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WASHINGTON -- Anthony Fauci, MD, used his last press conference at the White House on Tuesday to urge Americans to get their COVID-19 and flu vaccines.

"Clinical efficacy data will be released [today] from CDC looking at the ability of the [COVID vaccine] to protect against the real-world BA.4/5 that's been circulating," said Fauci, who is the White House's chief medical advisor and the director of the National Institute of Allergy and Infectious Diseases. "We know that it's safe and we know it's effective, so in what may be the final message I give you from this podium, please, for your own sake and that of your family, get your updated COVID-19 shot as soon as you're eligible."

Fauci was referring to , which looked at 360,000 PCR tests performed at retail pharmacies from mid-September to mid-November on symptomatic adults with no immunocompromising conditions. Those researchers found that the relative vaccine effectiveness of a bivalent booster dose compared with that of ≥2 monovalent vaccine doses among those for whom 2 to 3 months and ≥8 months had elapsed since their last monovalent dose was 30% and 56% for those ages 18-49, 31% and 48% for those ages 50-64 years, and 28% and 43% for those ages 65 and older, respectively.

"Bivalent mRNA booster doses provide additional protection against symptomatic SARS-CoV-2 in immunocompetent persons who previously received monovalent vaccine only, with relative benefits increasing with time since receipt of the most recent monovalent vaccine dose," the researchers wrote. "Staying up to date with COVID-19 vaccination, including getting a bivalent booster dose when eligible, is critical to maximizing protection against COVID-19."

Fauci did admit, however, that the newer XBB variant of COVID was posing some challenges for the bivalent vaccine. "The XBB [variant] evades immune response as measured by antibody, which is one of the elements -- not the only element -- of protection," he said. "The protection is diminished multi-fold with XBB ... It doesn't fall off the map, but it goes down. So you can expect some protection, but not the optimal protection."

Ashish Jha, MD, MPH, the White House's COVID-19 response coordinator, agreed. "The subvariants -- the good news, even if you see a diminishing [response] of our vaccines, they're still effective against these subvariants, way more effective than the original vaccine. I feel very confident that if people continue to get vaccinated in good numbers, and boosted, we can have a very safe and healthy holiday season ... Nothing I've seen in subvariants makes me believe we can't manage our way through it effectively."

In addition to getting vaccinated against both the flu and COVID, "another thing we shouldn't underestimate is testing," Jha said. "When we're gathering at a family gathering for Thanksgiving or Christmas or any other holiday, it makes sense that you might want to get a test that day before you come into a place in which you might be infected and spread it ... You can count masking, vaccine, boosting, testing -- all of that is part of the spectrum of protecting yourself and your family."

Fauci, 81, who will retire from the federal government at the end of the year, was asked what he wanted his legacy to be. "Although COVID is really very important, it is a fragment of the total 40 years I've been doing this," he said. "What I'd like people to remember about what I've done is that every day for all of those years, I've given it everything that I have and never left anything on the field."

He was also asked what was the most difficult moment during the COVID-19 pandemic. "One of the things as a physician whose goal in life is to care for patients, prevent and treat illness, and ameliorate suffering, I remember from my days back in medical school and as an intern and resident ... You treated everybody the same because you cared about them and wanted everyone to walk out healthy," he said.

"So when I see people in this country -- because of the divisiveness in our country -- not getting vaccinated for reasons that have nothing to do with public health, but have to do because of divisiveness and ideological differences, as a physician it pains me. I don't want to see anybody get infected, I don't want to see anybody hospitalized, and I don't want anybody to die from COVID ... That's the thing that troubles me most about this," he noted.

Asked about his outlook on the future of the virus, Fauci said he "did not imagine we'd see a 3-year saga of suffering and death and a million Americans losing their lives. The thing that was most disturbing was the continuation of multiple variants evolving over time. Where I think we're going is sooner or later -- and I hope it's sooner -- we're going to equilibrate to a low level" of virus in the community.

Conquering the virus will also require investment in different types of vaccines, Jha said. "For the long-run management of this virus, we need variant-resistant vaccines and we need vaccines that prevent transmission. What you have seen is China make a very large investment in mucosal vaccines, because they understand that that's how you deal with respiratory viruses. America is falling behind on this really important technology. A major report of our [FY 2023 budget] request is for funding for public/private partnerships to move those kinds of technologies forward ... Congress needs to do its job and step up and protect the American people."

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