New York, Arkansas, Senegal discussed on In Fact with Chelsea Clinton
I was honored to welcome to the podcast. Dr fauci it's become almost a cliche to say this is an unprecedented time. And i'm just curious given that you have lived through other pandemics worked in other pandemics. How much of. This feels unprecedented. And how much of. It feels eerily familiar. Well chelsea the only eerily familiar thing about it is the unpredictable nature of outbreaks. Where you just going along. And then all of a sudden something comes up it could be subtle the way. Hiv this month. In the next few days where commemorating the fortieth anniversary of the realization that we were dealing with a new syndrome. We didn't know what the microbe the pathogen was. We didn't even have a name for it back in june and july of nineteen eighty one having had. I guess i would call it the privilege in some respects but also the painfully experience of being involved in that from the very first day. That's sort of snuck up on you. It was low level below the radar screen. Then as we learn more about it we found out dealing with just the tip of the iceberg when we saw people who were very very sick not knowing until we had a test that we're dealing with something where they were literally millions of people infected so the fact that outbreaks are unpredictable. They come in strange ways. That's the common denominator. The difference with this that validates the statement. it's unprecedented. is that when you're dealing with something as explosive as this which has a couple of characteristics that. I have often referred to almost ironically years ago. What is your worst nightmare. Dr fauci people would ask me that five years ago. Ten years ago fifteen years ago. And longer i would always say it was. The emergence of a new virus generally jumping species from an animal host to a human that had two characteristics one that is extraordinarily efficient in spreading from human to human and two that it has the capability of a great degree of morbidity mortality. When you put those two things together. That's when you get my worst nightmare and that's exactly what we're experienced because we have not had anything like this in well over one hundred years since the historic influenza pandemic of nineteen eighteen so there is a very strong true element of this being unprecedented. At least in over one hundred years and dr fauci there's an adage in public health that are notable epidemics aren't now with the benefit of both hindsight and your decades of experience in pandemics. What do you think we could have done differently in january or february to help save american lives and save lives across the globe in some respects. It is not answerable because you could certainly have done things differently. If you new things differently so you can say to yourself in this country. What could we have done if we knew back in january what we know right now is the characteristics that i'm telling me would ability to efficiently spread from human to human the fact that fifty to sixty percent of the transmissions occur from someone who is infected but has no symptoms at all. We know anywhere from a third to forty percent of the people who get infected never develop any significant symptoms at all that would bring attention to any medical intervention so back then if we knew that we were dealing with in this country something as extraordinary as this in its ability to spread. We would have done something. That likely would have not been acceptable to the american public. Like when we had the first case in. i think it was january. Twenty first to say okay. It's here and then a few days later a week or two later it became clear that there was community. Spread it just air which means someone infected someone and you don't have the chain of transmission locked in. You don't know where the person got it from that. Being the case that means it's spreading in society beneath the radar screen if we had known its capability of spreading. We could have said. Let's shut the country down right now to prevent it. I think there would have been such extraordinary pushback to say. Well wait a minute what are you talking about. We have one or two cases you want to shut the country down. That's crazy so when you ask me a question what could we have done differently. Well now that we have five hundred ninety thousand deaths you go back and say well look what this has done. We may be could have prevented some of those really shutdown early and prevented the spread. But you know if you look. Throughout the world chelsea even countries that appear to have done well early on every country has gotten hit really badly even some of the asian countries now that we pointed to as models of their response are now starting to get into trouble including places like taiwan and singapore and yet nam and places like that who seemed to have done very well in the first waves. You made a comment that resonates with me is. How do you prevent an outbreak from becoming a pandemic. so. I don't think we're necessarily going to be able to prevent the emergence of new microbes. They've occurred historically for as long as before history even recorded it. History is full of them. But in answer to your question how do you prevent that from becoming a pandemic. and that's what we talk about lessons learned. What can we learn having gone through this. Where the united states was ranked by public health agencies as being the best prepared country in the world for pandemic and we got hit among the top three with brazil and india as the three worst in the sense of numbers of cases. And and dr batniji think that that is because we were prepared for previous pandemics in not future wanting. Where are we ready to fight the last war. Not the next war. I think it's partially that not completely. I think it was. There were things that went wrong early on in. That was the issue with the testing that we didn't have a testing system for a considerable period of time. And we were testing only symptomatic people. Because we're not fully aware that a symptomatic spread was really really very important so those are the things that i think could have been done differently. And then don't want to relitigate what went on last year but there are things that i think could have been done better. Although i live in new york now i grew up in arkansas and then moved when i was twelve to dc and it is heartbreaking to me. Dr fauci that arkansas louisiana tennessee mississippi so much of the south have vaccination rates. That are half of what we see in the northeast since you've had to communicate now over so many decades so many different public health challenges and also imperatives. How do you think we rebuild trust in science and especially trust in in vaccines vaccinations. That is something that is not going to happen easily chelsea. I think that we may have to find ways. And that's a complicated issue as you will know probably better than i do. It's a complicated issue of how you heal the differences and end the hostility. I mean i've been the object myself of a phenomenal amount of hostility. Merely because i'm promoting. What really fundamental simple public health principles that seems astounding that that would generate a considerable degree of hostility. But it is it is so. I don't think the answer is intensifying the hostility and pointing figures. I think the approaches to outreach to try and understand each other better and realized that we have differences but those differences should be the source of strength in some respects and not the source of chaos. So i don. I don't know the answer to your question is if it's a seemingly simple question with a complicated answer we've got to reach out to people and get them to understand that this is for their own safety their own health and also what i referred to as communal responsibility your responsibility to society because there is a thing called the chain of transmission of an outbreak and one of the very interesting and i must say quite unique aspects of sauce covy to in covid nineteen. Is that the same virus that has killed. Almost six hundred thousand americans makes many. Many people have no symptoms at all. Just doesn't bother them. I mean there's thirty forty percent of the people get no symptoms at all so that is in many respects on unprecedented to have that situation usually when you have something as potentially deadly as this it makes just about everybody a little bit sick. This is something where there are people who are saying why should i get vaccinated the chances of my getting into trouble of very very low. And they're correct if you look at the rate of hospitalizations of young people. It's zero it's small compared to the rate among elderly people and among people with underlying conditions. But there are a couple of things there that people don't fully understand you're not completely exempt because a lot of young people wind up getting into trouble statistically not nearly as many as the elderly and those with the line conditions but there's another aspect of it let's say you get infected and you don't get any symptoms at all and you say see. I got infected big deal. What's the difference the differences that it is conceivable and maybe likely that even though you got no symptoms that you would inadvertently an innocent. I'll use that word. pass it on to someone else. Who would then pass it on to someone else who would then get a serious consequence so there is a degree that have to consider of. What is my societal responsibility of. Not being part of the chain of transmission as opposed to being a dead end for the virus. So do you wanna be a dead end for the virus or do you want to be a situation where you're part of the transmission chain which would get other people in trouble but that's tough to get that concept across dr fauci. I never thought. I would say i wanted to be a dead end but yes here. I am like very happy to be fully vaccinated in a in a dead end. We'll be right back. Stay with us at children's national hospital. Everything we do is just for kids are top. Rank specialists are here for kids of all ages from babies who need help before they're even born to teens and young adults are pediatric work to diagnose problems quickly and thoroughly and use treatments designed exclusively for growing children with convenient locations. All across the dc metro area. Find a specialist. Today at children's national dot org slash stronger. Any college can make you on paper at penn college. We're more into looking good on steel and looking good on x-rays with looking good and code building and rebuilding vision and revisions and when it's all said and done you'll look good to everyone because the past might be written on paper but the future will be made by hand. Learn more at p. c. t. dot edu. I do want to ask about preparedness. Because i think probably a lot of people are now as we are vaccinating the country. I know a lot of people wanna put cove in the rear view mirror. Leave it in twenty twenty one not worry about it again but we know that the virus is not done with us until we have everyone vaccinated and we know. We need to learn lessons from this to help. Better prepare us going forward. So what lessons do you think we need to learn. And how do you think your work. The nih has to adapt. How do you think the biden administration has to adapt what concrete things have to happen to ensure we are better prepared for the inevitable next time. Okay so two components to my answer chelsea. The first is that when you're dealing with a global pandemic you have to have a global response. We're not gonna be safe on this planet until the pandemic is controlled globally. So right away. It is not necessarily a lesson but almost a mandate that we really need to help the rest of the world as as a rich country. Get this under control because if there's still viral dynamics somewhere even if we get this on the very good control here there's always the danger of the generation variants which then would make our protection somewhat tenuous even with the vaccines. That's the first thing when you look at the future. What lessons learned for the future. We need to also prepare in a global way. There was a thing called the global health security network of the global health security agenda. Will you have into connectivity. Among countries of the world good modern up-to-date communications sharing reagents sharing of of specimens continued good collaboration and communication building up in the local areas. The public health infrastructure. That would allow them to respond in quench when it breaks out in any given country because it's generally don't start spontaneously in twenty-five countries they generally start as a jumping of species usually not always from an animal reservoir to a human and then it spreads to the rest of the world. That doesn't mean that you gotta blame the country where it happens. It just so happens but you've got to have those countries prepared to be able to contain it. So that's the thing with preparedness. The other thing from a scientific standpoint is that we are very fortunate that we have made decades and decades of investment in basic and clinical biomedical research. Which has allowed us to do something. That's unprecedented to get a vaccine in. Which a virus was first identified in january of twenty twenty and then in december of that same year. Eleven months later to be putting vaccine into people's arms. That's ninety four to ninety five percent efficacious. If we were having this conversation ten years ago you would've told me. I was completely crazy thinking that that would happen. It usually takes us in years and the speed was not because we were reckless in doing things. In cutting corners the speed was related to the extraordinary amount of investment that was made of the previous decades in clinical and basic research so there another component of lessons learned we need to continue to make the investments in research that will allow us to have the scientific component of the response be optimal and fortunately for us. That's what happened with regard to the vaccines dr brought to you. You mentioned earlier. The global health security agenda which while it had antecedents for many years really got codified in the aftermath of a bola and of the united states saying what has happened in western africa is clearly a tragedy for people there but it is a danger to us here too and we do need to have more robust public health architecture and there and then that wasn't a priority for the trump administration but it wasn't really a priority for the world. I do admittedly have a little bit of a concern that once we are through covid nineteen. I worry we might lose. Focus on the need to build robust global architecture to help protect public health everywhere will chelsea. I definitely share your. And the reason i do is from my experience in that corporate memory for things that have been very very difficult in. The sense of responding in preparing is often short lived. And when you put this behind us we will be dealing with problems. That are real and present yet. It's difficult to get people to understand that the threat of an outbreak is perpetually a real and present danger so what we've gotta do as globe as as a planet as a community of nations is to just make sure we tell ourselves that when we get this under control that we've gotta say never again and mean it and never again means to really put the effort into the kind of preparation that will require considerable resources and even though it's tough to convince people to give resources to something that isn't happening now we've got a call back the memory of to nineteen twenty twenty and twenty twenty one because we started off in the beginning of this podcast. The fact is that this is really what happened to us. It just came out of nowhere and it just immobilized us for such an extraordinary period of time in a second year now. The economy has been wrecked by. This is sure not only here in the united states. Thank goodness where recovering now. But it's still a lot of people out of work. I think those kinds of memories should spur assan to make sure we are adequately prepared next time around one hopefully will spur us on returning to comment that you made earlier that i am vigorous agreement with it. We have responsibility to help. Vaccinate the world. And while i certainly appreciate president biden's commitment to donate seventy million doses by july fourth. We know we can't effectively donate our way out of this. So i am curious. Dr fauci think about the architecture that we really need to help protect public health globally while often. The focus is on surveillance and specimen collecting testing. What do you think it should be for vaccine research and development for example or the actual ability to manufacturer and to guarantee the quality of vaccines in the next generation. I'm with you one hundred percent on that. And that is referring to building up the capacity and the ability to do technology transfer. So that when you have an outbreak. It isn't only companies in switzerland. The united states in the uk but you have plants and companies and technology and the knowledge to do it in senegal and ethiopia and south africa and indonesia and brazil and chile. So that when you have an outbreak you do have the capability and that is building up. Not only the infrastructure of public health to do surveillance and monitoring but also the ability to respond at a global level to rely on. Donations is a quick immediate partial. Fix but the real durable sustainable fix now in the future is to allow other countries that generally don't have that capacity to be able to make vaccine in a timely fashion and not depend completely on donations from the rich country. The rich countries should donate if they have to but the real ultimate solution is to have a world where it's evenly distributed with his equity in opportunity to make your own countermeasures. 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