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September 20th, 2005
H5N1 - Killer Flu
Interview: Dr. Anthony Fauci
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September 20, 2005: DR. ANTHONY FAUCI, director of the Institute for Allergy and Infectious Diseases at the National Institutes of Health, discusses the possibility of an avian flu pandemic with anchor Bill Moyers.

BILL MOYERS: With me now is Dr. Anthony Fauci. He’s been with the National Institutes of Health for 30 years now and is presently the director of the Institute for Allergy and Infectious Diseases. That means he’s the commander in chief of the research to find vaccines that protect us against such major threats as flu and HIV/AIDS. Welcome to “Wide Angle.”

DR. ANTHONY FAUCI: Thank you. Good to be here.

BILL MOYERS: What would you like for Americans to know about avian flu?

DR. ANTHONY FAUCI: Well, Americans need to know that it is a threat, a real threat. It is an unpredictable infection, a pandemic flu, which really means a kind of flu to which the American public or the whole world, the global population has not been exposed to before. It is very different from the seasonal flu.

It has the potential to be a major public health threat, but it is unpredictable. So you have to walk that balance of being prepared for something that may not come this year, may not come next year, but sooner or later knowing the history of how pandemic flus evolve over a period of time, over decades and decades, it will occur. So we need to be prepared.

BILL MOYERS: When you saw the film did you think, “This could happen here?”

DR. ANTHONY FAUCI: Well, I certainly think it can happen here and that’s the reason why we really have to be very prepared. What is going on in Asia right now is the right constellation of events that increase the probability of there being a pandemic flu. We can’t give you a number–

BILL MOYERS: Right.

DR. ANTHONY FAUCI: –and say, “There’s a ten or a 15 or a 20 or an 80 percent chance that there would be a pandemic flu which can spread readily from person to person.” But the factors that are in place now in Asia that we saw on the film, the literally tens of millions of chickens in countries like Vietnam and Thailand and places like that that are infected. And the jumping of species, where it can jump, albeit inefficiently, from chickens to humans, the way it did in the film, and the very inefficient spread, very rarely, it’s only occurred in a couple of cases, of human to human, it’s evolving in a way that is making the threat more and more.

BILL MOYERS: What’s the difference between– just to clarify some terms — what’s the difference between an epidemic and a pandemic?

DR. ANTHONY FAUCI: You can have an epidemic in a state. You can have it in a region. You can have it in a country where the critical level of disease passes a certain threshold and we call that an epidemic threshold. When you’re saying pandemic you’re talking about that throughout the world. So a pandemic, we have a pandemic of HIV/AIDS now in the world. Virtually every country. A pandemic influenza would mean widespread infection essentially throughout every region of the world.

BILL MOYERS: I lost a grandfather in the great flu epidemic of 1918. My wife lost a grandfather in that same epidemic. But it’s correct to call that an epidemic, not a pandemic?

DR. ANTHONY FAUCI: No. The 1918 was indeed a pandemic.

BILL MOYERS: Really.

DR. ANTHONY FAUCI: It was the mother of all pandemic flus, really. It was one of the worst in history.

BILL MOYERS: So could you say if avian flu spreads as the film suggested it might and that you are warning us against, that it could be greater than the epidemic of 1918, the flu epidemic, pandemic?

DR. ANTHONY FAUCI: Well, let me put it into some perspective. 1918 was a total public health catastrophe. There were 20 to 40-plus million people worldwide infected and a half a million to 750,000 in the United States. We have lesser pandemic flus in 1957 and then again in 1968.

The one in 1957 had 70-plus thousand people died in the United States. In a regular, seasonal year, about 36,000 people die. Had less in 1968. So to have a pandemic flu it doesn’t always have to be a catastrophe like in 1918. The problem with a pandemic potential is that it’s unpredictable. So we’re watching very closely what is going on in Southeast Asia now, and we’re hoping that this virus doesn’t assume the capability of efficiently and in a sustained manner going from human to human.

If it does and the genetic changes will allow it to do that, we can’t predict whether it’ll turn into a 1918 type or a 1968 type. But the fact that we can’t predict it means we need to be prepared for the worst. So when you hear public health officials very carefully scrutinizing what’s going on in Southeast Asia and saying, “We really better be prepared because the potential of this is enormous.”

BILL MOYERS: What is the worst scenario?

DR. ANTHONY FAUCI: Well, the worst scenario is that this virus that’s circulating right now in Southeast Asia maintains its mortality rate. Right now there have been 112 cases in people with 57 deaths. So that’s about a 50 percent mortality.

BILL MOYERS: And that’s high?

DR. ANTHONY FAUCI: That’s really high. Even the pandemic flu of 1918 only killed one to two percent of the people who were infected.

What would likely would happen is as the virus genetically evolves to become more efficient in spreading from person to person or from chicken to person, it is likely that its virulence or its ability to kill, its mortality, would be less and less. Because viruses evolve in a way to self-propagate themselves. It’s to no advantage of a virus to kill almost everybody it infects.

It’s the advantage of the virus to spread, and you can only spread when you infect people and they infect other people without necessarily killing them. So if you had 100 percent mortality, the potential pandemic would almost self-eliminate itself. What you need, the right ingredients, is something that spreads very rapidly but has a degree of mortality that’s significant enough to cause a lot of deaths. So the worst scenario is that this evolves in two ways. It evolves in a way that it spreads very, very rapidly, and it keeps enough of its virulence to cause a lot of damage.

BILL MOYERS: Sounds like a smart virus.

DR. ANTHONY FAUCI: Well, you tend to think of microbes as thinking. They don’t. They just genetically evolve in a way that selects for their own self-preservation. And that’s what you mean when a microbe, in this case a virus, evolves. It’s smart when it does that really, really well.

BILL MOYERS: Have you seen the microbe?

DR. ANTHONY FAUCI: Oh yeah.

BILL MOYERS: Of the avian flu?

DR. ANTHONY FAUCI: Oh yeah.

BILL MOYERS: You’ve actually looked at it.

DR. ANTHONY FAUCI: You look at it in an electron microscope. It looks like a little particle. It’s got a little surrounding coat on the outside. It looks in many respects to be unitiated like any virus. They’re very, very, very small particles. You know, bacteria you look [at] under a regular microscope. You could actually see them with certain stains. When you have a virus like influenza, you have to look at it under a very special microscope called an electron microscope.

BILL MOYERS: Until the flu vaccine that I take now that I’m at that age, I used to get regularly — almost every year I’d come down with the flu.

DR. ANTHONY FAUCI: Right.

BILL MOYERS: I would go to bed for three days, take some aspirin and drink lots of liquid and I’d be up and around in three or four days. What’s the difference between this flu and that flu?

DR. ANTHONY FAUCI: Well, the fundamental difference when you say a potentially pandemic flu is one to which the population of the world has never been exposed before. Let me give you some examples. We call this H5N1. Flus are designated by two major proteins, the hemagglutinin which is the H and the neuraminidase which is the N.

And it gets certain numbers. The flu that you and I got exposed to for the last several years happens to be an H3N2. And now I’ll tell you how it’s different than H5N1. If we have a little bit of a change from last year to this year, or from two years ago to the next year, it has still been H3N2. It’s the Fujian strain or the California strain or the Panama strain.

So that when we get infected on a given year, even though we may get infected and sick, we still have some baseline immunity from either previous exposures in previous years or previous vaccinations. So even though we may get infected and we may get sick, our body is primed to ultimately suppress that virus. When you get H5 and N1, the H5N1 no one has ever experienced before.

So when that virus gets to your body, you don’t have any prime baseline immunity to come in and suppress it. So it can really do some significant damage in you before your immune system builds itself up enough to ultimately eliminate it. That’s the fundamental difference between a pandemic flu that you’ve never experienced before and a seasonal flu where you experience some modification of that virus.

BILL MOYERS: Right. So it is, if I may use this analogy, it is a smart virus but the body is smart too.

DR. ANTHONY FAUCI: Yes.

BILL MOYERS: And figures out how to respond and then the virus figures out how to respond to the body’s response?

DR. ANTHONY FAUCI: Well, that’s what it does when it changes. Like for example, this season you have a certain type of an H3N2. As it circulates, it starts to do what we call drift. It changes enough that the body doesn’t recognize it as exactly something it saw before, which is the fundamental reason why each year almost invariably you have to change your vaccine just a little bit.

BILL MOYERS: Is this an apt analogy to say that we’ve never had a hurricane like Katrina before? So that when Katrina hit, we had prepared for hurricanes we had experienced but not one like this.

DR. ANTHONY FAUCI: Well, yeah. And all analogies have their faults–

BILL MOYERS: I know.

DR. ANTHONY FAUCI: –but that’s a reasonable one; that it’s something that the body has not experienced before. The body was waiting for the regular flu. Kind of knows how to handle it seasonally. Then you get a flu that it’s never experienced before.

BILL MOYERS: Do we have a vaccine that will work against avian flu?

DR. ANTHONY FAUCI: We have been testing — most recently a vaccine made from an H5N1 that we isolated from an individual in Vietnam, actually. And we made what we call the seed reference virus for this particular vaccine. We contracted with some companies. Made a vaccine for a clinical trial, and we’ve been able to show that this vaccine, when given to individuals, induces an immune response that would be predictive, that it would protect if the person were exposed. Now the trick is going to be to make enough of it to be able to have available for those who might need it.

BILL MOYERS: How much of it do we have right now?

DR. ANTHONY FAUCI: We only have a couple of million doses. We need to get up to at least several tens of millions of doses and ultimately –

BILL MOYERS: 10, 20 million, 30 million?

DR. ANTHONY FAUCI: Well, no, probably even more than that.

BILL MOYERS: Really?

DR. ANTHONY FAUCI: Right now for example on a regular flu season year, just last year we were aiming at vaccinating 100 million people.

BILL MOYERS: Including me?

DR. ANTHONY FAUCI: Yeah. This year because of the problem we had with the contamination of some of the stores last year, we probably will get somewhere around 70 or so. You do somewhere between 80 and 100 million people. When you develop a new vaccine like this, you have to balance the capability of making vaccine for the seasonal flu at the same time that you’re going to insert a new one in there.

So the ultimate goal is to make enough vaccine for everyone who might need it.

BILL MOYERS: So how long would that take?

DR. ANTHONY FAUCI: Well, that takes many months. It takes several months to do if you’re doing nothing else. And that’s the reason why one of the issues that comes up when you talk about pandemic flu is that the vaccine development and production enterprise in this country and worldwide is very fragile.

BILL MOYERS: Why is it? You’re saying we don’t really have the capacity to produce it fast enough?

DR. ANTHONY FAUCI: Precisely. We don’t have that because the vaccine industry is fragile. It is not a big money maker. Flu in this country and worldwide is seasonal. It’s unpredictable. It changes each year. The production of a flu vaccine is something that has risk. You require chickens, chicken eggs. You grow in the eggs.

It’s not something that if you’re a drug company you look at this and you say, “This is what I really want to do because this is going to make a lot of money.” As opposed to investing in a blockbuster drug that you know if you hit gold with that, you really do very well. So what we in the federal government need to do, is we need to work with the pharmaceutical companies and help to incentivize them to turn their attention and their resources to being able to have the capability of what we call a surge capacity. Of being able to make 100 or more million doses if we need it within a period of a few months.

BILL MOYERS: Incentivize means capital.

DR. ANTHONY FAUCI: Yeah.

BILL MOYERS: How much?

DR. ANTHONY FAUCI: Well, we need to get them to invest and we need to invest with them. We need more plants. We need plants in the United States. We’re likely going to be involved in some liability protection for them, some tax incentives for them. We’ve got to get them more involved in this process of making vaccines.

BILL MOYERS: Have you run the numbers? I mean what let’s say you make –

DR. ANTHONY FAUCI: In order to produce hundreds of millions of doses, you’re talking about a couple of billion dollars to do that. Yes.

BILL MOYERS: And do you run into this problem the people say, “Well, you know, it didn’t happen so it was a waste of money. They cried wolf — in this case bird.”

DR. ANTHONY FAUCI: Exactly. A big problem.

BILL MOYERS: It is.

DR. ANTHONY FAUCI: And you have to get past that because if you’re concerned about that criticism you’ll never be prepared. We’re going to assume that the worst will happen in our preparedness, in our vaccine development, in our vaccine production, in developing and stock piling anti-influenza, anti-viral drugs.

If it doesn’t happen, you’re right. There will be criticism to say, “See? You invested all that money and nothing happened.” But you can’t take that chance with the health of the American public. You have to make that investment and you have to be ready.

BILL MOYERS: Ready. You know, we were not prepared for 9/11. We were not prepared for the ravages of Katrina. What makes you think we’re going to prepare for this?

DR. ANTHONY FAUCI: Because we’re on our way to doing that. There’s a commitment that certainly the administration — the President is committed to getting us prepared for a pandemic flu. He’s following it very carefully. Secretary Leavitt of the Department of Health and Human Services, [it] is of highest priority for him in his department. So this is something that at the very highest levels of our government from the White House to the Departments to the Congress are very concerned about this.

BILL MOYERS: Do we have a pretty good idea of how the flu gets translated from the birds to humans?

DR. ANTHONY FAUCI: Yeah. No, it’s pretty simple. When the chickens get sick, they get sick in the same way we get sick. They start to get secretions, saliva. They cough and they get a bunch of other things, including neurological abnormalities. But when they’re sick and they start coughing, as it were, the spray of their secretions gets on the nose, the mouth, the eyes of the people who were taking care of them. Now it’s very inefficiently spread but there are people as we saw –

BILL MOYERS: What do you mean inefficiently spread?

DR. ANTHONY FAUCI: Inefficiently. In other words, a lot of people are exposed to a lot of sick chickens. And yet a relatively few of them actually get infected. There have only been 112 documented infections with 57 deaths.

BILL MOYERS: Well, that would make me take a deep breath and say relax, wouldn’t it?

DR. ANTHONY FAUCI: Well, you know, except that if the virus mutates and evolves it can pretty easily be able to make that a much more efficient process. Efficient from the chicken to the human and efficient from human to human. As we saw in the film, it was a rarity to have those unfortunate people get infected. Because there are a lot of people who were exposed to infected chickens in Vietnam and in Thailand and in places like that. And yet there have been relatively few people who’ve gotten an infection. You don’t want to take too much solace in that because just a little bit of a change in that virus can make that efficiency go greater.

BILL MOYERS: What do we know about how it gets transmitted, if it gets transmitted, from a human to another human?

DR. ANTHONY FAUCI: Classic influenza transmissibility which is by aerosol spread.

BILL MOYERS: A sneeze?

DR. ANTHONY FAUCI: Exactly. Sneeze or material, saliva or material, from your nose or your mouth. You get it on your hands, you shake hands, you touch someone. They go like that, rub their eye, rub their mouth and that’s how influenza every year in a season, you can either sneeze on somebody, which is an aerosol, or you can get it on your hands and contaminate by shaking hands. Which is the reason why during the flu season we say, “Wash your hands as much as you possibly can.”

BILL MOYERS: Between the threat of terrorism and the threat of Asian flu I’m just going to stay home.

DR. ANTHONY FAUCI: Well –

BILL MOYERS: No, I’m serious.

DR. ANTHONY FAUCI: Unfortunately –

BILL MOYERS: No, I mean –

DR. ANTHONY FAUCI: — you can’t do that.

BILL MOYERS: This is such a simple question, I’m almost embarrassed to ask it. But let’s say somebody sneezes on me. What are the symptoms I watch for avian flu? I know about the others, the regular flu. I know that I’ll start sniffing and I get –

DR. ANTHONY FAUCI: It’s similar. First of all you can distinguish it from a standard cold because you will get aches, you will get a high fever, and then you will start to get respiratory symptoms, difficulty breathing, coughing. And to the point — if it becomes seriously a pulmonary compromising disease the way we saw in the film — you remember when they showed those X-rays of that young man and the young woman? A normal X-ray you see black. That’s air. The lungs are healthy. You could see right through it because there’s air being moved. When it got white, a little bit on one side of the lung, and then over a period of the next day. Two days later the whole lung whited out.

That means that that virus was replicating very rapidly in the lung and was destroying lung tissue. And the young man, even after he recovered, he was severely compromised because of what the virus did. So the virus gets in — you get fever, you get aches, you really feel totally run down and then you start to get symptoms that may be related generally to the pulmonary tree, namely your lungs.

BILL MOYERS: Which means you would start hurting in your lungs?

DR. ANTHONY FAUCI: Difficulty breathing.
BILL MOYERS: How would you know that the pandemic has started?

DR. ANTHONY FAUCI: You’ll know. What will happen, and we hope it never happens, but if it does, what will happen is that you’ll start to see cases like we saw in the film, but not just isolated cases. There will be spread from person to person so that that man in his home, when he was sick, he would give it to his father and his sister and they would give it to their friends. And you start to see major clustering of cases. What we are seeing is isolated cases. When they start clustering and spreading throughout the community, then invariably you’ve reached the point where the efficiency of the spread is such that it can go throughout the country, throughout the world.

BILL MOYERS: And there’s no barrier you can use to encircle that particular –

DR. ANTHONY FAUCI: Well, you can.

BILL MOYERS: — geographic location?

DR. ANTHONY FAUCI: And again, this is a very important point, because it is unlikely that if the virus develops the capability of going more efficiently from person to person or from chicken to person, that’s not going to go from really inefficient overnight to being spectacularly efficient. It’s going to gradually evolve in its efficiency. That’s the way viruses usually do. So it isn’t on a Thursday, it’s totally inefficient, and all of a sudden on a Friday, it spreads wildly.

When that happens, hopefully we’ll have time to do just what you are suggesting. Mainly if there are a couple of cases, a cluster of cases, be it in Vietnam or China, wherever, that you can go in, isolate those cases, treat the patient as well as the contacts of the patient and start vaccinating people in that region. Kind of getting the spark or the initial lighting of a forest fire and trying to put it out.

However, once it starts to spread outside of the community — and unfortunately that’s a very big risk in this era of jet travel — once it gets out of the contained area then it’s going to be very, very difficult to put the little fires out. Then that’s when you get a pandemic.

BILL MOYERS: You fellows did a really good job, I’m pleased to say, when SARS struck.

DR. ANTHONY FAUCI: Yes.

BILL MOYERS: You know, we were all frightened to death from SARS, particularly those of us who know people who were adopting children in China, from China or other parts of Asia at that time. You did such a good job with SARS that many of us sort of take a deep breath and say, “Well, if they do see these signs, they’ll get to it.”

DR. ANTHONY FAUCI: Be careful. And the reason we have to be careful is that the analogy between SARS and influenza is quite imperfect. Influenza is spread easily by aerosolize. SARS, with some exceptions, is spread by droplet. So that in order for me to infect you if I had SARS, I had to really be coughing and get visible droplets to contaminate you, is the usual way it’s spread. With influenza you can get infected from me even before I start to feel sick because there’s a period of 24, maybe even 48 hours where I’m incubating the influenza. And just the normal amount of spray that goes back and forth when people talk to each other, you can actually get infected.

BILL MOYERS: When we just talk this close?

DR. ANTHONY FAUCI: Yeah. What people don’t realize � it isn’t particularly aesthetically pleasing � but when people talk to each other, if you were able to get the right angle of a light, you’d probably see very, very, very fine little droplets go back and forth sometimes. And that’s what’s called aerosolize. And then even an inadvertent cough that you don’t even notice can do it. So it’s very easy to spread influenza where it was relatively inefficient to spread the SARS virus. They’re really qualitatively quite different.

BILL MOYERS: Alright. How do we think about avian flu in regard to HIV/AIDS?

DR. ANTHONY FAUCI: They’re totally different.

BILL MOYERS: But in terms of the potential victims. I mean how many people have died from HIV/AIDS?

DR. ANTHONY FAUCI: Over 23 million.

BILL MOYERS: So could avian flu kill more people than that?

DR. ANTHONY FAUCI: Yeah. They’re very different because one, as you know, is a sexually transmitted and blood transmitted disease, and one is a disease that’s transmitted by casual contact, just by talking or sneezing or shaking hands.

BILL MOYERS: That is right.

DR. ANTHONY FAUCI: Yeah. The potential in the worst case scenario can be devastating, which is the reason why even though there are relatively few cases in Southeast Asia, why we’re taking this so seriously. And better err on the side of taking it more seriously than people would think than just ignoring it and then really being in trouble.

BILL MOYERS: But you know we’re up against a phenomenon of nature. Birds fly.

DR. ANTHONY FAUCI: That’s another whole story and that is the reason why this is not going to all of a sudden overnight go away. The reason is that it is being propagated by migratory fowl that have flyways that cannot only contaminate one country to another that’s proximal to each other, like Cambodia will contaminate Laos. You get chickens in Cambodia, they’re infected, ducks fly from Cambodia to Laos or from Cambodia to Thailand or to Vietnam and they cross-contaminate each other because the fowl get infected and they don’t necessarily die.

For example, not all ducks get sick when they get H5N1. So they can spread it. But now what we’re seeing, is that migratory birds like geese and other birds that get involved in transcontinental flyways, are capable of spreading H5N1. So that’s the reason why we saw in the summer of 2005, when we saw what was confined to a few countries in Southeast Asia, we began to see it in China. We began to see it in Siberia, in Russia, in Kazakhstan. So that the contamination gets wider and wider and that’s why the people in Europe are concerned that their flocks are going to be contaminated.

BILL MOYERS: Are any of those countries better prepared than we are?

DR. ANTHONY FAUCI: I don’t think so. We’re the only ones that are pretty much into a vaccine development. We have a candidate that is inducing a good response. We’ve contracted for a significant number of doses. We’re stockpiling. Other countries are relying maybe a little bit more heavily on drugs, anti-viral drugs, than they are on vaccine. But I don’t think there’s any country that’s better prepared than we are. There are some that are prepared, doing well, but I don’t think you could say that this country is clearly more prepared than we are. Not at all.

BILL MOYERS: We’re coping now with, of course, the aftermath of Katrina, billions of dollars. Terrible devastation. We’re constantly spending money on the combating of terrorism. I mean a lot of people are watching. Where will we be a year from that? A year from this September. Where will we be in the number of vaccines we have available?

DR. ANTHONY FAUCI: It’s not necessarily the number of vaccines but the quantity of vaccine doses that we have.

BILL MOYERS: Alright. Where will we be a year from now? We’ve got 2.3 million now you say.

DR. ANTHONY FAUCI: Yeah. We have two million, which actually with the dosage changes translates into less than that. We hope in the next year to get close to 20 million — and then in the next two or three years, even ratchet that up even more.

BILL MOYERS: The success of the Public Health Service is hard to judge because if you do your job well we never know why you needed the money.

DR. ANTHONY FAUCI: Exactly. Exactly. That’s something you have to live with. But it’s a reality. That your job is successful if nothing happens or if you put out a fire and there’s no catastrophe. You’re measured by what happens or doesn’t happen. It’s a failure, theoretically, if you have a disease that got out of control. But sometimes, even the best preparation doesn’t necessarily make you immune to that.

BILL MOYERS: After watching the film and talking to you, I don’t think I’ll sleep tonight. But do you sleep at night knowing this responsibility is on your shoulders?

DR. ANTHONY FAUCI: Yes. We separate, you know, an affective emotional response to something that is threatening and frightening to the job you have to do. You’ve concentrated on the job that you have to do. There are so many unknowns. You can’t get fixated on fear and concern. You’ve got to say, “I’m going to do everything in my power not only as an individual public health person but as an agency.” The Public Health Service, the Department of Health and Human Services, other agencies that are involved with this, do the best that you can, even though the threat is considerable and the consequences of a pandemic can be devastating.

BILL MOYERS: Did you, as a public health official, learn anything from Katrina that you can apply to this situation?

DR. ANTHONY FAUCI: Yeah, you always learn lessons when you see things that turn out to be catastrophes. And the situation that we feel very strongly about is that you’ve got to be prepared for even the completely unexpected. And that’s why whenever I talk about pandemic flu I say it’s entirely unpredictable. And the Katrina situation was something that just was worse than anyone ever expected.

BILL MOYERS: Now there were warnings you know. People kept saying, “If it reaches level two it’s going to be bad. If it reaches level three�” Is there a level three in avian flu? Levee three?

DR. ANTHONY FAUCI: Yeah. Right. Right. What is the levee of influenza? And the levee of influenza I think, is the issue of getting a vaccine that matches the microbe that’s circulating, and being able to produce it in quantities enough that when you do have a clear indication that you’re having a pandemic-like spread, that you could scale that up and get the American public protected within a period of a few months.

BILL MOYERS: But there’s nothing they can do unless the vaccine is ready.

DR. ANTHONY FAUCI: Right. Well.

BILL MOYERS: We’re a long way from that.

DR. ANTHONY FAUCI: Yeah. And what we’re doing, and this is coming from the very highest levels of government, is engaging with the pharmaceutical companies to really put a full-court press on to develop the capabilities so that we will be able to make hundreds of millions of doses within a period of a few months — from the time we know we have an issue to go ahead and do it.

BILL MOYERS: So they would have the capacity but not the command yet.

DR. ANTHONY FAUCI: Right. The capacity. And then when you turn on that light and push that button, you go and you develop it within a period of a couple of months. We don’t have that capacity yet. But we’re on our way to trying to get it.

BILL MOYERS: What should I do in this regard? What do you want me to watch out for?

DR. ANTHONY FAUCI: I just think stay informed and help inform others about tracking this, watching the evolution, if there is an evolution of it, staying well educated on it. And when the time comes to move in the sense of getting people vaccinated, to be amenable to that and to participate in that.

BILL MOYERS: How can people find out more from the National Institutes of Health?

DR. ANTHONY FAUCI: Well, we and the CDC also –

BILL MOYERS: Centers for Disease Control.

DR. ANTHONY FAUCI: Yeah. The Centers for Disease Control is a very big player in this, in surveillance and letting the American public know where we stand. It’s very easy. They have a wonderful website.

BILL MOYERS: What is it? Do you know?

DR. ANTHONY FAUCI: It’s www.cdc.gov. You click on there and they have an influenza — a pandemic flu — subcomponent on their website. You get all the information you need.

BILL MOYERS: So the first thing I can do is go to www –

DR. ANTHONY FAUCI: — .CDC.gov.

BILL MOYERS: And it’ll give me some basic information about it.

DR. ANTHONY FAUCI: It will give you the fundamental, basic information.

BILL MOYERS: When you saw that film, did you think that what you posted there, what CDC’s posted there, is pretty consistent with the reality that’s happened?

DR. ANTHONY FAUCI: But CDC, to their credit, is all over what’s going on in Southeast Asia. They have people there on the ground and collaborating. The NIH, my area of responsibility, we have scientists who are working with the Vietnamese, to try and take a very careful monitoring of what we call the molecular evolution of the virus, because remember, in its present state, this virus is inefficient in going from chicken to human, and very inefficient from human to human. You periodically sample the virus to see how it’s evolving and you can get a big heads up if it starts to change its molecular confirmation, as it were, its molecular makeup, that might predict that it’s now going to be more efficient. So, not only do you have the CDC surveillance as to what’s going on there, but you have scientists who are continually sampling the viruses.

BILL MOYERS: If the virus is steadily changing, if every experience it endures creates a new virus in a way, changes its identity, changes its appeal, how can you produce the vaccine?

DR. ANTHONY FAUCI: Well that’s a very good point and that’s the reason why it is not only just isolating a virus and making a vaccine, it’s building up the capacity to surge up when you get in your hand what’s the real culprit. For example, it may be that the virus that’s there right now, even as it changes to become more efficient in its spread, doesn’t change so much as to elude or escape protection from the vaccine. But it is entirely conceivable that as it does evolve it will elude or escape protection from the vaccine. But if you’re building the capacity to make pandemic flu vaccine, as we are doing, and the virus changes enough and starts spreading from human to human, and you say that’s the culprit, that’s the one we want to make a vaccine against, you plug that into your system and if you have the surge capacity to really ramp it up, within a period of six months, you could probably get enough vaccine that you need for this country.

BILL MOYERS: So it’s not a situation that you could produce 50 million vials and put them in the cold storage and just take them out and use them?

DR. ANTHONY FAUCI: It might be. It might be, but you got to be ready to move. You’ve got to be nimble. So we are assuming now, we’re going to make a significant amount, not necessarily three hundred million doses. We’re going to make a significant amount in partnership with the companies of the vaccine that we already have against the H5N1 that is now circulating in Southeast Asia. As we do that, we’re building the capacity so that if and when it changes, we can then take the new virus that’s evolved, and plug that into the vaccine manufacturing system to be able to make doses of that vaccine.

BILL MOYERS: You scared the — boy I can’t say that on public broadcasting… You scared me, but you also make me feel better because I know that you and your team are on top of this. But I have to come back as a journalist with the reality and say we knew the terrorists were coming. There were plenty of intelligence warnings. I did a broadcast three years ago that anticipated what’s happened in Katrina.

DR. ANTHONY FAUCI: Right.

BILL MOYERS: Nothing happened. We Americans seem to wait until they strike Pearl Harbor or they strike the World Trade Center or the flu epidemic takes us down.

DR. ANTHONY FAUCI: We have our eye on this terrorist, and nature can be the worst terrorist. We’re watching that virus. It may not be the virus that is the cause of the next pandemic. It may dead end itself or we may have something else a year from now that becomes a pandemic flu. But the one thing that we can promise you and the American public — not necessarily there’s 100 percent guarantee we’ll be able to stop this in its tracks — but the one thing we can guarantee is that we have our eye on and we’re following it very carefully.

BILL MOYERS: So the best case scenario is that you spend $2-3 billion to produce this vaccine and a sneeze is just a sneeze.

DR. ANTHONY FAUCI: Exactly. Would that we waste, as they say, and — and not really waste — would it be the best thing that we spend money to have a vaccine for pandemic flu that never happened? That would be a great outcome as far as I’m concerned.

BILL MOYERS: Well, suppose the worst case scenario happens and a pandemic strikes. What would be the total impact, the overall impact on our economy, on our education, on the workplace?

DR. ANTHONY FAUCI: If we have a pandemic that is truly a pandemic, that is truly a devastating pandemic with tens of millions of people getting sick and hundreds of thousands of people dying, we will have a situation in this country. And again hopefully it will never come to that, and we’ll have the countermeasures, the vaccines and the drugs to prevent that. But if that happens, the effect broadly on society is multifaceted and potentially devastating. Because when you have such illness, you can rapidly overcome and supercede the capability of your hospitals and your clinics to be able to take care of patients.

You have an economic issue, not only an economic issue of work lost from people who are sick, but the communications and transportation among countries might be closed down or broken down. Normal healthcare systems will strain under this terribly. So there are so many implications — economic, healthcare interactions, global considerations when countries throughout the world also have a devastating impact.

Take a look at what happened with SARS to Canada and SARS in Hong Kong. I mean, just what turned out to be not a lot of deaths and relatively few cases had an enormous negative impact on the economy in Canada, and Toronto particularly, as well as in Hong Kong and in China. So when you have a disease with the potential of the pandemic flu, the consequences go well beyond the purely health issues.

BILL MOYERS: Yeah, people died and people got sick, from the Gulf Coast to New Orleans, but the whole infrastructure of the region was totally wiped out.

DR. ANTHONY FAUCI: Right.

BILL MOYERS: Are you saying that a true pandemic of avian flu could do what happened there in a widespread area?

DR. ANTHONY FAUCI: Well, what happened there was destruction of existing infrastructure. When you have a pandemic flu it would be more likely to overwhelm the existing infrastructure rather than destroy it, yes.

BILL MOYERS: In your 30 years as a public health physician, have you seen anything as scary as this?

DR. ANTHONY FAUCI: Again, I tend not to describe things as scary, but as really challenging and potentially devastating.

BILL MOYERS: Bigger threat than most?

DR. ANTHONY FAUCI: Well, HIV is a big one. That’s something that even though it has a well defined, more limited way of spreading than influenza, which spreads very easily, if you look at the impact of over 20 million people having died already, 40 million people living with HIV, I would think that HIV right now is something that trumps everything.

The potential for a pandemic flu is there and the implications are really fuzzy. Because you don’t know whether it can be something like we had in 1968, which serious as it was, it was not a public health catastrophe, or if it’s going to be an 1918. Sitting here talking with you, Bill, we can’t predict what’s going to happen. But since the potential for something very devastating is there, I would say that it’s something that I take very, very seriously.

BILL MOYERS: It’s scary just thinking that a conversation like this where we’re feet apart, or when I shake your hand and say good night that that moment could become a fatal moment.

DR. ANTHONY FAUCI: Respiratory diseases that have the potential to kill are indeed frightening.

BILL MOYERS: Dr. Anthony Fauci, thank you very much for joining us on “Wide Angle.”

DR. ANTHONY FAUCI: Good to be here.

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