S1E42 / One on One with Tony Fauci

We are in the middle of a very politicized situation. So when you try to get a public health message out, unfortunately, it becomes so political that there are those who are in favor of what you want to do from a public health standpoint and those who oppose it to the point of almost as if you were doing something to hurt them. You've got to try to understand them and not just criticize them. Criticize them, because if you criticize them and put them down, you will never, ever win them over. They will continually be pushing back against you.

Hi everyone, this is Dr. Celine Gounder, and you're listening to Epidemic, the podcast about the public health and social impacts of the coronavirus. We're back from our summer break, and we have a special guest to welcome you all back to the show, the one and only Dr. Tony Fauci. We spoke with Dr. Fauci on Wednesday, September 9th, about his role as the nation's chief science communicator. We'll hear his take on the latest COVID vaccine news, how he tries to reach people who don't always believe the science, and we'll hear why Mario Puzo's novel, The Godfather, is one of Dr. Fauci's favorite books of philosophy. So let's get to our conversation with Dr. Tony Fauci. Welcome, Dr. Fauci. It's so great to have you join us on The Epidemic Podcast. So the hot science topic of the moment is, you know, vaccines and the AstraZeneca Oxford vaccine trial that was put on hold while they investigate a potential adverse event. And it's been confirmed that that study participant did indeed receive the experimental vaccine, not the placebo, and that she experienced an adverse event called transverse myelitis. So for our audience, transverse myelitis is inflammation of the spinal cord. How concerning is this pause in the trial to you?

Well, first of all, I think what it manifests is the, the success of the checks and balances of doing a phased trial. I mean, the whole purpose of going from phase 1 to phase 2 to phase 3, where you have a lot of people in a trial, is to determine efficacy, but also to determine safety. So the fact that you have a serious adverse event in this case, which was identified, I believe the New York Times has already said it was transverse myelitis. I'm not sure the company has confirmed that that's what it is, but it certainly was a serious adverse event. What that means is that you put the rest of the enrollment on hold so you don't enroll any other individuals until you can more thoroughly check out the nature of this. And that's the reason why you have 30,000-person clinical trials so that you have enough people in the trial. If it looks clear, they likely will go back to more carefully accruing individuals, enrolling individuals in the trial.

Earlier this week, 9 major pharmaceutical companies involved in vaccine development issued a joint pledge about the COVID vaccine approval process. Why did they do that, and what were they trying to communicate, do you think?

I think they did that because they wanted to assure the American public that they were going to do it in a way that was up and up. They were not going to try and rush it, and they would only apply either for an EUA or for a license when they had enough safety and efficacy data that they would feel comfortable with it. So I think it was actually a good thing that they did.

Given what we know about immunity to this coronavirus, to other coronaviruses, how likely is it that a vaccine will provide long-lasting immunity?

Well, I think it's much more likely that we will get a vaccine that does show protection that's safe and effective. The thing that still is questionable is how long is that immunity going to last in a way that it is actually protective. Classically, when you look at the common coronaviruses that cause the common cold, the duration of protective immunity is really measured in several months to a year or a bit more. You don't usually ever see lifetime immunity protection against coronaviruses that you've been exposed to before. We'll just have to wait and see what kind of protection we see, whether or not it's against infection or against significant recognizable disease. Now, either one would be good, but I'm not sure which one it's going to be.

So, Dr. Fauci, you're not just a scientist, but you're also a science communicator. And I think a lot of people don't quite know in some ways what your job is. If you could just explain what is your job and why is science communication such a big part of that job?

Well, my fundamental job is that I'm a physician scientist. I'm the director of the National Institute of Allergy and Infectious Diseases, which is the second largest institute at the National Institutes of Health. So my fundamental core responsibility is to be the director of the scientific enterprise in infectious diseases and clinical immunology. Because of the COVID outbreak and because of other outbreaks, I've also taken a secondary role of communicating in general and to the American public and to the world different aspects of these outbreaks that is important for people to know. I'm doing that currently with COVID-19. It isn't written into the job description, but it's just a responsibility that over now multiple decades I've been doing this in 6 administrations for 6 separate presidents. Involving outbreaks ranging from HIV/AIDS to the anthrax attack to Ebola to Zika to pandemic flu and a variety of others.

So we don't hear so much from Dr. Deborah Birx or Dr. Adams or Dr. Redfield as we used to, and Dr. Hahn has had his credibility called into question over the emergency use authorization for convalescent plasma. In some ways, you're the last the last science communicator left standing. What does that feel like for you?

Well, you know, it's a role that I welcome because I think it's important. It's challenging, but I think it's very important. Science communication and getting the facts and the data out to people in a way that has a degree of clarity to it and a degree of consistency to it is important. I think it's as important as some of the fundamental, basic, and clinical scientific things that we do. I welcome the role. It sometimes gets complicated because you're dealing with people who keep pushing back on you when you try to communicate.

Some people may not know that you're an avid reader of political histories. Is there an example that you can point to that's influenced the way you approach your leadership and how you communicate about science?

You know, the political history of World War II, I think, is important. I've been very much interested ever since I was a young boy, and I think, you know, the challenge to the world of something that had the potential of completely upheaval in the world was, was the extraordinary situation with World War II and the kinds of draconian things we ultimately did with production of the materials to win the war and to get to the point where you went through a potentially totally catastrophic situation and yet came out when it was all over with a world that was actually somewhat better. So I would hope that with the lessons learned from this very difficult situation that we're going through, that we will be better prepared. You know, as I've always said multiple times, There have always been pandemic outbreaks long before even recorded history. We're going through them now and we will in the future. So hopefully we'll be in a situation where we'll be better prepared.

So we're speaking on Wednesday, September 9th, and earlier today there was a Senate hearing on the coronavirus vaccine and other control issues. Senator Lamar Alexander of Tennessee commented specifically on our underinvestment in public health over decades and the need for greater preparedness moving forward. What would that look like in your opinion? You know, applying, as you said, those lessons from World War II, how would we be better prepared to handle a pandemic in the future?

Well, you know, one of the things that unfortunately has happened, probably a victim of our own success, is that when we developed vaccines and antibiotics against many of the common infectious diseases, that we don't think very much about now, but that really devastated societies, we had a public health system in this country that was really quite good at the local level. We've let that essentially dissipate a bit. And right now, when we needed to respond at the local level, we don't really see the kinds of things that we would like to see. We've really got to build up a local public health structure, number one. We also have to have better communications, and we tried to do that with the Global Health Security Network that we built up a couple of years before this outbreak. We've got to strengthen that even more right now so that there's interconnectivity between different countries to be able to respond in real time, exchange information, and help each other respond when you have an outbreak like this. Those are just a couple of things that I believe we need to do.

So I've heard that one of your favorite books of philosophy is The Godfather. Why is that?

Well, it's kind of funny, but it's true. If you look at some of the things that are said there, even though they're in the context of a criminal situation, they really do have some truth to them. You know, the issue that I use an awful lot is when somebody says, how can you put up with this stuff that goes on And I always say the famous words from The Godfather, "It's nothing personal, it's strictly business." It's not personal, Sonny. It's strictly business. And a lot of times the things I have to put up with, with activists in the beginning where it looked like they were attacking me, they weren't. There wasn't really anything personal. It was something they just wanted to get the point across. So that's why I use that often, The Godfather, as a book of philosophy.

So you mentioned activists. So during an earlier episode this season of the podcast, I interviewed HIV activists Mark Harrington and Peter Staley, and they tell me you throw a great dinner party. How did you use those dinners as a tool to bring people together to work on contentious issues?

Well, I did it because during the early years of HIV, it was very clear that the activist community had very important contributions to make, even though the generally rigid scientific and regulatory community really shut them out and did not give them the opportunity to express the concerns that they had. They became very iconoclastic, very provocative, very theatrical. And I felt if you could get beyond the theatrics and get beyond the confrontation and listen to them, that we could learn a lot. And one of the ways I found to do that was to do it in a friendly social setting. So what would happen is that I would often invite them down to Washington, D.C., with the help of my deputy Jim Hill, who was also very much involved in the outreach to the activist community. And we would have dinners in Washington. We would sit down, you know, have a glass of wine, a bottle of wine, have a nice meal. And it's amazing when you have people in a relaxed setting how you can really develop the kinds of relationships that holds you in very good stead in getting important and difficult issues resolved. And they have led actually to long-term friendships because the people that I had the dinners with back then just to get to know them have turned out to be some of my best friends now.

So things are different today in part, in no small part due to social distancing and mask wearing, but is there a modern day, a current day equivalent for you in terms of how you're reaching out to people of different mindsets on the COVID issue?

Well, yeah, I mean, right now it's a different situation because we are in the middle of a very politicized situation. You know, a lot of divisiveness in our country. So when you try to get a public health message out, unfortunately it becomes so political that there are those who are in favor of what you want to do from a public health standpoint and those who oppose it to the point of almost as if you were doing something to hurt them, as opposed to realize that we're all in this together and the public health measures are important to be able to protect the individual and society. So you have to reach out to people who are pushing back on what you're trying to do and get them to understand the rationale and the importance of what you're doing.

How do you do that? And is it just about science and facts Or is there more to it? Is there a psychological component?

Well, there's certainly a psychological component. It isn't only about science. In fact, you've gotta understand and keep an open mind as to why people are pushing back on things that seemingly are so obvious that need to be done. You've gotta try to understand them and not just criticize them because If you criticize them and put them down, you will never ever win them over. They will continually be pushing back against you.

Take for instance, mask wearing. Why do you think some people have concerns about that and how do you approach them regarding those concerns?

Well, I think mask wearing has become a symbol of resistance or not. I mean, the people who don't want to wear masks in many respects, are resisting the authority of telling you that it's a good idea to wear a mask. So it has very little to do with public health and more to do with the resistance of somebody telling you to do something that you may not really want to do.

And how do you overcome that kind of mindset?

Well, again, it's the same way of trying to reach out to people and understand their individual perspective without necessarily criticizing them.

Many, including my former co-host Ron Klain, who served as White House Ebola coordinator, have said public health is by definition political. Do you agree with that?

Well, you know, you would like it not to be political, but it turns out that it is political because there are different viewpoints about what you should do, about the seriousness of situations. So, you know, inadvertently and unfortunately, it does become a political issue. You would've wished that politics were completely out of the picture when it comes to public health, but that's unfortunately not the case.

And so given that, how do you stay as apolitical as possible with something like public health that is at least to some degree political?

Well, what you do is don't ever get involved in anything that is political. Don't take a political stance. You really, if you have any ideology, you've got to not express it. Once you start showing a political bent, then you've essentially neutralized half of what you can do. The reason that I have survived and I think been successful with multiple administrations that clearly are some very conservative, some moderate, and some very liberal, and some liberal moderate, I've been through them all. And the reason I've been able to to continue to interact with them is that I don't let politics get involved in anything I do. It is purely scientific data and evidence.

And why do you think public health is seen as political in a way that basic science research isn't?

You know, that's a good point because public health involves the general public and things that are meaningful to them in their life right away. Whereas basic and clinical science sometimes seems far removed from what is meaningful to people in real time. And whenever you get things that are important to people in real time and has an impact on their lives, there's always the possibility that there are going to be political considerations that come into play.

There's been a lot of controversy about data collection, of reporting of data. How transparent do you think the government should be with the public health data, or for that matter, with clinical trials data? And to what level of detail should the public have access to that?

I think it should be totally transparent because, you know, a lot of the details of it, the general public may not understand, but I think the broad strokes principles of it should be very transparent. I mean, this is data, this is science, it impacts people. They should have the opportunity to be able to look at it. And those in the general public who have the inclination to delve more deeply into it can, whereas others may just want to take it from 40,000 feet and see what it is. But in any event, it should be all transparent.

Dr. Fauci, thank you so much for your time. Glad to see you're recovering from the surgery, and, uh, we appreciate everything you've done in service of our nation over your long and distinguished career.

Uh, thank you. I appreciate it. Nice being with you. Thank you for having me.

Epidemic is brought to you by Just Human Productions. We're funded in part by listeners like you. We're powered and distributed by Simplecast. Today's episode was produced by Zach Dyer and me. Our music is by the Blue Dot Sessions. Our interns are Annabelle Chen and Brian Chen. If you enjoy the show, please tell a friend about it today. And if you haven't already done so, leave us a review on Apple Podcasts. It helps more people find out about the show. You can learn more about this podcast, how to engage with us on social media, and how to support the podcast at epidemic.fm. That's epidemic.fm. Just Human Productions is a 501(c)(3) nonprofit organization, so your donations to to support our podcasts are tax deductible. Go to epidemic.fm to make a donation. Starting this fall, we're going to release Epidemic every Friday, but producing a podcast costs money. We've got to pay our staff. So please make a donation to help us keep this going. And check out our sister podcast, American Diagnosis. You can find it wherever you listen to podcasts or at americandiagnosis.fm. On American Diagnosis, we cover some of the biggest public health challenges affecting the nation today. In Season 1, we covered youth and mental health. In Season 2, the opioid overdose crisis. And in Season 3, gun violence in America. I'm Dr. Celine Gounder. Thanks for listening to Epidemic.