Dr. Anthony Fauci on What It Will Take to End the Pandemic

0:00This episode is brought to you by Welch's Fruit Snacks. Back to school season can be tough on parents, but choosing a snack you and your kids can both get behind doesn't have to be. Stock up on Welch's Fruit Snacks, made with whole fruit, and now made with no artificial dyes. It's a snack kids already love, and one you can feel good about giving them. Go back to school with Welch's Fruit Snacks, now made with no artificial dyes. When you need to build up your team to handle the growing chaos at work, use Indeed Sponsored Jobs. It gives your job post the boost it needs to be seen and helps reach people with the right skills, certifications and more.

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1:08Welcome to HBR Quarantine. I'm Adi Ignatius, Editor-in-Chief of Harvard Business Review. My co-host is Josh Macht, our C-suite guy in charge of product and innovation. Our special guest today is going to be Anthony Fauci, America's foremost spokesperson in the fight against COVID-19. This is our last show for the season. We're going to take a break for the rest of July and for all of August. We'd love to know what you think of the show, what we could do better, and be sure, as always, to put in questions for our guest in the comment box. So let me just do a quick read from our partner. Support for this program comes from Medtronic, a medical technology leader.

1:44Guided by its mission to alleviate pain, restore health, and extend life, Medtronic is bringing the power of medical technology to help healthcare professionals respond to COVID-19. Learn more about Medtronic's efforts, including how they've contributed to the global ventilator supply at Medtronic.com slash COVID-19. So without further ado, it's my pleasure to introduce Dr. Anthony Fauci. He is a man who currently needs no introduction. He is director of the National Institute of Allergy and Infectious Diseases, the job he's held for 36 years, serving under six U.S. presidents, and working at the forefront of efforts to confront viral diseases like HIV, AIDS, SARS, swine flu, Ebola, and others.

2:25He's now America's top spokesperson on the COVID-19 pandemic. And in that role, he has become an international star. There's now an Anthony Fauci bobblehead and a plush toy with a superhero cape. In other words, America's biggest rock star is an immunologist. As you know, we always like to show a TikTok video each week. So here's one from a doctor fan that illustrates the phenomenon.

3:05Welcome, Dr. Fauci. As you can see, you've touched a lot of people. Wow.

3:15Let me dive right in. So at this moment, we're seeing a resurgence in cases COVID-19 cases in parts of the U.S. The European Union is restricting travel by Americans. My question for you is, what is wrong with us? Is American sense of individual freedom simply incompatible with a prudent health response? You know, I think there's no doubt that that's part of the process. It's probably much more complicated than that. But if you would ask me what the one thing that I think is common about it is exactly what you said. You know, when the European Union shut down at the time when they went to lockdown, as it were, about 95 or more percent of the country truly locked down.

4:00When we were in our lockdown, about 50 percent of the country was in lockdown. So at the time when their curves peaked and then went way down, ours peaked and then kind of stayed like this, which where they've been for the last several weeks to a couple of months. And now what we're seeing in an attempt to open, which in many respects, we never really completely closed, we're starting to see what unfortunately is that rather robust spike back up. Yesterday, there was over 50 ,000 new cases, which is something that's really going to be a persistent problem unless we attack it in a different way than we're attacking it right now.

4:45Well, that's the question, Dr. Fauci. You know, you see these spikes, it is pretty scary and inconsistent all over the country. What should the government or could the government doing from a federal point of view? What could it be doing better? I mean, this episode is brought to you by Welch's Fruit Snacks. Back to school season can be tough on parents, but choosing a snack you and your kids can both get behind doesn't have to be. Stock up on Welch's Fruit Snacks, made with whole fruit, and now made with no artificial dyes. It's a snack kids already love, and one you can feel good about giving them.

5:20Go back to school with Welch's Fruit Snacks, now made with no artificial dyes. When you need to build up your team to handle the growing chaos at work, use Indeed Sponsored Jobs. It gives your job post the boost it needs to be seen and helps reach people with the right skills, certifications, and more. Spend less time searching and more time actually interviewing candidates who check all your boxes. Listeners of this show will get a$75 sponsored job credit at indeed.com slash podcast. That's indeed.com slash podcast. Terms and conditions apply. Need a hiring hero? This is a job for Indeed sponsored jobs.

5:56Do we have a stronger federal response or national response? You know, that's the ongoing debate and tension about the very special nature of how the founding fathers, you know, developed our country. You know, the federalism, the state's rights, giving the states the options to do things in a way that's peculiar and specific to their particular region of the country, you know, in some respects works very well. But one can make an argument, and many people have, that we do need more central direction, central control. But boy, that's a very, very hotly disputed area, I can tell you that. I think you already know that.

6:39But you can make, you know, very compelling arguments on either side. But whatever it is, we're seeing such disparate responses among the different states, among the different regions, among the different cities, that it's very, very difficult to be able to put something in a unidimensional fashion. It just doesn't happen that way, probably to our detriment. There's also a split along political lines. And I'm sure you don't want to be drawn into a political battle. You survived six presidents, after all. But faith in experts like yourself does seem to break in part along political lines. And put it simply, Democrats seem to trust experts like you more than Republicans do.

7:21How do you interpret that and how do you cope with that? Well, first of all, you have to cope with that because it's a reality of what's going on right now. One of the big difficulties is that when you have such the political divisiveness that we have right now, it's very, very difficult to get a clear, crisp message across when you have leaders who are very, very different in how they interpret what's going on and what the primary goal of where you want to go, it's really not a unified response. And you don't need me to tell you that. You just need to look at what's going on in the country. That makes it very difficult to do the kinds of things you need to do from a public health standpoint.

8:03When you talk, everyone is hanging on every word. And we're curious to the extent that when, are you making recommendations purely as a medical expert, meaning preaching maximum caution, or are you thinking about the weight of your words and trying to balance the medical necessity with social needs? You know, I always try to do a balance, but I'm very often being put in a position where I'm asked for my strict medical advice, interpretation of the patterns of the disease you're seeing, what it might mean if we go in one direction versus the other. And I always give my very honest opinion and advice if I'm asked for advice, but I certainly let the evidence and the facts and the data guide what I tell people.

8:57Now, I think that something that people don't understand is when you're dealing with a situation where the entire country is involved, that there are people who clearly come from a different perspective than I do. They have a very, very heavy focus on the economy or on things like jobs and things like that, which are important to me as an individual citizen in the country. But I'm not asked to give an opinion that has economic impact or not or that has jobs impact or not. I'm being asked to give my opinion vis-a-vis the pure health issues. Others will take an opinion from me or an opinion from one of the economists, Larry Kudlow, Steve Nunchen and others, and then weigh it and then make a decision.

9:48So even though I'm sensitive to the economic issues, you know, that's not my job to do it. My job is to give just the pure public health. This episode is brought to you by Welch's Fruit Snacks. Back to school season can be tough on parents. But choosing a snack you and your kids can both get behind doesn't have to be. Stock up on Welch's Fruit Snacks, made with whole fruit, and now made with no artificial dyes. It's a snack kids already love, and one you can feel good about giving them. Go back to school with Welch's Fruit Snacks, now made with no artificial dyes. When you need to build up your team to handle the growing chaos at work, use Indeed Sponsored Jobs.

10:31It gives your job post the boost it needs to be seen and helps reach people with the right skills, certifications and more. Spend less time searching and more time actually interviewing candidates who check all your boxes. Listeners of this show will get a$75 sponsored job credit at Indeed.com slash podcast. That's Indeed.com slash podcast. Terms and conditions apply. Need a hiring hero? This is a job for Indeed sponsored jobs. Evaluation. I mean, for example, what I was saying that, you know, you got to take your choice. If you want to open up the government and get back to more normality, I am aware, apropos of the question that you asked, of what economic impact a certain direction will take us.

11:14So it isn't as if I'm completely blind to that. I understand that. But what I try to do is to get people to understand that they're not extremes. It's almost as if there's the public health approach, and then there's the devil-may-care approach. They're polar opposites, but they don't need to be. I keep saying that for those, including myself, who are interested in the economic impact, in the impact on jobs, on the impact on employment, on the impact on the economy in general, that you should make the public health measures be a vehicle to opening the country, not an obstacle to opening the country.

11:55And I think an example of that is that when certain states decided, even within the realm of the right recommendations to open up, we saw the citizenry of some of the regions of the country immediately say, okay, we're no longer locked down, so let's storm the bars, go to the beaches, go to crowds, and then you see that peak that goes up. So, I mean, I think that's counterproductive because it's almost like, okay, you've relieved me of the public health constraints. Now I can do whatever I want. No, there has to be a balance. And even though I'm a public health person, I'm acutely aware you have to have the balance.

12:35You have to be sensitive and aware of the importance of public health constraining issues. On the other hand, you can't always say, if it doesn't work, let's lock the government down again. We can't be just locking it down because then we'll have secondary consequences that are going to be really quite consequential. So if you just joined us, this is HBR Quarantined. Our guest is Dr. Anthony Fauci. Quick plug, visit our Healthcare and Pandemic Insight Center on hbr.org, which is sponsored by Medtronic. So Dr. Fauci, this is a classic HBR type question. Do you have advice for viewers about telling your boss something that he or she doesn't want to hear?

13:17How do you approach a conversation like that? Well, I mean, it depends on the circumstances that you're in. I could give you a personal example. I made a decision the very first time I walked into the White House during the Reagan administration. And it was something that was part of my own way that I've been brought up by my family and by my education, which was, you know, in very intellectual, Jesuitical, Catholic elementary, not elementary, but high school and college about the importance of public service and the truth and the rigor of science and evidence. So with that as a background, I made a decision that when you go into a situation and you have to tell people things that they might not like to hear, you've got to be able to make the sacrifice that that person might not ever ask you for advice again, or you might not ever ask back again.

14:16So the first time I went into the White House, which was the 1980s, the early 80s, I take the same attitude as they take right now. I'm going to tell the truth. And a lot of times that's going to be something a person doesn't want to hear. So you've got to be aware of the fact that that person might not ask you back. And what happens if you do that, what happens is that people know that you're not being partisan one way or the other. You're just telling the truth that people gain respect for you and they do ask you back. And that's probably the reason why I have been doing this with so many different administrations.

14:56This episode is brought to you by Welch's Fruit Snacks. Back to school season can be tough on parents. But choosing a snack you and your kids can both get behind doesn't have to be. Stock up on Welch's Fruit Snacks, made with whole fruit, and now made with no artificial dyes. It's a snack kids already love, and one you can feel good about giving them. Go back to school with Welch's Fruit Snacks, now made with no artificial dyes. When you need to build up your team to handle the growing chaos at work? Use Indeed Sponsored Jobs. It gives your job post the boost it needs to be seen and helps reach people with the right skills, certifications, and more.

15:36Spend less time searching and more time actually interviewing candidates who check all your boxes. Listeners of this show will get a$75 sponsored job credit at indeed.com slash podcast. That's indeed.com slash podcast. Terms and conditions apply. Need a hiring hero? This is a job for Indeed Sponsored jobs. So I want to pivot to the vaccine for a second here. You've been on the record as cautiously optimistic. We recently, I think we're seeing that you said that even as early as this winter, we would really have the knowledge of are we on to something that's safe and effective? A couple of things.

16:14One is what is effective mean for you? What is the bar here? And then And the second thing is, because it goes hand in hand with eventually having so many people being willing to take this vaccine, what is the government going to do or preparing to do to ensure with so much anti-vaccine sentiment out there and the headwind, it feels like a huge challenge. What's the government going to do and planning to do to ensure that it's widely distributed? Okay, two very good questions. Yes, with the caveat that you're never going to be able to guarantee when you're dealing with vaccines. That's just the nature of vaccinology, that you're going to have a safe and effective vaccine.

16:57But the early preliminary data on what several of these candidates can induce, they can induce the kind of immune response that you would predict would be protective. But your specific question, what is success? What does that mean? For the most part, I mean, the perfect thing would be to have a vaccine that completely protects you against infection. It's called sterilizing immunity. You don't get infected at all. But what we would accept gladly is a vaccine that when administered and a person gets exposed and infected, they don't get sick. In other words, to prevent someone from getting a clinically recognizable or clinically important disease that would require the attention of a healthcare provider.

17:47So you may have a low-level smoldering infection that doesn't bother you very much. If we had 70 % of the efficacy of people who get to that endpoint, I would be very satisfied with that. Will we get there? No guarantee. I think there's a reasonably good chance we will. The timeframe is really going to depend on how many infections there are in the community to allow you to be able to prove that it is both safe and also effective. So if we get to that point by the end of this calendar year into the first quarter of 2021, that would be good and that would be success. Your second question, how do you get people in an era of anti-science, which kind of spills over into anti-vax, to take a vaccine when there's a lot of skepticism about government, about authority?

18:44I think it's essential, I know it's essential, to do what we call community outreach and community engagement, to start now to get people to understand in a very transparent way why it will be important to get vaccinated when we have a vaccine that we know is safe and effective. We need to also put particular effort into the most vulnerable communities. And in many respects, the most vulnerable communities are those to have every reason in some respect to not necessarily trust authority. People have been disenfranchised, including minority populations, African Americans, Latinx, Native Americans, and others, because when you look at the statistics, those are the ones demographically that are at the greatest risk of serious complications of COVID-19.

19:37Well, so let's talk some more about risk. So there are people who took what seemed like huge risks going to the Tulsa rally for Trump or taking part in street protests. Are we seeing, you know, that cohort? Are we seeing those people? This episode is brought to you by Welch's Fruit Snacks. Back to school season can be tough on parents. But choosing a snack you and your kids can both get behind doesn't have to be. Stock up on Welch's Fruit Snacks, made with whole fruit and now made with no artificial dyes. It's a snack kids already love and one you can feel good about giving them. Go back to school with Welch's Fruit Snacks.

20:18Now made with no artificial dyes. When you need to build up your team to handle the growing chaos at work, use Indeed Sponsored Jobs. It gives your job post the boost it needs to be seen and helps reach people with the right skills, certifications, and more. Spend less time searching and more time actually interviewing candidates who check all your boxes. Listeners of this show will get a$75 sponsored job credit at Indeed.com slash podcast. That's Indeed.com slash podcast. Terms and conditions apply. Need a hiring hero? This is a job for Indeed Sponsored Jobs. People get sick at a concerning rate or are they somehow not?

20:56You know, it's very difficult given all the other things that are going on simultaneously with the protest demonstrations, with the political rallies, with the holiday of Memorial Day, you know, four weeks or so ago with the opening of certain states to so-called normalize back. All those things were confluent together. So it's very difficult to say that this particular demonstration or that particular rally or that particular holiday at a beach did it. But something happened to make the spike go way up like that. So I think you have to be suspicious of every single one of the elements that you just mentioned.

21:44And it is likely that there was a contribution to a greater or lesser degree of all of those, but we can't really pinpoint it because everything was conflated. Let me just do as a quick follow-up. The cases are up, and it's not just testing. I appreciate that. But the mortality rate seems to be down. And I guess the question is, has coronavirus, has it perhaps mutated into a form that maybe is not much worse than the flu? Well, that's always possible, but I think that's unlikely to explain the phenomenon that you just described. If you look at the demography age-wise of the people that are getting infected that are responsible for that spike that we see, they're about a decade and a half younger than the people who got infected and were responsible for the hospitalizations and deaths a few months ago, when we saw New York and Boston and New Orleans and Chicago hit so hard.

22:44So I think the reason is that you're not now, but a few weeks from now you might. You're not seeing as many hospitalizations and certainly not a sharp spike in deaths. Younger people are getting infected, and probably we've learned the lesson of what it means to protect the vulnerable, particularly people in nursing homes, which really accounted for a disproportionately high number of the hospitalizations and deaths, certainly the deaths of people who for any of a number of reasons were in a nursing home. Right now, you're seeing younger people getting infected. But the one thing we need to realize that if you're young and you get infected, and even though you have no symptoms, you are part of the dynamic process of an outbreak.

23:37And although you may think you're living in a vacuum and your infection is going to have no impact on others, that's not true. Because you will likely inadvertently and even innocently infect someone else who will infect someone else who then will infect a vulnerable person, someone's grandmother or grandfather or uncle who's getting chemotherapy for a neoplastic disease. And that person will be the one that's in the hospital and dies. So we're a continuum. We're a part of a dynamic process. And I think that's one of the things that confuses people who feel, I'm probably invulnerable. I'm young.

24:19my colleagues get infected, my friends, and they don't really get sick. It doesn't matter. You're lucky that you don't get sick. Young people can get sick, but you are part of the spread of a pandemic. That's the issue you really need to understand. And to me, that's a societal responsibility that you can't run away from. No, that makes sense. Help us here with the whole idea of first wave and next waves because I think, at least for myself, it's easy to lose the thread with all the spikes that are going. You want to know what quality sounds like? It sounds like a Ford Super Duty towing up to 40 ,000 pounds before the sun comes up.

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25:36There's a reason millions of companies like Mattel, Heinz, and Allbirds continue to trust and use them. With Shopify on your side, turn your big business idea into... Sign up for your$1 per month trial at shopify.com slash special offer. ...going on, but thinking about business going forward into the fall, what's the thinking, the latest thinking now on what a second wave, and when would that be and what would that look like? Well, Josh, that's a great question. But that relates historically to the 1918 outbreak, when in the spring, there was a sprinkling of infections that was clearly dangerous because it was a pandemic that was killing people.

26:19And then it kind of disappeared. I mean, literally disappeared in the summer. And then it came back with the roar of a lion in the fall, in the winter. That was what we referred to as the second wave. We should not be thinking about a second wave. We are still knee deep in the first wave. Take a look at the curve for us in the United States. It went up, it kind of flattened out, and it stayed that way for weeks and weeks and weeks. And now it's going right back up and peaking. So there's no such a thing as the second wave for us right now. We're still in the first wave. So I have one more question that I want to take some from our viewers.

27:04The debate about the origin of the virus is likely to gather steam in the coming months as we head toward an election, with some voices charging that it was created in China and then released either accidentally or even on purpose from a lab there. What is the science telling you about that? This is a virus that is very, very commonly seen in bats that are in China, for sure, as well as other intermediate hosts of it. The way the phylogenetic tracing of this was that this was evolving in the environment for a very long period of time. And there's every reason to believe that it did what the original SARS did and what MERS, the Middle East Respiratory Syndrome, did, both of which are coronaviruses, that it jumped species, perhaps to an intermediate host.

28:02We don't know what that host is. And then started efficiently affecting humans. There's no evidence at all that anybody created this. It was naturally in the environment, in bats, in a very, very similar virus to what we're seeing right now. All right, I'm going to go to a question from a viewer. This is from Felipe from Bogota. The question is, would it be beneficial to allow non-vulnerable populations to slowly and carefully go back to their lives and to try to get immunity or protecting the most vulnerable portion while we wait for a vaccine? Well, the first part of that question I liked was to get the non-vulnerable people, while you're protecting the vulnerable to go back to some degree of normality of opening up businesses and culture.