Dr. Albert Rizzo:
I’m Dr. Albert Rizzo, chief medical officer of the American Lung Association. Welcome to Lungcast.
Let me ask you: as a result of the last nine months, whom do you trust right now? The answer may not be as easy as you think—your family, friends, co-workers, your doctor, your news sources, your favorite celebrities, your legislators… everyone has informed thoughts and ideas around COVID-19 and its implications, including you.
So I ask again: during the COVID-19 pandemic, whom do you trust?
What's amazing about that question is that, even given the sheer magnitude of people invested in what happens during the pandemic and all the sources they have available to guide them, there has been a popular answer to this question that has remained consistent since nearly the beginning of the pandemic.
And here’s our guest today: Dr. Anthony Fauci, the longtime and current director of the National Institute of Allergy and Infectious Diseases. He needs little introduction—he has been the voice of responses to epidemics in the United States for four decades. He has guided the public health measures of six presidents. He is possibly the most well-known infectious disease expert in modern history, and he is certainly the only one to be portrayed by Brad Pitt on Saturday Night Live. You know who he is, and you likely trust him. He’s here to discuss COVID-19 with me today.
[Music]
Dr. Albert Rizzo:
So I guess I’ll get right into it, if that’s all right with you.
Dr. Anthony Fauci:
Sure, let’s do it.
Dr. Albert Rizzo:
Many surveys of the public found them hesitant to receive the COVID vaccine when it’s available. Many factors seem to be playing a role in this, but one often-cited reason is Operation Warp Speed in the development of a vaccine—very quickly compared to other projects in the past. I’ve seen Dr. Francis Collins mentioned that the speed has been mostly about getting the mRNA vaccination platform up and running, because it’s something we’ve worked on since SARS and MERS. I just wanted to get your take on that platform, since most of the vaccines close to approval are of that same platform.
Dr. Anthony Fauci:
Okay, first of all, with all due respect to my colleagues, I’ve never liked the term “Warp Speed.” It has a connotation of almost reckless speed, and that’s not right. And I think you kind of hinted at it, Albert, when you said that it’s really the advances in platform technology that have allowed us to do things in months that usually take literally years.
I’ll give you an example: there are six or seven platforms under the Operation Warp Speed umbrella, which means they’re being facilitated, developed, or financed by the federal government. There are three separate platforms involved: one is essentially the genetic platform exemplified by mRNA, others are vectors such as chimp adenovirus, human adenovirus, VSV, measles, and then there are standard recombinant proteins.
To give you an example of why we feel the speed in no way compromises safety or scientific integrity: the Chinese published the sequence of SARS-CoV-2 on a public database on January 10. I got my team together on the 11th and said we need to partner with Moderna to develop this on an mRNA platform. By the 15th—five days later—we started doing it. Sixty-five days later, we were in a Phase 1 trial, and six months later, we were in a Phase 3 trial. Normally this process would take a few years, but we didn’t compromise anything.
Now we have three—and very soon, four—candidates in Phase 3 trials. One trial has 30,000 people, another 44,000, and Johnson & Johnson will have 60,000 participants. This gives us a lot of data both for efficacy and for observing safety over time.
Dr. Albert Rizzo:
Amen. I was just talking with Paul Stoffels from J&J, and he mentioned there will be a two-year follow-up. And we’re working with Moderna and Pfizer for long-term safety follow-up as well.
Dr. Anthony Fauci:
Yes. Our challenge is reaching out to the public, particularly vulnerable people, to enroll them in clinical trials. We need representative diversity in the population—brown and Black people, the real-world African-American population—so that when we show the vaccine is safe and effective, we can say it works for everyone, not just white people. Public perception is critical.
Dr. Albert Rizzo:
Totally. I wanted to pick up on the multiple vaccines in the pipeline. In the past, 50% efficacy was the benchmark, but I know you’d like 75% or greater. If early adopters get a vaccine with only 50% efficacy, and later ones are 75–80%, will people switch?
Dr. Anthony Fauci:
It depends on the difference in effectiveness. If one is 70% and another 65%, it won’t matter much. But with a big difference, like the first- vs second-generation Zostavax vaccine, people will likely seek the more effective option.
Dr. Albert Rizzo:
How about trial pauses, like the AstraZeneca one? How does that affect public perception and transparency?
Dr. Anthony Fauci:
A pause is normal. Any serious adverse event is reviewed by a Data and Safety Monitoring Board. The pause ensures safety before continuing. People may worry, but it actually shows the system is working.
Dr. Albert Rizzo:
Switching gears: monoclonal antibodies are also being developed as treatments. Can you comment?
Dr. Anthony Fauci:
Yes, companies like Lilly, Regeneron, and AstraZeneca are working on them. Trials are ongoing for outpatient, inpatient, and prophylaxis use. Early interventions like these are critical to prevent hospitalization.
Dr. Albert Rizzo:
What about serologic antibodies and “immunity passports”?
Dr. Anthony Fauci:
Too early to determine. Some people lose antibodies within months; some have non-neutralizing antibodies. We can confirm prior infection but not guaranteed protection yet.
Dr. Albert Rizzo:
And aerosol vs droplet transmission?
Dr. Anthony Fauci:
There is likely some degree of aerosol transmission. The Chinese restaurant case shows airborne spread can occur beyond immediate contact.
Dr. Albert Rizzo:
Colleges: do they risk being hotspots? Could there be localized herd immunity?
Dr. Anthony Fauci:
Herd immunity on campuses is misleading. Testing, isolation, and segregating infected students on campus is key to preventing spread. Don’t send them home; that reseeds the community.
Dr. Albert Rizzo:
What about preparedness? We were rated highly before the pandemic, yet hit hard.
Dr. Anthony Fauci:
Multifactorial. Lessons will need a thorough postmortem to improve future response.
Dr. Albert Rizzo:
Inhaled vaccines, peptides, interferon beta?
Dr. Anthony Fauci:
Inhaled or spray vaccines are in development but not advanced trials yet. Peptides and interferon beta are early-stage.
Dr. Albert Rizzo:
Future of COVID-19: seasonal, endemic, or fade away?
Dr. Anthony Fauci:
Highly transmissible. Will not disappear like SARS. Outcome depends on vaccine efficacy and uptake. If effective and widely adopted, elimination is possible; otherwise, it may linger seasonally, posing risks to vulnerable populations.
Dr. Albert Rizzo:
How much does presidential ideology influence federal response?
Dr. Anthony Fauci:
Mostly to a lesser degree. The bigger problem is divisiveness. Public health has been politicized, interfering with effective response.
Dr. Albert Rizzo:
Final note: you were captain of your basketball team?
Dr. Anthony Fauci:
Yes, back in the day. I’ve shrunk a bit since then.
Dr. Albert Rizzo:
Thank you for your time. Your expertise is invaluable.
Dr. Anthony Fauci:
Thank you. It’s a pleasure.
Dr. Albert Rizzo:
Thanks to Dr. Fauci and his team at NIAID for setting precedence for science-informed pandemic measures. This concludes our third episode.
After three episodes focused on COVID-19, next month we’ll honor Lung Cancer Awareness Month with researchers from the Lung Cancer Interception Dream Team.
Until then, this is Dr. Albert Rizzo reminding you: if you can’t breathe, nothing else matters. Take it one breath at a time.
