Science Journalist on Tension Between Pres. Trump and Fauci

CHRISTIANE AMANPOUR: And we’re going to turn to our next guest, Jon Cohen, who’s an award- winning journalist. He’s been reporting on infectious diseases for 40 years now. And he tells our Hari Sreenivasan about the remarkable research being done right now, even as some people are still ignoring the facts. The two started with the revealing conversation Cohen had with Dr. Anthony Fauci about this very topic.

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HARI SREENIVASAN: One of the interviews that you had was with Dr. Fauci, who is very available to lots of press. He has been on the circuit, so to speak, really trying to get his message out. But he was a little more candid with you in a way. What did you get from that interview? Were you surprised? I mean, you have known him for a long time.

JON COHEN, SENIOR CORRESPONDENT, “SCIENCE”: Yes. So ,I have covered HIV/AIDS since 1989. And there’s a work family. And Dr. Fauci, Dr. Birx, Dr. Redfield, they’re all HIV/AIDS researchers. All these people are in my orbit. I have traveled the world with them at conferences. We know each other. We have spent a lot of time together. And so we do have candid conversations because of the long-term relationships we have. I think, at that moment in time, when I spoke with Dr. Fauci, he was extremely frustrated, and he had explained his frustration to others. Maureen Dowd in “The New York Times” that same day had an interview with him, where he had — where he said that, look, I say it the way I see it, and if it pisses him off, it pisses him off. He was he — I think he was at his wit’s end in some way with trying to correct inaccuracies and misstatements and confusion or cloudy messages coming out. There’s been a tremendous amount of mixed messaging happening. And the scientific message itself is pretty clear-cut and isn’t mixed. The scientific community isn’t speaking with 30 voices here. It’s speaking pretty much with a single voice about data. And, again, data speak, and scientists who are good scientists hear the data. And I think Fauci is an excellent scientist, and he hears the data, and he’s been put in a position repeatedly of being in the background in this scenario of almost props behind the president. And things are being said that, scientifically, aren’t accurate, and that’s what I really was trying to get at with him, is, how do you do this? And Fauci has survived many, many administrations for a reason, because he’s politically deft. He knows how to absorb things that he thinks are inaccurate and shift conversations and move people more toward where he thinks they should be. So, that’s what a lot of our conversation focused on, is, how does he do that? And he has a sense of humor. And he’s a Brooklyn guy. I mean, both Trump and Fauci are street kids from New York on some level, and they’re communicating on that level with each other, I think. And I think you have to keep that in mind. You’re talking about two New Yorkers talking to each other. And there’s something about that.

SREENIVASAN: You have had an exclusive interview with the head of the CDC in China. What was his advice, his warning to us?

COHEN: I asked him, tell us — tell me, what are we doing wrong? What are the big mistakes we are making? And he said the biggest mistake you’re making — and this is true for the United States and Europe — is that you’re not all wearing face masks. But think about it for a second, Hari — 1.4 billion people wearing face masks for two, three months. That’s not how China typically lives. And, yes, people in China wear face masks more than they do in the United States in Europe when there’s no coronavirus, but it’s not that common, and it’s not everyone. And so his feeling was that it’s made a big difference, and that we’re making a mistake by not doing the same thing.

SREENIVASAN: One of the things that Anthony Fauci and his counterpart in China both agree on is that having thermometers, widespread use of them, outside grocery stores, outside public places would help. Why aren’t we doing that?

COHEN: It’s a great question. I don’t know. And my son worked at a grocery store down the block, and I spoke with the owner about doing it. And I pointed out there was a grocery store in Atlanta that was doing it. And I think it should happen. It’s a very logical, simple thing to do. I don’t know why, Hari. I don’t know. And I asked my son to stop working at the grocery store, because I was afraid, as case counts grew in my neighborhood, that he putting us all at too much risk.

SREENIVASAN: Let’s shift gears a little bit to the vaccination part that is happening. If you could, right now, if you go to the CDC Web site, you see dozens of different attempts at coming up with a vaccine. If you could, break down the different categories or different approaches that people are taking to try to solve for this problem.

COHEN: So, the World Health Organization keeps the master list. And I’d encourage anyone to look at that. There’s a blueprint there of all the vaccines in development. I looked at it this morning. There are over 60 in development. Two have moved into human trials already. And think about that. That’s remarkable speed, right? This virus is first identified in “The Wall Street Journal” on January 8. The sequence of the virus becomes available January 10. That day, that day, vaccine makers start making vaccine, because they can make it from the sequence of virus. So now we’re into early April. We already have clinical trials. I have never seen anything like this. And I have covered vaccines for more than 30 years. That’s tremendous speed. What the different categories are, start with the old-fashioned, traditional vaccine. If you go back 50, 75 years, basically, all vaccines were made one of two ways. You take the whole virus, if it’s a viral vaccine, take the whole virus, you kill it, an activation, or you weaken it through passaging and cultures, or you find a natural variant that’s weaker. So that’s the inactivated and the live attenuated vaccine. Those two approaches are being done. But those are old-fashioned. The sexier, modern approaches that everyone loves, genetically engineer the protein that’s on the surface of the virus that’s the key component of the vaccine in most people’s mind. Most people think you don’t need the whole virus, that you can just use the surface protein. So you can just engineer that. Or you can take that gene for that surface protein and stitch it into a harmless virus. So, there are harmless adenoviruses, cold viruses, for example, that can carry in like a Trojan horse that gene, so the body makes that protein. You can also use the measles vaccine as that Trojan — as that Trojan horse to bring in what’s called the spike protein, the surface protein. Then there’s messenger RNA, a very novel, sexy technique that you just stitch in the spike protein gene in the messenger RNA and you use that. You can also use just DNA itself. It used to be called naked DNA. It’s just a circle of DNA, you stitch it into that. You can use bacteria to carry in the virus. So there’s a whole range of different approaches. And who knows which ones will work best.

SREENIVASAN: So how long? If we’re already in kind of clinical trials for a couple of them now, how long until a vaccine is readily available? Is it the 12 months or 18 months that Anthony Fauci and others have been telling us about, or could it be faster?

COHEN: Well, it’s a bit of a mug’s game. We have — with every new pathogen, we always ask this question. We always want to know, how long is it going to take? Traditional vaccine testing requires three phases. The first phase is very few people. Let’s say 10, 20, 30 people, and you’re just looking for safety and immune responses. The second phase, you expand the same questions to maybe 100 people or 200 people or 500 people, but you’re really just looking for safety and immune responses. The third phase is, you’re really doing the real-world efficacy study, where you’re putting people who are at high risk of becoming infected and splitting half into the placebo group, half in the vaccine. If you go through that three phase process, it takes a year to 18 months. And that’s assuming things don’t go wrong. And, Hari, things always go wrong, always. There’s a manufacturing problem. There’s a safety issue. There’s no more transmission of a virus in a region. Look what happened with the Zika and Zika efficacy vaccine trials. They hit the wall, because Zika went away in the regions where the vaccine is being tested. So that’s traditional. Now, can we speed it up beyond that year or 18 months? There are very provocative ideas out there that potentially could speed things up even more.

SREENIVASAN: OK, so let’s say, best-case scenario, we do come up with a vaccine. Is this something that everyone on the planet needs to have? Do we get some sort of global herd immunity? Or are we essentially going to be concerned about coronavirus, COVID-19 outbreaks, depending on what country you lived in, whether you had access to this, and where you’re traveling?

COHEN: So, to break the back of an epidemic, you have to get below one. One is each infected person infecting one other person. If you get below that, the epidemic peters out. So, how do we get below one? It’s called R0 of one, to get technical, but how do you R0 below one? A vaccine in about half the population, with the existing herd immunity that already exists from natural infection, will get you below one. And there’s an interesting experiment that occurred in the United States with the introduction of the polio vaccine. The polio vaccine that came out in 1955 from Jonas Salk was about 70 percent effective. About 70 percent of the kids in the country received the vaccine. Between 1955 and 1961, the polio new cases dropped by 96.6 percent from 70 percent efficacious vaccine with 70 percent of the people receiving it. We broke the back of polio entirely in six years’ time with a mediocre vaccine that a lot of people didn’t get. So it doesn’t have to be everyone. Does this go away? Do we get to that smallpox eradication, which is what we really want? I mean, smallpox went into freezers. That’s the only place it exists, because of an eradication program that the world jointly did together. We’re attempting to do the same thing with polio now. We can do that with vaccines. We can take these things out of world. We can. But it takes a hell of a lot of effort.

SREENIVASAN: Right now, there’s also a lack of patience. Just recently, we saw the president expressing his impatience at the testing process. He says there’s people dying now. I’d love to go to a lab and do this the old- fashioned way, but I want to solve this problem today. Look, there’s a lot of people who are tired of being cooped up in their houses, and they want to get back to work, right? And one of the things that the president has been exuberant about is hydroxychloroquine and azithromycin, or the combination thereof. Should we be cautious of this?

COHEN: Yes. And we should be aware of what the past has taught us. And what the past has taught us about medicines for viral diseases is, most don’t work. I’m sorry to say that. And some will. It takes a lot of testing to find the stuff that truly works. And to blatantly say that this is safe and will not cause harm is not accurate. Hydroxychloroquine and chloroquine can cause harm in some people. And the dosages that you might need to stop this virus may well be too high for humans to tolerate. There are clinical trials under way. They will have answers quickly, within the next few weeks, I would guess, a month. And they will have strong comparisons with people who aren’t treated that allow you to say with certainty whether this is helpful, maybe helpful, or harmful, or does nothing. Those are the four possibilities. And, right now, the conversation and the hope that people have and that President Trump has that this will work can overshadow the reality of science and how nature and how drug development actually works, which is, it’s a step-by-step, careful process because it’s easy to be mistaken and it’s easy to be fooled. I think there’s a great deal of confusion that’s being created by Trump’s enthusiasm. And I understand his enthusiasm. We’re desperate. People want hope. And I put my hope and my excitement into the fact that there are clinical trials that are going to get answers, not into a product. And what we learned with Ebola in West Africa in 2014 through 2016 is that all sorts of advocates for different treatments waved their flags and chanted their chants and put their fists in the air. And they were all wrong. Every one of them was wrong. None of the things they believed work. It proved — in time, none of those things proved to work. So, caveat, everyone. Really, take a deep breath. Let’s wait a few weeks to get solid data and stop blaring the trumpets about this thing or that thing, because most of them probably won’t do anything to help people.

SREENIVASAN: What’s the biggest lesson you have learned now, covering all of these different viruses and pandemics and outbreaks and different governments and countries? What do you find is a common thread?

COHEN: I think the thing I have learned from this is, this has altered our sense of the world. And the world we once knew no longer exists. It’s that profound. And I think of the Kubler-Ross stages of grief. And I think we’re collectively grieving the death of the world we knew, and we’re reinventing a new world that accepts that COVID-19 is here. That requires us to adjust and adjust and adjust. And we keep having to wake up to things that we never imagined seeing before, to take actions we never thought were actions we would tolerate or could do, and to work together in a way that we never have before. And I once went to a baseball game with my son and his coach, who was a former professional player. And I said to him, you’re looking at the field and seeing something I’m not seeing. What are you seeing? And he said, everyone came to this game with a plan. And when the first pitch was thrown, everyone started adjusting every single pitch. And that’s what I see the world doing now. Everyone’s adjusting every single pitch, and it just doesn’t end. You don’t make a decision and say, OK, now we have done it. Now we’re good. We’re seeing everyone fight this in a dynamic sense, and to keep looking around at others to say, well, what’s working for you? What isn’t working for you. The biggest thing I see at fault with the world and with the governments of the world is this reluctance to be self-critical. Politicians want to crow about how much good they’re doing. What we really need is politicians to put up a dashboard, the way that Debbie Birx has with PEPFAR and the AIDS program, that says, here are our goals, here’s what we’re providing, here’s where we’re missing, here’s an area where it’s working, here’s an area where it’s not. And we need to constantly reevaluate to find our weak spots and to start being honest about how we can do better, because we have to do better than this.

SREENIVASAN: Jon Cohen of “Science” magazine, thanks so much for joining us.

COHEN: Thank you so much, Hari.