>> HELLO, EVERYONE.
JUST AS COVID-19 ISN'T OVER,
NEITHER IS THE SEMINAR SERIES.
WE'VE STILL GOT LOTS OF COVID-19
SCIENCE TO TALK ABOUT IN THIS
WORST PANDEMIC IN MORE THAN 100
YEARS.
SO I'M SURE YOU WILL WANT TO
SIGN UP AND WATCH EVERY EPISODE
OF THIS FALL'S SERIES.
FOR THOSE LOOKING FOR CME
TODAY'S CODE IS 43927.
WHO WOULD BE BETTER TO START
THIS OFF THAN OUR OWN TONY
FAUCI, LEGENDARY EXPERT IN
INFECTIOUS DISEASE, DIRECTOR OF
NIAID SINCE 1984, CHIEF MEDICAL
CENTER TO THE PRESIDENT,
CONSUMMATE SCIENTIST, WISE AND
COMPASSIONATE PHYSICIAN,
VISIONARY MANAGER OF RESOURCES,
WORLD CLASS COMMUNICATOR TO ALL
AUDIENCES, HE SERVED SEVEN
PRESIDENTS AS HE LED RESEARCH ON
HIV, INFLUENZA, EBOLA, ZIKA, AND
MUCH, MUCH MORE.
HE WAS A MAJOR ARCHITECT OF WHAT
MIGHT BE CONSIDERED THE MOST
AMBITIOUS AND COMPASSIONATE
PROGRAM EVER ACROSS THE WORLD,
PEPFAR.
NOW ESTIMATED TO HAVE SAVED OVER
20 MILLION LIVES, BY PROVIDING
ACCESS TO ANTIRETROVIRAL THERAPY
FOR HIV.
AND OF COURSE SINCE JANUARY 2020
HE HAS BEEN THE WORLD'S MOST
RESPECTED LEADER IN THE RESEARCH
EFFORT TO ADDRESS THE COVID-19
PANDEMIC.
DURING 2020 AND 2021, TONY WAS
MY DAILY AND OFTEN ALSO NIGHTLY
TELEPHONE PARTNER IN INSTITUTING
A 24/7 ALL-HANDS ON DECK TO
BRING THE POWER TO SCIENCE TO
BEAR ON THIS CRY IS.
I BELIEVE THE RESULTS FOR WHICH
ALL OF YOU AND NIH SHOULD TAKE
PARTICULAR PRIDE WILL BE
RECORDED LIE HISTORIANS OF YOU
AN OF SCIENCES FINAL HOURS,
INCLUDING DEVELOPMENT, TESTING,
APPROVAL OF mRNA VACCINE IN 11
MONTHS.
IF IT'S FOUR MONTHS OR MORE
SINCE YOUR LAST BOOSTER, GET
YOUR NEW BIVALENT BOOSTER NOW.
TONY HAS BEEN THE VOICE OF TRUTH
ABOUT THE PANDEMIC THROUGH THE
TUMULTUOUS TWO YEARS, NEVER ONE
TO SUGARCOAT, GAVE IT TO US
STRAIGHT, MOST AMERICANS
APPRECIATED THAT.
ON THE SILLY SIDE THAT LED TO
FAUCI BOBBLEHEADS AND FAUCI
DOUGHNUTS.
BUT ON THE MORE DISTURBING SIDE
THAT LET TO ATTACKS BY
POLITICALLY MOTIVATED
INDIVIDUALS WHO CHOSE TO
DISTRACT FROM THEIR OWN FAILINGS
BY SEEKING TO DEMONIZE THE
DEVOTED PUBLIC SERVANT.
I TRUST THAT HISTORY WILL JUDGE
VITRIOLIC CRITICS APPROPRIATELY
AS THE SELF-SERVING DISTORTERS
OF THE TRUTH THAT THEY HAVE
BECOME.
DESPITE THOSE ATTACKS ON HIM AND
HIS FAMILY THAT REQUIRE ARMED
SECURITY DETAIL TONY CONTINUES
TO LEAD WITH VISION AND DETAIL,
ANNOUNCED HIS INTENTIONS TO STEP
DOWN FROM HIS GOVERNMENT
RESPONSIBILITIES BY THE END OF
THIS YEAR.
THAT IS HARD FOR ALL OF US TO
IMAGINE, ME ESPECIALLY.
BUT AS THE PRESIDENT TOLD HIM,
NO ONE HAS EARNED THE RIGHT MORE
TO STEP BACK FROM SUCH SUPER
HUMAN DUTIES.
FOR ME IT'S BEEN A PRIVILEGE TO
BE TONY'S COLLEAGUE AND HIS
FRIEND OVER MANY DECADES.
AND IT DOES MAKE ME SMILE THAT
WHEN I, AS NIH DIRECTOR FOR 12
YEARS, WOULD OCCASIONALLY BE
ASKED BY SOMEONE WHO DIDN'T KNOW
A LOT BEFORE INSTITUTION TO
DESCRIBE WHAT IS IT, DR.
COLLINS, YOU DO, WHAT IS THE
RANGE OF YOUR RESPONSIBILITIES.
I WOULD GO THROUGH THE MAIN
THINGS.
THE LISTENER WOULD LISTENED
SURPRISED, MAYBE NOT ENTIRELY
COMPELLED BY THE RESPONSE, OH,
YOU OVERSEE 27 INSTITUTES?
UH-HUH.
A BUDGET OF $45 BILLION?
WELSHING THAT'S A LOT DID --
WELL, THAT'S A LOT, UH-HUH.
PROJECTS ON ALZHEIMER'S, CANCER,
SICKLE CELL DISEASE, SOUNDS
GOOD.
BUT WAIT WHAT?
YOU'RE TONY FAUCI'S BOSS?
HA!
THAT ALWAYS GOT THE BIGGEST
RESPONSE.
WELL, AS IF TONY NEEDED A BOSS,
WE'RE ALL GOING TO BE INTERESTED
TO SEE WHAT THE NEXT CHAPTER
BRINGS.
FOR TONY, 81 IS THE NEW 41.
YOU'RE ABOUT TO HEAR FROM THIS
REMARKABLE LEADER IN THIS FIRST
LECTURE OF THE FALL SERIES ON
COVID SCIENCE, SO JOIN ME IN
WELCOMING THE MOST DEDICATED
PUBLIC SERVICE I'VE KNOWN, TONY
FAUCI.
>> THANK YOU FOR THE KIND
INTRODUCTION.
I THANK THE ORGANIZERS OF THE
SIG LECTURE SERIES FOR GIVING ME
THE OPPORTUNITY TO MAKE THIS
PRESENTATION TODAY.
I'LL BE TALKING ABOUT COVID-19
UPDATE BUT ALSO FOCUSING ON SOME
OF THE LESSONS LEARNED THROUGH
OUR EXPERIENCE OVER THE LAST 2
1/2 YEARS.
THE PRESENTATION OBJECTIVES ARE
TO REVIEW THE CURRENT STATE OF
THE PANDEMIC, AS I MENTIONED TO
PRESENT LESSONS LEARNED, BUT
ALSO TO DISCUSS THE PRO-ACTIVE
RESEARCH AIMED AT PREPARING FOR
FUTURE SURGES WITHIN THIS
OUTBREAK AS WELL AS OTHER FUTURE
PANDEMICS OF THIS OR OTHER
PATHOGENS.
FIRST, A QUICK LOOK AT THE
CURRENT STATE OF COVID-19.
JUST HISTORICALLY TO BRING US
BACK 2 1/2+ YEARS, TO THE FIRST
AWARENESS OF AN UNUSUAL VIRUS
THAT HAD EMERGED OUT OF THE
CORONAVIRUS FAMILY, FROM A
MARKET IN THE CENTRAL PART OF
CHINA, IN THE WUHAN DISTRICT
CITY.
IT BEGAN AS A CLUSTER OF CASES
WHICH AS WE FAST FORWARD TO
TODAY SEE WE'VE BEEN
EXPERIENCING OVER THE LAST 2 1/2
YEARS THE MOST IMPACTFUL AND
DEVASTATING PANDEMIC OF A
RESPIRATORY DISEASE THAT THE
WORLD HAS EXPERIENCED IN WELL
OVER 100 YEARS WITH A GLOBAL
NUMBER OF OVER 600 MILLION
CASES, DEATHS ABOUT 6.5 MILLION
WHICH IS LIKELY A SIGNIFICANT
UNDERCOUNT OF DEATHS ASSOCIATED
WITH THIS PANDEMIC, THE UNITED
STATES UNFORTUNATELY AND
PAINFULLY HAS SUFFERED
DISPROPORTIONATELY GREATER THAN
MOST ANY OTHER COUNTRY WITH
ABOUT 100 MILLION CASES, AND NOW
2 1/2 YEARS IN, OVER ONE MILLION
DEATHS.
AGAIN, WHICH IS LIKELY A BIT OF
AN UNDERCOUNT.
THE SARS-COV-2 FAMILY HAS
EMERGED OVER THE LAST 2 1/2
YEARS HAS BEEN EXTRAORDINARY IN
THE NUMBER OF VARIANTS THAT HAVE
SEQUENTIALLY PRESENTED
THEMSELVES TO THE COMMUNITY
LIKELY THROUGH A SERIES OF
SELECTIVE PRESSURES.
I CIRCLE IN RED WHERE WE
CURRENTLY ON, THE OMICRON
VARIANT, AS I'LL SHOW IN THE
NEXT SLIDE HAS A NUMBER OF
SUBVARIANTS, STARTING OFF WITH
BA .1 AND GOING TO BA.2, 2.12.1
AND BA.5/4.
IF YOU LOOK AT CASES IN THE
UNITED STATES, WE HAVE HAD
VARIOUS SURGES OVER THE 2 1/2
YEARS THAT HAVE BEEN REFLECTIVE
OF NEW VARIANTS THAT HAVE
OBSERVED, ALPHA, AND THEN DELTA
YOU REMEMBER IN THE SUMMER OF
2021, FOLLOWED BY OMICRON.
AT THE PEAK OF JANUARY THIS YEAR
WE WERE APPROACHING ONE MILLION
CASES A YEAR.
NOW ALTHOUGH YEAR NOT AT A LEVEL
THAT IS ACCEPTABLE, IT HAS GONE
DOWN TO BETWEEN 75 AND 100,000
CASES A DAY.
IF YOU LOOK AT DEATHS, IN THE
UNITED STATES, AGAIN IF YOU LOOK
AT THE SEVEN-DAY ROLLING
AVERAGES AND PEAK OF THE
OMICRON, IN JANUARY OF THIS
YEAR, WE HAD OVER 3,000 DEATHS
PER DAY.
AGAIN, IF YOU LOOK AT WHERE WE
ARE NOW, BETWEEN 350 AND 450
DEATHS PER DAY, SUBSTANTIALLY
LOWER THAN WHAT WE EXPERIENCED
BEFORE.
HOWEVER, STILL AN UNACCEPTABLY
HIGH LEVEL OF DEATHS.
SO WHEN PEOPLE ASK US WHERE ARE
WE IN THE OUTBREAK, WE'RE NOT IN
THE FULMINANT STAGE WE
EXPERIENCED AT THE PEAK OF THE
OMICRON SURGE, BUT WITH MULTIPLE
SUBVARIANTS WHAT WE'RE TALKING
ABOUT WE STILL HAVE A
CONSIDERABLE NUMBER OF CASES.
NOW, THIS SLIDE IS A COMPLICATED
SLIDE BUT IT'S REALLY IMPORTANT
BECAUSE IF YOU GO FROM LEFT TO
RIGHT, AND YOU LOOK AT THE
VARIOUS COLOR CODES REPRESENTING
THE VARIANTS, YOU CAN SEE HOW
ONE VARIANT OVER TIME BECAUSE OF
A TRANSMISSION ADVANTAGE OVER
THE PRIOR VARIANT ESSENTIALLY
PUSHES OFF THE SCENE THE PRIOR
VARIANT THAT GETS REPLACED BY
THE CURRENT VARIANT.
AS YOU CAN SEE TO THE FAR
RIGHT-HAND PART OF THE SLIDE,
WHAT THE MEDIAN DENSITY PURPLE,
YOU HAVE BA.5 AT 88.6, AND BA .4
AT 2.8, AND 4.6 AND .4.
BA .4.5, IT'S WELL OVER 90% OF
VARIANTS CIRCULATING IN THE
UNITED STATES, ALSO RELATIVELY
SPEAKING RIGHT REFLECTIVE IN THE
REST OF THE WORLD.
WE ALL KNOW OF THE SUCCESS OF
THE VACCINES.
THESE ARE THE THREE PLATFORMS.
mRNA, ADENO, AND RECOMBINANT
WITH ADJUVANT.
IMMUNOGEN DISCOVERED HERE BY
BONNIE GRAHAM AND KIZZY CORBETT,
AND THE GROUP AT THE VRC, THE
STABILIZED PRE-FUSION SPIKE
PROTEIN, WE HAVE MULTIPLE
COMPANIES INVOLVED, AND THE
VACCINES AS YOU SEE ON THE RIGHT
HAVE EITHER RECEIVED FULL
APPROVAL AS WITH MODERNA AND
BioNTech, OR AN EUA AS SHOWN
WITH THE REST OF THE VACCINES ON
THE SLIDE HERE.
THESE ARE NOT THE ONLY VACCINES
THAT ARE USED.
MANY OTHERS ARE USED THROUGHOUT
THE WORLD.
BUT THESE ARE THE ONES THAT ARE
CURRENTLY BEING DISTRIBUTED IN
THE UNITED STATES.
WE'VE DEVELOPED A SUCCESSFUL
THERAPEUTIC TOOLKIT
PREDOMINANTLY FOR OUTPATIENTS TO
KEEP THEM FROM PROGRESSING TO
ADVANCED DISEASE REQUIRING
HOSPITALIZATION.
THE MOST IMPORTANT OF WHICH THAT
IS USED WIDELY NOW IS PAXLOVID,
A PROTEASE INHIBITOR, ALSO
CLINICAL TRIALS HAVE SHOWN
BENEFIT OF REMDESIVIR,
M ALNOPIRAVR, AND NOW BEBTELOVIM
ARCB, EFFECTIVE AGAINST THE BA
.4.5.
WE HAVE PROPHYLAXIS WITH A
MONOCLONAL ANTIBODY WHICH REDUCE
THE 80% RISK OF DEVELOPING
SYMPTOMATIC DISEASE AT SIX
MONTHS COMPARED TO A PLACEBO IN
A WELL-CONDUCTED CLINICAL TRIAL.
SO THE QUESTION IS, WHY DO WE
HAVE THE PERSISTENCE OF DAILY
COVID-19 CASES THAT EVEN THOUGH
THEY ARE LOWER THAN THEY WERE
BEFORE, THEY ARE, AS SHOWN ON A
COUPLE PREVIOUS SLIDES, THAT I
SHOWED YOU, STILL AT A RATHER
DISTURBING LEVEL.
IT HAS TO DO WITH THE INCREASED
TRANSMISSIBILITY OF THE CURRENT
VARIANT, BA.5, THE MOST
IMPORTANT IS WANING IMMUNITY,
BOTH TO THE PRIOR INFECTION
AND/OR TO VACCINATION.
TOGETHER WITH THE RELAXATION OF
MITIGATIONS THAT WE COMMONLY SEE
WITH THE DECREASE IN THE USE OF
MASKING, AND INCREASE IN USE OF
INDOOR CONGREGATING EVENTS SUCH
AS WEDDINGS, PARTIES, AND
DINNERS.
NOW, IF YOU LOOK TO WHERE WE ARE
RIGHT NOW, THE CDC HAS
RECOMMENDED THE FIRST UPDATED
COVID-19 VACCINE WHICH IS A
BIVALENT BA .4/5 COMPONENT
AUTHORIZED FOR PEOPLE OVER 12
YEARS OLD, IF YOU USE THE PFIZER
OR OVER 18 YEARS OLD, 18 OR
OVER, IF YOU USE THE MODERNA.
AND IN THE COMING WEEKS, THE CDC
EXPECTS WITH THEIR ACIP TO
RECOMMEND UPDATED BOOSTERS FOR
PEDIATRIC GROUPS YOUNGER THAN 12
LIMIT NOW SET BY THE FDA
AUTHORIZATION.
SO LET'S MOVE ON NOW TO TAKE A
LOOK AT SOME LESSONS LEARNED AS
WELL AS THE RESEARCH THAT'S
INVOLVED TOGETHER WITH THESE
LESSONS LEARNED.
THESE ARE THE SEVEN POINTS THAT
I'M GOING TO BRIEFLY MAKE.
FIRST, GLOBAL INFORMATION
SHARING AND COLLABORATIONS ARE
ESSENTIAL TO OUR SUCCESS.
WE KNOW THAT NOW BECAUSE OF THE
FACT THAT THE SHARING OF
REAGENTS, SURVEILLANCE DATA,
CONVALESCENT AND PATIENT
SAMPLES, REAL WORLD CLINICAL
DATA, ISOLATES, GENOMIC DATA
HAVE BEEN EXTREMELY IMPORTANT IN
OUR ABILITY TO ADDRESS THE MANY
PROBLEMS THAT HAVE ARISEN OVER
THE LAST 2 1/2 YEARS, AND THAT'S
INFORMED RESEARCH NOT ONLY HERE
IN THE UNITED STATES BUT
THROUGHOUT THE WORLD.
NEXT, THE EXISTING CLINICAL
TRIAL INFRASTRUCTURE SHOULD BE
UTILIZED.
THIS IS AN EXAMPLE OF USE OF
RESOURCES THAT WERE INVESTED
DECADES AGO, WITH THE HIV
CLINICAL TRIALS AND LEVERAGING
THESE TO BE USED NOW TO TEST THE
COVID-19 VACCINES.
I REFER NOW TO THE COVID-19
PREVENTION NETWORK WHICH WE
REFER TO AS COV PN, ESTABLISHED
BY MERGING FOUR NIAID-FUNDED
NETWORKS, SUCCESS UNTIL IN
DEVELOPING DRUGS IN THE ACTG,
PREVENTION TRIALS NETWORK SO
SUCCESSFUL IN THE PRE-EXPOSURE
PROPHYLAXIS WORK AS WELL AS
HIV-INFECTED VACCINE TRIALS
NETWORK.
AS I MENTIONED, THAT'S REFERRED
TO NOW AS THE COV-PN.
IMPORTANTLY, FOR THE BASIC AND
FUNDAMENTAL SCIENTIFIC
COMMUNITY, PRIOR ADVANCES IN
BASIC RESEARCH HAVE ENABLED THE
RAPID VACCINE DEVELOPMENT.
I ARTICULATED THAT IN A
COMMENTARY IN "SCIENCE" IN APRIL
OF 2021.
AS I SAID IN THAT, THE SPEED AND
EFFICIENCY WITH WHICH THESE
HIGHLY EFFICACIOUS VACCINES THAT
I SHOWED ON THE PRIOR SLIDE WERE
DEVELOPED IN THEIR POTENTIAL FOR
SAVING MILLIONS OF LIVES, DUE TO
AN EXTRAORDINARY
MULTI-DISCIPLINARY EFFORT THAT
INVOLVED BASIC PRE-CLINICAL AND
CLINICAL SCIENCE THAT HAD BEEN
UNDERWAY OUT OF THE SPOTLIGHT,
UNDER THE RADAR SCREEN,
LITERALLY FOR DECADES BEFORE THE
UNFOLDING OF THE COVID-19
PANDEMIC.
TO THE POINT WHERE "SCIENCE"
MAGAZINE, YOU MIGHT RECALL, IN
DECEMBER OF 2020 DESIGNATED THE
COVID-19 VACCINES AS THE
BREAKTHROUGH OF THE YEAR OF
2020.
AND, AGAIN, HERE ARE THE SAME
VACCINES THAT WE MENTIONED WHERE
WE HAVE NOW MULTIPLE VACCINES
THAT ARE BEING USED WITH UP TO
94 TO 95% EFFICACY PREVENTING
CLINICALLY RECOGNIZABLE DISEASE
BUT AS I'M GOING TO MENTION IN A
MOMENT, AND AS I MENTIONED
EARLIER, THE ISSUE THAT WE HAVE
IS WANING IMMUNITY WHICH HAS
REQUIRED A VERY UNUSUAL APPROACH
OF MULTIPLE UPDATING BOOSTERS
FOR THE WANING IMMUNITY WHICH
WHEN PRESENT IS REALLY QUITE
SUCCESSFUL.
NEXT, PROTOTYPE AND PRIORITY
PATHOGEN APPROACHES ENABLED OUR
ABILITY TO PREPARE FOR
PANDEMICS, INCLUDING THE PRESENT
ONE.
WHAT DO WE MEAN BY THE EMERGING
INFECTIOUS DISEASE VACCINE
DEVELOPMENT APPROACH?
THERE ARE TWO.
PRIORITY PATHOGENS AND PROTOTYPE
PATHOGENS.
PRIORITY PATHOGENS MEAN YOU
ACTUALLY PICK OUT A PATHOGEN AND
PREEMPTIVELY MAKE A VACCINE FOR
THAT.
AS IS BEING DONE NOW AS WE DID
WITH ZIKA, AS WE'RE DOING WITH
NIPPA, AS WE DID WITH EBOLA.
HOWEVER, THE OTHER IS A
PROTOTYPE PATHOGEN APPROACH,
TAKE FAMILIES OF PATHOGENS AND
AS DESCRIBED, AND THIS CONCEPT
DEVELOPED BY BONNIE GRAHAM FOR
NIAID, IN WHICH MADE THE
PROPOSAL OF LOOKING AT PRIOR
EXPERIENCES WITH DIFFERENT
FAMILIES OF PATHOGENS AND TO USE
THAT EXPERIENCE TO PROVIDE A
COMMONALITY OF KNOWLEDGE WITHIN
THAT FAMILY THAT WOULD ALLOW US
TO MOVE QUICKLY IF WITHIN THAT
FAMILY A NEW PATHOGEN EMERGED.
THERE ARE ABOUT 20 PATHOGEN
FAMILIES OF IMPORTANCE.
SEVEN OR EIGHT OF WHICH ARE OF
THE HIGHEST PRIORITY.
AND SHOWN ON THIS SLIDE WE
ALREADY DID THAT WITH
CORONAVIRUS, FOR EXAMPLE WE HAVE
EXPERIENCE WITH WORK THAT WAS
DONE ON SARS 1 AS WELL AS MERS,
WHICH LED US OVER A PERIOD FROM
2002 TO 2020 TO GIVE US THE
EXPERIENCE TO RESPOND RAPIDLY TO
SARS-COV-2.
AND WHAT YOU DO IS YOU APPLY THE
STRATEGIES AND TOOLS OF ONE
VIRUS WITHIN A FAMILY TO INFORM
VACCINE DESIGN FOR RELATED
VIRUSES.
SAME WHAT WE DID WITH THE EARLY
STUDIES ON CORONAVIRUSES.
BASIC VIROLOGY, ASSAY
DEVELOPMENT, ANIMAL MODELS,
ANTIGENIC TARGETS, OPTIMAL
PLATFORMS, WHETHER IT IS mRNA,
NANOPARTICLE, ADENOVIRUS, AND
OTHER VECTOR EXPRESSED,
POTENTIAL IMMUNE CORRELATES AS
WELL AS MANUFACTURING STRATEGIES
FOR THE VACCINE.
REMEMBER, IF WE DO THIS FOR EACH
OF THOSE FAMILIES, WHICH IS
GOING TO BE A LOT OF RESOURCES,
BUT IT WILL PUT US IN GOOD STEAD
FOR THE NEXT PANDEMIC THAT WE
WILL INEVITABLY FACE.
ANOTHER IMPORTANT LESSON WE MUST
CONTINUE THE SURVEILLANCE OF THE
HUMAN/ANIMAL INTERFACE.
THIS IS CRITICAL.
MY COLLEAGUE DAVID MOREENS AND I
OVER TWO YEARS AGO, ACTUALLY,
WROTE IN "CELL" THAT THE
COVID-19 PANDEMIC IS A TRULY
STARK REMINDER, ADDED TO THE
GROWING RAPIDLY ARCHIVE OF
HISTORICAL REMINDERS THAT IN THE
HUMAN-DOMINATED WORLD IN WHICH
HUMAN ACTIVITIES REPRESENT
AGGRESSIVE DAMAGING, AND AS I
HIGHLIGHT HERE, UNBALANCED
INTERACTIONS WITH NATURE WE WILL
INCREASINGLY PROVOKE NEW DISEASE
EMERGENCES.
AS MOST OF YOU KNOW, ABOUT 75%
OF ALL NEW PATHOGENS IN HUMANS
ARE ZOONOTIC, THEY HAVE EMERGED
FROM AN ANIMAL RESERVOIR SOURCE.
COGENT EXAMPLES, HIV, INFLUENZA,
EBOLA, AND NOW COVID-19.
HUMAN HEALTH IS INEVITABLY
CONNECTED TO THE HEALTH OF
ANIMALS IN OUR SHARED
ENVIRONMENT, AND IN FACT RECENT
STUDIES THAT WERE FIRST IN THE
META ARCHIVE NOW APPEARED IN
"CELL," "SCIENCE," AND PEER
REVIEW, ALTHOUGH WE KEEP AN OPEN
MIND OF THE ORIGIN OF COVID-19
THAT IT MAY HAVE BEEN OUT OF A
LABORATORY ACCIDENT, THE
OVERWHELMING EVIDENCE NOW IS
SHOWING THAT IT WAS A NATURAL
OCCURRENCE THAT WAS CENTERED IN
THE WUHAN MARKET, WHERE EVIDENCE
INDICATES THAT ANIMALS WERE
BROUGHT IN FROM THE WILD THAT
WERE VERY LIKELY INFECTED WITH
SARS-COV-2, AND SPILLED OVER TO
HUMANS IN THE SETTING OF THAT
MARKET.
NEXT, LONGSTANDING SYSTEMIC
HEALTH AND SOCIAL INEQUITIES
DRIVE PANDEMIC DISPARITIES.
THIS IS A JAMA COMMENTARY THAT
OUR COLLEAGUES HERE AT NIH LED
BY ELISEO STABLE-PEREZ INDICATE
WHAT WE HAVE EXPERIENCED
THROUGHOUT THIS AND OTHER
PANDEMICS.
THAT THE MOST PERVASIVE
DISPARITIES IN HEALTH WITHIN A
PANDEMIC SETTING ARE OBSERVED
AMONG AFRICAN AMERICAN AND
LATINO INDIVIDUALS AND WHERE THE
DATA EXISTS ALSO AMONG NATIVE
AMERICANS, ALASKA NATIVES, AND
PACIFIC ISLANDERS.
THAT IS THE RESULT OF
LONGSTANDING SYSTEMIC HEALTH AND
SOCIAL INEQUITIES THAT DRIVE
THESE DISPARITIES.
DISCRIMINATION, LIMITED HEALTH
CARE ACCESS AND USE, THE
OCCUPATIONS OF MINORITY
POPULATIONS THAT
DISPROPORTIONATELY PUT THEM IN
ESSENTIAL WORK SETTINGS WHERE
REMOTE WORK OR PHYSICAL
DISTANCING IS DIFFICULT IF NOT
IMPOSSIBLE.
THERE ARE ALSO EDUCATIONAL,
INCOME, AND WEALTH GAPS, AS WELL
AS ISSUES LIKE HOUSING WHERE
SOME PEOPLE LIVE IN CROWDED
CONDITIONS WHERE IT'S VERY HARD
TO FOLLOW THE PREVENTION
STRATEGIES THAT ARE RECOMMENDED
TO PREVENT COVID-19.
AND FINALLY, MISINFORMATION,
WHICH HAS ALWAYS BEEN AND STILL
IS THE ENEMY OF PUBLIC HEALTH
AND PANDEMIC CONTROL.
AND THESE ARE JUST SOME OF THE
EXAMPLES OF THE EGREGIOUS
MISINFORMATION WHICH HAS
CHARACTERIZED OUR RESPONSE NOT
ONLY IN THE UNITED STATES BUT
THROUGHOUT THE WORLD TO
COVID-19.
FROM CRAZY CONSPIRACY THEORIES
TO JUST FRAUDULENT CLAIMS ABOUT
PRODUCTS SUCH AS
HYDROXYCHLOROQUINE AND OTHERS.
LET'S LOOK AHEAD NOW.
IN JANUARY OF THIS YEAR, MY
COLLEAGUES DAVID WARRENS, JEFF
TAUBENBERGER AND I WROTE IN THE
NEW ENGLAND JOURNAL ON THE
URGENT NEED FOR CORONAVIRUS
VACCINES, IT GOES BEYOND THAT.
FIRST LET'S LOOK AT A PAN
CORONAVIRUS VACCINE.
AS I MENTIONED, WE SAID THERE IS
AN URGENT NEED FOR THIS.
THESE ARE SOME OF THE PAPERS OF
WORK THAT'S ALREADY BEING DONE
BY MANY OF OUR GRANTEES, AS WELL
AS HERE IN THE INTRAMURAL
PROGRAM.
ONE OF THE PAPERS THAT JUST CAME
OUT A FEW WEEKS AGO FROM ONE OF
OUR GRANTEES, PAM BORKMAN, ON AN
EXCITING POTENTIAL CANDIDATE,
MOSAIC NANOPARTICLES THAT
PROTECT AGAINST CHALLENGE BY
DIVERSE VIRUSES IN ANIMAL
MODELS.
THERE ARE ALSO A NUMBER OF OTHER
TRIALS THAT ARE DONE OUTSIDE OF
THE REALM OF NIH FUNDING THAT
ARE ALSO IMPORTANT.
WITHIN THE CONTEXT OF NIH, NIAID
HAS MADE SIX RECENT AWARDS OF
ABOUT $60 MILLION FOR RESEARCH
ON BROADLY PROTECTIVE CROHN
VACCINES AND THESE ARE THE GRANT
THAT HAVE BEEN AWARDED THUS FAR
WITH MORE TO COME.
IMPORTANTLY, MUCOSAL VACCINES
CLEARLY ARE THE VACCINES OF THE
FUTURE TO PREVENT NOT ONLY
AGAINST DISEASE BUT AGAINST
ACQUISITION AND TRANSMISSION, AN
ISSUE THAT HAS BECOME EXTREMELY
IMPORTANT IN THE CONTEXT OF
CORONAVIRUS.
THERE HAVE BEEN A NUMBER OF
DISCUSSIONS ABOUT THIS, MOST
RECENT ONE LAST MONTH IN SCIENCE
IMMUNOLOGY BY ERIC TOPOL AND
IKKAAWASAWI ABOUT NEED FOR NASAL
VACCINES.
THERE'S TRANSFORMATIONAL PROMISE
OF MUCOSAL VACCINES.
ONE, FASTER IMMUNITY RECALL AT
THE SITE OF ENTRY AT THE MUCOSA,
AFTER VIRAL EXPOSURE.
THE IMPORTANCE OF BOTH INFECTION
AND TRANSMISSION BLOCKING AND
THEN AGAIN THE FACT THAT IT'S
NEEDLE-FREE DELIVERY.
YOU KNOW THE EXPERIENCE THAT
WE'RE HAVING NOW WITH COVID-19
THAT EVEN PEOPLE WHO ARE
VACCINATED AND BOOSTED, ALTHOUGH
IT'S VERY CLEAR THAT THE
PROTECTION AGAINST SEVERE
DISEASE LEADING TO
HOSPITALIZATION AND DEATHS, DOES
NOT PROTECT VERY WELL AGAINST
ACTUAL INFECTION.
I MYSELF BEING AN EXAMPLE OF
THAT.
A PERSON WHO WAS VACCINATED,
DOUBLY BOOSTED, WHO GOT INFECTED
DURING THE OUTBREAK OF BA
.1.21.1 IN JUNE OF THIS YEAR.
IT WAS A RELATIVELY MILD
ILLNESS.
THAT WAS THE IMPORTANCE OF THE
VACCINE AND BOOSTER BUT I STILL
INDEED GOT INFECTED AND MAY HAVE
TRANSMITTED IT TO OTHER PEOPLE
INADVERTENTLY.
THERE IS SOME GOOD ACTIVITY IN
THE INTRANASAL WORK, THE BARRATT
BIOTECH IN INDIA RECEIVED
EMERGENCY USE APPROVAL OF
ADENOVIRUS VECTOR THAT WAS A
CONCEPT THAT WAS ORIGINALLY
DEVELOPED THROUGH AN NIH GRANT
TO MIKE DIAMOND AND HIS
COLLEAGUES AT WASHINGTON
UNIVERSITY.
WE CAN'T DISCUSS THIS ABOUT THE
FUTURE OF PANDEMICS WITHOUT
TALKING ABOUT THE IMPORTANCE OF
ANTI-VIRALS.
I MENTIONED THAT IN MY EARLIER
SLIDES TALKING ABOUT THE STATE
OF COVID-19 AND OTHERS WITH
PAXLOVID AND OTHERS BUT WE HAVE
AN ANTI-VIRAL PROGRAM FOR
PANDEMICS AIMED AT CATALYZING
NEW MEDICINES TO COMBAT COVID-19
BUT TO PROTECT FOR OTHER
PANDEMIC THREATS, BASED ON TWO
CONCEPTS, DEVELOPMENT OF DRUGS
AND MOLECULES ALREADY EXISTING,
THE WAY WE DID, FOR EXAMPLE,
WITH AZT DURING THE HIV
SITUATION DECADES AGO, BUT ALSO
THE DISCOVERY OF NEW MOLECULES
BY EXPANDING THE BASIC SCIENCE
KNOWLEDGE AND GETTING NEW
ANTI-VIRAL MEDICINES.
THIS IS A SCHEMATIC OF THE
REPLICATION CYCLE OF SARS-COV-2.
VERY SIMILAR IN THE CONCEPT OF
WHAT WE DID IN THE DISCOVERY OF
ANTIRETROVIRALS FOR HIV.
WHERE YOU TARGET VULNERABLE
AREAS OF REPLICATION CYCLE AND
DEVELOP INHIBITORS SUCH AS
POLYMERASE, PROTEASE INHIBITORS,
ENTRY INHIBITORS, AND THEN GO ON
TO ADVANCE DEVELOPMENT FOR DRUGS
THAT WOULD HOPEFULLY BE
EFFECTIVE AGAINST THIS PATHOGEN
AS WELL AS FUTURE PATHOGENS THAT
USE THIS TARGETED ANTI-VIRAL
APPROACH.
AND IN THIS REGARD, THE SPRING
OF THIS YEAR WE ANNOUNCED A
NUMBER OF AWARDS FOR ANTI-VIRAL
DRUG DEVELOPMENT TO ESTABLISH
NINE CENTERS CALLED ANTI-VIRAL
DRUG DISCOVERY CENTERS,
AVIDDs, LOOKING AT PATHOGENS
OF PANDEMIC CONCERN INCLUDING
PARAMIX VIRUSES, FLAVORY
VIRUSES.
SO WRAPPING UP, WHAT IS THE END
GAME FOR 2022 AND BEYOND WITH
REGARD TO COVID-19?
I THINK WE CAN BEST EXPLAIN IT
BY LOOKING AT THE VARIOUS PHASES
AND ISSUES WHEN YOU'RE DEALING
WITH A PANDEMIC.
WE'VE BEEN THROUGH THE VERY
FULMINANT PANDEMIC PHASE AND
HAVE SEEN DECELERATION OF NEW
CASES BUT HAPPENS AT THE END OF
ALL THIS?
WILL WE ERADICATE SARS-COV-2?
I WOULD SAY WITH SOME CONFIDENCE
THAT THE ANSWER TO THAT IS NO.
BECAUSE WE'VE ONLY ERADICATED
ONE VIRUS IN THE HISTORY OF
HUMAN PUBLIC HEALTH.
AND THAT IS SMALLPOX.
BUT THERE WERE REASONS WE WERE
ABLE TO DO THAT.
THERE'S NO ANIMAL RESERVOIR.
IT'S A PHENOTYPICALLY STABLE
VIRUS.
SMALLPOX THAT AFFLICTED PEOPLE
CENTURIES AGO IS THE SAME I WAS
VACCINATED AGAINST AS A CHILD.
WE HAD A WIDELY ACCEPTABLE
GLOBAL CAMPAIGN OF VACCINATION.
BUT IMPORTANTLY, THIS IS
CRITICAL, THE IMMUNITY THAT'S
INDUCED BY VACCINE OR INFECTION
WITH SMALLPOX, THE DURABILITY IS
MEASURED IN DECADES AND LIKELY
LIFETIME.
NEXT, WHAT ABOUT ELIMINATION?
CAN WE ELIMINATE SARS-COV-2?
I'LL EXPLAIN IN A MOMENT WHY
NOT.
BUT LET'S LOOK AT THE ONES WE
HAD ELIMINATED, POLIO AND
MEASLES IN THE UNITED STATES.
AGAIN, WE'RE DEALING WITH A
PHENOTYPICALLY STABLE VIRUS.
MEASLES OF DECADES AGO IS THE
SAME MEASLES WE'RE SEEING NOW IN
SOME DEVELOPING NATIONS.
IN THE UNITED STATES, WE HAD AND
STILL HAVE A WIDELY ACCEPTED
NATIONAL VACCINATION CAMPAIGN
AND IMPORTANTLY AGAIN FROM AN
IMMUNOLOGICAL STANDPOINT THE
IMMUNITY INDUCED BY EITHER
INFECTION OR VACCINES OF BOTH
POLIO AND MEASLES, THE
DURABILITY IS MEASURED IN
DECADES, AND LIKELY LIFETIME.
BUT WHERE ARE WE WITH
SARS-COV-2?
WE KNOW THERE ARE ESTABLISHED
ANIMAL RESERVOIRS, UNIQUELY
THERE'S THE EVOLUTION OF
GENOTYPICALLY AND PHENOTYPICALLY
DIVERSE VARIANTS, AND WE'VE
EXPERIENCED FIVE OF THESE IN THE
LAST 2 1/2 YEARS.
IMPORTANTLY, AND I MENTIONED
THIS A FEW TIMES, THAT THE
IMMUNITY INDUCED BY EITHER
INFECTION OR VACCINE WANES OVER
TIME.
PARTICULARLY WITH REGARD TO
PROTECTION AGAINST INFECTION.
LESS SO AGAINST PROTECTION
AGAINST SEVERE DISEASE.
AND UNFORTUNATELY FOR US, WITH
THE ANTI-VAX SITUATION IN THIS
COUNTRY AND THE WORLD IS THE
LACK OF WIDE ACCEPTANCE OF SAFE
AND EFFECTIVE VACCINES.
WE'RE DEALING WITH CONTROL.
AND THE LEVEL OF CONTROL IS
IMPORTANT.
TO GET TO A LOW ENOUGH LEVEL,
WHERE IT DOESN'T DISRUPT THE
SOCIAL ORDER, THAT'S WHAT WE
REFER TO WHEN WE SAY A RETURN TO
NORMALCY OR ENDEMICITY, A
DIFFICULT-TO-DESCRIBE SITUATION,
BUT SOMEWHAT SIMILAR TO OTHER
RESPIRATORY VIRUSES THAT DON'T
DISTURB THE SOCIAL ORDER.
IT DOESN'T INTERFERE WITH THE
ECONOMY OR OUR SOCIAL
INTERACTIONS.
AND THAT'S RESPIRATORY VIRUS,
COMMON COLD, INFLUENZA, WE'RE
LOOKING AT A LEVEL THAT DOESN'T
DISTURB OUR SOCIAL INTERACTIONS.
TO GET THERE, WE BELIEVE WE HAVE
TO HAVE THE AVAILABILITY OF
INTERMITTENT VACCINATION, LIKE
WE REFERRED TO JUST RECENTLY
ABOUT GETTING CORONAVIRUS
VACCINE AT LEAST ON A YEARLY
BASIS.
AS WELL AS OTHER THINGS, SUCH AS
RESPIRATORY HYGIENE, ATTENTION
TO VENTILATION IN INDOORS,
MASKING WHERE APPROPRIATE, AND
THE AVAILABILITY OF EFFECTIVE
VIRUS ANTI-VIRALS AND MONOCLONAL
ANTIBODIES.
I WANT TO CLOSE WITH THIS LAST
SLIDE.
AN ARTICLE THAT DAVID MORENS,
GREG FOCUS AND I WROTE IN
"LANCET" 14 YEARS AGO.
THAT MERGING INFECTIOUS DISEASES
HAVE ALWAYS BEEN WITH US BEFORE
WE EVEN RECORDED THEM, IN
RECORDED HISTORY WE'VE
EXPERIENCED THEM OVER OUR
LIFETIME AND WE'RE IN THE MIDDLE
OF ONE RIGHT NOW.
THEY ARE INDEED A PERPETUAL
CHALLENGE.
AND THE ONLY WAY TO ADDRESS THEM
AS A GLOBAL COMMUNITY IS TO BE
PERPETUALLY PREPARED.
AND THAT IS THE REASON WHY WE'RE
SPEAKING TODAY ABOUT THE LESSONS
LEARNED FROM OUR CURRENT VERY
DIFFICULT EXPERIENCE THAT WE'VE
HAD OVER THE LAST TWO YEARS, AND
LET'S HOPE THAT OUR CORPORATE
MEMORY OF THOSE LESSONS DOES NOT
FADE AS WE PUT COVID-19 BEHIND
US IN THE FUTURE YEARS.
THANK YOU.
>> THANK YOU, DR. FAUCI, FOR THE
INSIGHTFUL AND INSPIRING TALK.
I'M PAM SCHWARTZBERG, ON THE
BEHALF OF THE STEERING
COMMITTEE.
I THANK YOU FOR ATTENDING THE
FIRST TALK OF THE SEASON.
IF YOU'RE INTERESTED,
PLEASE JOIN THE COVID-19
SCIENTIFIC INTEREST GROUP, JUST
SEARCH NIH AND COVID-19 SIG AND
YOU'LL FIND OUT OUR WEBSITE WITH
INSTRUCTIONS ON HOW TO JOIN AND
THE LIST OF UPCOMING SEMINARS.
NEXT SEMINAR IS OCTOBER 6.
IT WILL BE MICHELE MINCI FROM
STANFORD SPEAKING ON NEUROCOVID.
YOU'LL FIND INFORMATION ON OUR
COVID-19 SCIENTIFIC RESEARCH
WORKSHOP WHICH WILL BE HELD
DECEMBER 15 AND 16 THIS YEAR.
AND REGISTRATION WILL BE OPENING
IN THE NEXT FEW WEEKS.
AND WE REALLY HOPE YOU CAN ALL
ATTEND WHAT WE THINK WILL BE A
VERY EXCITING AND DIVERSE
WORKSHOP.
AND NOW I'D LIKE TO TURN THE MIC
OVER TO DR. VERONIQUE
NUSSENBLATT, HOSTING QUESTIONS
WITH DR. FAUCI.
THANK YOU AGAIN, DR. FAUCI AND
DR. NEWSEN BACK.
>> WE HAVE SEVERAL QUESTIONS FOR
YOU.
SO, THE FIRST QUESTION HAS TO DO
WITH MUCOSAL VACCINES THAT YOU
DISCUSSED.
SO WHAT ARE THE MAJOR CHALLENGES
ANTICIPATED FOR NEXT GENERATION
COVID-19 MUCOSAL VACCINES?
>> WELL, THERE ARE A COUPLE
CHALLENGES.
THE FIRST IS, YOU KNOW, WE DON'T
HAVE VERY GOOD MUCOSAL VACCINES
FOR RESPIRATORY VIRUSES.
I MEAN, WE DO HAVE THE FLU MIST
FOR FLU, WHICH SEEMS TO BE QUITE
GOOD.
BUT WHAT WE HAVE NOT WORKED OUT
IS THE COMBINATION OF GETTING
GOOD PROTECTION AT THE SOURCE OF
ENTRY IN THE UPPER RESPIRATORY
MUCOSA, AT THE SAME TIME AS
GETTING GOOD SYSTEMIC PROTECTION
AT THE SYSTEMIC LEVEL.
THE OTHER THING IS THAT
SOMETHING THAT PEOPLE DON'T
REALLY APPRECIATE IS THE SAFETY
ISSUES BECAUSE IF YOU'RE TALKING
ABOUT SPIKE PROTEIN, IT'S A VERY
SOMEWHAT OF A MYSTERIOUS
MOLECULE, WHAT WE'RE SEEING
ABOUT SOME OF THE IMPORTANT
ADVERSE EFFECTS FROM THE DISEASE
ITSELF RELATED TO ABERRANT
RESPONSES TO THE SPIKE PROTEIN
AND SPIKE PROTEIN'S ABILITY TO
INFLAME AREAS, FOR EXAMPLE, THAT
HAVE TO DO WITH TASTE AND SMELL,
THERE IS A SUBSTANTIAL SAFETY
ISSUE.
I TAKE THAT BACK.
WE DON'T KNOW WHAT THE SAFETY
ISSUE IS, RATHER THAN TO SAY A
SUBSTANTIAL SAFETY ISSUE,
THERE'S A SUBSTANTIAL SAFETY
QUESTION.
THE OTHER THING IS, YOU KNOW, AS
AN IMMUNOLOGIST, AFTER ALL THESE
YEARS, I'M NOT A MUCOSAL
IMMUNOLOGIST BUT I'M STUNNED HOW
LITTLE WE KNOW ABOUT MUCOSAL
IMMUNITY AFTER SO MANY YEARS OF
GREAT ADVANCES IN IMMUNOLOGY IN
GENERAL, AND THAT MAY BE TO THE
DIFFICULTY IN SAMPLING, IT'S SO
EASY TO SAMPLE BLOOD AND THINGS
LIKE THAT, BUT TO SAMPLE AREAS
OF MUCOSA I THINK IT'S
IMPORTANT.
SO, IT'S LACK OF A TRACK RECORD
OF GOOD MUCOSALLY ADMINISTERED
VACCINES THAT WILL BE THE
BIGGEST PROBLEM AS WELL AS
THEORETICAL AND PERHAPS REAL
SAFETY ISSUE.
WHEN IT COMES TO COVID, NOT WHEN
IT COMES TO OTHER VACCINES LIKE
INFLUENZA WHICH WE'VE ALREADY
DONE THE PROOF-OF-CONCEPT WITH
FLU MIST.
>> GREAT.
THANK YOU.
SO, THERE'S ANOTHER QUESTION
THAT HAS -- THAT'S ALONG THE
SAME LINES.
WHY DON'T WE USE NASAL VACCINES
FOR OTHER RESPIRATORY VIRUSES?
>> YEAH, I JUST ANSWERED IT.
THAT WE JUST HAVE NOT HAD THE --
YOU SAY WHY DON'T WE USE THEM?
BECAUSE WE HAVEN'T DEVELOPED
THEM.
AND IT'S JUST A SIMPLE ISSUE OF
THE REAL GAPS IN KNOWLEDGE OF
MUCOSAL IMMUNITY.
IF WE HAD A GREATER HANDLE ON
MUCOSAL IMMUNITY I THINK YOU
WOULD SEE A LOT MORE OF THE
EFFORTS THAT ARE GOING TO BE PUT
IN DEVELOPING PRODUCTS THAT
MUCOSALLY ADMINISTERED.
THE ORAL POLIO VACCINE IS A GI
MUCOSALLY ADMINISTERED AND
MECHANISM OF ACTION IS NOT TO
PREVENT REPLICATION IN THE GUT
BUT FROM MAKING THE NEXT STEP
ENTERING INTO THE NERVOUS
SYSTEM.
WHEREAS IF YOU GET PAST THE
FIRST STAGE OF A RESPIRATORY
VIRUS CHALLENGING THE MUCOSA IN
THE UPPER AIRWAY, THEN THE HORSE
IS OUT OF THE BARN.
YOU'RE ALREADY INFECTED.
YOU REALLY HAVE TO HAVE A VERY
SUBSTANTIAL DEGREE OF PROTECTIVE
IMMUNITY.
WE'VE NOT BEEN ABLE TO ACHIEVE
THAT VERY WELL WITH MOST
RESPIRATORY VIRUSES.
>> THANK YOU.
SO, THE NEXT QUESTION IS MORE OF
A PERSONAL QUESTION.
WHAT ARE YOU MOST PROUD OF FROM
YOUR TENURE AT NIH?
>> WOW!
WELL, THERE ARE A NUMBER OF
THINGS.
I DON'T THINK I COULD PICK OUT
ONE THING.
CERTAIN THINGS HAVE TO DO WITH
THE MULTIPLE HATS I WEAR.
SO IF YOU'LL ALLOW ME A COUPLE
MINUTES, I CAN EXPAND BECAUSE I
CAN'T GIVE YOU A TWO-CENT
ANSWER.
I'M USUALLY SOMEBODY VERY
PRECISE IN THEIR ANSWER.
SO THERE'S CONTRIBUTION AS A
SCIENTIST WHICH HAS TO DO WITH
MY TENURE AT NIH BUT NOT
NECESSARILY AS MY TENURE AS
DIRECTOR.
AND THAT IS THE FACT THAT I HAVE
BEEN INVOLVED NOW FOR OVER 40
YEARS IN THE STUDY OF THE
PATHOGENIC MECHANISMS OF HIV,
AND ALONG WITH OTHER
INVESTIGATORS INCLUDING HERE AT
THE NIH I THINK WE'VE MADE A LOT
OF PROGRESS.
I'M PROUD OF IT AS A SCIENTIFIC
ACCOMPLISHMENT AS WELL AS THE
PRE-AIDS ERA, WHICH ALREADY
TELLS YOU HOW OLD I AM, THAT I
DID SOME SIGNIFICANT WORK ON
AUTO-INFLAMMATORY DISEASES
DEVELOPING THERAPIES FOR
VASCULITIES THAT WITH FATAL,
DEVELOPING THERAPIES THAT
UTILIZED INFORMATION FROM CANCER
INSTITUTE WHERE THEY WERE USING
CHEMOTHERAPIES FOR CANCER, WE
USED VERY LOW DOSE DRUGS LIKE
CYCLOFOSIMIDE AND PUT IN
REMISSION POLYANYITIS.
WHEN I CAME, IT WASN'T ON THE
RADAR SCREEN, PEOPLE THOUGHT
THAT INFECTIONS WERE THINGS OF
THE PAST AND YOU DIDN'T HAVE TO
PAY OF ATTENTION -- MUCH
ATTENTION.
IT WAS IN INSIPIENT STAGES OF
IMMUNOLOGY IN HUMANS AND BUILT
IT INSTITUTE TO A $6 BILLION
INSTITUTE OVER THE PERIOD I WAS
DIRECTOR, DEVELOPING THE AIDS
PROGRAM WHICH I'M PROUD OF, THAT
LED TO DEVELOPMENT OF DRUGS
WHICH HAVE BEEN EXTREMELY
LIFE-SAVING AND TRANSFORMING THE
CLINICAL COURSE OF PEOPLE WITH
HIV, THAT HAS TO STAND AS ONE OF
THE THINGS I FEEL MOST GOOD
ABOUT.
THERE WAS RELUCTANCE EARLY ON
HAVING A SEPARATE AIDS PROGRAM
BECAUSE PEOPLE FELT IT WOULD
TAKE ATTENTION FROM OTHER
DISEASES, WHICH IT DIDN'T.
IF ANYTHING, I BROUGHT ATTENTION
TO INFECTIOUS DISEASE.
AND SOMETHING THAT HAD VERY
LITTLE TO DO WITH MY LINE ITEM
RESPONSIBILITIES AS DIRECTOR BUT
BECAUSE I'VE HAD THE OPPORTUNITY
TO BE THE ADVISER TO SEVEN
PRESIDENTS NOW, ONE OF THE
PRESIDENTS DEVELOPED A VERY
CLOSE RELATIONSHIP WITH ME,
SEVERAL DID, BUT ONE WE DID
SOMETHING VERY IMPORTANT
TOGETHER, AND THAT WAS THE
DEVELOPMENT OF THE PEPFAR
PROGRAM UNDER GEORGE W. BUSH
WHERE HE GAVE ME THE MANDATE TO
PUT TOGETHER A PROGRAM WHICH HAS
NOW LED TO THE SAVING OF ABOUT
18 MILLION LIVES GLOBALLY.
SO THAT HAD NOTHING TO DO REALLY
WITH MY RESEARCH EXCEPT THAT MY
RESEARCH PUT ME IN A POSITION TO
GAIN THE TRUST OF THE PRESIDENTS
AND MY RELATIONSHIP WITH THE
PRESIDENTS ALLOWED ME TO BE IN A
POSITION TO PUT THE PEPFAR
PROGRAM TOGETHER.
SO I KNOW THAT'S A LONG-WINDED
ANSWER TO THE QUESTION BUT IT
HAS TO DO WITH THE THREE HATS AS
A SCIENTIST, AS AN INSTITUTE
DIRECTOR, AND AS PUBLIC HEALTH
OFFICIAL.
>> DR. FAUCI, YOUR ANSWER IS
INSPIRING AND LEADS US TO THE
NEXT QUESTION, WHAT IS YOUR
PROFESSIONAL ADVICE FOR PEOPLE
STARTING IN THEIR CAREERS
INTERESTED IN PUBLIC HEALTH?
>> YOU KNOW, TO ME, IT'S FOLLOW
YOUR PASSION.
FIRST OF ALL, HAVE -- YOU HAVE
TO BE KEENLY INTERESTED IN
SOMETHING AND FEEL VERY
PASSIONATE ABOUT IT BECAUSE THE
ENERGY THAT YOU NEED TO PUT INTO
SOMETHING, TO BE SUCCESSFUL WITH
IT, IT HAS TO BE A PROBLEM, IN
MY MIND, THAT PICK OUT A PROBLEM
THAT'S RELEVANT.
YOU KNOW, THERE ARE SOME
PROBLEMS THAT YOU CAN DO A LOT
OF EXPERIMENTS ON THAT ARE NOT
PARTICULARLY RELEVANT.
AND THERE ARE OTHERS THAT ARE
RELEVANT BUT IT'S VERY DIFFICULT
TO DEVELOP THE RIGHT KIND OF
QUESTIONS TO ANSWER THEM.
PICK OUT SOMETHING THAT YOU CAN
ACTUALLY WORK ON, EVEN IF IT'S
FUNDAMENTALLY A BASIC SCIENCE
QUESTION.
THAT WOULD HAVE SOME CONNECTION
TO SOMETHING YOU CAN FEEL VERY
STRONGLY ABOUT.
AND DON'T WORRY ABOUT WHAT OTHER
PEOPLE THINK ABOUT WHAT YOU DO.
I MEAN, OBVIOUSLY WHEN YOU ARE
TRYING TO GET A GRANT YOU HAVE
TO WORRY ABOUT WHAT OTHER PEOPLE
THINK ABOUT IT, BUT YOU'VE GOT
TO BE THE ONE THAT REALLY FEELS
VERY STRONGLY ABOUT YOUR WORK
BECAUSE THAT'S GOING TO DERIVE
IN YOU THE ENERGY THAT IT TAKES
TO BE SUCCESSFUL IN IT.
SO, YOU KNOW, SCIENCE IS AN
AMAZING PROFESSION.
WE SHOULD FEEL SO FORTUNATE THAT
WE'VE HAD THE OPPORTUNITY THAT
WAS PROBABLY GIVEN TO US BY
EVERYTHING GOING BACK FROM OUR
PARENTS TO MENTORS AND OTHERS
WHO PUT US INTO A POSITION TO BE
ABLE TO CONDUCT SCIENCE.
IT'S ONE OF THE MOST
SELF-FULFILLING, GRATIFYING
PROFESSIONS WE CAN THINK OF.
DON'T GET DISCOURAGED BY LACK OF
SUCCESS.
YOU KNOW, PEOPLE LOOK AT ME
BECAUSE I'VE BEEN AROUND A WHILE
AND I'M VERY WELL KNOWN.
I HAD AS MANY FAILURES IN THE
LAB THAT ALL OF YOU NOW ARE
THINKING ABOUT THE FAILURES IN
THE LAB.
YOU KNOW, THE FIRST GROUP OF
EXPERIMENTS I GOT INVOLVED WITH
DIDN'T WORK VERY WELL.
I WAS VERY DEPRESSED, MY FIRST
PAPER, "JOURNAL OF IMMUNOLOGY,"
I GOT REJECTED.
YOU KNOW, I THOUGHT MY CAREER
WAS OVER.
SO, JUST BECAUSE YOU SEE ME ON
TV DOESN'T MEAN I DIDN'T GO
THROUGH THE SAME THING YOU'RE
ALL GOING THROUGH.
>> THANK YOU.
I THINK THAT ANSWER RESONATES
WITH A LOT OF PEOPLE.
SO, THE NEXT QUESTION HERE IS,
WHAT DO YOU FORESEE AS THE
BIGGEST CHALLENGE IN THE NEXT
YEAR OF COVID?
>> YEAH, I THINK THE BIGGEST
CHALLENGE IS HOW -- IT'S A
COMBINATION OF A SOCIETAL
CHALLENGE AND A SCIENTIFIC
CHALLENGE.
THE QUESTION IS GOING TO BE, AND
THAT HAS A LOT TO DO I THINK
WITH ONE OF YOUR FIRST
QUESTIONS, IS HOW DO WE GET THE
PROTECTION OF THE COMMUNITY SUCH
THAT THE LEVEL OF VIRUS IN THE
COMMUNITY IS LOW ENOUGH THAT IT
DOES NOT DISRUPT THE SOCIAL
ORDER, BECAUSE WE REALLY CAN'T
GO ON FOR A LONG TIME THE WAY
WE'VE GONE ON.
WE'RE ALMOST THREE FULL YEARS
INTO AN ENTIRELY DISRUPTIVE
PANDEMIC.
IF WE HAD A VACCINE THAT WAS, A,
HIGHLY EFFECTIVE, WHICH WE DO,
GOOD NEWS, BAD NEWS IT DOESN'T
PROTECT FOR A DURABLE PERIOD OF
TIME.
THE OTHER CHALLENGE IS THE FACT
THAT UNLIKE THE VIRUSES THAT
WE'VE CONQUERED, POLIO,
SMALLPOX, MEASLES, THE ABILITY
OF THIS VIRUS TO FORM VARIANTS
THAT ELUDE PROTECTION OF
VACCINES, MORE SO AGAINST
INFECTION, THAN AGAINST SEVERE
DISEASE, IS IN MANY RESPECTS
UNPRECEDENTED.
I MEAN, WITHIN ONE SEASON, WE'VE
GONE FROM WILDTYPE TO ALPHA TO
DELTA, TO THE END OF THE YEAR
OMICRON.
THAT IS A SCIENTIFIC AND PUBLIC
HEALTH CHALLENGE, THE LIKES OF
WHICH WE HAVEN'T SEEN, EVER,
REALLY, WITH ANY PATHOGEN.
SO THE CHALLENGE IS GOING TO BE
TO DEVELOP THERAPEUTICS AS WELL
AS A VACCINE THAT PREVENTS
AGAINST INFECTION, HENCE YOUR
QUESTION ABOUT MUCOSAL.
NUMBER TWO, HAS A DURABILITY OF
PROTECTION.
AND THREE, IS BROADLY
PROTECTIVE.
SO THAT WE GET A RESPONSE
AGAINST ANY ASPECT OF A
SARS-COV-2, ANY VARIANT, THAT
MAY NOT JUST BE CONCENTRATING ON
THE SPIKE PROTEIN.
THERE MAY BE OTHER COMPONENTS OF
THE ANTIGENIC STRUCTURE OF THE
VIRUS THAT WE NEED TO AIM AT.
BUT THAT REALLY IS THE CHALLENGE
TO ESSENTIALLY GET IT TO SUCH A
LOW LEVEL IT DOESN'T DISRUPT US.
>> THANK YOU.
THERE ACTUALLY IS A QUESTION
ABOUT -- IF YOU COULD COMMENT ON
MUTATIONS OUTSIDE OF THE SPIKE
PROTEIN, AND IF THESE MIGHT LEAD
TO LONGER INFECTION OR THEIR
SIGNIFICANCE.
>> THERE'S A LOT WE DO NOT KNOW.
WHETHER OR NOT IT'S GOING TO BE
RELATED TO LONGER INFECTIONS, OR
WHAT HAVE YOU, WE DON'T KNOW.
BUT WE DO KNOW THAT, FOR
EXAMPLE, YOU KNOW, THE BA .4 AND
BA.5 AND BA .1, ET CETERA, YOU
LOOK AT THE SPIKE PROTEIN IN
MANY RESPECTS THEY ARE QUITE
SIMILAR BUT YET HAVE DIFFERENT
DEGREES OF TRANSMISSION
EFFICIENCY.
THEY HAVE DIFFERENT DEGREES OF
OTHER PHENOTYPIC ASPECTS OF THE
VIRUS.
SO, THERE'S A LOT WE NEED TO
KNOW.
THAT'S THE REASON WHY, YOU KNOW,
WHEN I PUT A RESEARCH AGENDA
TOGETHER, AND PEOPLE SAY WHAT
MORE DO YOU NEED TO STUDY ABOUT
THE VIRUS, THERE'S A LOT.
WE KNOW A LOT ABOUT THIS VIRUS,
BUT THERE'S A LOT WE DON'T KNOW.
WE HAD TO MAKE SOME ASSUMPTIONS
EARLY ON, WHICH THANK GOODNESS
WERE ASSUMPTION THAT PAID OFF,
OF WHAT WE'RE GOING TO PUT IN
THE VACCINE, AND THE KIND OF
VACCINE THAT WE'RE GOING TO USE.
SO, THE TWO QUESTIONS OF A
VACCINE, THE TWO BIG PILLARS,
ARE PLATFORM AND IMMUNOGEN.
SO, THE PLATFORM SERVED US VERY,
VERY WELL.
BUT WE PROBABLY NEED TO GRADUATE
TO OTHER PLATFORMS BECAUSE EVEN
THOUGH mRNA IS HIGHLY
ADAPTABLE, AND IT ALLOWED US,
REMEMBER, TO GO FROM A PLATFORM
THAT WAS AN ANCESTRAL STRAIN TO
SWITCH TO A BA .4/5 BIVALENT
BOOSTER IN TWO MONTHS NO WAY
COULD WE DO THAT WITH PROTEIN
VACCINE.
ONLY mRNA ALLOWS THAT BECAUSE
OF THE FLEXIBILITY OF INSERTS.
NOW WE HAVE TO FIGURE OUT CAN WE
DO BETTER WITH NANOPARTICLE
VACCINES, FOR EXAMPLE, THAT HAVE
AN ARRAY OF DIFFERENT ANTIGENIC
DETERMINANTS ON IT.
THOSE ARE THE KIND OF QUESTIONS
THAT STILL REMAIN UNANSWERED.
SO ANYBODY WHO THINKS THE
VACCINE STORY IS A CLOSED
RESEARCH STORY FOR COVID,
BECAUSE WE HAVE THIS PHENOMENAL
mRNA 93, 94, 95% EFFICACY, NO,
THERE'S A LOT OF WORK TO BE DONE
ON VACCINE DEVELOPMENT FOR
COVID.
>> GREAT.
THANK YOU.
THE NEXT QUESTION HAS TO DO WITH
CLINICAL TRIAL NETWORKS.
YOU MENTIONED IN YOUR TALK THAT
THE COVID-19 PREVENTION NETWORK
WAS RAPIDLY CREATED BY MERGING
FOUR EXISTING NIAID-FUNDED
CLINICAL TRIAL NETWORKS.
DO YOU ENVISION A SIMILAR
APPROACH FOR FUTURE OUTBREAKS
AND WHAT DO YOU SUGGEST CAN OR
SHOULD BE DONE TO STRENGTHEN
U.S. CLINICAL NETWORKS TO
PREPARE FOR THE NEXT OUTBREAK?
>> WELL, THE ANSWER IS A
RESOUNDING YES.
AND THAT'S ONE OF THE THINGS,
YOU KNOW, SOMETIMES IT'S VERY
DIFFICULT TO USE MONEY THAT IS
DESIGNATED FOR ONE THING, FOR
ANOTHER.
ACTUALLY, YOU CAN GET IN SOME
TROUBLE IF THE APPROPRIATIONS
LANGUAGE SAYS YOU NEED TO USE IT
SPECIFICALLY FOR ONE PURPOSE.
BUT WHEN WE PUT TOGETHER THE
CLINICAL TRIALS NETWORKS, IT IS
THE LARGEST GLOBAL CLINICAL
TRIAL NETWORK EVER PUT TOGETHER
FOR ANY DISEASE.
AND YOU KNOW, IT'S THE ACTG,
AIDS TREATMENT CLINICAL TRIAL
GROUP, THERE'S THE VACCINE
PREVENTION, THERE'S THE AIDS
PREVENTION GROUP, THERE'S A
WHOLE BUNCH OF THEM.
WE COMPLETELY PIVOTED THEM TO BE
USED TO TEST NOT ONLY THE COVID
VACCINES BUT ALSO SOME OF THE
THERAPIES THAT WE USE.
I FORESEE ABSOLUTELY THAT WE'RE
GOING TO USE THOSE FOR OTHER
EMERGING INFECTIOUS DISEASES,
AND I THINK THE PROOF THAT IT
CAME TO THE RESCUE OF COVID BY
PROVIDING A READY-MADE HIGHLY
EXPERIENCED WITH CLINICAL
INVESTIGATORS WHO REALLY KNEW
HOW TO CONDUCT A CLINICAL TRIAL,
AND THAT WAS BECAUSE OF 30 YEARS
OF EXPERIENCE OF DOING IT.
AND THE ANSWER IS, WHAT FURTHER
DO WE HAVE TO DO?
WHAT WE HAVE TO DO FURTHER IS TO
MAKE SURE WE KEEP THOSE CLINICAL
TRIAL NETWORKS WARM.
WE DON'T LET THEM DISSIPATE.
SO, YOU KNOW, PEOPLE ALWAYS ASK
ME WHAT'S THE ADVICE THAT I HAVE
FOR THE PERSON THAT'S GOING TO
REPLACE ME.
I ALWAYS SAY THERE ARE A NUMBER
OF BITS OF ADVICE BUT ONE OF
THEM IS MAKE SURE YOU DON'T
ALLOW THE CLINICAL TRIAL
APPARATUS TO ALL OF A SUDDEN GO
INTO ATTRITION BECAUSE YOU DON'T
HAVE A BIG OUTBREAK BECAUSE
WE'RE GOING TO NEED THEM TO COME
BACK AT THE NEXT INEVITABLE
OUTBREAK THAT WE HAVE.
WHICH I THINK WAS THE LAST SLIDE
ON MY TALK.
>> THANK YOU, DR. FAUCI.
SO WE WANT TO BE RESPECTFUL OF
YOUR TIME.
YOU HAVE MANY COMMITMENTS TODAY.
BUT AGAIN THANK YOU SO MUCH ON
BEHALF OF THE COVID-19 SIG
STEERING COMMITTEE FOR SPEAKING
WITH US TODAY AND TO THE
AUDIENCE, THANK YOU FOR JOINING
US.
WE LOOK FORWARD TO SEEING YOU AT
THE NEXT WEBINAR.
>> YES, THANK YOU FOR HAVING ME.
IT'S BEEN A PLEASURE.
TAKE CARE.