US Declares An End To The COVID-19 Public Health Emergency

IRA FLATOW: This is Science Friday. I’m Ira Flatow. Just over three years ago in late January 2020, the Secretary of Health and Human Services Alex Azar issued a declaration that a public health emergency existed nationwide as a result of the novel coronavirus SARS-CoV-2, often called COVID-19. That declaration kicked off a cascade of funding policies and restrictions aimed at combating the spread of the pandemic.

Over a million people died in the US due to COVID-19 over these three years. And yesterday, that emergency declaration finally came to an end– after being renewed over a dozen times– although the virus is still circulating. People are still getting sick and dying.

A statement released by the Department of Health and Human Services said, quote, “COVID-19 is no longer the destructive force it once was. Since January 8, 2021, COVID-19 deaths have declined by 95%, and hospitalizations are down nearly 91%.”

So where do we go from here? Is life back to normal? Is there a new normal? What have we learned from the past three years about responding to the future outbreaks? Joining me now is someone who became inextricably linked with the government COVID response, Dr. Anthony Fauci, former head of the National Institute of Allergy and Infectious Diseases at NIH. He stepped down from that role at the end of 2022. Welcome back to Science Friday.

ANTHONY FAUCI: Thank you, Ira. Good to be with you.

IRA FLATOW: Good to have you back. Our number, if you’d like to talk about this– we let our listeners know– 844-724-8255. 844-SCI-TALK. Or tweet us @scifri. It’s nice to have you back. Just to begin, you’re now a private citizen. What are you up to?

ANTHONY FAUCI: Well, I’m up here talking to you on Science Friday. That’s one thing, Ira. I’m doing fine. I’m giving a bunch of lectures, still writing opinion pieces, and probably going to be starting soon on a memoir to sort of document my experiences over the last– I was at the NIH for 54 years, and I was the director of the Institute for 38 years.

And we had a number of experiences that I think might be instructive for younger people interested in going into science or those who are already in science starting way back more than 40 years ago with HIV and then a number of other challenges– Ebola, Zika, pandemic flu, the anthrax attacks, and now, as you mentioned, over the last three plus years with COVID-19, so there’s a lot of public health science and medicine in there.

IRA FLATOW: Let’s talk about the results of this declaration ending our emergency state. Are there any practical differences that people are going to see?

ANTHONY FAUCI: Well, yeah. The practical differences are that the accessibility, ultimately, to vaccines and therapeutics– particularly for people who don’t have health insurance– could be an issue. Right now when you call off the emergency nature, there are a number of advantages in the sense of accessibility of interventions for everybody that’s free– the vaccines, the therapeutics, even some of the diagnostics that we know of.

There are still a supply– it’s going to run out before it ultimately becomes privatized where you’ll have to buy the vaccines if you want it. We’re not there yet. Even with the discontinuation of the emergency, there are still a supply of vaccines that have not yet been used that could be available to be free.

But when they run out, if you have insurance, then you could obviously charge that to the insurance. But if you don’t, then there’s going to have to be some programs to provide somewhat of a safety net for those who need the vaccines but who don’t have the financial accessibility towards them. And that’s one of the things that needs to be worked out.

IRA FLATOW: Yeah, I’m sure you’re right about that. Let’s talk a bit about your experience with COVID-19. You were the central figure in this. If you had to give the government an overall grade on how it handled the pandemic, what would you give it?

ANTHONY FAUCI: Ira, I’d have to break it up into two separate categories because they really are distinct. If you talk about preparedness and response, I tend to break it down into two general buckets. One is the scientific response, and the other is the classical public health response. From the scientific response, I would give it an A-minus, maybe even for the vaccine component of that, an A-plus.

Because as you well know– and you mentioned it earlier– on January 10 of 2020, we got the genomic sequence of the new novel coronavirus, which we called SARS-CoV-2. And then in a completely unprecedented manner, 11 months later and tens of thousands of people in a clinical trial, that vaccine was shown to be safe and more than 90% effective in preventing clinical disease.

We’ve never had anything that really approached that in the field of vaccinology, so that was judged by Science magazine as the science breakthrough of the year, and I think appropriately so. And that was the result of literally dozens of years of investment in basic and clinical biomedical research.

When you go to the other bucket, the public health bucket, I don’t think we did very well. I mean, you could go maybe generously a B-minus, and possibly a C or a C-plus for the simple reason that the local public health and the interaction between the federal and the local public health, I think, reflected the discontinuation– or the disconnection is a better word between individual health and public health at the individual level and public health at the broad national level.

For example– and the CDC has made it very clear and admitted that this is something that they’re working on improving right now– is the lack of complete accessibility in real time of data from the local public health infrastructure– namely, the local public health departments– which it isn’t required that they give the information to the CDC in a certain amount of time. The CDC has to ask for it.

And then they may or may not get it to them in an expeditious manner. That really has to change, whereas in many other countries, the connection between the individual health and the delivery of health care and the accessibility of data is almost in real time, which is the reason why we’ve got a lot of our real time information by collaboration and coordination and communication with countries like Israel and South Africa and the UK.

So those are the things that we really need to do better on is the general public health approach. As I mentioned, the scientific approach did very well.

IRA FLATOW: Do you think that because of this the public has lost faith in the public health system?

ANTHONY FAUCI: Well, I think that might be too strong a word to say the public, like everybody. I think there are certain segments of the population– understandably when they saw some of the inconsistencies and the communication issues– felt that we could do better. I mean, losing faith is a pretty dramatic endpoint to get to.

I think everybody realizes that we have lessons to be learned, and that’s one of the lessons that we have to learn. We have to really bolster up our local public health capabilities and the connection between the federal and the local public health. We need to do better. I wouldn’t say lost faith, but had some concern about the performance.

IRA FLATOW: OK. We have so many calls– so many interesting calls. Let’s go to the phones. Let’s go to Katherine in Minneapolis. Hi, Katherine.

KATHERINE: Hi. Thank you for taking my call. Just to piggyback on Dr. Fauci’s comments there– and that was most useful. It helped my question. How prepared are we to, first of all, discover any new virus coming along and B, deal with the next pandemic? Because certainly COVID will not be the last pandemic we see in light of the fact that the Trump administration cut the funding and eliminated the science teams out in the other countries that were doing this work. And I will listen on the air. Thank you.

IRA FLATOW: Thanks for your call.

ANTHONY FAUCI: Well, that’s a great question, Katherine. And right now, even in the midst of the height of the pandemic, we and the government– when I was the director of NIAID– we had NIH and the CDC and HHS, particularly BARDA, put together a pandemic preparedness program and request of being able to do many of the things that Katherine was alluding to– to be able to rapidly identify and go from the identification of a pathogen to the point where we have countermeasures in a very expeditious period of time.

The G7 has endorsed and put together what we call the 100 Days Mission, which is the aspirational hope that we can go from the identification of a new pathogen to actually have intervention starting to be distributed– certainly not to everyone, but at least starting to be distributed within 100 days.

And we have a program at the NIH, which we started, which we called the prototype pathogen approach where you anticipate within the categories of the various families of viruses to do seed work in immunology, virology, and vaccinology already within that category so that we’ll be able to literally hit the ground running when the next outbreak occurs– whenever that will be, which of course, is entirely unpredictable.

IRA FLATOW: Speaking about the next virus and the next vaccine, one highlight of the response was the rapid development of a vaccine using this mRNA technology. It certainly worked in a crisis, but this technology means that we have to make another version for each new variant for the spike proteins, does it not?

I mean, we have talked with researchers who say we should and we could be putting more effort– and by that, I mean the drug companies– into making vaccines the old fashioned way using parts of the actual virus that don’t change from one variant to another. But these critics say the drug companies don’t want to do that because they don’t make as much money on this. What’s your take on this?

ANTHONY FAUCI: No, no. That’s nonsense, Ira. Really, that’s nonsense. We would love to be able to get a good, durable immune response to the invariable or the unchanging component of the virus, but there’s a lot of technical and scientific stumbling blocks they have– particularly, the immunogenicity of it and whether or not can induce broadly neutralizing antibodies from those particular epitopes.

It is a scientific challenge. It’s not something that you don’t want to do because you want to be able to make a lot of different versions of the vaccines. Certainly from the standpoint of the scientists at the NIH and the thousands of scientists that we fund throughout the country, we’re all trying to get– we use the terminology a universal coronavirus vaccine.

Namely, one that would be effective against any variant of a coronavirus, but you want to start off first with getting a universal SARS-CoV-2 vaccine or a universal betacoronavirus vaccine. And then ultimately, aspirationally, to get a universal true coronavirus vaccine. There’s a lot of work going into that.

We refer to it as next generation vaccines. And recently, you may recall, Ira, that the government has put in $5 billion for that goal to be able to get next generation vaccines.

IRA FLATOW: This is Science Friday from WNYC Studios talking with Dr. Anthony Fauci, the first time we’ve ever talked to him as a civilian, if I might term it that way because you’ve been coming on this show for 30 years. Here’s an interesting tweet from Ken from Baltimore who says he’s a teacher. He’s exposed to the virus a lot. What’s going to happen as he gets exposed to the virus repeatedly over time? What’s going to happen to him or other teachers?

ANTHONY FAUCI: Well, again, it gets to the different types of immunity, Ira. I mean, for example, my case. I was doubly vaccinated with the original regimen of Moderna, and then I had two boosts. And then I got infected, and then I got the bivalent boost. So I have a lot of hybrid immunity.

I mean, that doesn’t mean I’m not going to get infected when I get exposed again, and I probably will because there’s still SARS-CoV-2 out there. But it is unlikely– knock on wood– unlikely that if I do and when I do get exposed that I’m not going to get severe disease if I do get infected.

So the person who just called in or tweeted in– that person likely was already vaccinated and maybe even was infected, which means that subsequent exposures to the virus– so long as the virus doesn’t change dramatically like we saw when we had the Omicron. Omicron variant was a very profound change from the initial Alpha, Beta, and Delta variants that we had early on in the outbreak.

If we don’t have another really truly dramatic change, subsequent exposures for those who have been vaccinated and maybe hybrid immunity because they’ve also been infected– doesn’t mean you’re not going to get a mild infection, but it’s a very, very small chance that you’ll get a severe outcome.

IRA FLATOW: Let’s go to Will in Chicago. Hi, Will.

WILL: Hi. How are you?

IRA FLATOW: Fine. Go ahead.

WILL: Just a quick question. I’ve been reading a little bit about the issue of mucosal vaccination, and I’m wondering what Dr. Fauci thinks about the future of nasal vaccines, especially with respect to COVID.

ANTHONY FAUCI: Well, certainly, it’s something we’re striving for, Will. It’s one of those things where it would be– if you get a successful mucosal vaccine, you would build up mucosal immunity at the surface where the virus enters into the body– namely, the mucosal surface of the nose, of the upper airway.

That would be very good protection against infection itself, whereas some of the systemic vaccines don’t protect– at least for a long period of time– very well against protection, but they protect very well against severe disease. There’s a lot of activity right now working on a mucosal vaccine.

No guarantee we’re going to get a really good one, but you try and you try, and hopefully with a good input from a number of good investigators, we’ll get there. That’s a goal that we certainly are striving for.

IRA FLATOW: That makes a lot of sense, doesn’t it? Hit it where enters your body.

ANTHONY FAUCI: Right. Exactly.

IRA FLATOW: And so how much more difficult is that to do?

ANTHONY FAUCI: We have an example of that with the FluMist for influenza. That has been partially successful– not necessarily as successful in adults as in children, but it isn’t a home run in the sense of, that is the answer to preventing infections at a very high level with influenza. It’s worked reasonably well, but it hasn’t been a home run.

IRA FLATOW: I got it.

ANTHONY FAUCI: So although conceptually, it could work and it could work well, we don’t have the answer to that immediately right now.

IRA FLATOW: Yeah. We’ve got to wait to hit one out of the ballpark. Stay with us. We’re going to take a break. And when we come back, lots more to talk about with Dr. Anthony Fauci, so don’t go away. This is Science Friday. I’m Ira Flatow. We’re talking this hour about the COVID pandemic, the end of the National Public Health emergency declaration, and the future. What’s in store?

Looking through our crystal ball with us is Dr. Anthony Fauci, former Head of the National Institute of Allergy and Infectious Diseases at NIH. If you’d like to get in on the conversation, our number, 844-724-8255. You can also tweet us @scifri. Would you agree, Dr. Fauci, that the poor nations got a short shrift on the vaccines, that rich countries got– and do we have to do better on that?

ANTHONY FAUCI: Yeah, Ira, they did. I mean, obviously, if you’re talking about true equity, there was not true equity, and the developed nations certainly were able to get as much or even more vaccine than they really even needed. And several of the countries in the relatively less affluent south– countries in Southern Africa and other areas of the world, other regions of the world who do not have as good access to kind of health care interventions didn’t do as well.

We try. The United States really went a long way and donating a considerable amount of doses to the developing world and contributing a substantial amount to COVAX, which was the UN-based organization or enterprise that try to get vaccine to the developing world.

Having said that, we still have to do much better because there still is a disparity in this arena of equity for things like vaccines and therapeutics for those in the developing world. You’re absolutely correct.

IRA FLATOW: Let’s go to the phones. Let’s go to Brandy in Portland, Oregon. Hi, Brandy.

BRANDI HERRERA: Hi.

IRA FLATOW: Hi there. Go ahead.

BRANDI HERRERA: Hi. Yeah. My name is Brand Herrera, and I’ve been living with long COVID now for three years after a mild acute infection in early 2020. And I’m wondering if Dr. Fauci can speak not only to where we are with solving for severe outcomes when it comes to an acute infection, but also long term impacts of the virus like long COVID.

I think it’s unfortunately a little bit more common than we once thought, and so I’m wondering what the outlook looks like for long COVID diagnostics and approved treatments, which we still don’t have after three years.

IRA FLATOW: Good question.

ANTHONY FAUCI: Yeah, Brandi. It’s a good question, and it’s a very perplexing problem. First of all, long COVID is a real phenomenon. There are varying levels of severity of long COVID, and long COVID can actually occur in people who have not only severe COVID disease, but even those who have mild to moderate degree of severity of disease.

And it’s the either persistence of or the acquisition of new symptoms that you may not have had with the COVID that lasts for very long periods of time. There’s a lot of effort going on. The NIH has a $1.15 billion effort called RECOVER, which is looking at both the cohorts to determine some common denominators– what the pathogenic mechanisms are of it.

And it’s still unclear. There are some hints, some suggestions, that it may be persistence of response to viral antigens. That hasn’t been definitively proven yet, but it looks like the body tends to be in overdrive a bit even after you get through the acute phase of COVID. And it manifests itself in different ways in different people.

It could be profound fatigue particularly induced by exercise in individuals who otherwise were pretty good from an athletic standpoint. It could be sleep disturbances. It could be autonomic dysfunctions– namely, an unexplained rapid heart rate called tachycardia. And any of a number of things– tingling, neurological abnormalities, things like that.

It’s very difficult to prescribe or develop a therapeutic approach when you don’t fully understand what the underlying pathogenic mechanism, and that’s where a lot of effort is going on right now to try and understand, what are the mechanisms of this syndrome, which is a real syndrome that a significant proportion of people have?

IRA FLATOW: Researchers and the government taking it seriously, Dr. Fauci, I guess is what–

ANTHONY FAUCI: Oh, you’re darn right. I mean, it’s a real phenomenon. It’s not something that you’re going to blow off because if you look at the volume, the just sheer numbers of people who have been infected with SARS-CoV-2– even if a very, very small fraction of those get long COVID, you have a lot of people who have prolonged suffering due to a viral infection that you would have hoped would have cleared completely.

IRA FLATOW: Yeah. Brandi, does that answer your question?

BRANDI HERRERA: Yeah, I think it does. I mean, I think more than anything, I just appreciate the response and also driving awareness, I think, because not a lot of people really understand what long COVID is, and many people have it.

IRA FLATOW: Good luck to you. Thanks for calling.

BRANDI HERRERA: Thank you.

IRA FLATOW: I have a few tweets about this, and actually, a personal experience I want to share with you, Dr. Fauci. I went into my local pharmacy to get a second booster shot, and the pharmacist told me that he would give it to me if I wanted one, but he advised me to wait because the drug companies will be coming out shortly with a more new effective vaccine– one that defends against the newer variants than the current booster does. But if I decided to go ahead and get the current booster, I wouldn’t be eligible for the newer one because it would be too soon. Is that right?

ANTHONY FAUCI: No.

[LAUGHTER]

OK, so let’s unpack that for a second.

IRA FLATOW: Please. I’ve got at least three tweets on that one also.

ANTHONY FAUCI: OK, so here’s the situation. Somewhere around the end of August, the beginning of September, the bivalent BA.4/5 which was more matched to the circulating Omicron sub-lineage viruses that was circulating was available, and people got it then.

What the FDA and the CDC are saying right now is that right now, if you’ve had several months– like if you got a vaccine in September, which is seven to eight months earlier– right now, if you are an elderly individual and/or a person with an underlying immune compromised condition, you can get and should get the bivalent booster that’s available now.

Come the fall, likely in the end of September, the beginning of October, you’re going to have the big push for people to get the flu vaccine, and they’re hoping to be able to give an updated version– the most recent updated version of what is circulating with regard to SARS-CoV-2 at that time in the fall of 2023. So if you go in now, Ira– and you’re not, but let’s assume that you’re an elderly person, and you have an underlying condition.

And you get vaccinated now in the first week or week and a half of May. If you look at May, June, July, August, September, October, that would be six months from now. If you had the availability of the most recent one, you can get a vaccine now to get your defenses up, and you could also then appropriately get it six or seven months later in the fall.

So remember, we’re talking about now vaccines for people who might be immune compromised or elderly. If you are a healthy person and you’ve been fully vaccinated, then you can wait until the early fall when the newer, more updated version of a vaccine will be available, and they’ll be pushing to have people get it at the same time as you get your flu vaccine.

IRA FLATOW: So get that second booster now, and get the later one in the fall. OK. Free advice. I didn’t have to pay for that one. Let’s go to Joe in Virginia Beach. Hi, Joe.

JOE: Hey. Thank you so much for taking my call. Thank you, Ira and Dr. Fauci. I appreciate your leadership. 80 billion animals are slaughtered every year, and these animals are kept crammed in cages in filthy conditions. Antibiotic resistance, bird flu are spreading like wildfire. Are we brewing our next pandemic by keeping billions of animals in cages and slaughtering them for food? Should we go vegan for health and justice? Thank you.

IRA FLATOW: OK. Thanks for that call. Dr. Fauci? Are these captive animals breeding grounds for the next–

ANTHONY FAUCI: Well, you know what’s more of a breeding ground for the next outbreak, Ira, is encroaching on the animal human interface. And by that I mean going into rainforests and putting humans in contact with animals that they never would have otherwise been in close contact with.

In addition, what we saw, for example, with SARS-CoV-1 and very likely also with the etiology of SARS-CoV-2 where you have wet markets, where animals from the wild are brought in to markets for people to shop. We know that SARS-CoV-1 went from a bat to a civet cat to a human.

We know that when you have bird flu, you have birds– as the caller was mentioning– that are packed together in flocks sometimes in association with pigs and other animals that can harbor influenza. That’s the perfect breeding ground for a new type of influenza.

And that’s the reason why we’re really keeping our eye out now on the H5N1 bird flu, which is starting to infect mammals, which makes it more adaptable that it might jump into humans. So it’s the animal human interface that we have to be paying a lot of attention to when you’re talking about the possibility of outbreaks.

Because as you know, Ira, 75% or more of all of the new emerging infections are zoonotic in that they come from an animal reservoir, jump species, and infect a human. If they adapt themselves well to human, you could have an outbreak. If not, you may have a one off infection or a two off infection, but that’s really the issue, the animal human interface.

IRA FLATOW: I get it. Let’s go to another phone call. This one, Jeff in Sacramento. Hi, Jeff. Let me get you punched up here. Welcome to Science Friday. Hi, Jeff.

JEFF: Hello.

IRA FLATOW: Hi, go ahead.

JEFF: Thank you. I’m doing fine. How are you?

IRA FLATOW: Fine. Go ahead.

JEFF: Thank you, Dr. Fauci, for taking my call. I have a two part question. What is your understanding on the origin of COVID? And my second part is having COVID start and originate from a virology lab in Wuhan, is that a reasonable hypothesis? And I heard some of what you said from the previous caller. Those are my questions.

IRA FLATOW: OK.

ANTHONY FAUCI: OK. Well, first of all, with regard to the origin of COVID, we don’t know definitively where it came from, for sure. And until we get a definitive determination, which unfortunately, Ira, we might not ever get there. But when you are in a situation where you don’t have a definitive determination, you have to keep an open mind as to the various possibilities.

And two possibilities that are discussed very actively are one, a lab leak origin like the Chinese somehow or other were working on a virus in the lab that escaped and was able to infect humans, or they brought a virus in from the wild, worked on it, and it infected humans and began to spread. There’s no real evidence at all for that, but it certainly is a possibility.

And the other possibility, which many, many of the experienced evolutionary virologists think it’s the most likely– but again, not definitively shown– is that it was a natural occurrence jumping species from an animal reservoir into a human. Again, to underscore, we don’t know definitively what it is, so we have to keep an open mind.

IRA FLATOW: This is Science Friday from WNYC Studios talking with Dr. Anthony Fauci. OK. In the few moments I have left, Dr. Fauci, I have a big task for you. I want you to lay out for me a program that will keep us– what do we have to do? What kinds of money do we have to spend to be prepared for the next big one?

ANTHONY FAUCI: Well, we have to spend a fair amount of money, Ira. And that’s one of the things that I mentioned earlier on in our interview is that we put together a program right in the early year or year and a half of the outbreak, which was a pandemic preparedness program to not only help us respond better to the ongoing outbreak, but to be prepared for the inevitability of a pandemic again. We don’t know when that will be.

And that is a combination of what I answered to one of the other caller’s questions– is both a scientific approach as well as a public health approach to continue the sustained investment in basic and clinical biomedical research that allowed us to come up with the vaccine but also to put a substantial upgrading of our public health process both locally at the government level and in our international collaboration because pandemics are global, Ira.

IRA FLATOW: I guess what I’m driving at is where’s the money going to come from? Because Congress doesn’t want to spend money on this now, does it?

ANTHONY FAUCI: Well, they don’t. That’s understandable. I don’t think it’s advisable not to spend money. I think we need to put a lot more money into pandemic preparedness. And hopefully, we will have the Congress appreciate soon– they have put a lot of money in. In fairness to them, Ira, they have put a lot of money into this outbreak.

But that doesn’t mean that because we put a lot of money in that we don’t have to put even more money to help prepare us for the possibility of another outbreak. And that’s what I hope we see happen over the next year or so.

IRA FLATOW: Are you going to be doing any lobbying for this kind of outcome that you hope for?

ANTHONY FAUCI: Well, lobby is a charged word.

IRA FLATOW: Yeah.

[LAUGHTER]

I don’t mean a registered lobbyist. You’re right.

ANTHONY FAUCI: Yeah, I am going to continue to speak out as I have. When I was in the government, I spoke out very actively. You know that. And I will continue to speak out for the support of both in money and resources for both biomedical research as well as for public health infrastructure and capability. Yes, I will continue to advocate for that.

IRA FLATOW: Well, we hope you come back and talk lots more with us on Science Friday, and thank you very much for taking the time.

ANTHONY FAUCI: My pleasure, Ira. Good to be with you.

IRA FLATOW: Dr. Anthony Fauci, former Head of the National Institute of Allergy and Infectious Diseases at NIH.

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