Dr. Anthony Fauci on California's New COVID-19 Restrictions and Lessons from the HIV/AIDS Epidemic

Dr. Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases, joins Marisa Lagos and Scott Shafer to discuss California’s new regional stay-at-home order, the politicization of vaccines and the “spectacular” advances in their development, and lessons he learned from fighting the HIV/AIDS epidemic. Then, San Francisco Chronicle health reporter Erin Allday joins to discuss the new statewide order and how public health guidance has evolved since the spring.

Here are some highlights from our interview with Dr. Fauci:

On California’s new shelter-in-place order

Fauci, the nation’s leading infectious disease specialist, enthusiastically supports Gov. Gavin Newsom’s new order, which calls for regional shutdowns of some businesses and other activities once ICU hospital bed capacity drops to 15%.

Fauci said he consulted with California health authorities ahead of the announcement, and called it “a prudent and correct decision.”

“The reason is that you are all on a brink, literally on the threshold of getting the almost unimaginable situation of getting the health care system overrun. You just can’t let that happen. That is unimaginable and unacceptable,” Fauci said. “I spoke to some of his health people and I said I would back them in that decision. So I certainly back what the governor’s doing.”

Fauci warned that while hospitals across the nation are already filling up, we have not “seen the full brunt of what we expect to be yet again, another surge, hopefully a mini surge, as opposed to a major one.”

“There almost invariably will be a surge associated with what went on last week, with Thanksgiving, with the travel … and the congregate settings of dinners,” he said. “The trouble is, the spike won’t come for about two and a half to three weeks after the Thanksgiving holiday, which would put it right before the Christmas and Hanukkah holiday, which is kind of a double whammy. So we are in a really precarious situation. And because of the stress on the health care system, I think what the governor did was both prudent and advisable.”

On the nation’s inconsistent approach and mixed messaging

Fauci, who’s careful not to get too political, said this: “Mixed messages are bad. One of the problems inherent in mixed messages is that [it] provides license for people to do things according to their own preconceived notions. Because if they hear that going left is right, going right is right, then they say: ‘I’m going to go wherever I want to go because it’s a 50-50 chance.’ that’s not good. We need consistent messages at all levels.”

Asked where we stand now as compared to where he thought we would be when the pandemic started, Fauci was blunt.

“I think I would have to say honestly, worse,” he said. “I thought that we were going to have a uniform public health response that would not have allowed us to never get below a precarious baseline. And every time we try to do something like open up the economy, we’d slip up and then come down. And then we do this, we slip up, and now we’re going into winter, we’re going into the holidays and we’re seeing the same thing.”

He also acknowledged that governing a large state like California — and ensuring a consistent message across its diverse 58 counties — is difficult. But, he said, even though the entire nation is seeing a surge in cases right now, places like California are in a better position to tackle the increase because of our stricter state guidelines around mask wearing and social distancing.

“I think initially you may think you’re seeing the same result, but when it really plays out, there’s no doubt in my mind that … uniform mask wearing, distancing, avoiding crowds or the kinds of shutdowns that you’re talking about, it does make a difference and you should be assured of that,” he said.

On the vaccine and his hope for the coming months

Fauci encouraged Americans not to lose hope, saying we need to hang on for just a few more months.

“Help is on the way because we have extraordinarily efficacious vaccines, plural, more than one vaccine that will start to be implemented and distributed in the middle and end of December. And then as we get into January, February, March, more and more and more people will be vaccinated so that by the time we get to April, it will be available for the general public,” he said.

Fauci said he’s confident we will “crush this outbreak” and urged the nation to double down, to make difficult sacrifices as we head into the holidays — knowing that there’s light at the end of the tunnel.

“Once we get a substantial proportion of the population vaccinated, we’ll get that umbrella of herd immunity and that will ultimately crush this outbreak,” he said. “That to me is an incentive … to double down even more and say [that] although things like the lockdown, things that the governor is trying to do are difficult and straining your comfort, your economy and all those things, the fact is that at the end of the day it will get us through. And then when a vaccine comes in full blast, we’re going to be out of this.”

On vaccine skepticism

With regular Americans as well as health care workers expressing concern about the safety of a vaccine created in record time, Fauci urged everyone to examine the scientific record and consider the independence of our regulators.

“These skepticisms are understandable when there are mixed messages,” he said, noting that people have concern about both how quickly the vaccines were developed and whether they are safe and effective.

“The fact that we were able to go from the recognition of a brand new virus in January to a vaccine that’s able to be distributed by December is a completely unprecedented accomplishment,” he said. “It is spectacular not because it was rushed by compromising safety or scientific integrity, because of the extraordinary scientific advances that have been made in vaccine platform technologies, which is the fruit of basic and applied research that’s been going on for decades.”

Fauci said it’s not as if the underlying science and technology “just popped up.”

“This is people who have been working throughout the country, in the world, for decades on exquisite technologies that have allowed us to do things in weeks to months that a decade ago would have taken several years. So the speed does not compromise anything,” he said.

What about the safety and the efficacy? Fauci said he knows some people are skeptical that the Trump administration may be trying to prove something, or that the vaccine manufacturers are just trying to make money.

“It’s neither of the two, and here’s why,” he said. “Because the determination of safety and efficacy is made by an independent data and safety monitoring board that has allegiance, not to the president, not to the administration and not to the company. It has an allegiance to the American public.”

Fauci noted that the process starts with a group of independent scientists, statisticians, ethicists and vaccinology experts who examine the data for safety and efficacy.

“They then, and only then, release it to the company, which then examines it and gives it to the [Food and Drug Administration], where career scientists — not politicians but career scientists who do this every day for decades — examine the data and then in accordance with their advisory committee, which is another independent committee, determine if it’s safe and able to be given to the American public. So you have a process that is not only independent, it’s completely transparent.”

Fauci noted that “nobody can hide anything,” because the data will ultimately be published in a peer-reviewed journal.

“So we’ve got to be able to communicate that to the American public, that even though there’s a lot of skepticism, the process is independent and transparent, period,” he said.

On his own personal journey

Fauci also discussed his remarkable career — he has been at the National Institute of Allergy and Infectious Diseases since 1972 and was appointed director in 1984.

While this pandemic has made Fauci a household name, many in the public health community first got to know him in the 1980s as the nation struggled with another new, mysterious, deadly and terrifying virus: HIV.

Fauci recognized the threat before many of his colleagues and began researching the virus. But by 1988, he and other government scientists were also becoming the subject of protests by AIDS activists — mostly young, gay men — who felt the government wasn’t doing enough to let infected Americans try new treatments and that they didn’t have a seat at the table.

Fauci invited them in, and ended up traveling the country to talk to gay communities stricken by AIDS. Their inclusion and input helped change the way the government approached experimental HIV and AIDS treatments — and more broadly, how we approach medicine in the U.S.

We asked Fauci what he learned from that experience.

“Well, that was really one of the more transforming periods in my own professional career, in my own life, in which I made a decision — which retrospectively it really turned out to be a good decision — to reach out to the community,” he said.

“In this case, it was dominated by young gay men in San Francisco and in New York and in Los Angeles. Because they had some very valid points that the government, the scientific and regulatory community just did not fully appreciate the situation they were in, and they excluded the constituents from participation in important decision making that had a great impact on their lives and their deaths. And yet no one was listening to them.”

The activists’ exclusion, Fauci said, made them “iconoclastic, theatrical, confrontative, which unfortunately turned off the government and the scientific and regulatory community even more.”

What he did — putting aside the theatrical protests and sitting down with them — “was one of the better things I’ve ever done in my career.”

“It became eminently clear to me that what they were saying really made sense, and if I were in their shoes, I would have been doing exactly what they were doing. And that’s when I said I need to sit down and start talking to these people. And once we did that, we found out that we had a lot in common. And that’s when the bonds of collaboration began decades ago to the point now that is a very productive component of what we do,” he said.

Fauci, who will be serving his seventh presidential administration as NIAID director when Joe Biden is sworn in next month, has survived Republicans and Democrats, as well as numerous outbreaks: HIV/AIDS, Ebola, Zika, H1N1 and now the coronavirus. What has he learned?

“As a scientist and as a public health person, it’s absolutely essential that I stay above and beyond the politics and focus completely on the public health, the scientific issues, because that’s what I’m supposed to be doing,” he said. “Once you start getting involved in ideology and political things, you just lose any credibility. So I have stayed completely away from the politics and focused on what my job is, which is public health and the safety and the health of the American public. You do that, you’re in good shape.”

This interview has been lightly edited for clarity.