Emma Ross
Good morning and thank you for joining us today on the Living With COVID-19 webinar series with Chatham House Distinguished Fellow, Professor David Heymann. This week, we have with us Dr Anthony Fauci who, as many of you know, has emerged as the face of America’s response to the coronavirus. Tony has been the Director of the National Institute of Allergy and Infectious Diseases in the US since 1984, serving under US – serving as the US Government’s top infectious disease expert under six Presidents, and he said the day before yesterday that he has every intention of serving under his seventh. He is a hugely committed Scientist and public health servant, who is revered across the world and, given everything that’s going on at the moment in the US, we’re very grateful that he has spared the time to be with us today to share his perspective on the pandemic, both in the US and globally.
Just a reminder of the housekeeping stuff, the briefing is on the record and questions can be submitted using the ‘Q&A’ function on Zoom. Upvoted questions are more likely to be selected, so if you have a question that’s similar to one already, that’s in the ‘Q&aA’, please upvote it. Just to add that I’m sure there are likely to be a lot of questions that, as with previous sessions, we’re not going to be able to get to them all. So, I apologise in advance for that, but hopefully, some of your questions will be answered, in the course of the first bit of the conversation. So, Tony, welcome and thank you for taking the time to be with us today.
Dr Anthony Fauci
Thank you, Emma, I appreciate you having me on.
Emma Ross
There’s so much we could engage you on and it seems there isn’t a single question about this pandemic that you haven’t already fielded. But just to orient us, I was hoping you could kick off with a brief overview of where you think the US is right now with this epidemic and what you think have been the factors that have most influenced the course of the American epidemic to date?
Dr Anthony Fauci
Well, thank you, Emma. I mean, obviously the answer to that question has to be quite sobering. We’re not in a very good place right now. If you look at the numbers, you know, data speaks and data is telling us that we are in a very difficult, challenging situation. We have now about ten million cases in the United States, about 240 plus thousand deaths. We had 60,000 hospitalisations yesterday and 140,000 new cases, that is not a good position to be in. About 40 plus of the 50 states in the United States are seeing increases in cases. This is a situation, particularly when you’re now going into the middle of the fall with the cool weather and the soon-to-be cold weather in the winter, when people are going to be congregating out of necessity because of the weather indoors, that makes for a very challenging and ominous situation.
The reasons for that are multitude, Emma. I was always concerned, from the beginning, when we had our big peak in the beginning in the spring, as did Europe and the UK, after that peak, they came down to a baseline that was really rather low. The United States never did, our baseline was about 20,000 cases a day. Then, when we tried to so-call open the economy and open the country again, we did it in a disparate way. We didn’t have a uniform adherence to the guidelines among the 50 states. That’s very clear history now. Some did it well, some did it not so well. So, instead of coming down, we actually went up to about 70,000 a day, then came down to around 40 for about a month or two, which is an exceedingly high baseline. And the reason I bring it up to you is that that essentially tells you there’s a considerable amount of community spread already going on, and when community spread is already going on and you’re at a baseline of 40/50,000 cases, as you get into a more challenging time of people going indoors in the cooler weather, that’s what we’re seeing right now, is the increase that’s going up.
We have got to double down on the fundamental public health implementation that we’ve been talking about incessantly and appropriately: universal wearing of masks, physical distance, avoiding crowds and congregate settings, outdoors more than indoors, and washing hands. That sounds so simple. Sometimes people equate that with lockdown and there’s no appetite for lockdown. There’s COVID fatigue in the United States, in the UK, in Europe, everyone has that and we’re seeing that throughout the world. So, what we’ve got to do is have that balance of pushing for more uniform implementation of fundamental public health measures.
Finally, I think the point needs to be made that now that we see vaccines on the horizon, we already clearly have a very effective vaccine that’s getting ready to be deployed. We have another one literally on the threshold of being announced, where you have enough data to make a statement about the second, and then there’s two or three or four or more vaccines. So, vaccines will help us. What we’ve got to do is just hang on and continue to do and double down on the public health measures.
Emma Ross
Do you think one of the challenges, in the immediate future, is that maybe with this vaccine arriving, we might collapse…
Dr Anthony Fauci
Yeah.
Emma Ross
…into complacency and just kind of say, “Oh, well, the cavalry’s arrived…
Dr Anthony Fauci
No.
Emma Ross
…we can relax”? Is that a danger and what are you going to do about that?
Dr Anthony Fauci
I think the opposite, Emma, I really do. I think the message that I’ve been giving now, ever since it became clear a few days ago that we have a really quite effective vaccine getting ready to deploy, is rather than, “Hey, don’t worry, you’re okay,” it’s that, “Don’t stop shooting, the cavalry is coming, but don’t put your weapons down. You better keep fighting because they’re not here yet.” Help is on the way, but it isn’t here yet, so, to me, that’s more of an incentive of “Please don’t give up, don’t despair, the end is in sight,” as opposed to, “Hey, we’re good to go, don’t worry about anything.” We’re not good to go. We’ve got to continue to double down on public health measures.
Emma Ross
Okay. David, I wanted to ask, do you want to add anything there, in terms of distinguishing characteristics that might explain why the US is where it is with the virus, and what you think the lessons are from the American experience to the global community?
Professor David Heymann CBE
You know, Emma, it’s been very difficult, in many countries, for the Politicians to speak with the Scientists, and the US has not been excluded from that, and so, what needs to happen is a new way of communication that people can understand. Political leaders have political ambitions and the public health leaders and the technical leaders have ambitions on stopping the outbreak, and two of those have to be reconciled in some way. So, countries have been promising vaccines, at least the political leaders, and that’s good. But the public doesn’t understand all about vaccines, as Tony just said, and including that this disease may, even with vaccines, become endemic and will be with us and we’ll have to live with this somehow going forward, and we have other tools that we can use to live with that, such as outbreak investigation and stopping disease from spreading into communities, at least decreasing that transmission. So, it’s been – the US has been no different than many other countries in having this difficulty between political leaders and technical leaders. What’s been very difficult for me to see though in the US is to see the way that the agency that I came from, the CDC, has been marginalised, and this is really difficult. Unfortunately, Tony has been there to take up the slack, which was left by a CDC, which was not able to project itself and to use its usual ways of networking with State Epidemiologists and others, to try to unify the response.
Emma Ross
Okay. Tony, just to – a little bit more on your vision for the optimal response in the US right now. So, if you were totally in charge of everything and everyone, what would be your plan right now for how to get more on top of this? And also, could you chuck in there what you think will be the biggest challenges, and the most important priorities for the immediate term? You’ve mentioned some of them, but I just wanted to press you a little bit more, to get a bit more juice out of that one.
Dr Anthony Fauci
You know, Emma, what I would like to see is something that I’ve been talking about for some time now and it relates to the comment that I made a little bit ago about why, when we tried to essentially open the country again, it was done in a disparate way, it wasn’t done uniformly. What I would like to see is that, even though there’s a lot of positive aspects and beauty to the system in the United States, the federalist system, namely the independence of the different states, what I would like to see is a much more uniform approach of all the states with a top – I wouldn’t say top-down because you don’t want to be absolutely, you know, dictating to states. But we should have a uniform response, because we really are all in this together and David knows so well, because of his decades of experience in outbreaks and will resonate with this, that when you have an infectious disease, it doesn’t matter if you have a country with 50 states, what happens in one part of the country is going too influence what’s happening in the other part of the country, so much so similar to what we public health people have been saying forever, when something happens in one part of the world, and it’s a respiratory transmittable disease, you can be darned sure it’s going to happen in every other part of the world. So, that’s what I really would like to have seen, and as we move forward to see that uniformity of response, everybody pulling together, whether you’re in the United States, in the European Union, in the UK, anywhere, everybody pulling together at the same time.
Emma Ross
Okay. How do you think the US response might change with the change in regime? I mean, what are you expecting between now and January, and after January, or if you haven’t got any expectations or indications, what are your hopes?
Dr Anthony Fauci
Well, I can tell you that right now, whether it’s now to January or beyond January, the things that the medical people will be doing, the push, the all-out push for the development successfully of, and deployment successfully of vaccines and other countermeasures, particularly things that we do need, Emma, is we need more therapies for early in the course of disease.
The studies that have shown that things like dexamethasone and remdesivir have very positive effects late in the course, when people are hospitalised, even when they’ve been on ventilators and requiring oxygen. What we do need, and we have some promising results that I think will get better as the weeks and the months go by, monoclonal antibodies directed against the virus to prevent people from having to go to the hospital, as well as direct antivirals. We’ve been so successful with anti-HIV drugs, you know, targeted antiviral therapy that has been so successful. I would like to see that, and we’re putting a big push on that, as are other countries, to be able to develop and make a regimen of an antiviral, so that if someone comes in with symptoms, you don’t wait until they progress to the point of having to go to the hospital, you prevent them from going to the hospital. That’s going to happen now, through these months, and into January, February, March, that’s not going to change. The idea of what the broader approach is, you know, I would leave that to what happens in January, obviously.
Emma Ross
Okay. I wanted to come onto how you see your role in guiding the country through this crisis going forward, regardless of what any kind of change in plan might be, on a national level, where do you fit in and how do you see yourself moving forward with – in relation to this?
Dr Anthony Fauci
You know, Emma, I don’t mean to be presumptuous, but I see it really essentially similar to what I’m doing right now. I mean, I’m the Director of the Institute, I mean, David knows well, we’ve been together for so many years, the Institute in the United States, that’s responsible for the overwhelming majority of research conducting and support in the arena of infectious diseases. That’s critical, that has nothing to do with politics, with administrations, it’s just something that’s been there for quite a while. I’ve been Director of that Institute, as you mentioned, 36 years. Last week was my 36th birthday for being Director of the Institute, and we’ve been through a lot of things through that Institute. HIV, the anthrax attacks, Ebola, Zika, pandemic flu, so I see my future as doing the same thing, as we get our arms around this outbreak, we essentially put it to rest. But, as David said, putting it to rest doesn’t mean eradicating it. I doubt we’re going to eradicate this. I think we need to plan that this is something we may need to maintain control over chronically. It may be something that becomes endemic, that we have to just be careful about. Certainly, it’s not going to be pandemic for a lot longer, because I believe the vaccines are going to turn that around.
The other thing I do is that I, like David, am a public health person, so you’re going to hear us, both of us, talking to the world, talking to the various countries, including the country that I’m responsible for, the United States, on getting the message across, based on science. So that’s what I do, I give guidelines, I give policy, I give messages that are science and evidence-based. I’ve done that for decades and I think I’m going to be continuing to do that.
Emma Ross
That’s a good segue actually into the next thing I wanted to discuss and it’s an issue certainly not unique to the US and it’s something we’ve discussed in other sessions on this series, and that’s the whole area of the relationship between science and policy, public trust in science, and community buy-in to response measures. Attacks on science aren’t new and there have been some countries where Scientists have had to fight to hold onto their integrity or independence, and, it seems, to avoid being set up to be blamed for negative outcomes in the pandemic response. But in America, it seems a disdain for science has reached a particularly high level among some population groups during the pandemic and, Tony, although you’ve got the trust and admiration of a huge proportion of the population, and the world, you’ve taken a fair bit of the brunt of that, as somewhat of a symbol of science in the pandemic.
I mean, you’ve been quite open about the death threats and the harassment of your family, that you’ve had to have a bodyguard, you’ve been threatened with the sack, disparaged, had your words instrumentalised and on and on. But still, you’ve unflinchingly, or should I say it looks like you don’t flinch, continued to hold up the side of science, and not just uphold it, but proactively champion and defend it with confidence and grace. I just wanted to say that, but the question I have is, have you been surprised by the level of resistance to science, the vitriol in this pandemic and do you think it can be healed and, if so, how? And related to that, what do you think is the secret to your survival, your maintaining of your credibility and respect with all of this going on?
Dr Anthony Fauci
Well, I do feel it – we can change that, Emma, I certainly hope we can. There is globally variable degrees of anti-science attitude, you know, it goes back a lot to the anti-vax feelings, the anti-vaccine feelings that we’ve seen. But, you know, there has been a pushback on authority and what I think – I know, I can see an element of it, that science is felt to be authoritative, people interpreted that, and there’s a pushback on authority, and it spills over into a pushback on science. People do not like to be told what to do.
Science gives the evidence and the data to make an appropriate decision about what to do, and what has happened is that when you’re into – when you’re involved in a divisive society that becomes very politicised, all of that subliminal, and sometimes not so subliminal, anti-science feeling becomes intensified. And I think you captured it very well because it isn’t just an anti-science feeling, it’s almost an aggressive push against science, which is the reason why, what I’ve seen as something unprecedented, throughout outbreaks you always have disagreements about how things should be done. But we’ve never seen the polarisation, which is the reason why, as you say, there are many people who are very much encouraging of what I’m doing in the arena of science, and some people that pushback sometimes with the extremes that you mentioned, actually with threats.
If you just sit back and think about that for a while, how little sense that makes, that someone who disagrees with what you’re saying from a public health standpoint actually takes that to the extreme of suggesting violence. We’ve never had anything like that, at least in the years that I’ve been involved. So, getting back to the first part of your question, I do hope we can turn that around and I think we can. I happen to be somebody who, although I consider myself a realist, I also am somewhat of an idealist, and I have a good deal of faith in the goodness of people, not only in the United States, but globally. As an infectious disease person, I’ve developed friendships and relationships over the years, as David has, with people from all over the world, and I do have a fundamental confidence that the better angels will prevail. I don’t want to seem naïve, but I don’t think I am naive.
Emma Ross
Yeah. David, I wanted to ask, do you think this rejection of science is particularly bad in the US, relative to other countries, or particularly bad in this pandemic compared with previous epidemics? And do you think it’s temporary, or we could be dealing with this?
Professor David Heymann CBE
Well, I think it is temporary and I think it is greater in the US than in most other countries, although it’s happening in many different countries. Interestingly, the countries in Asia that began to respond very rapidly in January have continued to use science as it directs their responses and have had a good sustainable response, letting the virus enter slowly, without overwhelming their systems.
Here in Europe and in North America, the threat was the hospital capacity and so everything was shut down, and shut down without an exit strategy, and, as a result, when exit came, people just came out altogether at the same time, instead of scientifically listening to the people who were telling where transmission was occurring and then not listening to how to shut that down. So, Asia listens, some parts of Europe listen, North America is not listening to Tony or to others, in many instances, and it’s also become a partisan issues in the US. You know, a mask-wearer many times is a Democrat and a non-mask-wearer is a Republican, unfortunately, but that’s what’s happened, it’s been highly politicised in the US.
Emma Ross
Okay, well, before we move onto the audience questions, Tony, what do you hope for the legacy of COVID? I mean, when this is all over, how would you like the world to change as a result of the pandemic?
Dr Anthony Fauci
Yeah, I would hope that the world realises what we keep saying whenever we get an outbreak that we’ve got to develop corporate memory in lessons learned for preparation for the next one. People do not like to, and it’s human nature, I know, ‘cause when I testified before the Congress, so many, many times over the years, that there’s so many current problems that people have, when you talk about preparing for something that hasn’t happened yet, that’s a difficult water to carry. And I hope that the terrible ordeal that we’ve gone through together globally will not soon be forgotten, and when we talk about the kinds of global health security network, the kind of communication and transparency among nations, the mutual respect, the mutual interactions that we have, really gets solidified.
Now, outbreaks will occur. I mean, the emergence of new microbes, there isn’t anything that anybody’s going to do about that, but what we can do is to control what happens when they do emerge, that’s the point. We’re not going to stop an emergence, but we certainly can do better on how we handle an emergence.
Professor David Heymann CBE
Emma, I just might add to that as well that one of the legacies is going to be how well we’ve been able to make sure that there’s an equitable distribution of the goods that are developed, whether it’s a vaccine, or an antibody therapy, or whatever, and that’s really on the top mind of many, many people at present, and hopefully, that will also be a legacy that we can see that not only have individual countries been able to deal with this, but the global community, as a whole, has made sure that those inequities have been addressed.
Emma Ross
So, are you saying, David, that that’ll be one of the things by which the pandemic response will be judged, whether we…?
Professor David Heymann CBE
I would say that. I don’t know, Tony, if you’d agree with that or not.
Dr Anthony Fauci
David, I’m – I lit up when you said that, because it’s so, so true. Here is our opportunity now, knowing what – that this is the total definition of a real pandemic. There isn’t a part of the world that’s not suffering from this. The companies who are being involved now, a number of different companies are talking about the ability to make billions of doses, that’s what we need. We don’t need hundreds of millions for the rich country, we need billions, so whether you live in the darkest part of a developing world, or if you live in London, you should have the same access to this, because life-saving interventions should be available to everyone and, as so many people in our field have said, you should not live or die depending upon where you happen to have been born, that would be unacceptable.
Emma Ross
Okay. I’m going to move to the audience questions now and the most upvoted question is from Tinne Hjersing Knudsen, apologies if I’ve mispronounced – mangled the pronunciation, from the Danish Broadcasting Corporation, and that is, either of you could speak to this, but, “Do you think there’s a reason to believe that the mutation in the virus found in mink in Denmark and other countries could undermine a future vaccine? And do you think the Danish Government made the right decision when they decided to cull all the mink in Denmark, after finding the Cluster-5 mutation spreading from human to human?”
Professor David Heymann CBE
Tony, do you want to start?
Dr Anthony Fauci
Yeah, yeah. So, let me just start off, you know, Emma, whenever you see something like that, you need to pay attention to it. You certainly can’t just blow it off, you’ve got to look at it, you’ve got to take a look at what it means, what the mutation has to do with various aspects of the molecules that are responsible for binding of antibodies. We took a first look, the group here in our vaccine research centre, who takes this very seriously, and says that when you look at the binding sites, you know, the spike protein has a receptor-binding domain that binds to the ACE2 receptor on cells throughout the body. It does not appear, at this point, that that mutation that’s been identified in the minks is going to have an impact on vaccines and the effect of vaccine-induced immune response. It might have an impact on certain of the monoclonal antibodies that are developed against the virus. We don’t know that yet, but at first cut, it doesn’t look like something that’s going to be really a big problem for the vaccines that are currently being used to induce an immune response.
Emma Ross
David, do you want to add anything?
Professor David Heymann CBE
Yeah, I think what Denmark has done is a precautionary measure. They don’t understand completely what the impact might be, and so they’ve decided to sacrifice the minks, which is an acceptable precautionary measure. I think what’s been very difficult for many people to understand though, is that this virus is in every country and it’s mutating differently in every country, and so in order for this virus from the minks to be able to replace virus in other countries and impact on vaccines, it would have to be more fit than the other viruses that are around now and spread easier, more rapidly and replace those viruses in other countries. But this is no longer, it never was, just one outbreak, it’s a whole series of outbreaks in different countries with mutations occurring at different rates and in different manners. So, you know, precautionary measures are acceptable in public health, unfortunately we’re all building the ship at the same time and don’t know what we will work and what won’t work.
Emma Ross
Okay. Next question, most upvoted, is from Paul Williams and there are a couple of similar questions, I’m going to kind of fold them all in together, and that’s about, “What three things should the international community do to prepare for and prevent, as much as possible, the next pandemic?” And a similar question is, “What do you think the global community should be doing to minimise the chance of future viruses crossing the species barrier?” Let’s start with that. Tony, do you want to take that one first?
Dr Anthony Fauci
Well, sure, there are a bunch of things. So, some of them we’ve already actually mentioned, you know, and that has to do with lessons learned, of making sure that we do have a global health security network that is quite transparent and has the capability of communications and openness, so that when we do get another emergence of an infection, which we inevitably will, that we should do that. Second thing is not necessarily a global health issue, more of a fundamental scientific issue, which I think is an example of why we were able to respond so rapidly in developing a vaccine, and that is to continue to pursue the science, such as perfecting platform technologies to get vaccines done quickly, safely, and effectively, in addition to doing platform technologies for therapeutics, to develop things like a universal coronavirus vaccine.
We’ve now had three pandemics, SARS, MERS, and COVID-19, the time has come to make sure that everybody realises that coronaviruses, which we used to think of as the common cold, have potential – pandemic potential, more than potential, but reality. The other thing is, I think, make sure that the international health structures, the WHO, really gets strengthened in a way and, you know, it’s not a perfect organisation, it has faults and – that have been pointed out by others, but I think it has – the world does need a global organisation. I think David can address that better than anyone because of his extensive experience there, but those are the kind of things that we need, preparation at the local level, and an international connectivity that is sustained, so that the next time this occurs, we can move quickly.
Emma Ross
David, did you want to add anything?
Professor David Heymann CBE
Yeah, I would just say that, you know, what we need to do – our Politicians understand what health security is. It’s keeping diseases away, keeping them out. What we need to do is help them understand that that definition needs to be broadened to sufficient universal coverage of health, for one thing, and also, it needs to be broadened to good health promotion, to prevent the co-morbidities and the diseased people who are actually at greatest risk of serious illness if they’re infected. So, if we can broaden the understanding of health security among our political leaders to include those three elements, orders, universal coverage and health promotion, I think we’ll have a – gone a good way to preventing future outbreaks that can be so devastating as this one has been.
Emma Ross
Okay. There’s a question here from – oh, it was there, on – from Charles Clift, on solidarity. Tony, what’s your sense of “to what extent the world has demonstrated solidarity and to what extent not?” In what ways not, I guess, he’s alluding to Dr Tedros’ frequent refrain for calling for global solidarity in beating this pandemic. How do you think we’ve done on that?
Dr Anthony Fauci
I don’t think that we’ve done as well as we can. I think you hear people like Tedros talk about that because it is a – somewhat of a lacking of that. We really need – and this is difficult, as you know, because of the tension sometimes between countries, we’re seeing that right now, when it comes to disease, as I’ve said so many ways and so many times, that everybody is in this together. I mean, if there’s one element of international interactions in which the pain and suffering is going to be common to everyone when you have a pandemic. There’s no one country out there that’s looking at the rest and saying, “Ha, I’m in really great shape, I’m going to be on my own and to heck with you.” It’s we are really all in this together and the only way you stop something in which you are all in it together is that if you pull together and, you know, I guess pull together is another definition of what solidarity is.
Emma Ross
Okay. The next question is from Dr N Kumarasamy, “Tony, what are your insights on reinfection and the fading of COVID-19 antibody?”
Dr Anthony Fauci
Well, we do know that there have been individual cases now, several that keep accumulating, not massive numbers by any means, but individual cases of well-documented at the molecular level of reinfection with a virus that is not the same virus, it’s a different virus. It’s the same virus that is coronavirus, but it is a different – as David said, it has different mutations, which mean it isn’t an exacerbation of the same virus you were infected with, it’s a reinfection in the real sense. So, that can occur. The issue of the durability of immunity is absolutely a critical question.
If you look historically, the common cold coronaviruses that really account for about 15 to 30% of all the common colds that each and every one of us get reinfected with, particularly children, as each year, usually during the winter months, tell us that the durability of immunity for coronavirus is not of the scale of measles, where it essentially is lifelong. It is definitely finite, likely measured in a year or so, or two, not in 20, 30, 40, 50 years, which means that we probably, after we get successful vaccines to get us through this, have to take a good look at what the durability of that is, ‘cause we may need, as David said, this may become endemic and we may need to revaccinate intermittently. How often that’s going to be, remains to be seen, as we follow the vaccinees over a period of a couple of years to see how durable that immunity is.
Emma Ross
Okay, here’s another upvoted question from Anna Ruda JR Atney, again, apologies if I’ve mangled that, “by approving the Pfizer vaccine really quite quickly, without long-term data, do we not run the risk of creating a whole raft of clinical issues and a whole set of new challenges for health systems?”
Dr Anthony Fauci
Well, I don’t know, I’d like to hear David’s opinion on that, but I can say that…
Emma Ross
Yeah, David?
Dr Anthony Fauci
Yeah, but, you know, when people say quickly, we’ve got to be careful because the speed at which it was done was largely due to the extraordinary scientific advances that one made in the area of platform technology, where you could get the sequence on January 9th, start making a vaccine on January 15th, be in a Phase I trial 65 days later, and be in a Phase III trial six months later, that is completely unprecedented. But that isn’t a rash degree of speed, that’s speed based on technological advances, so there really was no compromise in safety, nor in scientific integrity. We are going to be following the vaccinees for a couple of years.
The idea that Pfizer was able to show a rather striking degree of efficacy was essentially inherent to the capability of the vaccine and the fact of – that the – that we have so many infections in the United States that a vaccine trial that might have taken years was able to be done in months, because we’re in the middle of an outbreak. There’s a big difference between trying to show the efficacy of a vaccine when you have an indolent infection that’s just puttering along, versus the efficacy of a vaccine when you’re in the middle of a fierce outbreak, that’s the reason why it was done so quickly. So, although we need to obviously continue to learn more and more about it, I don’t think that the speed is something that really is detrimental to the process, but I’d be happy to hear what David has to say, with his vast experience.
Professor David Heymann CBE
No, I agree that the speed doesn’t really reflect badly on this, in fact what it shows is that the regulatory agencies, the vaccine developers and the Clinicians, the clinical trial experts, are all working together, from the very beginning, and that’s what’s cutting down, to a certain extent, the time. And, as we know, Tony, this will be on an emergency licence afterwards and it will still be following some type of protocol in order that the long-term side effects, if there are any, could be detected. So, I think it’s remarkable and it will be one of the legacies of this, in that we’ve decreased a bureaucratic process of regulation to one that’s looking at the information very rapidly and being able to licence much more rapidly than before.
Emma Ross
And isn’t that what public health specialists have been calling for, for years, to accelerate these processes and get barriers out of the way, in a safe way, but isn’t this the delivery of what’s been called for, for quite a long time?
Dr Anthony Fauci
Yes, I believe so, Emma.
Professor David Heymann CBE
Absolutely.
Emma Ross
Okay. The next question, upvoted question, from Dina Mufti, “Since normal distribution freezing temperatures reduces efficacy to 45%, what is being done globally to ensure storage and transportation of the potential vaccine is consistently at a minimum of -70o Celsius?” I don’t know, David, are you aware globally – you want to take that one first?
Professor David Heymann CBE
You know, I would just say that we’ve seen that a vaccine at -70 storage can be used effectively in Africa. There are containers that carry the Ebola vaccine to the people who need it in -70 degree conditions, but there are other things that will be done, I think, in the future, such as possibly [inaudible – 39:05] of that vaccine, drying it out so that it can be used at a different temperature or stored at a different temperature, but I would turn to Tony for that.
Dr Anthony Fauci
Yeah, I agree completely with what David said, we’ve done this before, so it isn’t as if it’s uncharted waters. It’s more difficult when you have such stringent cold chain requirements, but I think we should point out to the questioner, as well as to anyone else who asked the question, is that there will be other vaccines, the more classic vaccines that have less stringent cold chain requirements. Things like the recombinant proteins with adjuvants and even some of the other viral vector vaccines, the human AD, the chimp AD, the VSV, those are a bit different.
Emma Ross
Okay, I’ve got time to fit in one more question from the audience, and this is from Celia Dunlop from the FPA, “Is the virus following a pattern, is it likely that it is mutating and could end up being as hard to cure as the common cold?” And maybe, Tony, if you could kind of come back in on the therapeutics aspect, I was thinking, given that for HIV that’s been, you know, really important and a gamechanger, taking away a lot of the fear and turning this into normal life, especially if the vaccines don’t deliver everything we hope they would, they’re not going to be the panacea, where do you see this all falling out?
Dr Anthony Fauci
Yeah, I think what people need to realise, is something that David alluded to a few moments ago, that this virus is an RNA virus. RNA viruses mutate, I mean, for sure, they mutate all the time. Most – the overwhelming majority of the mutations are not necessarily functionally relevant, in that it doesn’t change something that’s important about the virus. We would expect this virus to continue to mutate. The thing about the virus that is important is that it is an acute virus and it isn’t like HIV, in which it is in a person for a considerable period of time and we have people on therapy, you can have selective pressures of long-term therapy if you don’t control it.
This is a virus that’s acute, so we would hope that, despite the mutations that you have to pay attention to, we don’t really foresee that viruses are going to mutate in a way that is going to make it necessarily more virulent. Historically, viruses, as they continue to go through populations, actually tend to transmit better, but are less virulent. So, I wouldn’t be surprised if we saw that, but, again, I don’t think that necessarily is going to interfere either with a vaccine, or with therapy. I think therapy a bit more than vaccines, when you see mutations away, I hope that what we see is that this virus, when you look at the common cold coronaviruses, they are RNA viruses. But historically, they have not changed very much, they will always mutate, but they haven’t all of a sudden completely changed in their ability to transmit or become more virulent, except for the emergence when you jump species, from a bat into an intermediate host to a human. But the viruses that are out there in the humans don’t seem to change that much to be phenotypically very, very different.
Emma Ross
Okay, thank you. Unfortunately, that was the last question from the audience, but I have one more that I want to squeeze in for you, Tony, and I’ve asked you about your hopes for the legacy of the pandemic. But you’re coming up for your 80th birthday on Christmas Eve, and I know you’ve said you have every intention of carrying on, but this pandemic will probably be your last big professional challenge, your most recent legacy, what do you want people to think or say about how you played in this crisis? What do you want to be remembered for, actually, and whether it’s in relation to this pandemic or your numerous other contributions to public health? I mean, not that I’m trying to kill you off or anything, but…
Dr Anthony Fauci
It sounds like it.
Emma Ross
David hates it when I ask him this kind of thing, you know, “You’re putting me in the grave already.”
Dr Anthony Fauci
It sounds like an obituary, Emma. No, actually, something that I’ve just guided myself by and that is let the science and let the evidence guide you. Always stick with the science, stay away from politics, public health and global health is what I’ve devoted my entire professional career to, and with a very strong science base, because I’m a Scientist. So, I’d hope to be remembered for someone who stuck with the science and made contributions through multiple outbreaks, from HIV up to the most recent now with COVID. But I must say also, that I have not forgotten about other things that when I became Director, I said I’d like to not leave until we have rather effective countermeasures against some of the great killers, and in my mind, in addition to COVID-19, which is still obviously something we’re facing with, let’s not forget malaria, let’s not forget tuberculosis, let’s not forget these tropical diseases that are not killers, but maimers. We have a long way to go in global health and I’m not leaving until we actually get our arms around those. So, hang on, you’re going to have me to kick around a lot longer.
Emma Ross
Okay, well, that – on that note, I’m afraid that’s all we have time for today, so to our audience, I’m sorry we couldn’t get to everyone’s questions again, but we’ll be back next Thursday morning to talk about access to vaccines, with Seth Berkley and Jane Halton, two of the leaders of the global effort to get vaccines to everyone who needs them. But, Tony, thank you so much for joining us today, for all your candour and for your tremendous commitment to public health.
Dr Anthony Fauci
Thank you, Emma, thank you, David, it’s great being with both of you. Thank you for having me.
Emma Ross
Thank you, and thank you everyone for tuning in. See you next week.
Professor David Heymann CBE
Goodnight.
