Voices of HHS
Dr. Anthony Fauci: “Science is Truth”
On this episode of “Learning Curve,” Caputo sits down with NIAID Director and Coronavirus Task Force member, Dr. Anthony Fauci to break down the vaccine development process, his early days growing up in Brooklyn, and why science is a good faith attempt to get to the facts.
Michael Caputo: Hello and welcome to Learning Curve. I'm Michael Caputo. I'm the assistant secretary of Public Affairs at the United States Department of Health and Human Services. And when I was asked to join this organization a couple of months ago by the President, I -- the biggest criticism I had was I didn't know much about healthcare. It's indeed true.
I don't -- everything I learned about healthcare I learned from the Obamacare website. So, I was woefully uninformed. And of course, to me, I am very lucky I get to learn from the experts. And I'm so -- you know, my learning curve is vertical. It's a leap. And I have to, you know, go to work every day and be ready to help try to get the people who understand our health issues here in the United States, especially in the time of coronavirus out there in the media. And I'm learning from the smartest people on this -- on the planet. I've had a lot of the principals of HHS on this podcast and I'm delighted today to have Dr. Anthony Fauci.
If you don't know Dr. Fauci, welcome back. You have been asleep for about 10 years. And certainly, you have been asleep for the last four months. Dr. Fauci, thanks for joining us.
Anthony Fauci: Good to be with you, Michael.
MC: Dr. Fauci is on the Coronavirus Task Force. He's been in the United States Public Health for how long now?
AF: Actually 50 years.
MC: Fifty years. It's amazing. I mean, most people don't think they're going to work for 50 years, let alone work in the same field. And of course, work in the same city and the same organization.
MC: It's -- and now you're focused at NIAID.
MC: And can you tell people what that is?
AF: Yes. The National Institute of Allergy and Infectious Diseases. It's the second largest Institute at the NIH.
MC: National Institutes of Health.
AF: Yeah, the National Institutes of Health.
MC: There are more acronyms in HHS than the United States Navy.
AF: Indeed, indeed. It’s the case. I've been the director of the Institute for 36 years this coming November. I started there after my medical training as an internist in the New York hospital, Cornell Medical Center in New York City. And I came down as a fellow -- combined fellowship in infectious diseases and immunology. Did that for three years, went back to New York doing more clinical medicine, and then I've been back here at the National Institutes of Health since 1972.
MC: And you come from New York.
AF: I do indeed. Brooklyn, New York.
MC: I've heard of that place. Actually, I talked to somebody who we both know who said you have the most beautiful Brooklyn accent?
AF: Yes, so they say; so they say.
MC: Well, I mean, you grew up like everybody in Brooklyn, haven't you?
AF: Yes, I did. Yeah.
MC: What road did you grew up on?
AF: Well, I grew up in the Bensonhurst section of Brooklyn, right across the street from the Utrecht High School, which was a public high school in Brooklyn. There my mother and father went to, met there, and got married right after graduation. How about that?
MC: How about that? And then a lot of people don't realize that you bring with you all the knowledge of growing up in Brooklyn, all that, you know -- basically you grew up like most Americans did.
AF: Right, I did.
MC: And I think you have that frame of reference when you look at infectious disease, when you look at public health, and now when you're looking at the coronavirus. When people say, "There's a spike in in virus infections in Brooklyn." You have a picture in your mind.
AF: I do. In fact, I spent so many years of my life and the first component of my life before I came down here, growing up on the streets of New York, so I know New York City. New York City is in my DNA. I become a Washingtonian, but, you know, you'll never get New York out of you. It's such an amazing place.
MC: What's the difference between the two cities, Washington and New York, when it comes to the way people grow up? And, you know, who -- I am thinking in the terms of public health. I mean, it's a very different place, isn't it?
AF: Yeah. When I -- I'm going to try and say without insulting any New Yorkers because I love New York. New York -- when I think of New York, I think of asphalt. When I think of Washington, I think of trees.
MC: Right. Sure.
AF: So, Washington is very green and apart -- green city -- apart from, you know, certain park sections of New York. You know, it's a big, big place with a lot of people but it's an exciting, vibrant place. Washington is an international place. It's really the capital of the world. It's where things happen in some respects. It may not be as socially sophisticated as New York is in some respects, but it's a great city. I love Washington
MC: And the way that both cities experienced the coronavirus, very different, right?
AF: Well, you know, yes and no because, you know, when people see New York City, they see the multicultural component of New York City. And it's a big city, different boroughs, you know, great cultural diversity. We see that in Washington but Washington in some respects, when you look at the population of Washington, it's a very heavily African-American city.
And African-Americans have suffered disproportionately from coronavirus disease. They've suffered in that their rate of infection is higher because of the nature of the economic status that many of them find themselves in where they're outside working, being unable to physically separate. And then when they do get infected, given the social determinants of health which make it for them, have a higher incidence of diseases like hypertension, obesity, diabetes. They are at much greater risk of suffering the deleterious consequences including death.
So, they are different in some respects, but they are the same. I can tell you as big cities, both of them have gotten hit hard. New York obviously devastated. I mean, there was a time back when things were really intense. When I was in my sleeping three hours a night to days when New York was almost, not quite, but it was so perilously close to getting their health system overrun. Thank goodness that didn't happen, but it was really tight there for a while, needing personal protective equipment, needing ventilators, those kinds of things. It was quite, quite, difficult.
MC: Well, I was still locked in my house with my kids when it was really looking bad. And I'm from a little village outside of Buffalo, by the way, the finest city on the planted, Buffalo, New York, and the Buffalo Bills. But I was sitting on the edge of my couch waiting for the Coronavirus Task Force press conference. I had no idea that I was going to come here and work with you. But my family hung on every word, every single word. And we hung on every word that Governor Cuomo said. And we hung on every word that our Erie County Executive said. And, you know, some people got it right, some people got it wrong, but we really paid attention. What -- that must weigh heavily on you.
AF: Yeah. I mean, I take very seriously the responsibility. My job in the Task Force is as a scientist, a physician, and a public health official. So we examine the data, look at the dynamics of the infection, which we understand. I'm an infectious disease expert. I have trained -- and I've been doing it, you know, for 36 years as director. So, the job is to provide advice to develop guidelines about how we're going to handle this. And, you know, the Task Force is chaired by the Vice President. We meet with him. He briefs the President, and then the decisions that are made based on input from a number of individuals. My job is to give public health based on facts, based on evidence, and to give it honestly, both to the Vice President, the President, and to the general public.
MC: And I noticed that you're always frank. You stick with the science. And that confuses some people.
AF: Well, it does. And I do stick to the science. I have the responsibility, which I take very seriously, of always being consistent and basing what you say on evidence. And there are times when you don't have all the evidence you need, but you have to make judgments based on both prior experience and the degree of evidence that you have. When you get more information, you process your information according to the facts and the evidence, which is the reason why when people see what's going on, and you have an evolving outbreak, it's a work in progress or a disaster in progress.
This was unprecedented, you know, and when you give advice about what should you be doing, should you be out there, should you be shutting down earlier versus later? I mean, people get confused. And they say, "Wow, you know, we shut down and we caused a great disruption in society. We caused great economic pain, loss of jobs." But if you look at the data, now that papers have come out literally two days ago, the fact that we shut down when we did and the rest of the world did, has saved hundreds of millions of infections and millions of lives. And yet, there are those who say, "You shut down, you did destructive things by disrupting the economy." And others say, "Well, if you save so many infections by shutting down, why didn't you shut down two weeks earlier? You could have saved many more lives."
So, I think that's where I wouldn't say that confusion is. Sometimes what appears to be inconsistencies, but they're not because at any given moment, you've got to make your decision based on evidence. And it isn't your decision. It's your advice and your guidelines because the people who make the decisions at the top of the top, the President and the Vice President, and at the local level, the governors and the mayors, they take into account advice and recommendations, not only from the health sector, but from the economic sector, from the political sector, from things that they're responsible for.
So, the thing we have to stick by our guns in the sense of we got to make sure that we make consistently the public health recommendation based on the truth and the evidence as we have it.
MC: And the fact is, the evidence we -- as we have it is shifting.
MC: So, some people when they hear about masks, no mask, you know, spike, no spike, you know, et cetera, they don't they don't understand that with the shifting evidence comes some shifting advice.
AF: Yeah. I mean, I think a typical example of that was the misunderstanding about masks. At a time when there was a shortage of PPE and a shortage of masks, many health officials, myself included, were saying, "Masks are not perfect." The people who really need the masks, the N95s and other masks, the surgical masks, are the people in the healthcare community who in fact, are putting themselves in harm's way every day to take care of sick people.
So, it would be terrible if all of a sudden everybody started hoarding masks so when they weren't available, and the health care providers wouldn't have it. Then when it became clear that there was transmission by people who without symptoms, that you can't assume that if you walk out in your society and someone is not coughing and is not sneezing that you're okay. Because we know now that 25 to 45 percent of people who are infected are asymptomatic.
Therefore, there's a compelling reason to wear a mask. One, in case I am infected, but one of those asymptomatic carriers, I'm not going to spread the infection to a vulnerable person who might actually get very sick and die; or if I'm uninfected and somebody else is infected, that they are going to -- there are going to infect me if I don't have a mask. So, right now people are saying, "Well, wait a minute, a couple of months ago, you said, don't worry about masks." The situation has changed. It's changed because we now have enough masks for the healthcare providers and we know that if the infection can be spread from an asymptomatic person.
MC: You've said you spent your life briefing Congress, briefing elected officials, briefing senior government officials, briefing international government officials, presidents of many different nations, you -- I know that you traveled to Africa with some of my colleagues when the Ebola thing was a real concern. And I find it very interesting that there is kind of a wide variety of opinion about Dr. Anthony Fauci in America.
My cousin, Chris, who is in Western Ohio, we grew up together. You know, Western Ohio is a very different place. You know, and she doesn't believe you. She doesn't. She doesn't have an advanced degree. She works in tight quarters in her office and is very concerned about that. But I don't know -- I can't ask -- I tried to ask her why she doesn't, right? And then there is my dear friend, Lynn, who I am close to, who lives in Suburban Washington. And you're the only person she believes. What does that -- how does -- you wake up every day and you face that disparate opinion in America.
AF: Right. Yeah.
MC: And -- but yet, you have to go to the podium and talk.
AF: Yeah. Well, one of the problems we face in the United States is that unfortunately, there is a combination of an anti-science bias that people are, for reasons that sometimes are, you know, inconceivable and not understandable, they just don't believe science and they don't believe authority. So, when they see someone up in the White House, which has an air of authority to it, who's talking about science, that there are some people who just don't believe that. And that's unfortunate because, you know, science is truth. And if you go by the evidence and by the data, you're speaking the truth.
And it's amazing sometimes the denial there is, it's the same thing that gets people who are anti-vaxxers, who don't want people to get vaccinated, even though the data clearly indicate the safety of vaccines. That's really a problem. I think the people who believe or people who understand and have trust in someone who has a very, very long track record of always speaking the truth based on evidence, and I've done that, as you said, through now six administrations. This is my sixth administration.
MC: You know, so it's interesting, doc, because I kind of see that the people who don't believe science are people who believe in absolutes. That the truth is it's either true or it's not.
MC: And in this process, we've seen the models shift. We've seen the data shift. We've seen an instruction shift. And I think perhaps those who believe in absolute truth, don't really end up being believing science that shifts. Don't you think that in the end, the American people have to begin to understand that science is an absolute truth?
MC: It really isn't.
AF: Well, science has a -- no, I think we have to be careful we don't confuse people. So, let me take a different perspective, Michael.
MC: I am here to confuse people.
AF: Okay. So, science is the attempt in good faith to get to the facts, and it isn't perfect. And what happens is that science can be self-correcting. The beauty of science is that it's self-correcting. So, if somebody comes up with an observation, there could be ways that they gathered the information, that they interpreted the information that isn't really necessarily the way it is. But the beauty of that is that there are so many other people independently, who are asking the same questions that sooner or later, something that really is true, will get confirmed time after time, after time. And something that in good faith was thought to be true but isn't when the scientific process repeats it over and over again, all of a sudden you realize, you know, there was something about that that wasn't quite right.
So, as long as science is humble enough and open enough and transparent enough to excel -- to accept the self-correction. It's a beautiful process. So, the science doesn't change. What it is, is sometimes interpretation. That's the point.
MC: See, I, you know -- and common here, I'm from the, you know, communications arena, from the political arena, you know, doing legal or litigation communications. I did -- science to me -- I had so much trouble with physics Dr. Fauci. I wanted to be an engineer. I got a journalism degree. I'm science stunted. I have a problem, I think, like most Americans. But now that I've been here for a little while, I understand that science is kind of an iterative process. And it's one that eventually you arrive at the absolute truth.
MC: And I think most -- many Americans haven't. They don't get that that science is really something that thousands of people participate in to end up on one -- in one immutable truth.
MC: I really feel that feeds into the vaccine debate, doesn't it? There are people who just don't believe in vaccines. I myself vaccinate my children. A lot of my -- some of my friends do not. And in this situation with the coronavirus, is it true that you're either going to get the virus or you're going to get the vaccine in the end?
AF: I don't think so. I don't think so because there is a certain something called herd immunity, which means that there are people in in the population who if you have enough infection or protection from a vaccine, that you box the virus out. So, it doesn't mean that everybody is either going to get infected or they're going to get the vaccine. That's not the case at all.
Now, when you have some situations --
MC: What do you mean by "box it out?"
AF: The virus has no place to go because virus will continue to propagate when it has enough vulnerable people. So, that by chance that when one person comes into contact with another, that that person is vulnerable and the virus says well there are seven people in the room who have been uninfected, I'm going to bounce around and see which one I'm going to get. I'm going to cough on this one, cough on that one et cetera. But when you have a major percentage of the people are protected, either by a vaccine or by being previously infected, the virus is going to, just by chance alone, die out because viruses disappear when you have an infection that when someone is infected, they infect, on average, less than a single person. It's called the reproduction rate.
So, if I'm infected and I infect three or four people, this outbreak is going to keep going. It's going to keep going, it's going to keep going. But once you get it to the point where there's not a lot of people around that are susceptible, then those who are there, they're going to benefit from that. That's herd immunity. So, there are some diseases that you can actually eradicate by just vaccinating people with smallpox vaccine, and that's what we vaccinated against. The same thing with polio. Polio we've eliminated. We haven't eradicated polio. We've eliminated it from the United States, but there are still some places where there is polio.
MC: It's interesting because we now talk about Operation Warp Speed, which you're reading on regularly.
MC: I mean, you're a major player in vaccine development. You are the major player in vaccine development in American. And so, you're kind of -- you're not a member of Operation Warp Speed, but you're one of the guideposts, one of the one of the chief advisors to them. And I've heard you say you're feeling pretty good about the development of vaccines, therapeutics, and diagnostics, which is the core -- that's the core mission of Operation Warp Speed. Is it true that you're optimistic?
AF: You know, I'm cautiously optimistic, Michael, for the following reason. First of all, we've moved quickly, but with attention to safety. We have not compromised safety.
MC: But people are saying, "Oh, it's not going to be safe."
AF: No, no, but that's incorrect. And we're not compromising scientific integrity. We proceeded very quickly, because of the technological advances that have been made and the ability to do things we never were able to do 20 years ago.
So, the Chinese put on the open database, the sequence, on the 10th of January. On the 11th of January, we had a meeting with our staff and said, "We got to jump on this." On the 15th, we began the development of a vaccine of January; 62 days later, we had a product that we put into clinical trial, in a phase one to see if it's safe and does it induce an immune response. That is overwhelmingly the quickest that has ever been done.
MC: In history?
AF: In history. You call it the world's indoor record. I mean, it --
AF: It absolutely is. But there are a number of steps to develop a vaccine. So, the reason we were able to do it so quickly is that we proceeded what's called at-risk. Not at-risk for safety, not at-risk for scientific integrity, but at-risk for finances. So, what happens is that in the standard way of developing a vaccine, you don't jump to invest in the next step until you're pretty sure that the step you're in is working. You don't stop producing virus -- excuse me, vaccine, until you're pretty sure you have a product that's going to work.
Well, given the fact that we needed to do this as quickly as possible without sacrificing safety or scientific integrity, the federal government partnered with multiple of these companies and said, "Guess what, we're going to move fast and we're going to assume we're going to be successful. And if we are, we saved several months. And if we're not, the only thing we lost is money. But better lose money than lose lives by delaying the vaccine."
So, right now, the initial data from the study showed that -- it makes me cautiously optimistic that we can induce a response that would be protective. In July, the first of a series of candidates will go into phase three trial for efficacy. In August, another candidate; in September, another one; in October, another one. So, given the fact that we're having a massive trial, the more people you have, the quicker you get an answer. We're going to be putting 30,000 people in each --
MC: Thirty thousand.
AF: In each trial. Exactly; 15,000 placebo, 15,000 experimental. We project that if everything goes well -- and remember there's a lot of speed bumps and potholes on the way to a vaccine, so there's no guarantee that we're going to have a safe and effective vaccine. But what we're fairly certain is that as we get to the end of the fall, the beginning of the winter, that by December, we'll know if it works or if it doesn't work. And if in fact that's the case and we're fortunate enough to have an effective vaccine, we could start vaccinating people in the first quarter of 2021. That is very, very quick. And the one thing we want to make sure people understand, when we say we're going rapidly, we are not sacrificing any of the scientific integrity or the safety.
MC: Not -- there's not one safety step that's being cut.
AF: No, there's not. We're just doing them in parallel. That's the point.
MC: And that -- and, you know, private sector can't do it in parallel because the CEO and management structure that decides to go ahead and produce something that isn't proven yet, they'll get fired when it doesn't work.
MC: In this situation, it's worth the loss --
AF: It is.
MC: -- of the financial -- you know, of the investment.
AF: Right. It's an important investment.
MC: And the American people can afford it.
MC: A private company can't.
MC: How many people need to get the vaccine, Dr. Fauci?
AF: Well, you know, it depends. It's so interesting that, you know, you don't want to see a lot of infections. But the more infections there are, the quicker you find out if the vaccine works. So, we --
MC: You have to explain that. That's --
AF: Okay. So, if you're out there right now and you have very few infections, it may take years to finally prove that the vaccine work. Because you have to have enough infections in the placebo group that's less than in the experimental group, so you could prove that there's a statistically significant difference, that the vaccine protects you 70 percent protection; whereas, the placebo, you know, you get infected. If that's the case, you need to get infections in the trial to know that.
So, when we did Zika vaccine, we did it very quickly. And we went to Brazil and South America, and Central America. By the time we got the vaccine trial going, because of the mosquito control, and the fact that so many people got infected, there were no infection. So, we couldn't prove that the vaccine worked. We proved that it was safe. We proved that it induced a good immune response, and we had good animal data. So, you might be able to approve a vaccine on that basis, but not definitively. Whereas, if you have a lot of infections, and all of a sudden there's a big outburst of infection, you could prove pretty quickly that a vaccine works.
MC: A hundred years ago, we had a pandemic and the America experienced quite a few deaths. It was a pre -- basically before modern medicine --
AF: It was.
MC: -- could really figure out a vaccine, et cetera.
MC: But it's on its way out. And here we are in an era 101 whole century later, where we have high technology, great surveillance, and incredible testing acumen, and we have therapeutics for everything and vaccines for everything else, and yet we got hit so hard by coronavirus. Is coronavirus much worse than what we experienced a hundred years ago?
AF: No. No, no. Not at all. A hundred years ago, there were 50 to 100 million deaths in a population of the globe that was one third the size it is now. So, if you look at that, let's take a low number 50 multiply that by 3, it's 150 million people would have been killed right now if now. So, that was really bad. You know why it was bad? We didn't have any internet. We didn't even know was a virus. We had no idea what it was.
And what happened is that it occurred right at a time towards the end of World War I. So, it was just, you know -- the world was in great, great turmoil. And they didn't lockdown the way we did. I think that was a good choice, even though there were secondary spin offs of locking down that have done things that are unintended consequences, unemployment, economic difficulties. The fact is, if we had not locked down, we would be much, much worse off than we are now.
MC: If we get a vaccine, are you going to be -- and it works with that --
MC: You're cautiously optimistic. Do you -- will it be safe?
AF: Well, we would not make it available unless it's safe.
MC: Right. Just flat out?
AF: Flat out. If it's not safe, it's not going anywhere.
MC: Yeah. Are we going to have more than one vaccine? Is it a possibility?
AF: I think -- Michael, I would think we will. And the reason I say that is that looking at the different candidates, they all look promising in the sense of animal data. Not every one of them has yet been in humans to show the initial immunogenicity, but the ones that have, they look promising. Again, never a guarantee, but they look promising.
MC: We -- when we stood up Operation Warp Speed, the idea was that it is the Manhattan Project, but trying to save people.
MC: And that we need the doctors to go in there, the scientists to go in, and invent, and lock the door and hold the key until it's all over. How important is transparency along the way to getting the American people to believe in what the ultimate result is?
AF: It's everything. And if you don't have transparency, you don't have confidence. If you don't have confidence, you're a dead duck.
MC: I think that -- I came here not knowing anything. Honest to God, I know much more about the NFL than I do HHS. And I want to go back to a Buffalo Bills game. I really do. I miss sports.
MC: I know you're a sports fan. I mean, I miss it so much.
MC: What's it going to be like?
AF: You know, this will end, Michael. And I think that's one of the messages I try to keep giving to the American people. As much as we're going through now, everything from a major inconvenience to a devastating economic impact to the health difficulties that results from that, but it will end. It will end. We will get it under control. We've been through a terrible ordeal, but if we stick together as a nation, we will get through this. And when we do, not if we do, when we do, you're going to watch a Buffalo Bill game again.
MC: I hope so, and I hope they finally win.
MC: But, you know, Dr. Fauci, I got to ask you this question. I've heard it. It's true, I don't know. I got to ask you. You have -- you know, people believe you, they don't believe you, but they see you all the time. Is it true that you're getting, like, love letters and emails that people figure out your email address and that you're -- you've developed quite a following out there.
MC: I mean, I can tell you that the older, you know -- like, my mother thinks that you hung the moon, you know, and, you know my wife -- I mean, I don't know what it is. You just got this magnetism.
AF: Well, I think it's more of a symbol of what the American people want. They want someone who speaks honestly to them. They want someone who gives them the truth based on data. And they feel the need for that, so I become a symbol. And all of that other stuff that, you know, sex symbol, Brad Pitt stuff, it's kind of interesting.
MC: That was funny, though, when Brad Pitt --
AF: Yeah, it was. The only thing that I've learned is that don't take yourself too seriously, because once you stop believing that, then you're in trouble.
MC: You're in big trouble.
AF: I know who I am. I am the person I was before this, and I will hopefully be the person that I am after this.
MC: I am 100 percent certain that you're never going to change.
AF: I'm not.
MC: A hundred percent certain. You know, I've -- I didn't know what to believe when I came here. I was scared to death like the rest of America. I had spent most of my months prior to this sitting on the couch, teaching second grade math to my child who was like every other child in this country being homeschooled suddenly. I -- this is actually more difficult than second grade math, just a little. I didn't have any idea what I was doing then but I'm learning more every day. And I can tell you, Dr. Fauci, you're one of the big reasons I believe that we're going to be fine. We're going to be fine, aren't we?
AF: We are. We will. We've suffered, but we're going to be fine.
MC: I trust you. I trust that the President and the economists are going to bring the economy back when you and the rest of the scientists figure out how to just -- how to knock this off. I think you're already on the way there.
MC: I don't know what happens after that. I think we're all going to find out, but I do believe and people who listen know that I'm a big fan of the President, and you served many different administrations. I believe that President Trump wouldn't put you at the podium if he didn't trust you. That's the truth. Everybody you see at that podium is someone that counsels the president. In the end, he takes his own counsel, but you've done just incredible work. And I want to say thank you for that. You know, I'm sitting here talking to Dr. Anthony Fauci, who has taught me so much since I've been here.
My name is Michael Caputo, I'm the assistant secretary of Public Affairs at Health and Human Services. Dr. Fauci, thank you so much for your time today. You've got so much work to do and -- I don't know. You're still running 4 miles a day, is that true?
AF: Three and a half.
MC: Oh, you cut back.
AF: Cut back.
MC: My gosh. Well, thank you so much. Ladies and gentlemen, take -- stay tuned next week, I'll have another one -- another interesting expert. I don't know if it's going to be as interesting as this one. Dr. Fauci, thank you very much.
AF: Thank you, Michael. Thank you for having me. It's a pleasure.
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