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Dr. Anthony Fauci Reflects on His 54 Year Career at NIH
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Dr. Anthony Fauci Reflects on His 54 Year Career at NIH
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Segment:0 .
ROD RUSSELL: Good morning. I'm Dr. Rod Russell from Memorial University of Newfoundland and Labrador. And I am the editor in chief of the Journal of Viral Immunology from Mary Ann Liebert. And today, I have the distinct pleasure to speak with the director of the National Institute of Allergy and Infectious Diseases at the NIH, Dr. Anthony Fauci. Good morning, Dr. Fauci, and thank you so much for taking the time to speak with us.
ANTHONY FAUCI: Good morning. My pleasure. Good to be with you.
ROD RUSSELL: We know you're a very busy man, so let's get right into the discussion. I wanted to talk today about three themes really. We can talk a bit about the pandemic and your thoughts on that, as well as some reflection on HIV/AIDS and the work you've done over your career, as well as some general career points that you might want to share. So let's jump right in. How do you feel about the pandemic, or how do you feel the pandemic has affected vaccine literacy in North America and globally?
ANTHONY FAUCI: Well, it's interesting because it depends on what people mean by vaccine literacy. If you mean the awareness of the importance of vaccines, I think it has heightened, in some respects, greatly the appreciation of people of the life-saving aspects of vaccine because if anyone seriously looks at the data of the degree and level of hospitalizations, serious disease often leading to death.
ANTHONY FAUCI: In the unvaccinated versus the vaccinated, there are about a striking data as you can imagine in the differences that the vast, overwhelming majority of people, regardless of their underlying status, that go on to severe disease leading to hospitalizations and death are either among the unvaccinated or those who have been vaccinated but not kept up to date on their boosting.
ANTHONY FAUCI: On the other hand, we're in an era unfortunately of anti-science, which is part of anti-vax, which is really quite frustrating how you have a historic pandemic, which in the United States alone has led to the loss of over 1 million lives and incontrovertible proof that vaccines save millions of lives.
ANTHONY FAUCI: And yet, there are so many people in the United States and throughout the world who refuse to get vaccinated because of a fundamental core anti-vax that's related in many respects from anything to pure disinformation to political ideology, which is really quite frustrating when you're dealing with a public health challenge.
ROD RUSSELL: So I agree, for sure. What would you say was the most unexpected aspect of the pandemic in your opinion? And I guess I would mean with respect to the virus itself and the curveballs it threw us, as well as in regard to the public's response to the pandemic.
ANTHONY FAUCI: Well, why don't we take one of those at a time? The most unexpected aspect of the pandemic from both the virus itself and the epidemiology is the unprecedented nature of the emergence of new variants in a manner that leads to a drifting of the virus approximately every four or so months. Not only in the United States, but in Canada, and throughout the world, and literally everywhere.
ANTHONY FAUCI: If you look at the evolution of this outbreak, we've never really seen anything even approaching that. We have drifting a virus of influenza from year to year, but we don't have the kind of variant emergence that we've seen with SARS-CoV-2. But also the other unexpected element of this was the very short durability of protection from prior infection or prior vaccination, which the viruses that we've dealt with, like polio, measles, smallpox, when you get infected and/or vaccinated, the durability of protection is measured in decades at worst and sometimes, lifetime at best.
ANTHONY FAUCI: And yet with SARS-CoV-2, the durability of protection is really strikingly short in its durability. The public response to the pandemic is what I mentioned just a bit ago, which is the extraordinary phenomenon of the availability of a life-saving vaccine and the fact that, for example, in the United States, only 68% of the population is vaccinated, and only about one half of those have been boosted, which seems almost inexplicable that that is happening, but it is.
ROD RUSSELL: Right. If we can stay there for a second. So with the short duration of protection with the vaccines and natural infection, what do you think we're going to need going forward? Are we going to get a better vaccine do you think that will give us longer protection? Or is this just what happens with coronaviruses, and we're never going to see longer duration of protection?
ANTHONY FAUCI: Well, I think there are two or three aspects of what is going to be needed regarding the relationship between vaccines, and durability, and depth and breadth of protection. We have great vaccines. I mean, one of the great scientific breakthroughs of the last few years have been the mRNA vaccine and immunogen design based on structure-based vaccine design. But even with that advance, we do need better vaccine platforms and immunogens to lead to greater durability and breadth of protection.
ANTHONY FAUCI: And that could be nanoparticles. That could be vector-based expression of immunogens. Also, we are going to need protection better against infection and transmission for a number of reasons. Because we now know that the vaccines that we have, although they still do a very good job of protecting you against severe disease, the protection against infection, how many people do we all know, myself included, that was vaccinated, doubly boosted, and still got infected?
ANTHONY FAUCI: So the protection, again, against severity of disease is pretty good. But if you really want to suppress the virus by suppressing acquisition as well as transmission, we've got to have better vaccines.
ROD RUSSELL: OK. So Dr. Fauci, that's interesting perspective for sure. Let's switch gears now and talk a little bit about HIV/AIDS, which has been the focus of much of your career. So the late Mark Weinberg, who I know you knew well, told me once that you said you hoped to see one person cured of HIV in your lifetime. And now we have seen that. So what do you hope we might see in the next 50 years in the world of HIV/AIDS?
ANTHONY FAUCI: Well, we've got to be careful about the person or persons now, there have been a few, that have been cured of HIV in the sense of not requiring daily medication and yet having the virus be completely absent from their body, essential eradication. That has only happened in very unusual circumstances of stem cell transplantation with the very aggressive conditioning that's associated with that in people who have an underlying condition, such as a lymphoma or a leukemia that required a stem cell transplantation to begin with.
ANTHONY FAUCI: Although that's a proof of concept, it's not a practical approach to the idea of curing people. However, what we have done extremely successfully is develop an array of drugs in combination, sometimes contained in one pill, that can chronically and durably suppress the virus to below detectable level.
ANTHONY FAUCI: Not only saving the life of the individual who's being treated and essentially rendering them to have an essentially normal lifespan, but also making it virtually impossible for them to transmit the virus to someone else. The terminology of undetectable equals untransmittable. That is a major advance. What we've done now over the last few years is to make the therapeutic approach much easier and user-friendly, such as with long-acting injectable drugs which can be given right now every couple of months.
ANTHONY FAUCI: And I believe as we get better at it over the coming months and years, it may be that you can give an injectable drug maybe twice a year and continue to suppress the virus below detectable level. That's not a classical cure in the sense of eradication, which we will continue to try to do. But the advances that have been made in therapy now are really quite breathtaking in their success.
ROD RUSSELL: Developing an effective vaccine for HIV has proven extremely challenging. You just mentioned the wonderful RNA vaccines that we're seeing now. Do you think that we will ever have an effective vaccine for HIV, or is the variability of the virus just going to be too challenging ?
ANTHONY FAUCI: Well, I don't know whether we're going to have an effective vaccine. We may not. And it has to do more than just what the variability of the virus. It has to do with the particular capability of a virus that once a person gets infected, the virus integrates itself into the genome of one's cells, forming a reservoir of virus that up to this point, we have not been able to eradicate.
ANTHONY FAUCI: One of the frustrating and very challenging aspects of developing a vaccine for HIV is that in classic vaccinology, you try to mimic natural infection because natural infection, with most infections, provides a degree of immunity after you recover that protects you from subsequent infection with the same virus.
ANTHONY FAUCI: Since the natural response to natural infection with HIV never actually gives an adequate immune response to eradicate the virus, what we have to do with the vaccine is to do even better than what natural infection does. And that's a very, very difficult challenge. I'm not saying that it is impossible. But it is going to be very difficult to get the body to mount an immune response to the vaccine that's even more powerful than the body's immune response to natural infection.
ANTHONY FAUCI: So that is going to be the challenge of the future efforts to develop a vaccine.
ROD RUSSELL: Along the same lines, in the last few years or the last decade, we've seen some great antiviral agents come in the field of hepatitis C, which is where I worked at the NIH for a while myself. Do you think that someday, we will have a small molecule inhibitor for HIV or a combination of them that will get the same kind of care success as we've seen with hep C?
ANTHONY FAUCI: Well, I mean, that's certainly an aspiration. But as I mentioned a moment ago, there's a big difference that HIV has from other infectious diseases that do not integrate themselves into the cellular genome of your cells. That is really unprecedented because it is a retrovirus, and that's the nature of a retrovirus. As it integrates itself into genomes, it becomes very difficult to essentially eradicate the virus.
ANTHONY FAUCI: So I would not say that we will have necessarily a eradication cure for HIV, but the same approach of developing small molecules that are aimed at the vulnerable components of the viral replication cycle that has led to the suppression of HIV actually was the stepping stone for why we were able to develop such truly curative drugs for hepatitis C.
ANTHONY FAUCI: So it was the approach that was really given a great jumpstart with HIV is fashioning your response, targeting the replication cycle that not only gave us good drugs for HIV, but actually led to the development of excellent drugs to cure hepatitis C.
ROD RUSSELL: You've mentioned that you will step down from your position as director of NIAID at the end of the year. So I'm curious to get your thoughts on your career. So what would you say is the most impactful finding that has come out of your own research over the years?
ANTHONY FAUCI: Well, I mean, I've had the privilege of wearing multiple hats over the last 54 years I've been here and the last 38 years that I've been the director of NIAID. And if you look at the individual hats, they're really different. For example, as an individual research scientist in the early part of my career, I was working with the development of therapies for inflammatory diseases like the systemic vasculitides, which had a very, very high mortality rate, close to 100%.
ANTHONY FAUCI: Diseases like granulomatosis with polyangiitis or polyarteritis nodosa, I was fortunate enough to develop therapeutic protocols that put those diseases into a very, very high level of remission, well over 90% when they were almost 100% fatal before. That was the first 10 years of my post-fellowship career. Then when HIV came along, I devoted literally the next up to the present time, 40 years, in delineating the pathogenic mechanisms of HIV.
ANTHONY FAUCI: And that led to insights into the development of therapies and some of the advances we've had. So that I feel quite good about it and quite proud of. But the other aspects of my career I believe are equally, if not more important, and that is when I took over as the director of NIAID. I developed it and nurtured the Institute from a small Institute of about a budget of $350 million to a infectious diseases global powerhouse of $6.3 billion, developed the AIDS program at the Institute, which actually is responsible in part, at least, for the development of the life-saving drugs that have been responsible essentially for transforming the lives of persons with HIV throughout the world.
ANTHONY FAUCI: And then the other hat as a public health official and a policy person, I was very fortunate to have been asked by President George W. Bush to be the principal architect of the President's Emergency Plan for AIDS Relief or PEPFAR, which now is responsible for saving between 18 and 20 million lives throughout the world.
ANTHONY FAUCI: So I feel very privileged to have been put into the position of being able to make those kinds of contributions.
ROD RUSSELL: You can't see me right now, but I have a big smile on my face because that's such an impressive body of work. And I remember when I was a master's student, your first papers came out on identifying the reservoir. And at that time, that was around '95, '96. We thought we might be able to cure HIV with the protease inhibitors. And I remember the reservoir was already based on your work and others was looking to be the problem.
ROD RUSSELL: And it's still what you mentioned now is the problem with vaccines and treatment today. So clearly, that was my favorite part of your work. Still on the same theme then. What would you what do you think has been the greatest scientific advance in viral immunology in general research that you have witnessed in your career?
ANTHONY FAUCI: Well, it's very interesting. As our discussion has proven, for better or worse, I've had a very long career. But when you talk about viral immunology, the thing that comes to my mind is the extraordinary success of vaccines. And let's just take our current, most recent three-year experience where you have a virus that was completely unknown in December of 2019, was identified as a novel coronavirus in January of 2020, namely SARS-CoV-II.
ANTHONY FAUCI: Proved itself to be deadly to the tune of killing millions and millions of people throughout the world. And yet in less than one year, from January of 2020 to the beginning of December of 2020, multiple vaccines were developed, put into clinical trial, proven to be safe and highly effective, and began to be distributed to people in a life-saving way.
ANTHONY FAUCI: To me, that is an entirely unprecedented accomplishment in the field of quote viral immunology I believe in the history of medicine. So we're fortunate that we're living through truly a historical accomplishment.
ROD RUSSELL: I've always found it interesting that the new platform of vaccines turned out. Despite the fact that many vaccines were developed with sort of traditional platforms, the new platform that people might have been most afraid of has turned out to be the one that we're relying on the most. So maybe last question. I have to ask, at this point in your career, what advice would you give to current trainees in the field of virology or immunology if they're planning their own future in research?
ROD RUSSELL: I have the same advice I've been giving for years now because it applied to me and the things that have driven the direction of my own career, is that go with what your passion is, what really turns you on. There are so many exciting things in the field of medicine and in research associated with medicine. And sometimes, young people tend to go what they think people want them to do or what is the most fashionable thing.
ROD RUSSELL: But if you listen to your gut and you get involved in something that you really are excited about, that creates in you a level of energy and drive that will really serve you very well, both in your accomplishments and in your feeling of self fulfillment. So to put it in the very colloquial way, just go with your gut, and you can't go wrong.
ROD RUSSELL: Beautiful advice, beautiful. You have to love it, right? OK. That's all the questions I had in mind to ask you. Thank you very much. We can stop it there then.