Wide Angle . H5N1 · Killer Flu . Transcript

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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.

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