The country’s leading expert on infectious diseases shares his thoughts on resolving the current public health crisis and preparing for the next
Anthony Fauci has led the National Institute of Allergy and Infectious Diseases for 36 years and has helped guide responses to a succession of viral epidemics: HIV/AIDS, severe acute respiratory syndrome (SARS), Ebola and Zika, among others. President-elect Joe Biden recently appointed Fauci as his chief medical adviser. A voice of reason on the Trump administration’s novel coronavirus task force, the physician spoke to Scientific American about next steps in the response to the COVID pandemic. During the discussion, Fauci highlighted an important gap in treatment options for newly infected people: more antiviral interventions are still needed for early cases of the disease—and, if successful, they could perhaps address future outbreaks that might be triggered by other emerging coronaviruses.
Coronavirus infections are surging exponentially. Can we still get them under control?
Yes, absolutely. I’ve been saying this every day. If we, uniformly throughout the country, implement public health guidelines—wearing masks, keeping physically distanced, avoiding crowded situations, doing things outdoors more than indoors and washing hands frequently—I believe we will see an effect. We know from experience that the states or cities or countries that have done this have always been able to blunt and mitigate the slope of a surging curve such as this one.
What are your near-term priorities going into 2021?
They extend from what I’ve been talking about all along: to get the outbreak under control by uniform adherence to fundamental public health measures and to push ahead with the development and implementation of the vaccine program. I believe that the vaccines that will soon become available, together with public health measures, will be the mechanism that puts this outbreak to an end.
What are your major concerns with vaccine distribution?
We hope to get the overwhelming majority of people in this country vaccinated. We have the logistics under Operation Warp Speed and General Gustave Perna [Operation Warp Speed’s chief operations officer] to put vaccines into the trucks, trains, planes and whatever it is that gets them to where they need to go. But then local public health officials will need the capability and resources to distribute the vaccines in an equitable way. It’s going to be a big task to vaccinate more than 300 million people—a very prodigious project.
Do you see large gatherings opening only to vaccinated people?
I don’t want to make that determination now. Policy decisions will be made after we get the vaccine program going, and I will likely be part of that discussion.
Do you think drugs for early COVID will be needed now that the vaccine is coming? And if so, why?
Oh, absolutely. A lot of people will still be getting sick until we get a level of herd immunity from the vaccine to essentially eliminate this infection from society. Until then, we’re going to need drugs for each and every stage of the infection: early, intermediate and late. Those types of drugs might also be used against yet another pandemic coronavirus. Remember, this is the third pandemic coronavirus we’ve dealt with in 18 years, starting with the SARS outbreak in 2002, then the MERS [Middle East respiratory syndrome] outbreak in 2012 and now COVID-19.
What sort of drug looks promising as a treatment for early COVID?
My overwhelming preference is for direct-acting antiviral agents that can be administered orally. We could give these drugs—likely in combination—for maybe five to six days or a week at most to completely suppress the virus. That, to me, is the highest priority.
What about a broad-spectrum agent against viral illnesses, almost like an antibiotic?
If you’re talking about an antiviral that protects against all viruses, then I think that’s a bridge too far. But you could get a broad-spectrum antiviral that will be good against all strains of coronaviruses and then maybe a different one that works within another family of viruses. An antiviral that worked against any manner or form of coronaviruses would be highly desirable. If we took the problem of yet another emerging pandemic coronavirus off the table, that would be a major advance.
What measures should the U.S. pursue to prevent the next pandemic?
We felt we were prepared for a pandemic before this one, and obviously, there has been a lot more suffering, infection and death than we might have anticipated. So we need to do better. We need global interconnectivity, a global health security agenda, and adequate resources and science. A part of the pandemic preparedness that was very successful—and I think we should recognize that—was the investment put into the technologies now available in the field of vaccinology that allowed us to go from identifying a brand-new virus [around early] January to having a vaccine that’s ready to administer to people in less than one year. That is a pace of scientific advance that would have been unimaginable 10 years ago. The implementation of some public health measures has obviously not been as successful.
The country has been so divided. Do you think we can overcome our differences in confronting the pandemic next year?
I don’t have an easy answer for that because there clearly is a considerable degree of divisiveness in society. I think uniting people will be a challenge for the new administration. I hope they succeed in doing that, because when it comes to public health, everybody needs to be pulling together.
Do you have plans for a memoir once the pandemic wraps up?[Laughs] Do I have plans for memoir? Yes, but I’m so busy right now, I can’t even get a good night’s sleep! So I think that’s going to have to wait.