Anthony Fauci, the director of the National Institute of Allergy and Infectious Diseases, has been putting his voice under some strain. Last Thursday, he underwent surgery to remove a polyp on his vocal cords and spent the weekend "resting his voice," an NIAID spokesperson told NPR.
But in the days before and after that surgery, he made himself clear on a few major coronavirus stories.
Here’s Fauci on why the FDA can’t treat vaccines the way it recently treated convalescent plasma therapy, why he’s not mad about missing White House press conferences, how Covid-19 has disproportionally affected people of color, and whether a vaccine will make life normal once again.
As a public service, Inverse is aggregating Fauci's comments regularly in the "Fauci Dispatch" series, as the White House has severely limited his visibility to the public.
- Read the Fauci Dispatch from August 19, 2020 here
- Read the Fauci Dispatch from August 13, 2020 here
- Read the Fauci Dispatch from August 5, 2020 here
- Read the Fauci Dispatch from July 29, 2020 here
- Read the Fauci Dispatch from July 22, 2020 here
Fauci on rushing a vaccine – Speaking to Reuters, Fauci discussed the importance of testing the coronavirus vaccine step by step, and not rushing approval.
“The one thing that you would not want to see with a vaccine is getting an EUA [emergency use authorization] before you have a signal of efficacy,” Fauci said.
The backdrop – Fauci has previously emphasized that we need to be sure vaccines are both safe and effective, but this comment comes against a different landscape.
On Sunday, the FDA issued an EUA for convalescent plasma therapy – an experimental coronavirus treatment that treats sick patients with blood plasma donated by recovered patients. That means it will be made available to hospitalized patients for whom other treatments are not effective.
There are promising signs that plasma therapy may be effective, but no confirming evidence from randomized controlled clinical trials. There's also been speculation that the FDA was under intense political pressure to make a decision on convalescent plasma therapy based on scant and emerging evidence.
The question is whether that political pressure may extend to vaccines as well. Fauci was reluctant to comment on whether there may be pressure from the President but did say that if a vaccine was given an EUA it could severely limit participation in clinical trials. These are the only studies that tell us if they actually work.
An EUA has never been used to approve a vaccine early before, making this is all speculative.
Fauci on not being a part of White House press briefings – Fauci has been making the media rounds but hasn’t been a part of White House press briefings on Covid-19. In an August 21 Q&A with The Washington Post, he said that he’s not mad about it:
“I like it this way — where I can be on a discussion without being in a situation where it’s a perfect setup to pit one against the press.”
The backdrop – When the White House restarted coronavirus press briefings in August, Fauci wasn't invited. He's met with the President, but he has traded appearances at White House press conferences with one-on-one interviews with news networks.
In the Washington Post interview, Fauci went on to say that he likes things better this way, partially because the press briefings, he added, were "not the right way to educate the public."
"I like it this way."
What is the right way to educate the public about coronavirus? There's some evidence that the US has struggled to provide a cohesive messaging. Example A: the way the agency communicated the change in opinion on masks. Speaking to NPR in July, Fauci added that the mixed messaging on masks early on hampered the government's ability to slow the outbreak. Masks work.
"We have to admit it, that mixed message in the beginning, even though it was well-meant to allow masks to be available for health workers, that was detrimental in getting the message across," he said.
In June, CDC director Robert Redfield also cautioned that the agency's public health message "wasn't resonating." Whether Fauci's new approach might help clarify messaging remains to be seen.
Fauci on whether a vaccine will make life normal again – During a conversation about coronavirus vaccines, 60 Minutes Australia posed a critical question to Fauci: Will a readily available vaccine mean life can go back to normal?
“That’s a good question, and the answer is I can’t tell you right now, because it’s going depend on what the level of efficacy is," he said.
The backdrop – The FDA will consider a coronavirus vaccine effective if it works to prevent Covid-19 or decrease the disease's severity in 50 percent of people. What we're really aiming for, according to Fauci, is efficacy around 70 percent.
If we got to that point, he told Der Spiegel, we could get “a good enough umbrella of protection over the whole community” and control the pandemic within a year or so.
How close we will actually get to that mark depends on the outcome of the numerous in-the-works phase III clinical trials, the largest stage of human testing.
We still don't know for sure what protection from this virus really means. Immunity to the coronavirus doesn’t necessarily mean that you can’t test positive for it again, or perhaps even spread the virus. A study released Monday on natural reinfection in a patient from Hong Kong speaks to this.
That case study follows a 33-year-old who was hospitalized with Covid-19 in March. He cleared the infection and then tested positive again four and a half months later, but showed no symptoms. That study suggested that immunity to the coronavirus may mean that someone simply has milder infection the second time around.
Fauci on how Covid-19 disproportionately affects people of color – Speaking to the American Journal of Managed Care, Fauci reacted to how Covid-19 has shined a light on, and in some ways exacerbated, existing health disparities in the US.
“So this is another assault, as it were, on people of color,” Fauci said.
The backdrop – According to the COVID Tracking Project, Black people have been dying of Covid-19 at 2.4 times the rate of white people. If you zoom into individual communities the statistics are even more striking. In April, 40 percent of people who died from coronavirus in Michigan were Black. Black people make up only 14 percent of the state population.
Fauci says these statistics are the result of a "double whammy."
A study conducted by The Center for Economic and Policy Research found that Black workers make up about one in nine workers overall, but they represent one in every six frontline (or essential) workers. That makes them more likely to be exposed to the virus in the first place.
From there, they're also more likely than white people to have underlying conditions, like diabetes or heart disease, that make Covid-19 more deadly. To top it all off, access to healthcare is also restricted or compromised due to systemic racism.
Fauci emphasizes that this double whammy isn't new, even if it is striking. Historically, people of color also suffer disproportionately from conditions like HIV/AIDS, he says. The comparison highlights the fact that these issues that contribute to health inequities aren’t secrets, they’ve been around for a long time.