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Coronavirus Q&A With Anthony Fauci, MD – September 25, 2020

Educational Objective
To understand the latest developments in the COVID-19 pandemic
0.5 Credit CME

Anthony S. Fauci, MD, returns to JAMA's Q&A series to discuss the latest developments in the COVID-19 pandemic. Recorded September 25, 2020.

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Transcript

This transcript is auto generated and unedited.

>> Howard Bauchner: Hello and welcome to Conversations with Doctor Bauchner. Once again, it's Doctor Bauchner, Howard Bauchner, and I'm here with Doctor Tony Fauci. Welcome, Tony.

>> Anthony Fauci: Good to be with you, Howard.

>> Howard Bauchner: I think at this point you probably need no introduction. You're the director of the National Institute of Allergy and Infectious Diseases. You've been an extraordinary public health servant for almost four decades. Welcome, Tony.

>> Anthony Fauci: Thank you very much, Howard.

>> Howard Bauchner: So Tony, before we get started, I have to ask you. You've probably testified before Congress before any other physician in the history of the United States. Do you ever get nervous?

>> Anthony Fauci: No. Not only any other physician, any other person.

>> Howard Bauchner: Any other person, right. I tried to count. I couldn't find a count anywhere, but I was wondering if you ever get nervous.

>> Anthony Fauci: You know, the answer is no, Howard, and the reason is if you're prepared, I wouldn't call it nervous. I mean, sometimes when you go into a hearing, you know that it could be politically charged. That doesn't make me nervous. It's just sometimes hearings are productive, and sometimes they're not. When you have a great degree of divisiveness, you're really that some of the politicians use the hearing to make a statement against either the other party or the administration if you're on the opposite side of the party. Sometimes you get caught in the middle of that, and they sort of like, you know, there's shooting here and shooting there. You got to duck.

>> Howard Bauchner: Do you ever leave and then go, "Oh, I should've said this or I should have said that?"

>> Anthony Fauci: Yeah, a couple times that would happen. I mean, I think it's more often I wish I had enough time to have said this in addition to what I said. I think only rarely that you would say, "Oops, you know, why did I say that?" Sometimes you will say something that is correct, but it's subject to misinterpretation. And you might say to yourself, "You know, maybe I should have been a little bit more clear about that." But that doesn't happen very often, Howard.

>> Howard Bauchner: Well, questions are already coming in, so I'll get to the questions in a bit. And I'm assuming some are going to be about vaccines. Tony, it's been a very difficult couple weeks in Europe, very difficult couple weeks. The stories the last four or five days talk about a large, large increase in numbers. What do you think that reflects, Tony? And what does it mean for the United States?

>> Anthony Fauci: Well, I think we have seen that, what they're seeing now. I mean, it's interesting, Howard, because it relates to what you and I spoke about the last time we were on. So let me just briefly say it because I'm fairly certain this has been going on. Remember, last time I told you that in Europe, when they had their peak, then they came down to a really, really low baselined.

>> Howard Bauchner: Very low, yeah.

>> Anthony Fauci: So my concern in the United States was we had a peak, but our baseline never went down to really where we felt it should be. It was stuck at 20,000.

>> Howard Bauchner: Yeah.

>> Anthony Fauci: Stayed at 20,000 for multiple weeks, if not a month and a half or two. Then we tried, remember, with the let's try and open America again, open the economy, and we did. However, there was variable adherence to the guidelines among individual states, and what we saw was that when they tried to open and didn't do it in a way that followed the guidelines, you had a surgence of cases that went from a baseline of 20,000 to thirty, forty, fifty, sixty, seventy. And then it started to come down, and now it's hanging around at forty, which is still an unacceptably high level. In Europe, almost certainly what happened is that they got down to a low baseline, but when they started to do what we were trying to do of opening up the economy and opening up the society, we see from the pictures in Europe of the bars that are crowded, of people congregating, very similar to what they saw of American film of people in bars. And what happens is that when that happens, you start to get a surge. So they went up, down to a good baseline, and now they're coming right up total to an average among all the countries of, you know, 20,000 infections a day total of all the European countries.

>> Howard Bauchner: Tony, do you think people are just tired?

>> Anthony Fauci: Yeah, yeah. Howard, they are, and that's one of the things that is difficult to get around, that people are exhausted from being shut down. Sometimes they see no end in sight, and they say, "Oh, goodness gracious. You know, I'm just going to try and live my life." That is so understandable. It's almost expected, so what we try to do to message is that there is an end to this. We just have to hang in there a bit, and I think one of the rescuing elements is going to be a vaccine. And hopefully that's only a few months away because I think by the time we get to November, December, we'll be able to start vaccinating people December, January, February. I don't think we're going to get to the point where we have a sufficiently effective enough vaccine in which enough people get vaccinated to essentially get back to normal in a few months. It's not going to happen, but I hope will happen is that the stringency of the health practices that would be essential to keep infections down will not be that necessary. So you're going to want to always wear mask. You want to do physical distancing, but what we don't want to do is have to shut down again. I think that's something that people won't accept, and I don't think it's the best thing to do. We've got to be able to gradually open up the society and open up the economy and do it in a prudent and careful enough way that we don't see those spikes that Europe is seeing now and that we saw, I mean, just a couple of months ago when we tried to do it.

>> Howard Bauchner: What gives you the biggest concern for the next few months, Tony?

>> Anthony Fauci: Well, what gives me the biggest concern is that we know, Howard, that there are four or five things that we say if practiced diligently -- and we know that from experience -- that you can prevent surges and even turn around ongoing surges. And that's universal adherence to mask wearing, face covering, keeping physical distancing, avoiding crowds, washing hands, and doing things outdoors more than indoors because if you look at some of the super spreading-type things that have occurred, almost all of them occurred in indoor situations. When we get to the fall and the winter, by the very nature of the climate in most parts of the country -- not every part but most parts of the country -- you're going to have to do a lot of things indoors at a necessity of the temperature. And I'm afraid with that being the case, if we don't carefully follow the guidelines, the other guidelines, the masking, the distance, the crowds, that we may see another surge again. So I was hoping, Howard, that we would enter the fall and the winter --

>> Howard Bauchner: Yeah, low levels.

>> Anthony Fauci: -- at a very low baseline. I told you that last time we [inaudible], and yesterday I just looked at the numbers. It was like 43,000 new cases yesterday. You don't want to enter into the fall and winter with a community spread at that level because if you do, you got a difficult situation that's going to be really challenging.

>> Howard Bauchner: My Lord, Tony. There's like two dozen questions already, but I want to ask one more. And then I'll get to the questions. Is there a bridge to the vaccines, Tony? You know, convalescent plasma, let's start with we know that steroids are the standard of care for people critically ill. There's the recovery trial. We published three clinical trials and a meta-analysis. WHO, the two critical care societies have all changed their recommendations. A very substantial mortality benefit 10%. So we know in critically ill people, steroids are clearly the standard of care. Is there a bridge to vaccines? And has anything else emerged that you think can really give a benefit, a clinical benefit outside of vaccines?

>> Anthony Fauci: Well, you say something important, that we have glucocorticoid dexamethasone. We have remdesivir also in hospitalized patients with lung involvement. What we are doing clinical trials on but we don't have yet solid clinical trial proven efficacy is in a number of approaches that's the bridge you're talking about. Probably the most, I would say important is a good word, but the one that we have the most hope in is monoclonal antibodies because we're looking at monoclonal antibodies now in people with earlier disease and people who are outpatients, inpatients, nursing homes as prophylaxis, families in which one person is infected and you want to prophylact the rest of the family to see if you could prevent spread in the family. That's clear. We know we have convalescent plasma that as an emergency use authorization, but we haven't nailed that down yet.

>> Howard Bauchner: Yeah.

>> Anthony Fauci: We don't know for sure whether that's going to be effective. We're pretty sure it's going to be safe, and that's why the EUA was given. Of course, it was felt that the benefit outweighs the risk, but there are a few studies that are ongoing. You may be seeing some of them in JAMA where they're submitted where there are randomized placebo control trials.

>> Howard Bauchner: Right.

>> Anthony Fauci: So convalescent plasma is one. Also, hyperimmunoglobulin that, in fact, is derived from convalescent plasma. Those are the things that are being, and then there are a bunch of other things. You know, for advanced disease some anticoagulants that are being used, some anti-inflammatories to see if you could dampen the inflammation, but we are focusing very heavily now on treatment of early infection and/or prevention of infection. And that's the bridge to the vaccine that you're talking about.

>> Howard Bauchner: Yeah. It's interesting to see the shift, even in what the journals are publishing. You know, initially it's largely epidemiology. Then it's the early clinical trials of seriously ill individuals, and then we begin to think about prevention and treatment of less seriously ill individuals. Tony, so lots of questions about the vaccine. I don't think you're surprised about that; 50% efficacy. Are you happy with?

>> Anthony Fauci: Well, it's better than none, but I would like to see 70, 75. That's what I'm hoping for. You know, the trials fundamentally are designed with all the statistical things that go into it to detect with a certain degree of assurity of 60% efficacy. I would -- and one at 50%. But most are 60%. I would like to see at least a 70 to 75% efficacy.

>> Howard Bauchner: Any instincts about what it will be?

>> Anthony Fauci: You know, Howard, it's always difficult to guess because the guess then gets taken as almost a definitive statement. I don't know what it's going to be, and that's why you do the clinical trial. You do a very well-designed placebo control trial, and you're going to get your answer. And I believe that answer is not too far away. As you know, we had first four and now even one more that's going into, [inaudible] is going into phase three trial. Two of them already started on July 22nd. That is the Moderna and the Pfizer. Astro-Zeneca, which is in the United States on hold, started in August. We have J and J which we just announced this week [inaudible] trial, the human Ad26 which is a single shot one, and then we're going to have the Novavax coming out soon, probably in October and then another one later on in December, I believe the Sanofi trial and Merck. So we have a bunch of candidates going. I would believe that given the rate of infection that we have in the United States and the fact that these trials have a lot of [inaudible] people. I mean, Moderna is 60,000 -- excuse me -- 30,000. The Pfizer has gone up to 44,000, and the Johnson is going to be 60,000. It's a lot of people in the trial, placebo control trials, that hopefully we will get an answer in November or December by the end of the year. There's no guarantee that you'll have a safe and effective vaccine. I'm cautiously optimistic, as I've told you multiple times, that given what we've seen in animal studies with these candidates as well as what we've seen in the induction of immunity in the phase one and phase two trials that this vaccine or these vaccines induce a level of neutralizing antibody which is comparable to, if not even better, than what you see in convalescent plasma. That is always a good indicator that the vaccine would likely be able to protect. It's not a guarantee, but it's a good indicator. So you put the timing of the trials, the number of infections that we've seen now with 30,000 infections, 40,000 infections a day, I believe we'll have an answer by November or December and possibly, Howard, even earlier. I mean, if you happen to have a bunch of infections that occur within the sites that are enrolling patients, then you might get an answer earlier. My prediction would be, safely speaking, November or December, but I wouldn't be overly surprised if you had an answer a little bit before then.

>> Howard Bauchner: Tony, is there enough known yet from natural infection to have any sense of how long immunity will last with a successful vaccine?

>> Anthony Fauci: The answer is no, and the reason is that it depends on what the immunity durability is depending upon if you get infected and the virus stays in your upper airway. We know that when you have coronavirus common cold infection, that the durability of immunity is measured in months, a year at the most, not very much longer. And that's the reason why you get repeated infections with the same common cold coronavirus over the years. If you get infected and you have systemic disease of people who get lung disease and GI disease and other disease, it is conceivable that you would induce an immune response that has a much greater degree of durability because you're stimulating the systemic response in addition to the upper airway. The bottom line, Howard, we've got to be humble and modest, and we don't know the answers to these things. We would hope that if you give a prime and a boost in some vaccines and the Johnson one is just a prime --

>> Howard Bauchner: Right.

>> Anthony Fauci: -- that you would induce enough of a response that it will be durable enough for at least a year or more. And if it turns out you need to get a boost subsequently, that's fine, but what I'd like to see, at least enough efficacy of a high enough percentage to get us through at least a full cycle and a cycle and a half. I'd be satisfied. I'd like to see it for multiple years, but we don't know that right now. So we shouldn't be guessing because then someone will take that guess, and that would be dogma. And we don't want to do that.

>> Howard Bauchner: Tony, will we reach a point do you think where there will be competitive vaccines out there and someone will have received vaccine A and then they should continue with vaccine A, or can they switch to vaccine B? Or is that all theoretical at the moment?

>> Anthony Fauci: It's theoretical, but I do wish that we have enough vaccines that we would have that kind of competition. That's the kind of thing you wish for, to have enough successful vaccines. I might say a point that I think is worth making that there may be different vaccines for different situations. Let me give you an example.

>> Howard Bauchner: All right.

>> Anthony Fauci: The cold chain requirements for different vaccines [inaudible] where globally you might want to use them because there are some of the candidates that have much more stringent cold chain requirements than do others. That's one potential difference. You might find when you do a clinical trial that you maybe have three or four vaccines that are effective, but you may find one that does better in an older population than another. And it could be that you would recommend that if you're an older person, you get this vaccine versus that. I mean, that's something wish for, namely that we have enough vaccines that you could tailor the better one for each individual group.

>> Howard Bauchner: Tony, are you comfortable that we've settled on the appropriate approach to vaccine approval through the FDA? They're the world's experts. It's a legendary group of individuals led by Peter Marks and colleagues. Are you comfortable that we've set up a system of FDA look at the data but with checks and balances by the advisory panel committee at the FDA and the advisory committee on infectious disease practices, immunization practices, ACIP?

>> Anthony Fauci: The answer is yes. Let me give you some details about that that I think is worth our viewers and our listeners hearing if they don't already know it. That the big elephant in the room is is somebody going to try and make a political end run to interfere with the process. Let's call it the way it is because everybody talks about that.

>> Howard Bauchner: Right. Thank you.

>> Anthony Fauci: It's the elephant in the room. So if you look at the standard process of how these things work, I think you could feel comfortable that it is really unlikely that that's going to happen, and here's the reason why. So each of these vaccines has a data and safety monitoring board that's independent, is not beholden to the company, not beholden to the administration, not beholden to FDA, not beholden to me, to nobody. What they do is that they are the ones that get the data. They have scientists, clinicians, vaccinologists, ethicists, and statisticians, and they at predetermined times look at the data. Nobody else has access to that data. So they look at the data, and the only one that sees the data -- because you can see a lot of infections -- but since it's double blind placebo control, nobody knows. You may know how many infections there are, but you don't know who's getting infected.

>> Howard Bauchner: Which group, right.

>> Anthony Fauci: So the unblinded statistician looks at the data intermittently, and that's independent of everybody. And there are a few possibilities. They could say, "You're not going to get an answer. This is futile so forget the trial." That's not going to happen. That's unusual. The other one would be, "We're looking at the data and keep going with the trial. We don't have enough data to go one way or the other." Or they could look at the data and say, "You know, you've got a problem here because there are more infections in the vaccine than in the placebo, so you may be having enhancement --

>> Howard Bauchner: Right.

>> Anthony Fauci: -- stop." Or looking at it and say, "You know, you've reached the predetermined endpoint of efficacy." At that point, they let the company know. Then the company makes the decision of applying to the FDA to either get an EUA, an emergency use authorization, or if they feel the data is strong enough, they'll go right for a BLA, or a biological response, a biological license, application. So remember, that step is done by an independent group, so now it's in the hands of the FDA. So that gets to your question. The FDA will look at those data, and I trust the career scientists of the NIH and I trust the commissioner -- excuse me -- I said NIH. I mean FDA. I'm sorry. Trust the career scientists of FDA, and I certainly trust the commissioner of FDA. Having said that, the commissioner and the FDA then discusses the data with their own advisory group, the VERPAC group, who are another independent group that are advisory to the FDA and the FDA commissioner. When that happens, those data become public so that the scientific community will be looking at the data, so when a decision is made to approve or not a vaccine, to do an EUA or not, that's going to be public. So any kind of hanky-panky there that people are worried about is going to be multiple checkpoints. You start off with the data and safety monitoring board. You then go to the FDA, who we trust. Then you go the advisory committee to the FDA, and then you have the scientific community looking at the data. So I would, you know, you got to reassure people who have concern and skepticism there that these are professionals at the FDA that have been doing this their entire career. They really know what they're doing. This is what they do every single day.

>> Howard Bauchner: Tony, you know, so much noise about anti-vaxxers, people who are vaccine hesitant. How do you think the scientific community needs to approach individuals and families? You know, I'm a pediatrician, so you know, immunizations have been a large part of my clinical career. You're an infectious disease expert. They certainly have played a prominent role in your career, but over the last couple years, it's become more difficult, not just in the United States, around the world. How do you think we get back to a sense of trust about vaccines?

>> Anthony Fauci: Yeah. It's got to be transparency, Howard, just what I said about the process. And that's why I wanted to take a minute --

>> Howard Bauchner: Yeah.

>> Anthony Fauci: -- to explain that, the process of the DSMB, the process of the FDA, the process of their advisory committee. Be transparent. Let people know what the process is, but you've got to reach out to them. You've got to be transparent, consistent in your message, and you've got to reach out to the community. The community in general [inaudible] maybe specifically the minority community who have an extra special skepticism about things involving the government because of the history of how in decades and decades ago, they've been mistreated. That history is not forgotten, so you've got to, a proactive effort to get out and engage the community. And you do that by getting trusted community people to interact and talk to them about the importance of getting vaccinated.

>> Howard Bauchner: Many questions, so I'll just throw out a few. Mutation of the virus, concern about whether or not that will affect vaccine efficacy?

>> Anthony Fauci: You know, SARS-coronavirus-2 is an RNA virus, and we know that RNA viruses mutate. I mean, we've known that forever. Most, overwhelming majority of the mutations are without any functional significance. Every once in a while you get one that is. The one that recently came out in a paper, we knew about it for a while -- of course, this information antedated the paper -- was a mutation in amino acid 614 of the spike protein. And that is the part of the virus that binds to the ACE2 receptor, and in in vitro studies and other studies, it looks like that binds more readily to the receptor, which would suggest that perhaps that this means that it's more transmissible. Doesn't say much about virulence but more transmissible. The discovery of the dominance of that mutated virus coincides with big spikes that we've seen in this country, so you could interpret that it becomes more transmissible and the spike is due to the mutation. Or you can say that the virus that spread so rapidly was the virus that led to this mutation that was going to spread more rapidly anyway, but you've got to keep in mind that there is a possibility that there will be mutations that might have a functional significance. If you look at the binding site, the receptor binding site of the spike protein that's going to bind to the ACE2 receptor, the mutation in fact is such that the antibodies that are made by the vaccine are not going to be impacted by that particular mutation thus far, but we keep looking at it. You know, keep an open mind, go with the science where you see virus, and viruses are isolated and sequenced all the time. We know now what a neutralizing antibody is. We know that we have a lot of people that have been vaccinated thus far, tens of thousands so far already. We're going to get antibody from them, and we're going to be able to see if the antibody is neutralizing the virus that's circulating in the population. So rather than guess, Howard, we're going to know the answer to your question.

>> Howard Bauchner: I asked you I think two visits ago about aerosolization versus droplets. It emerged again over the weekend for various reasons. CDC report that was then modified, taken down, and then we'll see what the final report is. WHO is making a specific recommendation. CDC has not yet weighed in. Your sense of aerosolization versus droplets, Tony?

>> Anthony Fauci: Well, there's no doubt that it's spread through droplets. I believe based on some epidemiological observations that I've seen together with now getting more information from experienced aerosol physicists who are now trying to help us to understand a bit just what aerosolize is, you know, the standard thing that you and I learned in medical school is the particle less than 5 micrometers just goes [inaudible]. And anything bigger falls to the ground.

>> Howard Bauchner: Right.

>> Anthony Fauci: Well, it's not that simple. When you talk to people who study these things as a career, it's not. You put all of these things together, and here's what I can say right now. I believe that aerosol transmission plays a role in indoor-type spread predominantly. What proportion and what percent of transmissions are that way, whether it's very minor, moderate, or whatever, I don't know the answer to that. So I always admit when I don't know the answer. I don't know the answer, but from what I see and what I'm learning about aerosol and what I see about epidemiological situations, I believe there is at least a proportion, the extent of which I don't know, of transfer, transmission of virus by classical aerosol, meaning something that's in the air for more than just a few seconds before it drops. The one thing you don't want to scare the public when they hear aerosol, they think it's in the air, so therefore, you go outside and it's in the air. Get away. No, no, no. You're talking about something that usually indoors can hang around a bit longer before it actually dissipates, and that's the reason why when you look at the recommendations we make, Howard, we always say try to do things outdoors preferentially over indoors because in that case, things get dispersed and diluted very, very easily.

>> Howard Bauchner: Yeah. I know. I mean, when I've spoken to other folks, that's the concern about the fall, in part, influenza coming along with COVID-19 indoors, not high quality ventilation. Tony, so many questions, some just offering love and respect. Vaccinations of the two ends of the age spectrum, children and the elderly, just questions about whether or not we'll have enough information about vaccination for either of those two groups.

>> Anthony Fauci: Yeah. I think we'll have information about the elderly before we have information about children because in several of these trials, elderly are already in there as part of the cohort that's going to be vaccinated in the phase three study. Traditionally, and I'm glad I'm talking to a pediatrician because you understand that very, very easily, that you want to make sure when you have a vaccine that has not been used in humans before that you make sure you have some degree of efficacy and safety in a larger trial before you start vaccinating children. And it is a delicate balance that we've had discussions about this verbally, in editorials, in perspectives, is that what is the right balance for withholding it from children because you're concerned about safety and that they can't give an informed consent versus providing it in a way that you're making them wait too long. And we try to do the delicate balance so that when you get into a study and you see some degree of safety that's clear, good efficacy, you go back. You do a quick phase one in the kids, and then you bridge it to the bigger study. Bottom line, elderly will likely be getting it more before the children do.

>> Howard Bauchner: I mean, in this case, we're fortunate in the sense that we do know that children get disease. How much they transmit it has become complicated. Younger children less so, 12-, 14-, 15-year-olds look more like young adults. But we know that the number of children getting seriously ill is limited, so some regards, that's helpful.

>> Anthony Fauci: That influences that. Right. It influences that decision.

>> Howard Bauchner: Tony, vaccinating 20 million people is complicated. You know, you can say a vaccine is approved. I think McKesson is the distributor. But where it goes, how it gets there, and how it's actually delivered at that interface between a nurse, a nurse's aide, a physician, and a patient is complicated. The various committees you sit on, the various groups you consult to, are systems being put in place? Is it going to be easier if it's healthcare workers and it goes to hospitals? What's your sense of kind of what we need to do around distribution, Tony?

>> Anthony Fauci: Well, there are people who are doing nothing but thinking about that and working about that. I mean, the primary vehicle for that has always been the CDC in association with advisory committee on immunization practices. Right now, as part of this Operation Warp Speed program that, as you know, Moncef Slaoui is the scientific lead, but you also have the logistic lead, General Gustave Perna, who is one who is an expert in supply chain, distribution in the military. But he's going to use some of those skills to help with what the CDC's primary responsibility is in essentially using the recommendations from the advisory committee as well as the National Academy of Medicine has weighed in on that to get the distribution to people in a priority way. The final decision hasn't been made, so what will happen is that if you look at the calendar of the totality of all of the vaccine doses that will be produced, not from one company, but from all six of the companies that the federal government has made significant financial investment, that will be a total of about 700 million doses that we will have by April of 2021. We will have substantial doses, tens of millions to maybe even 100 million by December, and then as you get into January, it incrementally gets more and more. The question that I think you're asking is important. There may be doses available at a time but the logistics of how it actually get distributed. Not only the logistics of the people who want it but the fact that in our society, it likely will be that many people will not want to get the vaccine right away. They'd want to wait to see what happens with the first 10, 20, 30, 40, 50 million people, and that may mean that in reality, even though theoretically you could vaccinate everybody by the end of four months in the first quarter of the year, in reality by the time you get enough people vaccinated so that you can feel you've had an impact enough on the outbreak so that you could start thinking about maybe getting a little bit more towards normality, that very likely, as I and others have said, would be maybe the third quarter or so of 2021, maybe even into the fourth quarter. But the availability and starting vaccination could very likely start in November or December.

>> Howard Bauchner: I was speaking to someone earlier today. It's interesting because if healthcare workers are a priority, and I think most of the groups have weighed in and said they will be a priority, their at least distribution just needs to go to hospitals who are very used to vaccinating their staff. I'm a little worried about skilled nursing homes and nursing facilities, but if the first shipment goes to hospitals, I think hospitals will have the capacity to distribute it to healthcare workers who work at those places. That will be easier than, for example, the frail elderly who's at home or low-income families. Where will those individuals get access? So if indeed healthcare workers are a priority, and I think the estimate is maybe -- you probably know what the estimate -- I think it's 20 million for healthcare workers. I could be off. There I think the first wave of distribution will work. It's after that where it could be a struggle.

>> Anthony Fauci: Yeah. And that's something that they're working out right now. I mean, they are clearly aware of exactly what you're talking about and what the challenge will be.

>> Howard Bauchner: I don't want to keep you too much longer, Tony, but there are a lot of questions. But a slightly different question. You've done science for a long time, Tony. You're one of the leading scientists in America and around the world, and you wrote a viewpoint for us two years ago, I remember, about the movement of vaccines from phase one to people. And you have a chart in that viewpoint about how the time has collapsed. It was prescient. Did you ever think in your lifetime you would see this extraordinary science around vaccine development?

>> Anthony Fauci: You know, I was hoping for it, but now despite the pain and angst we go through because we're dealing with a historically difficult, if not, you know, unprecedented epidemic in the, pandemic in the last 102 years, the fact that we're doing these things is a wonder to behold. I mean, the idea that you get a sequence on January 10th. You start developing a vaccine. You're in phase one two and a half months later, and then six to seven months later, you're at phase three. And it's like, "Wow, how did that happen?" And it happened because of scientific advances of platform technologies, of prototype pathogen understanding. That's how it happened.

>> Howard Bauchner: Now, Tony, you have two loves of your life, the Nats and the Yankees. The Nats, not so good. The Yankees doing better. So what's the story on your two baseball teams?

>> Anthony Fauci: Well, you know, I'm still savoring fruits of last year's World Series champion, so I still love my Nats. You know, I hark back to my childhood when I loved the Yankees, but that was, you know, with Mickey Mantle, Yogi Berra, Phil Rizzuto, and those guys. They're not around anymore, so I think I'll stick with my Nats.

>> Howard Bauchner: This is Howard Bauchner, Editor in Chief of JAMA. This has been Conversations with Doctor Bauchner. My guest has been a colleague and a friend, as described by some of the people, Tony Fauci, a national treasure, director of the National Institute of Allergy and Infectious Diseases. Tony, thank you and more than anything, please stay healthy. The United States needs people like you.

>> Anthony Fauci: Thank you very much, Howard. As always, it's a great pleasure to be with you, and I look forward to doing it again.

>> Howard Bauchner: Be well, Tony. Take care.

>> Anthony Fauci: Take care of yourself, take care. Bye-bye.

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