international commitment to decrease the carbon imprint in society, so you do not
have the kinds of crazy weather that we are having in this country. If you look at it, everything from the fire,
the tragic fire in Hawaii, to Texas, which had something like 75 days in a row, over
95 . It is completely amazing, what is happening with climate change. DR TEENA CHOPRA:
Like you said, I was also reading this, the wildfires can actually feed the atmosphere
with dangerous microbes. That was something that I did not know about
before. This is a big problem, and I hope that our
reviewers, who are listening, especially our younger generations, can be more knowledgeable
and aware and learn more about it in their respective schools. My next question, Dr Fauci. I hope you don't mind, this will surpass the
pandemic. Do you have any regrets about any of the decisions
you have made during your tenure in the NIH, while helping with outbreaks and emerging
infectious diseases? DR ANTHONY FAUCI:
The answer is, absolutely. (Laughs) I can tell you that, most certainly,
first of all, nobody is perfect, and certainly not me, I am not perfect. I look upon myself as a realistic but humble
person, but knows that you do not know everything. The one thing that I can say that I have done
is that I have acted with the knowledge I had at a given time to the best of my judgment. Now, the problem is, in our field of infectious
diseases, Teena, that you know well, that we are often dealing with a moving target. So, let's take wood for example. What we knew about the virus its transmissibility,
efficiency, aerosol, transmission by asymptomatic individuals, whether masks work or not outside
of the hospital setting. We, over weeks and months, learned more and
more and more, and I can say without a doubt if I knew in January what I knew in July 2020,
there are certainly things I would have done differently. Masks is a typical example. Early on, we were not fully aware of the advantage
of masks, so we were not recommended masks in the beginning because we thought the virus
was not easily transmitted, there is a lot of talk about it jumping from animals to humans,
but it is not very well transmitted from human to human. Then we find out a few weeks later, it is
very well translated from human to human, and we find out a week later it is aerosol
transmitted. Then we find out that 50 to 60% of the people
are transmitting it who have no symptoms at all, and then we find out that even though
we did not think masks worked outside of the hospital setting, that a good N-95 well fitted
mask actually does work, so in January you're saying that we do not necessarily need a mask,
and in April, May, June, July, everybody should be putting a mask on. If I knew in January what I knew in July or
April or May, I would have done things differently, so the answer to the question is, of course. You have to have regrets of things you could
have done, but it is not an excuse, but you did not know about it at the time you made
a decision. If I knew about it, I think we would have
done a number of things different. DR TEENA CHOPRA:
Thank you, Dr Fauci for this. I know that we are short on time, but I do
have to ask this, we have a new -- variant, and today is August 15, and we still do not
have our booster vaccine. Then there is his pandemic is over culture,
that we are all aware of. Our immunity has been waning after the boosters,
and hospitalizations are slightly up. I see no masks in the community and why where
one, I see people laughing at me. What are your thoughts on that? Any thoughts on what to expect in terms of
the flu RSV COVID moving into the fall? DR ANTHONY FAUCI:
First of all, you had about seven questions there but that is good, I will try to see
sickly answer. First of all, we are not in with COVID. We know that. If you look at just the last couple of weeks,
the number of cases last week at 12% greater than what the week before, and 25% greater
than what they were two weeks ago. Even up taking cases and hospitalizations
and deaths. It is not as nearly as bad as a year or year
and 1/2 ago, not saying that we are in an explosive surge, but it is picking up. It is picking up for the reasons you give.
96.7% of the United States population has antibodies that show they either were vaccinated,
boosted, infected or all of the above. So, we do have a degree of baseline cross-reactive
immunity. Most of the viruses that are circulating,
including the most recent one, that is what, 17% of that now is the new variant. It is going to go up to 20 and 25 and more,
but right now full, all of those, thank goodness, are derived from -- omicron. If you get the booster that is good to be
done in September and October, XBB 1.5, that one, even those not directly against the circulating
one, there is enough cross protection, that you should at least be protected against severe
disease. The bottom line is, everybody's immunity wanes
over time, we know that. Therefore, we should get boosted. And now, here's the trick, Teena we do not
need to mandate anything. We need to recommend to people that if you
want to be up to date on your protection, you should get a booster and what the CDC
and FDA is recommending is why not get it at the point in the fall where you can get
at the same general time that you get your influenza vaccine. However, if right now, you are a highly vulnerable
person, and the chances of you getting infected, you may get a severe outcome, you should not
wait. You should get the booster right now. For people who are otherwise healthy, the
general feeling is to wait until the fall, when you can get your flu shot. If you are elderly, you should get an RSV
shot. If you are anybody, you should one of getting
the flu. You should get three of them. Somebody like myself, who believe it or not,
as much as you'd like to see it, is an "Elderly man", I should get the boost, the flu shot,
and the RSV, and I will do that. DR TEENA CHOPRA:
Nicely summarized, Dr Fauci. I do want to share with the faculty that Dr
Fauci has written an article in the Journal of infectious diseases that was published
in April, pandemic preparedness and response, lessons from COVID-19. I really encourage you to read it and I will
share with you as well. I hope this fireside chat has ignited open
inspired you all, as Dr Fauci alluded, we can be part of public health, no matter what
role we play in our communities. With this, Dr Fauci, any parting words? Of course, I should also tell others, other
than being involved in public health, and maybe doing some spelling bees, you can be
like Dr Fauci. Any parting words? DR ANTHONY FAUCI:
My parting words, it's only really a big thank you. It's really great to be with you, and I have
enjoyed very much our conversation. As I mentioned, you folks, in Detroit, are
really in the trenches and the work you do, as they say, it is God's work that you're
doing there. Keep up your great work, you're doing a lot
for the community, and anyway I can help you, do not hesitate to contact me. Thank you so much. DR TEENA CHOPRA:
Thank you so much, thank you for being here. DR ANTHONY FAUCI:
My pleasure, thank you.
