LIVE: Dr. Fauci discusses antiviral program for COVID-19

LIVE: Dr. Fauci discusses antiviral program for COVID-19

vice president at the center for strategic and international studies in washington d.c where i direct the global health policy center we’re thrilled today to be joined by dr tony fauci he’s a long-standing friend director of the national institute of allergy and infectious diseases and chief medical advisor to president joe brydon welcome and thank you tony for joining us today thank you steve thank you for having me it’s always a pleasure to be with you and congratulations you’ve crossed the 70 line of adults with at least one vaccine you’ve crossed the 110 million line in terms of donations to our external partners congratulations on that thank you we’re here today to discuss the new 3.2 billion dollar antiviral program for pandemics launched by the biden administration on june 17th before we start two things first thanks to our to my colleagues amit mandavili and some samantha chivers into our production team margaret rogers john monsta nish matani and graham mcgillivray from nih david awad special thanks to david and to patricia conrad and greg folkers a few brief comments on this topic before we get to our first question for dr fauci recently the urgency of prioritizing therapies has intensified and become more visible it’s become clear that the pandemic is a long war it may become apparent it may become endemic and the proliferation of dangerous variants are fundamentally changing the nature of the pandemic including our understanding of what that vaccine production protection will truly mean and how long it will last while vaccines including boosters remain vitally important we may we increasingly recognize that therapy safe effective scalable affordable are no less essential to any lasting solutions for to the pandemic for all populations in america and across the full spectrum of countries rich poor and in between the demand for therapies will remain urgent and strong including those deployed early in infections replication of the virus and those that can be administered to address extreme illness looking out into the future we can anticipate it will be months even years before large segments of the global population are fully vaccinated there are populations who will remain hesitant or outright refuse to be vaccinated many others will seek vaccinations but face situations in which there’s a shortage of vaccines of adequate financing and delivery mechanisms so we’ve arrived at a moment of greater consciousness of the centrality of therapies we also have to be conscious of the chronic barriers therapies for soros cov2 are inherently problematic and the recent record is sobering a problematic and the recent record is sobering across therapies we face a pattern of neglect and under investment a lack of private sector interest to carry forward from this initial discovery phase through clinical trials to production and distribution through the valley of death and product development as we’ll talk about much of that is beginning to change in significant ways in the case of mers and sars interest in coronavirus therapies faded earlier as outbreaks declined there’s potentially a similar risk here with sars kov2 we’ve seen the development of promising monoclonal antibodies and the antiviral rem deserver but these remain infusions they’re expensive they’re often not available outside large hospitals and they apply to often to high risk patients with rem de severe its value has been the subject of much debate some monoclonals did not deal very well with variants two of the eli lilly’s candidates the regeneron cocktail and gsk’s monoclonal candidates do look quite promising we’ve seen false starts and politicized options hydroxychloroquine convalescent plasma ivermectin is the latest case of controversy and we’ve seen systemic problems in the american health system which has difficulties in rolling infected patients into clinical trials and getting promising therapies to those who need them and we’ve had problems with the research infrastructure that needs more coordination and prioritization antivirals a pill to block replication early are complicated they take time to develop it’s scientifically challenging to develop a pill that stops replication and does no harm to the infected human cell hiv drug cocktails took a long time to develop they become essential as we’ll hear from dr fauci we may have a similar experience of needing time to create an antiviral cocktail for kova 19 which brings us to today’s conversation the launch of the anti-viral program on pandemics it’s a major step forward in attempting to prioritize antivirals overcome challenges and accelerate change in both the immediate and the long term and it’s a major effort to use the the influence of the federal government to drive forward new partnerships with industry and academic centers so dr fauci thank you so much for being with us why don’t we start if you could just explain uh why the administration why the demonstration took this step of launching the app and describe both its immediate priorities with respect to uh malno pirovir of merck and the the merck candidate the uh atea roche and and pfizer products and also the longer term strategy of building up new academic centers thank you well thank you very much uh steve for that that introduction which was really quite good about where we where we stand with all of this but but let me start by saying that this pandemic is 20 months old and in fact medications have been a priority all along but when you had to move very quickly uh we really had a focus on the medications for the most people in dire need and namely the hospitalized patients for people who are advanced in their disease and we had a look at repurposed medications uh you what you mentioned quite correctly that monoclonal antibodies turned out to be an early success but they have their vulnerabilities particularly when you deal with the variants that we’ve had a face but the approach that we are taking right now is really a what we call a two-tiered approach a two fundamental pillars and the fundamental pillars address what you had alluded to in that the drugs that are already out there the amount of pepperier uh the protease inhibitor the adia roche product and even others that have not gotten as much visibility but are still somewhere along the early pipeline that falls into what we are referring to as the developmental pillar of the app which is the antiviral pandemic preparedness program those drugs have already gotten a head start with the companies that were involved you know merck and pfizer and roshantia and others we will partner with those pharmaceutical companies to further the advanced development of those products number one number two to be available for other companies biotech as well as pharma who might have similar products but the one part of the two pillared approach that i think looks in the long term as part of and i want to take the opportunity steve to mention this that this is all part of a comprehensive pandemic preparedness plan that is associated with an even broader and larger pandemic preparedness plan for vaccines which i know we’ll get a chance to talk about at another time in another setting namely the prototype pathogen approach for the development of vaccines rapidly against any pathogen of any family that program together with this antiviral program together with an extension of the diagnostics program is part of the broader comprehensive plan to prepare for pandemics just wanted to mention that it isn’t in a vacuum with antivirals but let’s get back to the antivirals you know because we’ve spoken about this over the years multiple times steve of the extraordinary and in fact spectacular success of the targeted antiviral program that we have had with hiv which we’ll get a chance to talk about a little bit later but that same approach of developing molecules right from the beginning by using the replication cycle of in this case the sauce coronavirus to identify vulnerable targets that program we’re putting forwards out right now funding opportunity announcements to get people stimulated and interested in doing that from the ground up development of molecules together and simultaneously with the developmental component of this two uh pillared process so we’re very excited about it um and i think that we are going to get both uh as you said early wins easy on hopefully one of the candidates that you mentioned will turn out to be as good if not better than the monoclonal antibodies in remdessevia which are the two approaches that we have right now and then hopefully as we go on into 2022 when we’ll start putting out some money for the discovery component of this two-pillar process that we’re going to start seeing some long-term action and results so i’ll stop there and happen to continue thank you i mean i’m struck by two things uh two steps that have been taken as part of this effort one uh the pre-purchase of one point seven million doses of the merck uh malnour pirovir if it is approved and reports that we could get an emergency use authorization by the end of the year early next year that changes the landscape the other thing that i found really significant was the decision by the ceo berla pfizer to put a billy commit a billion dollars towards the development of protease uh inhibitors those are pretty significant steps uh so do do you anticipate we’ll have quick wins and the landscape will begin to change so that we do arrive with pill pills in our hands that can can disrupt replication yes i i i don’t know whether it’s going to be the home run that we got with hiv when we in 1996 the transforming year when we had the triple combination and we went from modest suppressing a virus to complete durable suppression of iris with hiv which totally changed the landscape but you know i want some of the listeners if not all of them because i know many of them already appreciated it why it’s so important and a bit different than what we faced with hiv steve and the reason is with hiv you were talking about lifelong therapy for an individual to keep the virus suppressed to below detectable to get the person to return to some form of normality and we have been spectacularly successful we’re looking at a different type of a profile now we’re looking at an orally administered maybe seven to ten days given to person who is early on in the course of their infection before you get to the cascade of events that lead to the aberrant activation inflammatory response that kills people because we know now from a lot of experience with the care of these individuals that if you can keep that virus from going to the upper airway to going down into the lung and other organ systems you can change what could be a devastating disease and make it an upper airway common cold type approach which is really what we need to do we only need to knock out that virus for about seven to ten days rather than lifelong what we have to do with hiv now you mentioned monoclonals and rendezvir you’re absolutely correct one of the reasons why monoclonals which are really very good if you give them early enough and appropriately enough is the logistics of getting somebody into a situation where you can hook them up to an iv and observe them as they’re getting an iv infusion as simple as that sounds that has been a major stumbling block in the more wide use of what is otherwise a very effective antiviral namely monoclonal antibodies ask you i mean enter being able to intervene effectively in the first seven days time is of the essence you the patient has to know he or she is ill that patient has to be tested to know that he or she is ill and our testing has fallen off to under a half a million tests per day across this country does this imply we’re going to if we’re going to move in this direction of cocktails of antivirals to come in fast and disrupt replication are we going to have to rethink our whole national testing strategy absolutely yes and the reason is particularly if you get into the flu season where people present with very similar uh symptomatology that you’re going to want a test that will tell you immediately is this flu is this sars kovi ii or is this something else whatever that might be rsv para influenza rhinovirus whatever if you are going to effectively implement an antiviral program you have to get accurate and ready to use easily implementable diagnostics just the same way steve if you think about it would you ever institute triple combination of an antiviral to an hiv infected person if you didn’t know they were hiv infected it’s the same thing so they go hand in hand you’ve got to get a diagnostic before you do that so there are there plans on funded through the arp are there plans underway right now to massively expand testing yes uh particularly you know the the rad program the rad uh diagnostic program uh that the nih has initiated is looking now at just that product profile that you’re talking about of getting something that’s flooding the system easily administered highly sensitive and highly accurate so that if you wind up getting a a symptomatology that’s suggestive of sores cov2 you can get a test almost immediately and if in fact you’re hours thank you um let’s turn it can you let’s turn my variance figures in the strategy for the app you know um steve you you uh technically got cut out about 80 percent of what you said i only heard variance i didn’t hear what the question was sorry the question is i’m sorry we have a bad connection i may i may drop off and come back in the question is how do variants current and future variants figure in the strategy for this antiviral program okay so this is important because variants as we all know have emerged because of the pressure that the human immune system has put on the virus very likely from people who are immunosuppressed wound up getting infected and had virus in them for days and days and days before they cleared it and or died and then essentially led to the emergence of a variant we feel that’s very likely what happened with b117 and what happened now with the current delta variant that we’re dealing with as soon as we start treating covet 19 with new antivirals we need to plan for and anticipate the emergence of drug resistance and that’s the reason why we are in the process of doing the same approach perhaps even of combination therapies in case we do wind up getting variants we’re partnering with barter to help to get new agents through discovery into development and ultimately procurement part of that um is going to be with the active program that you know that we’re very use actively using right now because you know the app the antiviral pandemic preparedness program doesn’t have an established clinical arm so we’re going to have to rely on the drug network programs that we are now successfully using with active 2 a and active 2b and others because we’re using that as part of the respon as part of our capability to test the existing antivirals that we have right now but it’s the same approach when you have variance you’ve got to be read it isn’t going to be where you have one pathogen and one drug that’s the knockout home run drug you always have to be ready to continue to develop alternatives that could keep up with the variance thank you let’s talk about industry and the relationship with industry because this is intended this 3.2 billion is intended to change the incentives and calculations of industry you’re you’re committing two billion of that for the acceleration of these these promising vaccine promising candidates we talked about 300 million for research in labs a billion for clinical trials and 700 million for the production and distribution so tell us a bit about what is the interface going to look like with industry in this moment well steve it’s really an easy answer to the question because we really have in the past together with uh fundamentally our relationship with barda which the app is going to be very closely interacting with barter it is absolutely essential to have a very good partnership with industry in any program that talks about the development of a product particularly in this case a drug it will be very much the same as we’ve done with all of the pharmaceutical and biotech companies that we have partnered with in the development of drugs for hiv it’s absolutely essential we do that with direct collaborations for example we are collaborating in our clinical trial process with each of the ones that you mentioned early on with fisa with uh merck and with roche and atea in a partnership that involves right now since they’ve already developed the product we’re involved in the clinical trial testing of that the same will hold true as new products come along it will be a very close collaboration with industry i i don’t think it would be possible at all to have any success without doing that so do you think that 3.2 billion is going to be enough to change calculation change the picture and the orientation of industry you think it’s going to be enough steve you’ve known me a long time and you know what my answer is it’s a good start i’m very pleased that the that the program and and president biden uh allowed us to use money uh from the american rescue plan to get that 3.2 billion as really a good start i i think that success will breed greater enthusiasm for more support and that’s exactly what happened with the hiv program nothing convinces the source of resources to give more resources than success so if we come up with success i think we will get more obviously if you want to have a program that’s sustainable over a period of time you’re going to want more money but 3.2 is very generous and we’re very pleased with it thank you now tell us a bit about what you see as the ideal or optimal product profile what does a product have to look like in order to be a winner in your view when you take into consideration use equity considerations access what are you telling people is the is the optimal profile okay the optimal profile we we’re comfortable with this because we’ve we’ve developed uh product uh profiles um for so many other drugs including with hiv so first of all i want a pill that blocks a specific viral function i want to give it once a day if possible i want it to be low in toxicity and i wanted to have very minimal drug drug interactions so orally administered single pill given for seven to ten days little drug drug interaction and low toxicity give me that and i’ll be really happy and what about scalability ease of use and access to populations well yeah i mean obviously we want to do with this what we did with pepfar i mean that’s the model that you get a product that you can make give it i mean the companies are going to be involved with us i mean i hope that we can get arrangements given the investment that the federal government has made that we could have reasonable pricing so that we can make it available throughout the world the same as we’re trying to do with the vaccines we don’t want to have a situation where people in low and middle income countries don’t have access to this so it’s got to be able to be scalable not something that has a process of development that has 25 separate steps in it that you can’t translate that to being done in other parts of the world so you build that into the initial agreements with industry partners in terms of creating a pathway to reach all americans who need this but also to reach low and middle income countries down the road that has always been an important part of everything we do if you look at what we built into the vaccine program equity has been the most one of the most important aspects of it both domestic equity and now international equity and that’s the reason why as you know the biden program has already committed a half a billion plus 80 million that’s going out right now i’m pleased i want to say this because i think the listeners should hear that i’m pleased to see that we already have millions and millions of doses that have already gone out to africa just this past week we sent five million doses to south africa we’re sending doses to other african countries we want to do the same thing when you’re dealing with therapy we want to make sure we have international accessibility as well as domestic equity you talked earlier about the anti-viral program fits within a comprehensive strategy that addresses both vaccines diagnostics and therapies so are we going to see sometime soon a kind of formal roll out of a pandemic preparedness strategy that sort of embeds the development of therapies as a as a vital element of that and sets sort of targets in terms of trying to create the kind of ever warm capacities and stockpiles that we’re going to need um the answer is yes we are in active discussion right now sometimes sensitive discussions about amount of resources so i would rather not give you granular details of that right now steve but you know me and you know what my intentions are and to the extent that i could have any influence on it there will be a broad comprehensive approach to pandemic preparedness and response at every level thank you um i want to turn to the international context you know when you look at vaccines we have an international entity sepi coalition epidemic preparedness innovations which is charged with doing upstream development of vaccines that fall outside of market incentives for dangerous pathogens we have gavi the vaccine alliance at the other end of the spectrum that’s there for procurement distribution vaccines and partnerships with countries and the kovacs facility most of it’s being run right through gabby as the principal partner there we don’t have institutions of that kind we have a collection of different actors at those two ends of the spectrum when we talk about therapies we talk about antivirals do are we going to need something like sepi and gabby when we’re looking at therapies into the future and internationally the answer is yes stephen i think a good example of what we did with hiv the hiv model is good you know we had the global fund of which the u.s government is a third of and has been from the beginning we have the pepfar program and that has worked very closely with groups like the clinton health access initiative so that was kind of the the sepia and agave of hiv uh namely of of therapy so i would imagine that i can see something like that falling into place when you’re dealing with therapies something along the lines of what you mentioned gavi sepi but some international access organization very similar to what the clinton foundation the clinton health initiative has done for therapies for hiv the global funds getting very active across this whole spectrum of things we’ve just given them quite a large grant through the aarp funds for non-vaccine response in low-end middle-income countries are you expecting the global funds going to be a big partner as if we get uh winners in this process in terms of therapies you know that’s a possibility steve i mean i i can’t say that that’s gonna happen but it certainly is a reasonable question to ask and i think it would be a possibility remember when the global fund got set up it was started off to be the global fund for hiv and then we expanded it to malaria and tuberculosis i think there’s no reason to think that it isn’t possible to include in that pandemic preparedness yes well that’s a big debate there within their own board and yup yup they’re expanding they’ve expanded some significantly they’ve been very nimble and fast in that regard and so i would expect them to play what about the europeans the eu is is pre-purchasing some of these therapies that are you know in development um there they’ve announced they’re going to set up an uh a new institution h-e-r-a era as a counterpart to our barda institution uh what role do you see them playing and how does what we’re doing linked to that well i’m pleased to say that we are and have been and will continue to be in conversations with each of these players specifically you know with jeremy ferrara welcome uh a good friend and colleague in a lot of what we do we’ve been involved in discussions there with unitade with intrepid with the global fund so we’re trying to define how we can all work together on this because this obviously is something that has international implications so the answer to your question is there will be involvement with those entities that you mentioned thank you i want to shift back to some comments you made over the weekend on sunday um [Music] august 1st on this week abc you said um this you know we’ve entered this new surge we’re in we’re in this new phase you you said things are going to get worse we’re looking to some pain and suffering in the future as infections climb uh the focus was on the 93 million unvaccinated we’ve seen multiple pressure points come forward and intensify in trying to get people to accept vaccinations and overcome their resistance or refusals federal policy and workforce dod policy that’s in development actions by cities by mayors governors employers uh republican leadership have stepped forward in new ways faith leadership media we this has also been joined up with masking guide change of masking guidance it’s created some a little bit of anxiety and confusion there but public patience also it seems has worn very thin uh and we see this polarization between vaccinated unvaccinated in the characterization of by the president and others of of this as a pandemic of the unvaccinated um my question to you is this accumulate we’ve entered this new phase it’s more uncertain and it’s causing some some anxiety but it’s bringing these pressures again upon populations to to remask but also most importantly to to get vaccinated on that latter point are we beginning to see results and are you hopeful that we’re going to be able to move rapidly enough to close the gap well i think i think it’s going to be complicated but let me explain what i pre project will happen um you never can guarantee it’s going to be accurate but i think this is what’s going to happen since an acceleration of vaccines doesn’t give a result until several weeks after we are already on a trajectory that looks strikingly similar to the sharp incline that the uk saw so remember we went from an average of about 12 to 15 000 cases a day to 20 30 40 50 60 we’re up to 70 now we are going to be between 100 and 200 000 cases before this thing starts to turn around now with regard to vaccines in order to make sure that by the time we get into the fall we don’t continue to accelerate but turn around and start coming down acutely we’ve got to get those 93 million people who are eligible to be vaccinated who are not getting vaccinated what i believe we will see and interestingly even in those areas that are accounting for the vast majority of infections you know like 40 of all the infections in the country are in like three states or so 20 percent are in florida more i mean that’s one state out of 50 states is accounting for you know 20 or more of the infections yet we’re seeing that in those states where you’re seeing a lot of infection the rate of vaccination as an average is better than the rest of the country so that’s telling us that the states that are suffering most from the increase are starting to realize that you got to get vaccinated if you want to get out of this and we’re seeing um governors and others from those states who normally were not enthusiastic who are going out and speaking about getting vaccinated asa hutchinson in arkansas is out beating the bushes asking people to get vaccinated we have people even like governor desantis who doesn’t want to have mask mandates is going out saying people should wind up getting vaccinated steven scalise a republican leader is saying go out and get vaccinated so i think we’re going to see a turnaround the thing that i think is going to be a real somewhat of a game changer steve is as soon as the fda gives full approval for the vaccines those people who are hesitant to get vaccinated because they perceive the emergency use authorization as not being proof enough that it’s safe and effective even though we have ample ample evidence that it’s highly effective and highly safe i think you’re going to see more people get vaccinated and then you’re also going to see enterprises feeling much more confident in local mandates for vaccines you’re not going to see a central mandate coming from the federal government but you’re going to see more universities colleges places of business who once they get the cover of an officially uh approved vaccine they’re going to start mandating vaccines so we’re going to see an increase in vaccines and that’s going to be the solution to the problem because if you get the overwhelming majority of people vaccinated we wouldn’t even be having this conversation now there’s been a lot of a lot of reporting lately on the steps taken internally within the fda to try and sprint towards getting to that point uh internal procedures and the like and of course external parties like yourself have to be very respectful of their autonomy and ability to preserve the trust and confidence americans have in them it looks to me like we’re likely to get something early in the fall in terms of approval and you’re saying you think that some some significant share of those who are hesitant or refusals will change their minds on that basis because that concern that this is experimental hangs so heavy on them i believe that there will be a proportion i don’t know how large that proportion would be but going around speaking about vaccines literally on a daily basis steve there’s no doubt that there are a proportion of people likely not a majority likely uh relatively small 10 15 20 or so yeah as soon as this gets approved would say okay i’m ready to go get vaccinated yeah what right now we’re vaccinating less than a million people a day as i understand um what do we what do we need to reach what’s what’s the daily target we hit a peak of i think 3.2 million earlier in the year where do we need to be realistically in order to get the vaccination levels up to a point where we can close this gap most effectively and not have this just drag on through the winter um as a as a as a mixed set of outcomes well i don’t want to give a number steve uh the reason is that as you know i say it it becomes a sound bite the next thing you know everybody’s arguing about it but don’t want to go there but i can dance around it a bit if you want to use that terminology so let’s say we have 93 million people who are eligible to get vaccinated and we really want to get 90 of those people vaccinated if you really want to nail this thing down i’ll settle for 70 or 80 percent but i’d love to see 90 so you know uh 90 of that let’s say you get 80 you know 80 million people that you want to get vaccinated if you get a million people a day that’s 80 days that’s two and two thirds months that’s a long time so i want to see that gap closed so two and two thirds months from now you know is going to be sometime october maybe even into november or the end of october i’d like to see us there before then so i’d like to see hopefully between one and two million per day we may get there when mandates come but it can’t be two hundred and fifty thousand five hundred thousand a day otherwise it’s going to go well into the winter i wanna get there sooner and tell us what can we expect in terms of vaccination of children well that’s a good point because scientifically we are currently doing the clinical trials in an age de-escalation approach in kids from eleven to nine nine to six six to two and six months to two years we’re already collecting substantial data on the safety and the immunogenicity which would predict effectiveness in children in those age groups i think we’re going to get that information as we get into the fall then it becomes a regulatory decision is it going to come under an amendment to the eua or is it going to wait for the bla or is it going to be a separate bla i’m not sure exactly what it’s going to be but it’s going to be a regulatory decision so that’s the thing that’s going to hinge on how that rolls out and that’ll be in the in the fall i hope it’s in the fall i hope it doesn’t go beyond the fall okay when you look out now and think about all of these pressure points that in the exercises and changes in vaccination policy masking policy trying to expedite the approval of the vaccines trying to expedite getting children in the mix what what’s the missing pieces right now what missing pieces are there in terms of scientific unknowns or actions that we that we need to consider that we’ve kept in reserve or not thought enough about well you know vaccine looms as always the big factor the overriding factor as you mentioned we’ve got to get that 93 plus million people who are not vaccinated vaccinated that is going to require uh the kinds of things we just mentioned local mandates people being convinced that it’s okay to get vaccinated now that the vaccine when it becomes officially approved and we don’t have to rely on an eua but we also we really do need um a bit more of a uniformity in our approach and i have to say i know i don’t want to conflict uh in any way with the local authorities doing what they feel they need to do but you know you have situations where you have governors giving orders that you cannot mandate a mask in a school or in a workplace we need to mask up until we get to the point where we really have controlled this escalation of cases if everybody got vaccinated you wouldn’t be arguing about masks you’re likely the the need for masks would diminish dramatically um but in the meantime i would think that if we could get everyone to adhere to the cdc recommendations about mitigation that would be important what about boosters we haven’t talked about boosters as a next step here in trying to consolidate our gains um what do you see on the horizon there as we enter this phase well there’s two buckets of booster considerations steve the first is the immunocompromised those who are transplant cancer chemotherapy immunosuppressed because of autoimmune therapy and others giving them an additional shot is almost not considered a booster it’s considered part of what their original regimen should have been because if you examine them in multiple groups that are doing that many of them maybe most of them have not gotten an adequate immune response to begin with so i think it’s more emergent and as a physician as opposed to a public health authority but as a physician i feel that’s almost medically emergent to have to do that because they are vulnerable and what we need to do is to get whatever mechanism that is or a regulatory mechanism to get them as quickly as we can to get an additional shot then you ask the question well putting those people aside taking care of them what about the booster for the general population starting off with the elderly and then what about people who are otherwise normal not elderly we are we are gathering in real time with both the follow-up of the clinical trial data looking at the people that will be following over a two-year period as well as the cohort data’s and the cohorts that the cdc are following that literally on a week by week basis we evaluate whether we need it to whom and when and that decision could be made anytime because you know we’re already starting to see from israeli studies and others that the duration of immunity particularly in the context of delta is coming down in other countries france germany israel have already decided the uk will probably implement in september so we’re keeping an eye on that the decision was made by the cdc and the acip that right now today we don’t need the general public who’s been vaccinated to get a booster but that could change and that’s the reason why we’re following it really carefully on a week by week basis so that could change on a fast trigger potentially absolutely absolutely now that the news last the disclosures last week about breakthrough uh infections and the ability of those who are fully vaccinated who experience breakthrough infections to transmit that caused you know quite a stir uh and it it raised a lot of anxiety uh certainly across the spectrum of conversations that i was part of or witnessed do you think that people have overreacted a bit because when you do look at the numbers it’s a tiny 35 000 breakthrough infections in a population of 162 or 163 million people is a is a minuscule number what is your how do you talk to people this is a real phenomenon and it’s a serious phenomenon but it doesn’t it doesn’t fundamentally change the picture it seems to me well i do it multiple times a day every day and i’ll do it again now with you you you go through in a logical way the steps of what is actually going on so no vaccine is 100 protected and even the really really good ones that we have right now fortunately for us the ones that are 94 to 95 protective against clinical disease are somewhat less protective against asymptomatic disease so the protection against infection is probably you know somewhere in the high 70s the low 80s depending upon what candidate you have what product you have that means that there naturally will be breakthrough infections the word breakthrough kind of scares people you know breakthrough infection you expect that when you don’t have a 100 effective vaccine that some vaccinated people are going to get infected the good news is that what we are clearly seeing is that the vaccine is doing exactly what you’re asking it to do because it’s preventing people from getting seriously ill because when you look at the breakthrough infections they almost invariably not always but almost invariably are about 96 or so percent protective against advanced disease leading to hospitalization so even though you’re getting breakthrough infections the fact is if you’re vaccinated you’re prevented from getting severe disease and the numbers are astounding if you look at anywhere in the different states and different countries 99.5 percent of the deaths due to covert 19 are among unvaccinated people and a very small very very small percentage are among vaccinated people so we should be careful when you hear about breakthrough infections remember the more people you get vaccinated the more breakthrough infections you’re gonna get because if you have 90 of the people vaccinated and you don’t have 100 effective vaccine you’re going to get a lot of you’re going to get a lot of people who are vaccinated and infected that’s what we saw in provincetown that’s what we recently saw at san francisco general hospital and another hospital in san francisco but when you look at the ultimate effect those people didn’t get hospitalized or die they were protected yes well i do think that’s that’s very helpful to hear and i know you’ve you’ve had to say this over and over again uh and thank you thank you for going through that with us it is a confusing situation and it’s a very difficult one for communication purposes and i’m hearing that over and over again also from people that seem somewhat somewhat unclear exactly how to think about all of this well absolutely um we’re dealing with a highly transmissible changing virus and with that you were going to see modification of recommendations and i think the thing that got people most shook up is first it was said if you’re vaccinated you don’t need to wear a mask indoors and then you say if you’re vaccinated you still have to wear a mask indoors if you’re in a indoor public place in a region that has a high or substantial transmissibility and the reason for that relates to what we were saying about the fact that vaccinated people who get infected given this delta variant have a high degree of virus in the nasal pharynx and even though the vaccine protects them from getting severe disease they can transmit it and it has been documented that they do transmit it so the mask has a lot to do with protecting you so you don’t transmit it to someone else yes one last i know we’re at the end of end of your time and you’re going to need to move on going back to the anti-viral program for pandemics what are you most worried about in terms of achieving barriers to achieving success and what gives you the greatest confidence this is going to deliver the returns you’re looking for i have confidence in the science that will get us there we did it with hiv there’s absolutely no reason why we can’t do it for sars kobe 2. what i hope is that we have a sustained commitment that it becomes as we are planning part of a broad comprehensive pandemic preparedness plan that involves vaccines therapeutics diagnostics and production and distribution that’s what a comprehensive program is dr fauci thank you so much for all the time you’ve given us all your candor and all of the detail and nuance and for your continued leadership as the chief medical advisor to the president of the united states so thank you for being with us today my pleasure steve thank you for having me as always [Music] [Music] you
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LIVE: Dr. Fauci discusses antiviral program for COVID-19

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