Anthony Fauci: The COVID pandemic

Chris - Of course one of the points you make about the development and elaboration of treatments and therapies and so on where we really did see things go at a pace was in COVID. And this is probably the time when you did become a familiar household name. And it's quite a turnaround, isn't it? How quickly we went from having nothing, not even any knowledge about this threat to having vaccines going into people's arms. But what went through your mind, because I know what went through my mind in January, 2020 as I began to see these reports coming out from China. What went through your mind when you started to see all these dots lining up?

Anthony - Well, for me and for what my responsibility was, it was all hands on deck to develop a vaccine as quickly as you possibly can. And fortunately, we had made investments in basic and clinical biomedical research for the development of vaccine platform technologies and structure-based immunogen design for years before January, 2020.

Chris - But when did you realise that this was the big one?

Anthony - Oh, you know, it was a gradual process over weeks. I mean, the first reports that we got, like the very, very first week of January, of things that were going on in December. It was originally thought, well, maybe this is just like the original SARS-CoV-1 that had occurred in 2002, in 2003, which was a novel coronavirus that I guess you could call a mini pandemic or an epidemic. It had about 8,000 cases and killed 781 people. But it wasn't efficiently transmitted from humans to humans except in a public health medical setting, like in a waiting room of a clinic or a hospital. And it was very well controlled relatively quickly over about a year with good public health measures of identification, isolation, contact tracing, and quarantine. So it felt, well, maybe that was it. And the reports we were getting out of China first was that, well, it's really transmitted from an animal to a human, but very inefficiently from human to human. Then as we got into the first couple of weeks in January, the information started to change and we said, 'well, wait a minute. It is effectively transmitted from human to human.' And then a week or two later, it was like, wow, it is very, very highly transmissible from human to human. And then we started to realise that a lot of the transmission was from an asymptomatic person. 50 to 60% of the transmissions were from someone who had no symptoms. So the normal paradigm or the syndromic approach of isolation, identification, contact tracing when you had a symptomatic person wasn't very efficient. And then at that point it became clear that there was widespread transmission in China and the Chinese were building like thousand bed hospitals at the end of January, the beginning of February. Then it became very clear we were in for some serious trouble. And then a cascade of events in Europe, Northern Italy, got hit badly. You know, when you could say, well, maybe you could contain it if it was a disease that was able to be contained by public health measures. But once it started becoming very clear that a country as sophisticated as Italy and other European countries and then as we knew it was just like a domino effect, it was throughout the world. And that was in the very few weeks, January into February, it became very clear we were in for some serious trouble.

Chris - I gave a television piece and I was on shortly after Donald Trump did a press conference on the same international channel. And I think you were standing in that same press briefing and this is where he was effectively saying, 'we're well prepared. We've got this.' Would you agree at that time or were you thinking, actually I'm not so sure. February, March, 2020

Anthony - <laugh> Well, that's what got me into the situation now because as you know, when the president was saying 'It's gonna go away like magic', I had to get up publicly and disagree with him and say, no, it's not going to disappear like magic. We don't have good control over it. And then he started saying that interventions like hydroxychloroquine are going to be the magical cure for it. And I had to publicly disagree in order to preserve my own personal scientific integrity and to fulfil my responsibility to the American public, I had to speak out, which was not a very comfortable thing to do. That unfortunately made me public enemy number one of the far right who were those who were essentially highly, highly supportive of what the president was saying.

Chris - Later on that year, we began to get the first vaccine trial results, and then the UK was the first country to actively start vaccinating its population. And then we realised that we had more people to vaccinate than we could vaccinate following what was written on the pill bottle or the vaccine vial, which was a certain time between two doses. And you made a few disparaging remarks about both the rate at which the UK had approved things. And also then about bending the rules, lengthening the time between doses. And then the rest of the world actually decided that this was quite a good idea and they followed. Was that a misstep or do you still stand by that?

Anthony - No, I actually publicly apologised to my British colleagues for that. I think it was taken out of context a bit. I did say that I was very concerned that the way the trial was done, whether it was the optimal way or not, but the evidence based on the clinical trial was to vaccinate and then wait three or four weeks, depending upon the product. 21 days for 1, 28 days for the other. And when I heard what the UK was doing, I expressed some concern that that was not according to the results of the clinical trial. And it sounded like a criticism. And when I went back and listened to how it sounded, I was interviewed by the BBC very shortly thereafter. And I made it very clear that I felt badly that I did not want to in any way disparage my UK colleagues who I have a great deal of respect for. So it really was actually truly a public apology for that.