In the past 12 months of struggling with the coronavirus, one figure has come to symbolize forthrightness, scientific rigor, and epidemiological experience—at least to the majority of the American public that doesn’t boo when his name is mentioned. Of course, that’s Anthony Fauci, the longtime director of the National Institute of Allergy and Infectious Diseases. It was no surprise when President Biden appointed Fauci the chief medical adviser of the new administration as it attempts to end the Covid-19 pandemic. In the last few weeks, Fauci—who was sometimes silenced in the previous administration—has been ubiquitous in explaining vaccines, mask protocol, and the impact of potentially dangerous variants of the virus. Naturally, WIRED has some questions for him as well. In my third time interviewing the vigorous 80-year-old public official, we talked about vaccines, masks, and how he’s been portrayed on Saturday Night Live.
WIRED: We have a new variant of the virus in New York City, called the 526, and it sounds troubling. Is this the one where our luck runs out, and the vaccine might not do so well against it?
Anthony Fauci: I don't think that's going to be the case. It’s not as open-and-shut as you might think. For example, when the South African isolate was tested against the antibodies that are induced by the vaccine, the isolate diminished the effectiveness multiple-fold, but didn't eliminate it. That's the reason why in the Johnson & Johnson trial in South Africa, even though the efficacy against the variant was about 50-something percent, there were no hospitalizations and no deaths associated with that variant. I don't think the 526 in New York is going to be any worse in the sense of evading the vaccine or evading the monoclonal antibodies. I think we're going to see that it likely transmits a bit better than the standard wild type, and may even be a little bit more evasive of the vaccine. But that’s another good reason to get people vaccinated as quickly and as expeditiously as possible. We take the New York variant very seriously. We're following it very closely, but you asked a very provocative question—is this going to be the one that does ascend? No, I don't think so.
That’s the narrative—that we’re in a race between vaccination and variants.
There is a tenet in biology that viruses do not mutate unless you give them the opportunity to replicate. The easiest way to prevent the spread in the community is to vaccinate as many people as possible at the same time that you stick to the public health measures of wearing masks, of avoiding close contact, of avoiding congregate settings. Let's not declare victory yet, right? You don't want the decline that we're seeing to plateau at an unreasonably high level. Right now, the level of daily infections is somewhere between 60,000 and 70,000 a day. That's absolutely too high a level to be acceptable. I don't want to be a downer on all of this. But you've got to continue to practice public health measures until the level of infection goes way, way down. [Less than a day after this interview, the governor of Texas announced he would do the opposite.]
It seems to me that it's almost like a game of Russian roulette—if we don't do vaccination fast enough, sooner or later one of these chambers will have a deadly bullet.
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I would say it a different way. Vaccines are the answer to communicable diseases, spread from one person to another. Throughout our history, we've been confronted with diseases that have threatened our health, life, and even our survival. Smallpox, measles, polio—every one of them has been conquered by vaccines. We are fortunate that already we have three highly efficacious vaccines that have a very good safety profile. Soon, we will have even more. It is our task now to, as quickly and as expeditiously as possible, get as many people vaccinated as we can, in a very organized, quick, and efficient manner. When you do that, you suppress the virus enough that the threat diminishes and diminishes and diminishes.
Considering that urgency, some have argued that we should hold off on giving people the second doses of the Moderna and the Pfizer, to address the supply shortage.
That's rather risky. We don't know what the durability of a single dose is. And it is conceivable if all you do is give the first dose to people and significantly delay the administration of the second dose, you could have a diminution of efficacy. And getting back to your question about variants, we know that the second dose increases the level of antibodies by at least tenfold. That’s why we feel that even if you get infected with a variant, you won’t have hospitalizations and deaths, because you have enough antibody cushion after the second dose to protect you against serious disease.
How long is the efficacy of the second dose?
We know that the antibody levels after vaccination lasts at least six months, and maybe much longer. The reason we don't know how long is we've only been doing this for less than a year.
How and when will we be able to know how long it lasts?
What you do is you follow people for a period of time, you measure the level of antibodies, and you observe if there's breakthrough infections. If it looks like after a year and a half, the antibody levels go down and people start to get breakthrough infections, then we know that after a year and a half, we probably have to give them a boost.
Let's talk about the J&J vaccine. You know that some people are saying they will turn it down and wait for the Moderna or Pfizer, because they're 95 percent effective and the J&J is 65 percent.
No, no, no, it's 72 percent in the United States.
OK, that’s the US number. But what does that mean in a practical sense?
You can't compare one vaccine to another, unless you do clinical trials and compare them head to head. All you need to know is that all three of them are highly efficacious vaccines, period. There may actually be no difference between the two. One thing we do know is that when you get up as high as 70, 75, 80, 90, you have a very effective vaccine. So that's why we keep saying to take the first one that's available to you.
I want to talk a second about therapeutics. I know we had a disappointing result about convalescent plasma. But what about Regeneron and other experimental treatments in early stages of the disease? Last year Trump, Giuliani, and Chris Christie got early treatment and were cured. But if I got Covid symptoms tomorrow, the guidance would be to stay home. Can people in early stages of infection get treatments like Regeneron?
It's efficacious if it's given early. The data shows that if you give it to someone after they've already gotten sick enough to require hospitalization, it's not really going to work.
That’s my point—there’s a medicine that can help people in early stages. But you can only get it if you’re super connected.
I don't think so. I think you can get it right now on an emergency use authorization. If your physician would just contact the company, or if they have it in the hospital you happen to go to you can get it.
Well, I'll tell them you sent me.
You can say I sent you.
One question about masks. I'm curious if you've ever tried to buy a mask on Amazon. It's super confusing. And I think people are still a little uncertain about the best mask regimen.
There are a number of masks. The CDC makes a recommendation that most masks are fine. You can have a surgical mask. If you have a cloth mask, as long as it's a double-ply mask, that's fine. I would just go to the CDC website and it will tell you all about masks.
I find it confusing to know which ones match the standard. But another question. Can you give a quick overview of the differences between how the Covid response is done on the Biden team, as opposed to the previous administration?
I don't want to do comparisons, so I have to pass on that one. I want to look forward. I don't want to be criticizing anything.
Well, do you think it was helpful that Donald Trump said at the CPAC conference that everyone should take the shot?
I think that was very nice that he said that. I hope he continues to say that. He's got a lot of influence. And I believe that if he tells people to get vaccinated, that will be very helpful.
If you had gone to CPAC, could you have changed some minds?
What do you mean, change the minds?
The minds of the people who are skeptical about Covid vaccines, or who don’t wear masks that much.
I think that Donald Trump would have much, much greater influence on changing minds at CPAC than I would.
It’s been a year since the lockdown. What have you learned about the American people in this long year?
I think we are living currently in a very, very divisive society. Almost split right down the middle, in a divisive way that's unfortunate, because it isn't just differences of opinion. It's divisiveness to the extreme, where even public health measures take on a political overtone. Where wearing a mask or not wearing a mask is a reflection of what your political leanings are. That should not be. Public health should be independent of political differences. But we didn't see that with the Covid-19 outbreak. We're all in this together, and we've all got to be pulling together. But apparently that doesn't always happen.
One final question: Who did you better, Kate McKinnon or Brad Pitt?
They're both very different, but really terrific. I really like Brad Pitt's interpretation. He did a great job. And Kate McKinnon is just, you know, amazing. She could play Rudy Giuliani, Jeff Sessions, me, and whoever else she played. She's incredible. So I wouldn't want to say one was better than the other
Prediction: Dr. Anthony Fauci will one day host Saturday Night Live.
I don't think so. Whatever it looks like publicly, my job is as a public health person, a physician, and scientist. That's what I want to do.