番茄社区

In this exclusive video interview, Jeremy Faust, MD, editor-in-chief of 番茄社区, talks to Anthony Fauci, MD, former director of the National Institute of Allergy and Infectious Diseases, about his new memoir,

In this video, Fauci discusses how the U.S. might approach a next pandemic, debunking misinformation during the early COVID days, and what he hopes to see out of the next administration.

The following is a transcript of their remarks:

Faust: Hello, I'm Jeremy Faust, editor-in-chief of 番茄社区. I'm so glad to be joined today by Dr. Anthony Fauci. Dr. Fauci's new book is called

Dr. Anthony Fauci, thank you so much for joining us again.

Fauci: My pleasure. Good to be with you.

Faust: Well, we're going to have a new president, and I think about the future. If we had a pandemic today, what would we do? Is there a plan?

Fauci: The answer is in many respects, yes, but we still have some issues that we need to address that we could have done better in the initial response to the COVID outbreak.

If you look at it in two separate buckets, the scientific bucket and the public health bucket, the preparedness and response over many, many years that led to our ability to develop and deploy a vaccine that was over 90% effective in less than 11 months is totally unprecedented. So we need to make sure we maintain our support for basic and biomedical research that allowed us to make that unprecedented accomplishment that saved millions of lives globally, certainly hundreds of thousands, if not millions in the United States.

The area that we really need to look at lessons learned is our public health response, our somewhat fractionated response in the interaction between the federal response and the local response, which was somewhat different from place to place, that didn't have a uniform set of principles, which made our response less uniform and less coordinated, I believe, than we saw in other countries. But that's something we're aware of and hopefully that can be corrected.

One of the things that are in the way of correcting that is the profound degree of divisiveness we have in our country right now, which contributed to that somewhat discoordinated response.

Faust: Do you think that right now there would be a shutdown if we had a similar pandemic threat?

Fauci: It depends on what you mean by a "shutdown." If we had the kind of tsunami of hospitalizations and deaths that we had at one period of time, the only option that you had was to shut things down or we would've overwhelmed the hospitals and we would have to have made a Sophie's choice of who gets a ventilator and who doesn't get a ventilator.

The real issue is that if you do -- I don't want to use the word "shutdown" because we never completely shut down -- but if you do profound interruption of services and the steady flow of the regular social interactions that we've had, we've got to reexamine how long you do that for. Because the question is less, "Should we have shut down and shut the schools?" than "How long should we have kept things shut down and how long should the schools have shut down?"

I think the initial decision to just put things to a halt until we somehow flattened that very disturbing accelerated curve was the right decision. The real questionable issue is how long we kept that up.

Faust: And we've learned a lot about these non-pharmacologic interventions and how they are both imperfect and also extremely important. One of the things we've learned about in this virus is about contagious windows.

I wanted your take on the fact that President Biden just had COVID and he has been isolating for quite some time. He's now Binax-negative on his rapid [test], we learned today, but he isolated far longer than the CDC's guidance. What do you make of that? That he's actually isolated for longer than the CDC said he needed to, because he didn't have a fever and his symptoms were improving as per his doctor?

Fauci: Well, Jeremy, it depends on what you mean by "longer," because the guidelines evolved over time.

If you don't test yourself or you test yourself but you don't follow up and you say, "I don't know what my test is and I don't want to know," then after 5 days you can go out and wear a mask if your symptoms improve and if you don't have a fever in 24 hours. But he was testing regularly and he wanted to make sure he didn't go out until his test clearly turned negative.

So it wasn't that he was doing something contrary to guidelines. He just put himself in that category of doing follow-up testing, which according to the guidelines if you read them carefully, if you don't test every day and you don't have to, then you can assume that you can go out after 5 days with a mask. But he wanted to make sure that he was definitely negative.

Faust: But the CDC guidelines say 24 hours of no fever and improvement. That's way sooner than 5 days.

Fauci: Yeah, exactly, it is.

Faust: I just think that we talk about the public trust and I think there is a lot of unfairness about the fact that things change. We say one thing and then the next day we say something different because the science evolved.

But I wonder if people look at this and say, "Wait a minute, he didn't actually really follow the most up-to-date CDC guidelines." And what does that do? What does that mean for public trust? "Do what I say, not as I do." Ironically, he did more than he says the CDC says to do.

Fauci: Right. If he had done less, you would have a big problem.

Faust: When you look at the behavior of our politicians, and now you're a private citizen, you vote like anybody else. What kind of questions are in your mind when you're thinking about who to vote for from the standpoint of public health and policies and priorities?

Fauci: You know Jeremy, I have steadfastly over my 54-year career stayed out of making any kind of statement that had political connotations about who I would vote for or not. I want to stay in that lane of not getting into any political issues.

I mean, people know because of what I've had to do when I was in the White House -- both with Trump and with Biden -- that to me, the important issue is to stick with the facts and stick with the truth. I had a problem after a few months in the Trump White House because he was saying things that were just not true. And I had to and was put into a position -- as uncomfortable as it was in order to be true to my own integrity as well as my responsibility to the American public to when things were said that were not true -- to publicly say, "No, I disagree. It's not going to disappear like magic. No, hydroxychloroquine is not the cure-all. In fact, there's no evidence to indicate that it works, and there's some evidence to indicate that it could be harmful." I had to do that.

So my feeling is, if you talk about the next outbreak and the next president, I would hope that that president would abide by fundamental good public health principles and stick with data and evidence and not make up things like, "It's going to disappear like magic."

Faust: And as we make this transition into discussing your fascinating book, On Call, I can't help but feel that I went on a journey with you in terms of politics, where I think PEPFAR [President's Emergency Plan for AIDS Relief] under George W. Bush is one of the crowning achievements of your career and one of the great things that a president ever did for the world of public health. And yet, 10 years later or 15 years later, you're being grilled by Congress people on that side. It makes me feel like there's a sense of betrayal from you.

I know you're not going to say anything, but I have a hard time believing you would vote for people who are anti-vaxxer or who cohort with anti-vaxxers.

Fauci: Yeah. I mean, that's a reasonable assumption, Jeremy.

Faust: But I think that the kinds of people who ended up in the White House towards the end of your tenure in that Trump administration -- Scott Atlas, people who really didn't believe in the science you believe in -- could you see yourself voting for a Trump administration?

Fauci: Again, I'm not going to talk about who I'm voting for. I think it's very clear where I would go, Jeremy.

The thing that is interesting that you bring up -- you might want to talk about it as we get a little bit later on into the book -- but it really is striking when people talk about the false assumption that, "He's against a Republican administration because the fact that he had to pushback on things that Trump was saying and that people in his White House were saying." Well, that's not correct. All you have to do is read the chapter on George H.W. Bush and George W. Bush and what we did together to put together the PEPFAR program. That was a conservative, Republican president who did that. That was one of the most important public health endeavors in history. Now, 20 years later, it has saved 25 million lives.

So I was very comfortable working within the White House and working with the George W. Bush administration. I think that puts aside this issue that I politically lean one way or the other. I just try to do what's best for public health of our country as well as the world, and I think PEPFAR is an example of that.

Faust: That's the president's program on HIV that sent all these antivirals and other interventions to Africa that has saved so many lives. And I just remember as a consumer of that news cycle, people saying, "Whoa, this is coming from Republicans. Is this real?" And people that you had many ups and downs with -- your Gregg Gonsalves, your Larry Kramer types saying, "Nope, this is really exciting."

I think that was a great message of the book, which is that at the right time, people do the right things, and it's not always necessarily a red/blue thing.

Fauci: You're absolutely correct, Jeremy. And that is the reason why I put such stock in describing what went into those interactions between me and George W. Bush and the people around him, people who people may not have heard of like Josh Bolten and Gary Edson and those people who were the people surrounding the president who were very, very committed to doing the right thing.

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