Dr. Fauci On A Life Of Medical Research And Public Service

IRA FLATOW: This is Science Friday. I’m Ira Flatow. Joining me now is probably the person who has made more appearances on our show over the past 33 years than anyone else. He is someone I first met when I started covering the HIV/AIDS epidemic way back in the early 1980s. And over the years, we’ve talked about every disease you can name, I think, from the common cold to SARS and MERS, Ebola to COVID, even basic research into food allergies.

And after leading the National Institute of Allergy and Infectious Diseases since 1984, he stepped down from his role at NIH in December of 2022. But he certainly hasn’t disappeared from the public eye. He’s been called to testify regularly before Congress. And he’s written a new book, On Call, A Doctor’s Journey in Public Service. Dr. Anthony Fauci, welcome back to Science Friday.

ANTHONY FAUCI: Thank you, Ira. It’s always good to be with you.

IRA FLATOW: I think this is the first time we talked to you when not in public service. What does it feel like to be a, quote/unquote, “private citizen” now?

ANTHONY FAUCI: You know, it feels good. I think I was ready to make that transition. So it is a positive feeling. I really miss the people that I’ve been involved with over the years, but I’m excited about what I’m doing now, Ira.

So that makes the change much less traumatic. I made a decision that while I still had a lot of energy and passion, that I wanted to do something else besides what I had been doing for the previous 38 years as director. I wanted to get involved in a university and get surrounded by students, which is what I’m doing now at Georgetown. And that’s a different experience, but a very favorable and desirable experience.

IRA FLATOW: Tell me a bit about that. Tell me what kind of students, and what are you teaching them?

ANTHONY FAUCI: Well, I’m the Distinguished University Professor with a dual appointment in the School of Medicine and in the School of Public Policy. I don’t teach a course where I grade students, but I give a lot of lectures, seminars, fireside chats, and meetings with students from the various schools on campus and even some downtown off campus– The Medical School, School of Arts and Science, the Nursing School, even the School of Foreign Service. I’ve had some discussions with people in that school. So it gives me an opportunity to wide exposure of students of varied interests, not just medicine and science.

IRA FLATOW: Do they ask you what it’s like to be a public figure for all those years and about the challenges? And do you do you share that knowledge with them?

ANTHONY FAUCI: That’s one of the reasons I wanted to make my home base a university setting because that’s what students are interested in. They’re very curious about what it’s like to have reached a certain state of recognition and accomplishment because that’s the way I was when I was at their stage. I would look up to people who had a degree of accomplishment and just want to get a feel of, what was your course of life like? What did you do? How did you get to where you were? They’re deeply interested in that.

IRA FLATOW: Mm-hmm. And let’s talk a bit about it because it’s so much part of your book– COVID. You write that if we knew in the first few months what we knew now, many things would have been done differently. What do you mean by that?

ANTHONY FAUCI: Well, for example, in the very early weeks, Ira, we had the impression from the Chinese that this virus was not spread efficiently from person to person. So there wasn’t a big push to get everybody to wear a mask early on. There was a shortage of masks. There wasn’t data to show that masks outside of the setting of the hospital were effective in protecting you and protecting you from spreading it. And we had no concept at that 50% to 60% of the infections were spread from a person who had no symptoms.

IRA FLATOW: Wow. That is a learning experience, is it not?

ANTHONY FAUCI: Boy, that really was. So had we known that early on, there would have been a much greater push for greater ventilation, for wearing masks in indoor settings. That came later, but it could have come much earlier had we appreciated that.

IRA FLATOW: Mm-hmm. You write that of all the weaknesses in our public health response to COVID were profoundly compounded by one of the two enemies of public health– the spread of egregious misinformation and disinformation enabled by the internet and social media that, unfortunately, remains with us today. Instead of looking back at the past, why does that still remain with us today?

ANTHONY FAUCI: Well, because that’s the nature of the free speech in the internet. You can get up. And if you have a bunch of followers and say something that’s egregiously incorrect and it gets spread around enough, all of a sudden, to a certain segment of the population, it becomes a fact. It is amazing how much misinformation and disinformation are out there.

It’s just really stunning and unfortunate because misinformation costs lives. I mean, people don’t get vaccinated because of misinformation. And there’s an estimation that about 200,000 people die unnecessary deaths because of misinformation about vaccines, who they decided not to get vaccinated.

IRA FLATOW: Did not realize the number was that high.

ANTHONY FAUCI: Yeah, yeah.

IRA FLATOW: Wow. I don’t want to focus very much on the politics of the last four years of COVID, but I do want to touch on one aspect that you write about, and that is the controversy of the origin of the virus. And one side says it was a virus that escaped from a Chinese lab.

Another says it originated in the live animal market. And you say you have an open mind about that. Please explain what you mean by that.

ANTHONY FAUCI: Yeah. Until you definitively know what the origin is, you have to keep an open mind. But an open mind doesn’t mean that you can’t have an opinion based on data. So I have an open mind. And when definitive data one way or the other proves one of the theories, I will embrace that.

But when you look at data, there is accumulating data that’s rather convincing– not definitive– but rather convincing from evolutionary virologists from all over the world– Australia, Canada, the United States, the UK, EU– strongly suggesting that it was a natural spillover from an animal reservoir to a human. They haven’t proven it, but the data are pretty compelling. Yet there is no solid data that it’s a lab leak.

That doesn’t mean it didn’t occur. There’s just no solid data. So I still have an open mind, but I lean strongly towards it being a natural occurrence.

IRA FLATOW: Do you think we’ll ever know? We’ll have solid data that– one way or the other?

ANTHONY FAUCI: I think the more time goes by, Ira, the less chance that is. And I think one of the things that happened early on that would have been much more convincing about a natural occurrence is if the Chinese didn’t come in and quickly clean out the market and get rid of all the animals that shouldn’t have been there in the first place. As soon as there was an outbreak, it was so-called illegal to have these wild forest animals in a wet market.

But they were there. There’s photographic evidence that they were there. As soon as the outbreak occurred, the Chinese cleaned out the market. So any proof that animals were infected there is gone because the animals were removed.

IRA FLATOW: Mm-hmm. Let’s talk about the vaccines that were developed, I mean, quicker than anybody really had thought, right?

ANTHONY FAUCI: Beyond quicker. [LAUGHS] Completely unprecedented to have the sequence of the virus in the first week of January of 2020 and less than 11 months later, to have a vaccine that has been tested in tens of thousands of people to proven to be safe and effective to the tune of greater than 90% is beyond unprecedented. That has never happened in the history of vaccinology.

IRA FLATOW: And those vaccines largely are targeting bits of the spike protein. That’s come into our language over the years. And it’s been, like, what, four years since we’ve had the original vaccine? Why is it not possible to target some other constant part of the virus, SO we get a longer-lasting vaccine and not something that changes all the time like those proteins?

ANTHONY FAUCI: You know, that’s a good question, Ira, and it’s one that is common to a lot of vaccines for different viruses. The business end of that molecule is the one that binds to the human ACE2 receptor, and that’s the spike protein. So that would give you the greatest chance of blocking.

There may be other epitopes on the virus that, if you block, you may not get infected. But it is unlikely it would have the potency of blocking that epitope that directly binds to the receptor on the cell.

IRA FLATOW: Mm-hmm. I was reading some research just the other day that said, the best place to really stop this viral attack is in your nose and nasal spray. We don’t have a nasal spray in this country, but there are other countries that do. Isn’t that right?

ANTHONY FAUCI: Yeah, but there’s a lot of research going on now, Ira, a lot of research that’s being supported by the NIH, done in several medical centers throughout the country of getting exactly what you said, a nasal spray or installation of a vaccine into the nasal passage.

IRA FLATOW: Mm-hmm. Is it something that’s endemic, as you say, something that we’re just never going to get rid of, but we just have to live with it?

ANTHONY FAUCI: I think so. I don’t think there’s a chance we’re going to eradicate it. We’ve only eradicated one virus in humans, and that’s smallpox.

I don’t think we’re going to eliminate it the way we did measles and polio in this country. It’s just too prevalent and too highly transmissible, but we can control it at the lowest level possible. I think it is going to be with us indefinitely. I might not say forever, but for an indefinite period of time.

IRA FLATOW: That means we’re going to be still seeing new cases of long COVID. And isn’t that the dangerous part of this? I mean, so many of us tolerate this. I just got over my latest bout last week. I know so many people around us getting it. But no one thinks about, hey, I don’t want to get it because there’s a possibility I could have long COVID.

ANTHONY FAUCI: That is true. I got rid of my bout four weeks ago. Same thing– it was my third bout.

IRA FLATOW: So what about– is there any way we can do something about long COVID? What do we know about it?

ANTHONY FAUCI: Well, we don’t know a lot about it. There’s a lot of people working on it, and a lot of money is being poured into. It looks like it’s an aberrant, uncontrolled, inflammatory immunological response to what is likely fragments of virus that persist even after the acute infection.

But it’s not certain. I mean, there are a lot of theories. Some of them are more convincing than others. But one of the things that’s a common denominator is an aberrant hyperimmune response that doesn’t calm down after the acute phase of the viral infection.

IRA FLATOW: Mm-hmm. But it’s really interesting to see that there are some people, like my wife, who’s been around my grandchildren, and me, and my kids, and everybody who has gotten it and never come down with it. I mean, is there some genetic part, maybe, of some people’s genetic makeup that makes them a little bit more immune?

ANTHONY FAUCI: I’m sure there is. It hasn’t been definitively identified. But, Ira, like any infectious disease, there’s a lot of polymorphisms in the genome of the human species. And within that, there will be some that we haven’t recognized yet that protect you against one infection versus another.

IRA FLATOW: Or could it be that so many people get it and show no symptoms, that they may have it and really just don’t know it?

ANTHONY FAUCI: Exactly. And in fact, there are a lot of people who have asymptomatic infection.

IRA FLATOW: There are many things we have vaccines for now. And when I was telling people I was going to talk to Dr. Fauci, they said, you’ve got to ask him this question. We get this a lot. Is it safe to get more than one vaccine at a time?

ANTHONY FAUCI: Yes. Yes.

IRA FLATOW: Because people worried. Either my kids or I have to get the flu vaccine and the COVID vaccine at the same time. That’s safe.

ANTHONY FAUCI: That’s safe. And the reason people question that, Ira, is that they say the antigenic load of multiple vaccines at the same time is going to overwhelm your immune system. And that is not true because a single infection from one of those pathogens has an antigenic load that overwhelms the number of vaccines that you could take. So you shouldn’t be worried about an antigenic load from a vaccine.

IRA FLATOW: Mm-hmm. What can we learn from COVID that can be transferred to the next disease that comes along? And should we really not be surprised that a new one will be coming along?

ANTHONY FAUCI: Well, the answer to the second part of the question is that I would be astounded if another outbreak did not occur. We don’t know when– maybe not in my lifetime. But history has told us that pandemics have always arisen. They’ve arisen during our own tenure here on this Earth, and it will happen after we leave. So that answers that part.

The first part is there are many lessons learned from COVID. I wrote a paper in The Journal of Infectious Diseases in 2023, about 10 lessons. Some of them ought to expect the unexpected. I mentioned that to you a little bit ago when we were talking about things like COVID being transmitted mostly from asymptomatic people, aerosolized transmission, that kind of thing. Misinformation and disinformation are the enemies of public health.

Pandemics shine a bright light on disparities of health in society, as shown by minority populations who did much, much worse. Basic and clinical research investment pays off all the time. Those are the kind of– there’s many, many lessons that we could learn. We should not let the experience of COVID go without teaching us things to help us better prepare and respond to the next outbreak.

IRA FLATOW: Do you feel that because there was so much distrust of our public health system during the pandemic, that the health system has been permanently spoiled, any trust in it?

ANTHONY FAUCI: I don’t think permanently, but I think significantly. I just think that there’s so much misinformation. No system is perfect. The scientific community had to make changes in what their recommendations were based on evolving data.

That often gets interpreted as scientists flip-flopping. But it isn’t because it’s the nature of the corrective nature of science that is self-correcting. Unfortunately, that’s led to a mistrust in science. I don’t think it’s irreparable, Ira. But I think it’s something we have to deal with because it’s serious.

IRA FLATOW: Last time we spoke, we talked about the health of the health care system. Is it healthy? Or does it still need to be repaired itself?

ANTHONY FAUCI: Oh, it absolutely still needs to get repaired. We’ve got to do better than we have. We’ve done much better now with the Affordable Care Act. But right now, it still is not as good as in some countries that are on par with us as being developed countries. But even some developing countries do better than we do.

IRA FLATOW: Yeah. I mean, I’m still surprised by how many people are afraid to get vaccinated. I mean, I remember the story you told me when you were a kid in Brooklyn when there was– what was it? There was a smallpox vaccine.

ANTHONY FAUCI: Right.

IRA FLATOW: Tell me that story again.

ANTHONY FAUCI: Yeah, and I was about six years old. There was somebody who came from Mexico, I think, and entered into New York City and had smallpox. And the city panicked.

So they vaccinated a couple of million people in a few days, lining up in New York City. And it worked. And it worked.

IRA FLATOW: And they were able to do that because the system was set up, right?

ANTHONY FAUCI: Right.

IRA FLATOW: Because kids got vaccinated when they were born.

ANTHONY FAUCI: Exactly. So nobody objected. They just did it.

IRA FLATOW: Do you think we’ll ever get back to that?

ANTHONY FAUCI: I don’t think so.

IRA FLATOW: [LAUGHS] Well, we need to take a break. We’ll be back with more of my conversation with Dr. Anthony Fauci in just a minute. His new book is On Call, A Doctor’s Journey in Public Health. Stay with us.

This is Science Friday. I’m Ira Flatow. In case you’re just joining us, I’m speaking with Dr. Anthony Fauci.

As you may know, he’s a winner of the Presidential Medal of Freedom and the author of a new book, On Call, A Doctor’s Journey in Public Health, and for 38 years, was director of the National Institute of Allergy and Infectious Diseases at the National Institutes of Health, which directs the government’s research response to diseases from the common cold to Ebola. Dr. Fauci stepped down from that role in December of 2022. We have spoken with him many times over the years, but this is our first interview since he left public life.

Let’s talk about one of your other major focuses and one of your victories. And I’m talking about HIV/AIDS. Where’s the cutting edge in AIDS? Is it a permanent vaccine, a better PrEP therapy? Because I was just reading a recent issue of Science Magazine that said that they had this breakthrough headline, “Landmark trial may herald a new era in HIV protection, Twice-yearly injection provided 100% protection in study in African women.” You know what I’m talking about.

ANTHONY FAUCI: That’s lenacapavir. That’s a injectable drug that is twice a year that is just incredible. They did a study in cisgender women in Southern Africa– 100% efficacy in preventing the acquisition of infection. Amazing.

IRA FLATOW: How is that different than in men?

ANTHONY FAUCI: Well, in men, the problem is that PrEP had never been as good in women as it was in men. So men have good PrEP. I mean, you take a pill of Truvada every day, and you get 99% effected. And also, injectable cabotegravir every couple of months is just as good as oral Truvada. So we have good PrEP. We just need to implement it. We just need to implement it.

IRA FLATOW: So does that mean that AIDS is basically a solved problem?

ANTHONY FAUCI: Well, it’s not solved because it isn’t 100% implemented. I mean, there are scientific hurdles that we need to get over. We need a safe and effective vaccine.

We don’t have it yet. It’s been one of the real scientific challenges. But if we implemented all of the tools we have, Ira, we could probably stop this epidemic in its tracks.

So for example, if we identify everyone who is living with HIV and put them on effective antiretroviral drug and bring their level of virus to below detectable, they would not transmit the virus to anybody else. We know that. It’s called U equals U, Undetectable equals Untransmittable.

So that’s an implementation problem. Get everybody on therapy. Then, if you’ve got everyone who is at risk for infection and put them on PrEP, you would never get any infection. So we have the tools to shut down this outbreak now even in the absence of a vaccine.

IRA FLATOW: Is it a problem then, of compliance by the public?

ANTHONY FAUCI: Not only of compliance and accessibility.

IRA FLATOW: So the drug is out there, but it’s not getting to the right people.

ANTHONY FAUCI: Right. I mean, compliance means that the drug is available, but they don’t use it. Accessibility is because they don’t get access to the drug.

IRA FLATOW: Most people focus on the infectious disease part of your portfolio. But I know your Institute did a lot of work on the allergy part of its mandate. How much progress have we made in understanding allergies?

ANTHONY FAUCI: You know, we’ve made a lot of progress in some areas, and we still are not doing so well in others. I mean, one of the real advances in a very serious allergy problem is how to get people to be desensitized to peanut allergy, like them early, early exposure to peanut products early on as opposed to withholding them. And then they could get anaphylaxis later on in life when they get exposed.

IRA FLATOW: Hmm. So that still needs a lot of research, is what you’re saying.

ANTHONY FAUCI: Yeah, yeah.

IRA FLATOW: Yeah. Where we’re falling down with regard to infectious diseases– is it a money problem, a leadership problem, a knowledge problem?

ANTHONY FAUCI: You know, well, certainly, it’s a support problem. We’ve got to continue the support for basic and clinical research in infectious diseases. That’s the first thing.

The second thing is the disparity in access to health care. I mean, people who don’t get vaccinated die from vaccine-preventable diseases. So it’s an implementation problem, but also a discovery problem. We still need vaccines against HIV. We still need vaccines against other diseases.

IRA FLATOW: What do you tell your students about your different experiences in your career and how you tackled diseases like comparing, for example, AIDS and COVID? What’s the lesson that you tell them there?

ANTHONY FAUCI: Well, there’s many lessons, Ira. The first is that emerging infections have always occurred long before recorded history– history has recorded it. And in our own lifetime, we have seen the emergence of two book-ended infections that are historic in their magnitude.

So if you look at my own personal career of 54 years at the NIH, 38 years as the Institute Director, in the beginning there was HIV, which we have to this day. And when I left, we had COVID. That means that there’s emerging infections, always. So that’s a lesson to be learned.

The other lesson is, the investment in basic and clinical biomedical research always pays off. It paid off in spades with the COVID vaccine. Work on targeted antiviral therapy paid off in spades with HIV antiretroviral drugs– the greatest argument for investment in basic and clinical biomedical research.

IRA FLATOW: Well, we’ve run out of time, but I’m wishing you the best of luck. Your book is called On Call, but your new calling is to be a teacher–

ANTHONY FAUCI: Yeah.

IRA FLATOW: –it looks like.

ANTHONY FAUCI: I’m enjoying it. I’m enjoying it.

IRA FLATOW: Yeah. And do you learn stuff from the kids that you teach?

ANTHONY FAUCI: Oh, every day, every day.

IRA FLATOW: Yeah?

ANTHONY FAUCI: Absolutely.

IRA FLATOW: Take care, Dr. Anthony Fauci, former Director of the National Institute of Allergy and Infectious Diseases at NIH. He’s an awardee of the Presidential Medal of Freedom, and he’s author of the new book, On Call, A Doctor’s Journey In Public Service. Tony, it’s been an honor to know you. Please stay well and stay in touch.

ANTHONY FAUCI: Thank you very much, Ira. Always great to be with you. Take care.

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