Anthony Fauci, the country’s top infectious disease expert, said Tuesday he should have more aggressively pushed the federal government to flood communities where the coronavirus was starting to spread with testing early in the U.S. outbreak.
“It never became a reality because we never really had enough tests to do the tests that you had to do,” Fauci said Tuesday at the STAT Summit, referencing the testing that needed be conducted to confirm Covid-19 infections in people who were showing symptoms of the illness.
If communities could have implemented widespread testing, it could have helped slow transmission before it took off explosively, said Fauci, the director of the National Institute of Allergy and Infectious Diseases.
“Community spread doesn’t stop spontaneously unless you do something about it,” Fauci said in an interview with STAT’s senior infectious diseases reporter, Helen Branswell. “It is easier to stop when the level is relatively low. The only way that you can get at community spread is that you need to test people who are without symptoms, in order to show what the degree of penetrance of infection is.” (It can take a few days for people who get sick from Covid-19 to start showing symptoms, and some people never show symptoms, but they can all still spread the virus.)
Fauci said he raised the idea of mass testing early in the U.S. response, but that his message was not heeded. He acknowledged, however, he could have tried harder.
“Deep down, perhaps I should’ve been much more vocal about saying, we really absolutely gotta do that,” Fauci said.
“I said it, it went nowhere, and maybe I should have kept pushing the envelope on that.”
Snafus and limitations in the U.S. rollout of Covid-19 testing has been identified as one of the major problems of the federal response. The Centers for Disease Control and Prevention initially launched a test that had flaws and wasn’t usable in a number of public health labs around the country. Policies also restricted testing in most cases to people who had traveled to other countries where the virus was spreading, even after the virus started circulating domestically.
Regulators were also slow to allow commercial tests on to the market. And shortages of the supplies needed for tests have been an issue for months.
Asked about his experiences working with President-elect Biden, Fauci said the former vice president has a “considerable, in fact, if not profound” grasp of and appreciation for science, though he said the two have not spoken since Biden left office four years ago.
Both Fauci and Biden have expressed their desire to start working with each other, but President Trump’s refusal to concede the election has stalled the process.
Fauci worked with Biden during the Obama administration’s response to the West African Ebola crisis and said during those meetings, “not infrequently at all the vice president would come in and listen and contribute to the discussions about how we were handling Ebola.” He also noted that Ron Klain, whom Biden has tapped as his chief of staff, served as the Obama administration’s Ebola “czar.”
Biden stressed that he would respect and listen to scientists during the presidential campaign, contrasting his approach with that of Trump, who has repeatedly downplayed the coronavirus pandemic and undermined his own health officials’ recommendations.
Biden’s interest in science in part stemmed from his son Beau’s death from brain cancer, Fauci said, which led Biden to spearhead efforts to develop better cancer therapies.
“He got very much involved in talking to scientists and talking to mostly oncologists, but all kinds of scientists,” Fauci said.
Fauci did praise the Trump administration’s Operation Warp Speed program, particularly for its success in expediting the development of Covid-19 vaccines. Going from the discovery of a new pathogen to multiple vaccines reporting Phase 3 clinical trial data in less than a year, Fauci said, “is beyond historic.”
The federal government has spent billions on vaccine research, trials, and manufacturing — initiatives praised by public health officials in and out of the government. Much of the money went to building a supply of vaccine candidates before they had proven their safety and effectiveness, so that the immunizations could be deployed as widely as possible as soon as authorized.
In recent days, Moderna and a collaboration between Pfizer and BioNTech have reported their vaccines have greater than 90% efficacy in preventing symptomatic Covid-19, which are wildly positive initial results. Fauci said he hoped millions of doses of both vaccines would be available by the end of the year, though he noted that time frames “slip sometimes.” He acknowledged that so far, scientists don’t know how long that protection lasts, but that researchers will keep studying the question, which has implications for when people might need a booster.
“I take one step at a time,” Fauci said. “I’ll take the 94.5% effective for now,” he said, referencing the results of Moderna’s vaccine, “and we’ll worry about the durability of the effect” next.
Fauci stressed, however, that “a substantial proportion of the population” needs to get the vaccines as they become available if the country is going to get back to any sense of normalcy. He said the positive vaccine news should hearten people to keep up with Covid-19 precautions, such as masks, distancing, and avoiding crowds, for a while longer because the tools that could help reshape the pandemic are coming.
“A vaccine should not be considered as a total substitute at this point for public health measures,” Fauci said. “In my mind, it should be an incentive for people who have Covid fatigue and are really tired of public health measures to say, you know there is light at the end of the tunnel, help is coming, let me hang in there a bit longer.”
“If we could just hang on enough to do that until we get enough people vaccinated to turn around the dynamics of the outbreak, we will be OK,” he added. “We will be OK.”
Despite the challenges of the pandemic, Fauci, when asked, said he had never considered quitting.
“Not even close, no,” Fauci said when asked if he had ever thought about leaving his position. “It’s not even in my DNA. To quit? I’m a public health official, I’m a scientist.”
When asked if he was considering retirement, Fauci, who turns 80 next month, said that he would step down if he couldn’t give 100%, something he and other people, including his wife, looked out for.
But for now, he said, “I feel and I’m pretty sure that I’m on top of my game.”
This story has been updated with more from the interview.