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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.
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Dr. Anthony Fauci, director of the Institute for Allergy and Infectious Diseases at the National Institutes of Health
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