It’s been a big few days for Dr. Anthony Fauci, director of the National Institute for Allergy and Infectious Diseases, since President Joe Biden took office Wednesday and began making major changes to the nation’s approach to global health.
Fauci spoke with WTOP about those changes, as well as COVID-19 variants, the vaccines that have been developed for the ongoing fight and the way vaccines have been distributed so far.
Back in WHO
In Biden’s first 48 hours, the U.S. rejoined the World Health Organization, which former President Donald Trump had left, blaming it for the spread of the COVID-19 pandemic (without ever explaining the reasoning behind his assumption). When Biden made the announcement, he asked Fauci to become the head of the American delegation to the WHO executive board.
Fauci told WTOP he was “very privileged” to be asked and honored to accept.
“President Biden and Vice President (Kamala) Harris made as one of the top issues on their agenda to get back to some sort of normalization with WHO,” Fauci said. “When you have a pandemic that’s a global pandemic — which, by definition, that’s what a pandemic is — you have to have a global response. So, it was really untenable that we would not be intimately connected with the WHO.”
Fauci added that the U.S. would resume its financial contributions to the organization, and agreed to join COVAX, a consortium of countries dedicated to getting vaccines to developing countries.
The U.S. has also revoked the “Mexico City policy,” whereby any group connected with abortion could not get any funding from the U.S.
“So, that’s where we are,” Fauci said. “We’re back on the international scene whereas before we had withdrawn.”
RNA viruses such as SARS-COV-2 “have a tendency to mutate,” Fauci said, and the development of new variants, such as the one that was recently discovered in the U.K., isn’t that much of a surprise.
The good news about the new variant, which Fauci said is dominating cases in the U.K., is that it’s not by itself more deadly. But it is more transmissible, and under real-world conditions, “If you have an increase in transmissibility, you’re going to get more people going to go to the hospital and ultimately more people are going to die,” he said.
The big question with the new variant, Fauci added, is what impact it will have on the effectiveness of vaccines, as well as the monoclonal antibodies that are being used as treatments in some cases.
In the U.S., Fauci said, “It does not appear to have a significant impact on the efficacy of the vaccine, even though it might lessen it somewhat.”
Variations on the virus are, however, causing major problems in Brazil and especially South Africa, Fauci said — “not enough to take [treatments and vaccines] off the chart … but enough to make us say, ‘You really got to keep your eye out on it.’”
And though it’s not a major problem in the U.S. yet, the possibility of virus variations means authorities have to be “nimble” about the possibility of having to “modify the vaccine,” Fauci said.
He was quick to point out that that just makes getting vaccinated even more important: “Because when you prevent a virus from easily … replicating, then you prevent it from mutating. So, if you don’t want to see a virus takeover in this country, then suppress all the virus that’s here.”
“So, we’re looking at it carefully; it doesn’t appear to have a significant impact on what we’re doing, but we want to be ready to be nimble and make changes if we have to,” Fauci said.
As for further travel restrictions, the doctor said, “Nothing final, nothing definitive has been decided on that. But that certainly is being considered.”
Speaking of which, the rollout of the COVID-19 vaccines in the U.S. has had its problems, but Fauci said he’s confident that problems will get fixed. “We need to do better — I mean, obviously.”
That said, he added, “Some states, some cities have done really, really well with the initial rollout. Whenever you get the rollout of a very complicated situation, like trying to vaccinate a country of 330 million people in the middle of an outbreak, there will be bumps in the road and there will be hiccups.”
He said roughly 16 million Americans have been vaccinated, while a bit more than 30 million doses have been distributed.
“We’d like to see that gap closed a bit. Now, obviously, there’s a reporting delay. So they’re very likely significantly more than 16, 17 million people vaccinated; they’re just not yet reported to be vaccinated,” Fauci said.
The ideal is a “steady flow … as the vaccine comes in, it goes into people,” without vaccines languishing in freezers and without people waiting in line for a vaccine that’s not there yet.
“So, we can do better. I mean, you have to admit that — and that’s what we’re trying to do.”
Fauci said it was still important for people who had gotten their first shots to get their second. “What we know from experience with this and other viruses, and other vaccines, is that at the end of the primary, you get some degree — not optimal — protection before you get the second dose. We don’t know what the durability of the protection is.”
“Right now, protection after one dose is not optimal, but there is some to be sure. But we don’t know the durability, which is the reason why the clinical trial with a data guides us, tells us that to be optimally protected with the mRNA vaccines, you need two doses, and you’re optimally protected after the second dose,” he added.
After you’re vaccinated
And when you do get vaccinated, Fauci said, you need to keep wearing a face mask and continue the social distancing and other steps that help slow the spread of COVID-19.
If you’re vaccinated, you could still carry the virus, Fauci explained. “It is conceivable that you get infected, you don’t know it, you don’t get sick, you’re doing fine — but you’re shedding enough virus that you may be a threat to other people.”
Even if everyone in your household is vaccinated, Fauci said, “Herd immunity in the house is different than herd immunity in the population.”
That’s still a ways off: “We would likely need about 70% to 85% of the population vaccinated before you get herd immunity. When we get to that point, then you could talk about a relaxation of some of the public health restrictions — not completely, not everything, but not the stringency which we’re requiring now.”
Fauci reiterated the extra problems that Black and Latino communities face as a result of disparities that have been around in American society much longer than the virus.
“First, they have a greater likelihood of getting infected in the first place on the basis of the jobs that many of them hold, which are out in the community interacting with people in essential jobs. Next, when they do get infected, they have a greater incidence and prevalence of the comorbidities that make it more likely that you’re going to have a serious outcome if you do get infected. And those are things like hypertension, diabetes, obesity, chronic lung disease, kidney disease, cardiovascular disease.
“The social determinants of health are such that those people do, purely on a demographic basis, have a higher incidence. It’s not racial, it’s the things that they have, unfortunately, experienced, through no fault of their own, literally from birth — you know, improper diet, economic situations, lack of access to health care, those kinds of things.
“So, I would hope that if anything comes out of our experience here, we make a commitment to remove [them]. And it will take decades to do that,” Fauci said.
The bottom line
“I think things will likely get a little worse before they get better,” Fauci said.
He said case numbers are starting to level off, which means hospitalizations and deaths should eventually decrease from the “outlandish” statistics of a month ago, when there were 300,000 to 400,000 cases and 4,000 deaths per day.
“So, even though there are tough times ahead, I think things — if we stay on course, continue to implement public health measures — hopefully, we’ll get better and better as we get into February and March,” Fauci said.
WTOP’s Mike Murillo contributed to this report.
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