In a virtual forum hosted by the Brown University School of Public Health, Dr. Fauci joined incoming dean Dr. Ashish K. Jha to address the challenges and responsibilities as public health leaders work to limit COVID-19’s spread.
PROVIDENCE, R.I. [Brown University] — To say that Dr. Anthony S. Fauci is busy is an understatement.
“Not to engender sympathy, but I have not had a single day off since the very beginning of January, when we decided that we going to start working like crazy on a vaccine,” Fauci said on Friday, Aug. 7, to a virtual audience of many thousands.
The insight came in reply to a question from Dr. Ashish K. Jha, incoming dean of the Brown University School of Public Health, in a live-streamed Q&A discussion focused on the responsibilities that public health leaders face in limiting the COVID-19 pandemic’s spread.
One of the world’s leading infections disease physicians and a member of the White House Coronavirus Task Force, Fauci has served as the director of the National Institute of Allergy and Infectious Diseases at the National Institutes of Health since 1984 and has advised six presidents on pressing public health issues.
Fauci said that to make progress in battling the pandemic, a set of fundamental principles must remain at the forefront: universal mask-wearing, physical distancing, avoiding crowds, spending more time outdoors, proper handwashing hygiene, and staying away from bars. He said states that have stuck to those principles have seen lower infection rates than those that relaxed restrictions too early.
“If we do those things — and I’m going to repeat it until I’m exhausted — those things work,” Fauci stressed. “When you have something that needs everybody pulling at the same time, if you have one weak link in there that doesn’t do it, it doesn’t allow you to get to the end game.”
Somewhere during the course of trying to control the pandemic while also keeping the American economy afloat, Fauci said some state and federal leaders began to send the message that the country faced an “all or nothing” choice between the two — that communities could either follow public health recommendations, or they could reopen their economies.
“One is not the enemy of the other,” he said, disagreeing vehemently. “One is a gateway to get to the other.”
“I believe strongly and I’ll say it very clearly,” he added. “We do not have to completely lock down if we do things right. And if we do these things right I believe we can open up the economy, get the employment back, get people out of the doldrums of being locked down.”
In addition to discussion with Jha, Fauci answered questions from Brown students on topics ranging from vaccine development, how to ethically prioritize medical care and how structural racism is fueling the pandemic in underrepresented demographic groups.
Abdullah Shihipar, a public health research associate at Brown, asked Fauci what Americans can expect from a vaccine rollout.
Some vaccines guarantee a certain level of protection, Fauci said — measles vaccines, for example, carry an efficacy rate of nearly 98%. “You don’t have to worry about anything else, you just get yourself vaccinated and you’re protected,” he said.
But in dealing with novel coronavirus, a virus for which a vaccine depends on capturing a natural immune response just as well or better than a human body can create, researchers aren’t yet sure what the efficacy rate will look like.
“But the chances of it being 98% are not great…” Fauci explained. “Which means you must never abandon the public health approach. You’ve got to think of a vaccine as a tool to be able to get a pandemic to no longer be a pandemic, but to be something that’s well-controlled.”
When it comes to disease, there’s control, elimination and eradication, he explained. Scientists have only eradicated a single human infection in the history of the world — smallpox. But they’ve effectively eliminated polio and malaria in the United States and controlled other diseases to significant levels.
“What I’m shooting for is that with a vaccine and good public health measures, we can bring it down to somewhere between really good control and elimination,” he said. “So that’s what a vaccine is going to do, but it’s not going to do that alone.”
Discussing the issue with Fauci, Jha shared that when he was starting as a senior resident at the University of California, San Francisco, in 1997, he saw many cases of pneumocystis pneumonia, a serious and contagious infection of the lungs.
“These were patients that I saw every single day,” Jha said. “But in 2001, in my last year at UCSF, I don’t think I saw a single case of pneumocystis pneumonia. Science, when it works, really is miraculous.”
Fauci echoed that sentiment, offering words of encouragement for younger people who may not have lived through an epidemic or pandemic yet.
“This is going to end,” he said.
“And it’s going to end because of science,” Jha added.
Shekinah Fashaw, a public health graduate student at Brown, asked Fauci about the intersection of infection rates and race, noting the magnified impact that COVID-19 has had on communities of color.
“To get corrected, you have to make a decades-long commitment to change that,” Fauci said. “The thing you can do now is to make sure that resources are concentrated geographically to those demographic groups that are clearly at higher risk of infection so they can get immediate testing, immediate results and immediate access to health care.”
Decades of inequity and limited access to health care have had a detrimental effect on the overall health of minority groups, which Fauci called unacceptable. “We’ve got to do things societally to change that,” he said. “Maybe it will be a wake-up call for society to change.”
Responding to a question from Brown medical student Katherine Barry, Fauci urged young people to remain hopeful and to remain flexible as they plan careers in medicine and public health, sharing the story of how the emergence of HIV in the early 1980s unexpectedly shaped for him a career in infectious disease.
“In my own career, the thing that has shaped what I’ve done has been less my planning than the circumstances that thrust themselves in front of me, completely beyond my control,” he said. “Keep an open mind. Opportunities will come your way that you can’t imagine.”
In introductory remarks before the conversation, Brown University President Christina H. Paxson referenced a story told about Dr. Fauci by Luke Messac, a Warren Alpert Medical School resident.
Thirteen years ago, when Messac was an undergraduate writing a thesis about AIDS, there was one doctor in particular who Messac hoped would talk to him. So Messac emailed Fauci out of the blue and was floored when the doctor invited him to his office, where he answered all of his questions. Months later, Fauci went on to read and praise Messac’s thesis.
The interaction has since gone, well, viral.
“Dr. Fauci’s lesson has stuck with this doctor as he’s now on the frontlines dealing with COVID-19 here in Rhode Island,” Paxson said. “I think we will all look forward to being the students of Dr. Fauci for today.”