Dr. Fauci on His Retirement and a Universal COVID-19 Vaccine

SARA SIDNER, HOST: Turning now to an individual who has dedicated his life to public service. Dr. Anthony Fauci has been at the helm of the National Institute of Allergy and Infectious Diseases since the ’80s. Guiding the United States through AIDS, SARS, H1N1, and, of course, COVID. Ahead of his retirement, he joined Walter Isaacson to reflect on his storied career.

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WALTER ISAACSON, HOST: Dr. Anthony Fauci, welcome back to the show.

DR. ANTHONY FAUCI, DIRECTOR, NATIONAL INSTITUTE OF ALLERGY AND INFECTIOUS DISEASES AND CHIEF MEDICAL ADVISER TO PRESIDENT BIDEN: Thank you very much, Walter. It’s good to be back with you.

ISAACSON: So, it’s been 54 years since you became, sort of, in the public service on infectious diseases, and now, you are retiring at the end of December. When you got into this field, more than half a century ago, I think one of your mentors said, it’s heading for oblivion. Infectious diseases, that’s a backwater. And then since you went into it, we’ve had SARS, and MERS, and coronavirus, and of course, the AIDS epidemic, and PEPFAR that you did. If I could ask the young Tony Fauci, would you be surprised at how much infectious diseases have kept plaguing us?

FAUCI: Very much so, Walter, because our generation really had not seen the evolution of a new infection that had profound, global impact. And when I came into the field, a long time ago, I felt that there was more dynamic nature to the field of infectious diseases than some of my senior mentors who are making that comment that you correctly said, where they thought that the field of infectious disease was on the downslide because there is nothing really that important that was happening. But that all changed in a dramatic way in the very early 1980s, in fact, the summer of 1981 when we were confronted with the first cases of what turned out to be HIV. And from that point on, for the next 41 plus years, in a really sequential fashion, we were confronted with a variety of new diseases that we had not experienced before, as you mentioned correctly. We had HIV that came upon us in 1981, at least recognized in 1981. And then we had pandemic flu, and Ebola, and zika. And now, at the end of my career, which was bookended by HIV early on, now, with COVID-19, it’s been mostly extraordinary how our planet, as it were, has been confronted with really transforming infectious diseases. From HIV —

ISAACSON: So, why is that? I mean, I read your “New England Journal of Medicine” piece this week, which is very interesting, but viruses, what’s happened? Why are we plagued by viruses now?

FAUCI: Well, when you look at the new infections that have confronted us over decades, about 75 to 80 percent of them are what we call zoonotic. They emerge from an animal reservoir, and one way or the other, adapt themselves to the human species. Many viruses that jump species are really one offs. They make one or two people sick but they don’t develop the capability of easily transmitting from person to person. But then every once in a while, like HIV and COVID, the pandemic flu, you get a very easy adaptability. And what I think one of the important elements of that, Walter, is the encroachment of the human civilization on the animal human interface on the environment. And that is, you know, enhanced by travel, by encroaching, for example, in rainforests, in areas like South America and Brazil, and Southern Africa where you get Ebola emerging. And then when people get sick, it isn’t like 100 years ago where it takes months, if not longer for an infection to go from one region of the world to the other. When you can get on a plane and 18 hours later, be halfway around the world, then you get the spread of these infections. That’s what’s really changed over the last quarter to half century.

ISAACSON: Tell me what you think about China’s handling of its current shutdowns.

FAUCI: Well, you know as I’ve said many times, it is their choice. They make their decisions for their own country. But when you shut down as strictly, and in such, I described it as a draconian method, where they essentially lock people in their own homes. When you are going to shut down a society, you’ve got to do it with a purpose in mind. You’ve got to say, this is a very temporary mechanism to slow down or stop the spread so that we can do something so that when we open up we won’t be overwhelmed with infection. That something could be getting better PPE, making sure you have enough hospital beds, or most importantly, that something should be let’s get the population vaccinated so that when we open up, we don’t have a tsunami of infections.

ISAACSON: But by that standard, didn’t we take a little too long to open up? I mean, we had the vaccines. We said we were going to flatten the curve, the curve got flattened. And then, for a year or two, we shut down schools. It was pretty disastrous.

FAUCI: Well, that was local decisions, Walter. Those decisions about whether to shut things down locally, were local decisions.

ISAACSON: Well, do you think they were right?

FAUCI: Well, I think at the end you’re going to have to evaluate, there are negative offshoot consequences of interrupting the normal flow and society. But remember, Walter, our country lost one million people, more per capita than any other country. So, you know, you can argue back and forth whether restrictions carried on too long, did some well — and again, we have a very large country, 50 states and several territories. They all did it a little bit differently. It isn’t like we did it in a unidimensional way.

ISAACSON: But we have good evidence that stringent shut downs in states where it happened were better than less stringent shut downs.

FAUCI: Well, the answer is, there are so many confounding issues to it, Walter, that it’s impossible to isolate one factor and say, this is associated with more or less economic decline or impact on the kids. It’s very difficult to unpack that.

ISAACSON: What about herd immunity. We talked about that a couple of years ago. Has there been some herd immunity, especially both with vaccinations and people who’ve had the disease?

FAUCI: Has there been some protection against severe disease? Yes, of course. When you look at people who have been vaccinated, and those who have been infected and recovered, and then, perhaps, vaccinated, no doubt. If you look at deaths and hospitalizations among the unvaccinated compared to the vaccinated and boosted, the curbs are pronounced the different. Deaths in unvaccinated like this, deaths in vaccinated and boosted here. The difficulty with the concept of herd immunity is that the parameters that would lead to a realization of heard immunity are not presents with COVID. Let me explain. Let’s take measles. Measles is an infection that does not change. The measles that I got infected with when I was a child, since I’m old enough not to have gotten the vaccine, is the same measles that is circulating in the developing world. There is no variants of measles. It’s the same. Point number one. Point number two, the immunity that’s conferred upon you when you either get infected with measles or vaccinated with measles, is measured minimally by decades and optimally for a lifetime. So, if you get most of the population vaccinated or infected, and you get that kind of durable immunity, then you can get classical herd immunity where the population is protected. But when you get a virus like SARS-CoV-2, which since the beginning three years ago, we’ve had five or six variants. And the durability of immunity from infection and from vaccines is measured in several months versus decades and a lifetime. The whole idea of classical heard immunity is just not applicable.

ISAACSON: But wait, does that mean we can’t really just get back to normal?

FAUCI: No, you can. You can get back to normal. And it likely — we don’t know for sure, but it likely would entail. Like right now there’s an estimate that over 90 percent of the population has already been infected. That does confer certainly some degree of protection. Maybe not completely against infection, but certainly against some degree of severity of disease. So, what the thinking that as a population, it is likely that similar to influenza, we will require an intermittent updating of a booster vaccine, perhaps once a year. Maybe with immune compromised people or people with underlying conditions, possibly more often. But likely for the broad scope of the population, once a year, as the virus, perhaps, continues to vary over a period of time.

ISAACSON: Well, let me ask a complex question on that. If you do have those vaccines, and you’re looking to have a broader immunity, isn’t it kind of good to have some exposure to the virus to keep your immune system strong?

FAUCI: Provided it didn’t kill you, of course. That’s the point. I mean, that’s the argument. Again, so let the virus just rip through the population. That’s when you really get into trouble. You’ve got to have some degree of protection, which is the reason why it’s very important to get vaccinated first. If you get vaccinated, and then get infected, the way I did, I got vaccinated, doubly boosted, then I got infected. At my age, Walter, it is likely I would’ve had a severe outcome. I had a very mild infection that lasted symptomatically for a couple of days and then I was done. It was the vaccine that gave me that fundamental background of protection that I believe protected me from going on to severe disease.

ISAACSON: Well, like, you my wife and I both had COVID last week, we both tested positive, and we’ve had it before. Generally, it was pretty mild. Not symptomatic. But my wife, actually, even though she’s had two booster shots, was pretty sick this past week. Why is that? Why are some people getting sick, and some dying now when they’re vaccinated?

FAUCI: Well, it’s called polymorphism, Walter. Which means that our human species has a great degree of variability, probably largely genetically programmed of the ability or not to respond to different types of infections. The strength of your immune system, the durability of an immune response, it is like a big bell-shaped curve. I mean, there are some people who never gets sick, and just never — their immune system or their natural innate immunity is so strong. Then there are some people who are very susceptible, and get seriously ill. And then the big hump of the bell-shaped curve is the people in the middle who do reasonably well, occasionally get sick for these things, but it doesn’t become a very severe issue.

ISAACSON: Should we make a distinction between being infected, and actually having the disease? And if we occasionally get infected, and don’t have any symptoms, are we pretty safe to go around in public?

FAUCI: Well, that’s — you know, you bring up a great point, Walter, because there is something there that is important. Because one of the real confounding issues that we learned only months into COVID, back in early 2020, is that unlike other infectious diseases, where a symptomatic person is the one most likely to transmit it to another, so you stay away from someone who’s sneezing or coughing but with a fever. With COVID, it’s not that way. 50 to 60 percent of all of the transmissions occur from someone who has no symptoms at all. So, you may get infected, and feel nothing, no symptoms, but you may transmit it to someone, and the infection may kill that person.

ISAACSON: How do we know? I feel our statistics aren’t very good these days.

FAUCI: No, it’s pretty good. If you look at the epidemiology of the spread, there’s no doubt that this virus can be spread from someone with no symptoms at all. And there are very good epidemiological case studies of that.

ISAACSON: Coronavirus is circulating around the world now, are there any on your radar screen you’re worried about?

FAUCI: Well, there are so many variants out there and that gets back to a prior question that you asked me. Is that, we don’t have a single immutable coronavirus that is causing COVID. I mean, we went various variants from the original ancestral strain, to Alpha, Beta, Delta, Omicron, last winter. And now, we have circulating BA.4, 5, BQ1.1, and XBB. They were all different variants that are concerning, Walter, because as they get transmission capabilities, and dominants, they evade the immune protection that you and I got from our infection.

ISAACSON: Well, wait. Why can’t we get a vaccine that’s, sort of, pan- coronavirus that goes out —

FAUCI: There you go. That’s exactly what the major, major effort that’s going on right now is to develop a vaccine that has universality to it that can get all versions of the coronavirus. And we’re working very hard on that. We have some pretty promising leads that have been looking good in an animal model, we’re going to try and translate or we will translate it —

ISAACSON: And how do they work? Do they not go up to the spike protein, which is what changes a lot?

FAUCI: Well, they do two — there’s two approaches. There is getting a vaccine, for example, a nanoparticle that you put all different variants of it and you essentially cover the waterfront or you vaccinate someone against the common part of all of the viruses. Because the viruses that are coronaviruses, have a lot of things about them that differ by mutational differences. But some are core immutable parts of the virus. If you can induce a potent immune response against that common part of all of those viruses, you can protect against them all.

ISAACSON: Only 12 percent of people in the U.S. over the age of five have been booster shotted. Is that politics that’s causing that problem or what?

FAUCI: It’s a complex situation. First of all, it is unacceptable, and maybe unconscionable that we have a lifesaving vaccine that’s readily available, and we have such a poor uptake of the vaccine. I think it’s a number of factors. One, I think, is the dominant one because even people who got the original vaccine to begin with are slow to get the boost. I think it has to do with COVID fatigue, Walter. I think people want so badly to put this behind us that they don’t want to hear any more about COVID. I got vaccinated, I got boosted, I don’t want to be bothered. That’s a mistake. Because these updated vaccines do a really good job in being matched to what we’re seeing outside in the environment. And even with the new variants, there are going to be enough cross reactivity. Some of it has to do with ideological differences. You know that if you look at the vaccine uptake in red states versus blue states, it’s very, very different with much less vaccine uptake in red states. And then there’s the anti-science, anti-vax feelings. All of those things conflate to get their two account for the low uptake of the booster.

ISAACSON: So, it’s been 54 years since you’ve been in this battle against infectious diseases. Tell us, what great lessons do you have? When you look back, do you say, hey, how could we have made it so people trust science a little bit more than they do now?

FAUCI: Well, that’s a difficult question. I mean, one of the lessons that you alluded to in the article that I just recently wrote in the “New England Journal of Medicine”, is that we really need to always be alert to the emergence and reemergence of new infections because that, historically, has been the case. We’re experiencing it now and we will experience in the future. And we’ve got to always remember that we need to be perpetually prepared, because emerging infections will always be a perpetual challenge. To me, that’s the big lesson that we’ve learned of — that I have learned over 54 years.

ISAACSON: Dr. Anthony Fauci, thank you so much. And have a happy retirement.

FAUCI: Thank you very much, Walter. It’s always good to be with you.