I want to start with progress in the development of a vaccine. You said that as of January, we were 12-18 months from a vaccine, but now we hear people saying that there could be a vaccine by the end of the year. Is it realistic?
In January, when we started to develop one of the candidates, one of the many candidates, I said that we would hope by going through the various stages carefully but nevertheless quickly without compromising safety or scientific integrity, I felt from year to year and a half, we could very well have a vaccine available for deployment. I said it in January, and a year from January is December.
I think that with the way things are progressing now and the fact that we are going to go from one stage to another with an investment risk but no risk for the patients – in other words, in the way standard as you develop a vaccine, you do not make major investments in the next step until you are sure the previous step works and are satisfied with it. If you go ahead and at least prepare and make investments, for example by preparing sites for trials and even starting to produce a vaccine before you even know it is safe and effective, that you are taking a risk and that the risk is a financial risk, it is not a security risk. If you do this, you can reduce the process of getting vaccines by several months instead of waiting until you are pretty sure everything is working and for example starting to make the doses. When you start making them in advance, the risk is financial, because if it works, you save a lot of time. If not, you have invested money that you are not going to recover. I think that when you put these things together, always with great attention to safety and scientific integrity, it is conceivable that if things work well, you could have a vaccine that could be ready to be deployed from here the end of the year, the beginning of 2021.
This assumes that the vaccine works. We’re talking about schedules that whenever you develop a vaccine, you always remember it, you always have a question that you might not get an effective vaccine. Even if you do everything right and do everything on time, there is no guarantee that you will get an effective vaccine. So when we talk about having a vaccine that might be available in December or January, it assumes that the vaccine is really effective.
What does it mean to “have” a vaccine? How many doses must be developed, dispensed or administered before you can legitimately say that they are available? The director general of the World Health Organization, Tedros Adhanom Ghebreyesus, has warned that the virus will only be defeated if everyone in the world has access to a vaccine.
This is the reason why you not only need multiple shots with multiple companies involved, as this increases the chances that you have more than one successful vaccine, but also if you need multiple companies with all of their capabilities to produce a vaccine to have a vaccine that is not only enough for us here in the United States, but also for the rest of the world. We are not alone on this planet. There are many other countries and nations and regions that may need vaccines.
I’m pretty sure the idea of increasing production and starting months in advance, like this summer, instead of waiting until late fall and early winter, which delay availability of doses and medications if you start early enough near the end of spring, early summer and approach phase three, you could have 100 million doses by the end of the year and maybe a few hundred million doses early next year. I mean it’s ambitious. Companies think they can do it with the right financial support.
How concerned are you with the strength of the supply chain needed to deliver a vaccine – vials, needles, syringes, et cetera?
In this process, this rapid approach to a vaccine – it was given the name Operation Warp Speed. I worry a little about this name, because it can imply by the speed of distortion that you go so fast that you skip important steps and do not pay enough attention to safety, which is absolutely not the case. But in this program to accelerate the development of the vaccine, we think it is actually possible to get the types of doses that you would need.
As part of this program, we have employed a person, a United States Army general, Gustave Perna, who is very much appreciated in the military for his ability to do things like the supply chain and distribution and things like that.
Recently, the debate in Congress has focused on the economics of the recovery. What do you want to see from Congress to address the public health side of the crisis?
Congress has been extraordinarily generous in giving the CDC and NIH and other federal government agencies enough resources to do the job that we are challenged to do. Congress, the Senate and the House on both sides of the aisle have been extremely generous in terms of public health and the economy.
Just watching the amount of investment to help the economy recover has been extraordinary. Likewise, they have made major investments to enable us to do our work in public health and biomedical research.
The Senate is in D.C., but the House votes from a distance. Should lawmakers come to D.C. or is it too risky?
I would leave that to their complete discretion and to the advice of the House and Senate physician, rather than my opinion on what they should or should not do. They have good medical advice and should follow this medical advice.
The CDC has not issued guidelines on the reopening of churches and places of worship. How would you advise places of worship to reopen safely?
There are general guidelines for reopening that can be applied to places of worship. I wouldn’t say there are no guidelines out there, there are general guidelines for that, and this is done in the same measured way that we open up other areas where there is a congregation. You have to be careful, it depends on the state, city, region, county you are in and the dynamics of the epidemic. So if you are in an area where there is relatively little infection, as there is in some parts of the country, compared to an area where there is still a high degree of infection, the way you approach what you do in places of worship really varies. You want to make sure that you have a good physical distance, wear a mask if necessary when you cannot physically separate from an individual, all these things are a combination of what is already in the guidelines as well as common sense .
Were you surprised to hear President TrumpDonald John Trump Senate panel approves Trump nominee under investigation Melania Trump thanks students in video message at CNN city hall Fauci says media will “see more” of him is taking hydroxychloroquine?
I will not comment on this.
What is the best role for antibody testing now? Should we rely on antibody testing as a measure for reopening?
I think we have to be careful because we want to make sure that when we do antibody tests, we have tests that have been validated and are reliable. The other thing is that we have to be careful because we don’t know at the moment what a positive antibody test means. This certainly means that you have been exposed and that it is likely that you have recovered, especially if you have no symptoms. The durability of the antibody response, the degree of protection you get, the relationship between the type of antibody, whether or not you are protected and for how long are still things that are open questions that we are looking at to see if we can add solid science to it.
Certainly, the suggestion is that if you have recovered and have an antibody positivity, you are protected for at least a reasonable period of time. That’s the assumption. The assumption is probably correct, but we have not yet definitively proven it. So I think antibody tests have value in getting a sense of the penetration of the infection into society. You could easily understand this by finding out how many people were actually exposed and infected by doing an antibody test. Which you can determine and which would be important to give you an idea of the amount of undetectable infection in society. Due to the large number of infections, the person remains asymptomatic. You wouldn’t know unless you do a variety of surveillance studies, and one of the ways to do a surveillance study is to do screening with antibody tests.
Some states reopen without following CDC guidelines. Does this concern you?
It is prudent for states that are at different levels of infection to follow the guidelines that have been issued on the reopening or opening of America. And this consists of going beyond the gateway criteria and then moving on to the different phases at the rates prescribed by the directives. Obviously, if some states do not, there is always a risk of resurgence. Hopefully if there are states at least have the ability to deal with this by having the manpower, testing and process in place to identify, isolate and contact the trace. So I hope they will have this in place to avoid a major resurgence.
Much of the federal response has been to let states act on their own. Did this hinder the federal response? Without national guidelines, how can we be sure that each state communicates information and follows the same parameters?
The system in our country is that the federal government provides general direction, general direction and supports the resources, if any, the states. But the States have the discretion of the rhythm at which they will make this attempt to reopen. There is a set of guidelines they can follow, but there is some discretion as it is not unique. We have a big country and we have different degrees and dynamics of the epidemic in different parts of the country. And although the federal government provides support, support and advice, it is ultimately the states that make this decision.
The United States is approaching 100,000 deaths from coronavirus. How do you assess where we are on the epidemiological curve?
One of the things that is going to be important is that when we open up and try to go back to a certain level of normalcy and reduce the attenuation, what is our capacity? And I hope it’s intact. I think it’s in some areas. What is our ability to be able to respond to the inevitable flaws you will see when you remove the mitigation measures, and to the workforce who can do it to be able to identify, isolate and contact the trace. If we have that in place and it is fine, then there will not be a much greater number of infections. If we don’t manage this well, we could have even more infections than the models predict.
One of the models I was quoting at the time said that there would be between 100,000 and 240,000 deaths, and we’re very close to having 100,000 right now. Hopefully it won’t get much more than that, but it will depend on how we react to the inevitable bounces you see when you step back. If you answer correctly, you can keep this number relatively low.
When was the last time you were tested? How often are you tested?
I tested a lot negative. What day is it? Friday? Yesterday I was negative.
Were you surprised by the role that politics plays in this epidemic? Even a virus has become political football in our hyperpartisan era.
I’m trying to dissociate myself from that, and I’m doing what I’ve done from the start, is trying to give the best advice and guidance in public health on the database, on the basis of scientific data and evidence. I’ve always done this and I have managed to stay out of some political whirlwinds that happen all the time.
I am not surprised that this is a political situation. It happens, I mean it’s not the first time it’s happened, but I’m trying to disassociate myself with that.
You have become more visible than ever, even more so than during Ebola or H1N1. Has it changed your daily life in any way?
It sort of transformed my daily life into fairly intense 8 p.m., 6 p.m. and 7 p.m. days. As it should be, because this is a very serious problem and we feel very responsible for doing the right thing for the health and safety of the American public.
Do you see a possibility for the big professional sports leagues to play games this year, even without fans?
I think so. Several of the major organizations in the league, baseball, soccer, football are all trying to do something in a way that would be safe for the players, safe if there are spectators. Certainly, the first line would be that these sports where you can broadcast it and people can enjoy watching the sport without necessarily gathering in a stadium or arena. I think that the different major league sports try to be creative while keeping in mind that their first responsibility is the safety of the players and the staff, and also if there are fans, the safety of the fans .
I cannot predict with certainty what is going to be possible, but I can tell you that there is a lot of discussion to see if, in fact, we can organize sporting events during this year.
The coronavirus has disproportionately affected African-Americans and other minority communities. How are we using the crisis to address historical health disparities?
I hope we learn from COVID-19 to refocus on the things we have known from the start, that there are significant health disparities that need to be addressed. A bright light shines on this when you are in a crisis like we are now, when you see these very disturbing numbers of African-Americans and other minorities once again bearing the burden of the disease. And I hope that when we get this COVID-19 under control, we will not forget the fact that we still have to tackle these health disparities, which will be present unless we correct them.
How long do you plan to stay in your job? Have you considered retiring?
No, I never thought about retiring. I have too much work to do right now.