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(upbeat music) - [Woman] And now, "Crosscut Festival Main Stage," featuring a selection of curated sessions from this year's "Crosscut Festival."

Thank you for joining us for "It Changed Everything," with Anthony Fauci, moderated by Judy Woodruff.

Before we begin, we'd like to thank our Keynote Track sponsor, BECU.

We'd also like to thank our session sponsor, Mike and Becky Hughes.

Finally, thank you to our founding sponsor, the Kerry and Linda Killinger Foundation.

- Hello and welcome to the "Crosscut Festival."

I'm Judy Woodruff, Anchor for the PBS NewsHour, and today I'll be speaking with Dr. Anthony Fauci, who has been at the forefront of our response to the coronavirus pandemic since its start.

He is the Director of the National Institute of Allergy and Infectious Diseases, and he is the Chief Medical Advisor to President Biden.

Dr. Fauci, thank you very much for joining us, so much to talk about.

But I wanna start with new data that we are learning about, about how many Americans have been infected with the COVID virus among all Americans.

And I think this states back to February, 60% almost had been infected, and among young children ages three to four, 75% had been infected.

First of all, were you surprised by these numbers?

And second of all, does this in your mind change the way there should be an official response to the virus?

- Well, I wasn't terribly surprised, Judy, because we've been having this virus around now for almost two and a half years.

So the idea that if you look at the serology, which is the antibody test in the blood, which determines whether you've been infected or not, is not surprising that you have that proportion of the population.

I think it's important for people to realize that because although immunity, following infection and recovery, does not last indefinitely, it does give a degree of variable degrees of protection against severe disease if you get reinfected.

So if you add up the people who've been infected, plus the people who've been vaccinated and hopefully boosted, you have a rather substantial proportion of the United States' population that has some degree of immunity that's residual.

Either residual from prior infection, or hopefully people who are getting vaccinated and boosted.

We know we have 66% of the total population has been vaccinated and about half of them have been boosted.

So in some respects, that's rather favorable news for the kind of protection against severe disease that might be explaining, Judy, why even though this surging of infection we're seeing, we're not seeing a comparable surging of hospitalization.

We have to wait a little bit longer before we can feel that that trend is holding, but it looks like that's the case that even though we're having a lot more infections in this mini surge that we're having, we're not seeing a lot of people requiring hospitalization.

- But you don't think these new numbers suggest that there should be a different approach to this pandemic?

- No.

No, I don't think so.

I think the approach should be just what we're saying, get vaccinated, get boosted when your time is appropriate to get boosted.

- Well, let me ask you about, you mentioned the new variant that's out there.

We are learning that it's now something like what?

30%?

Of the American people have this BA.2.12.1, a subvariant of what?

The BA.2 which we were becoming familiar with.

Is this telling us, Dr. Fauci, that when you go back to Delta and then Omicron BA.2 and now there's BA.2.1, that there are gonna continue to be variants and subvariants, each one more infectious than the last one, at least that's the pattern we've seen, but less serious in that they're not sending so many people to the hospital?

- Well, the answer, the broad answer to your question is yes.

And let me just explain it a little bit in more detail.

So these are sub-lineages of Omicron, be it BA.1, BA.2, A, B2A, B12.1, multi sub-lineages.

They may be more transmissible.

None of them seem to be more serious when compared to the other, but the good news is that infection with one of the sub-lineages seems to give you good protection against another sub-lineage.

Maybe not protection against infection, but certainly protection against severe disease.

So it gets back to that paradigm that we're talking about.

Although these sub-lineages are a little bit different, they may or may not be more easily transmissible.

Some of them seem to be more transmissible, but we're not seeing a real spike in the severity of it, which is in some respects, encouraging news, if you want to call it that.

- [Judy] Does that give you confidence there won't be a spike in severity?

- Well, that depends on what the variant is.

If you are getting just sub-lineages of something that has already been circulating, then you're in reasonably good shape.

If you get a variant that's rather profoundly different, for example, the difference between Delta and Omicron was very significant as opposed to the difference between BA.1 and BA.2.

So it really is gonna depend.

You can't say that we're not gonna be dealing with a real challenge with another variant.

And that's the reason why we wanna be as prepared as we possibly can, by getting people vaccinated to the extent that we can, boosted, having therapies available, antivirals, having tested readily available, so that when people do get infected, we can address it.

- In connection with all this, Dr. Fauci, we live in the Northeast of the United States.

We are hearing about more cases here, including prominent members of the public, including lawmakers, the Vice President of the United States, and many of them are having mild or no symptoms at all.

What does that tell us about how many more Americans who aren't getting tested as regularly as these individuals are, who may just be walking around with COVID, but not aware of it?

- I think you just hit the nail on the head there, Judy, because I am virtually certain that we are under counting the number of infections, just for the same reason.

There are many people, people who I know myself, friends and others, who get infected, who do an antigen test, don't get many symptoms, but don't report it to anyone.

So the fact is there are infections that are not getting centrally reported.

So I do believe that there's an under count.

We should do better than that.

We should probably be able to track them a much better, but the good news is the one that you mentioned, and you're absolutely correct.

The relationship or ratio between hospitalizations and infections, is such that we're not seeing a comparable increase proportionately of hospitalizations.

Unlike what was happening with Delta, when as the cases went way up, the hospitalizations also went way up.

- [Judy] Should we have stricter reporting requirements though, so that the country can just keep better track of how many cases there are?

- Yeah.

I would like to see that.

I would like to see a way where when you get an antigen test somehow or other, you can put it in an app and just get some way of recording it.

It would give us a much better feel and a much better understanding of the scope of any rebound, even though it's a mild rebound.

You really like to know what the accurate counting of cases is.

- Well, for those who are having symptoms now, Dr. Fauci, there's been a fair amount of discussion lately about a treatment, a drug called Paxlovid.

And I know there are generic names for it as well.

Fair amount of confusion about who should be taking it, who shouldn't.

There's a sense that it's not available to many people who need it.

It does require a doctor's prescription.

We are told that it is available, but it's not reaching everyone who needs it.

What should we know about this drug?

- Yeah.

Well, the first thing that we should know is that we have a lot of Paxlovid.

We've gotta make it more easily available.

And the White House literally today has come out with a number of ways, how we're going to try and get it distributed more widely.

We are under utilizing what is a highly effective therapy.

In clinical trials, when you looked at the proportion of individuals who are protected from getting on and progressing to hospitalizations, it was close to 90%.

So we need to do more.

There are a lot of those doses available.

We have sites where you can, as we say, test to treat, which means you can come into a place, get tested, and if you are tested, immediately get put on therapy if they're eligible.

We've ordered tens of thousands more of these drugs, namely Paxlovid, and we're having sites where they're now.

We started off with 20,000 sites have Paxlovid available.

We're increasing that to 30,000, with the aim of going to 40,000, essentially doubling the number of sites where you can get it.

And I mean, pharmacies and clinics and places like that, as well as something that's important that you alluded to, is educating the public and the healthcare providers, that this is something that is available and that should be much more widely used.

- [Judy] But there are some people who should not take it.

Is that correct?

- Well, there are what we call drug-drug interactions, which means if you are on a certain panel of drugs, it is... You have to be careful if you're taking Paxlovid, because you may get a modification of the level of a drug that you're taking.

So for example, some of the anticoagulate, some of the lipid-lowering agents and some of those other agents that people are on, if you're on that, you might wanna modify the dosage.

And that's why we're trying to educate pharmacies and physicians, that we wanna make sure that in some people it might be contraindicated, but in other people they could probably still take it if they just modify the doses of some of the other medications that they're on.

- Dr. Fauci, let me broaden this out and ask you, here we are, it's the end of April, it's the spring of 2022.

How close are we to the end of this pandemic?

- Well, that's an unanswerable question for the following reason.

And I don't wanna be evasive about it, but let me tell you why I'm giving you that answer, Judy.

We are certainly right now in this country, out of the pandemic phase.

Namely, we don't have 900,000 new infections a day and tens and tens and tens of thousands of hospitalizations and thousands of deaths.

We are at a low level right now.

So if you're saying, "Are we out of the pandemic phase in this country?"

We are.

What we hope to do...

I don't believe, and I've spoken about this widely, we're not gonna eradicate this virus.

We've only eradicated one virus in the history of public health, and that's smallpox.

And it's unlikely that we're gonna eliminate it.

And elimination means you don't wipe it out of the face of the earth, but you don't have it in this country.

We've done that successfully with measles and with polio.

And we've done that for three reasons.

We have a virus that does not change from year to year from decade to decade.

Measles that we have now is the same measles we had decades ago.

Same for polio.

Number one.

Number two, the immunity that you get, either from infection or from vaccination, is virtually lifelong with those viruses.

And you have a widespread, widely accepted vaccination campaign.

Unfortunately, we don't have that with COVID.

We have a virus of which we've already experienced multiple variants.

So it changes.

Number two, the immunity from infection and even from vaccination is not lifelong.

It wanes, we know that.

We've already reported on that and we don't have a widely accepted, among the community, vaccination.

So what we're hoping for, is that we get a of infection that's low enough that it doesn't really disrupt our society.

It doesn't put people at risk for very severe disease on a large scale.

It gets us back economically.

It gets us back socially.

It gets us back into the school system.

If we can keep that level very low and intermittently vaccinate people, and I don't know how often that would have to be, Judy, that might be every year, that might be longer, in order to keep that level low.

But right now we are not in the pandemic phase in this country.

- [Judy] So are we wrong to say we're in a pandemic?

- Well, globally, we're still in a pandemic.

A pandemic means a wide spread throughout the world infection that spreads rapidly among people.

So if you look at the global situation, there's no doubt this pandemic is still ongoing.

- Given what you're saying, Dr. Fauci, how much sense does it make to continue to push people to get vaccinated?

And I understand the arguments for getting vaccinated, but the people who have chosen, who've made a decision, they don't want to get the vaccine, how much more effort should be expended on that at this point?

- Well, we should not give up on that, Judy, because there are some people who unquestionably are hardcore, no matter what you say or what you do, they're not gonna get vaccinated.

But there are some who still have some concerns about safety, about efficacy, or even the convenience of getting vaccinated.

I think there are those people that we might be able to convince to get vaccinated.

But you're absolutely correct, there are some that are just dead set against it, but that's their own personal choice, but we should not give up on some who still have some degree of being able to convince them.

- As you look back, Dr. Fauci, on how the government, both under former President Trump and under President Biden, has addressed this virus, this pandemic, what do you think has been done well, and what do you think, what do you wish had been done differently?

- Well, the thing that's been done very well, Judy, is the scientific aspect of it.

The idea that we could have a virus that was just recognized in January of 2020, and 11 months later have a vaccine that's highly effective and safe and going into the arms of individuals, that's already clearly saved millions of lives, millions and millions of lives worldwide.

That is an unprecedented accomplishment.

So the investment in basic and clinical research that led to that, and the implementation with Operation Warp Speed and continuing what we're doing now about getting vaccines available, is a resounding success.

There have been some bumpy parts of that road when it comes to public health.

There have been some missteps throughout the world, not only in the United States, but the one thing that prevails for me that when I look back I wish really was not the case, was the extraordinary divisiveness in our country, which politicized a public health issue.

There's a common enemy, as I've said before, and that common enemy is the virus.

And when you have ideological differences determining what a public health approach is, where some people refuse to get vaccinated, refuse to wear masks, refuse to accept the communal responsibility of getting this country out of that, that's one thing that I wish were not the case.

- [Judy] And whom or what do you hold responsible for that?

- Well, I don't think it's productive to pointing fingers at what's responsible.

I just think it's the inherent condition in this country.

We are in a very divisive nature of what's going on right now.

We see it, not only in public health, in virtually every aspect.

We're a divided nature.

We're culturally divided right now.

And if we're gonna fight this epidemic effectively, we've gotta get out of that.

- And just in connection with that, I had the opportunity to interview Dr. Francis Collins, back in December, as he was preparing to step down as the head of the NIH.

And I asked him a similar question.

I asked him if there was anything he wished that he'd been able to do during his tenure with regard to the pandemic.

And he said, "Maybe we under invested in research on human behavior."

He said, "I never imagined a year ago," he said, "when those vaccines were proving to be safe, "we would still have 60 million people."

This was, again, speaking in December who had not taken advantage of them because of misinformation and disinformation.

Do you think, whether it's not investing in research on human behavior or something else, that that could have made a difference?

- Oh, I don't think there's any doubt that that could have made a difference.

I think people not getting vaccinated is responsible for deaths and hospitalizations.

Just the same way, on the other side of the coin, Judy, that vaccinations have saved in this country, tens and tens of millions of lives and globally hundreds of millions, really.

- The vaccines...

I just have another question about the vaccine.

This is a practical question because a lot of people are trying to figure out what to do right now, Dr. Fauci, about boosters, whether to get a second booster.

The guidance doesn't seem to be absolutely clear.

Can you clear it up for us?

- Well, I don't think it's going to be able to be absolutely clear because there are different circumstances.

So take a look right now, and I believe you're referring to whether or not individuals should take a fourth dose or a second boost of an mRNA.

Well, the FDA, looking at that data, has said that people 50 years of age or older are eligible, and people older than that, 65 or older, particularly those with underlying conditions, should get vaccinated.

The CDC went along with that, recommends clearly that people with underlying conditions get vaccinated, but there's a degree of flexibility in people who are 50 years of age or older, depending on the level of risk within that group.

Myself as a physician, and I'm taking off a policy hat right now, and saying, as a physician, if someone comes in to me now and says, "I'm 54 years old," and many people at that age have some underlying condition, "I have a bit of high hypertension.

"Maybe I have diabetes.

"Maybe I'm a little bit overweight."

Those are the kind of things that might put you at an increased risk of severe outcome.

So I would recommend to that person, if they asked me as their physician, that they should get vaccinated.

If you're 65 and you have any of that, absolutely I would wind up getting that fourth dose.

- Let's broaden this out, Dr. Fauci, to ask about the global picture for COVID.

You said earlier, the world is still very much in a pandemic.

As we know, there was criticism in the beginning from the World Health Organization and others, that the wealthier countries should have shared more of their vaccine, that they should have held off on giving boosters.

But setting that aside, I mean, is there a responsibility still, and how much of a responsibility, for wealthier countries today to be doing all they can to provide vaccine to the developing world?

- Well, I think that the wealthy countries, and I have been very public about this, have a moral responsibility to do that.

Not only because it's important that people who don't have the capability and the ability of interventions that are life-saving, as a global community, we need to be involved in that.

It's also important for the health of the globe.

Because as long as you have virus circulating throughout the world, you have the possibility of variants emerging.

Delta came from India.

Omicron came from Southern Africa.

So if we think that we're safe here because we're in a vacuum of people getting protected, we're not, but one of the things that people need to understand, Judy, it's not only providing doses of vaccines, it's helping them with the infrastructure to get vaccines into the arms of individuals to become vaccinations.

We have doses ready to go to the developing world and they're saying, "We don't yet have the infrastructure "to be able to get those doses into people's arms."

So it's more than just providing doses.

It's helping them to build the infrastructure to get this implemented in a meaningful way.

- I'm asking you this in part, because we're starting to see conversation, even a debate underway among global public health leaders, about what the right approach is.

Now, you have some arguing that COVID is no longer a health emergency because you have this baseline of immunity, and that it's time to pivot to the next, focusing on the next pandemic.

Is there a right answer for the world, or is this something that needs to... That should be decided country by country, region by region?

- Well, I think it's a global problem because when you have pandemics, they're global, they don't affect one region and not another, but if it's a respiratory virus.

If it's something like malaria or something like that, that's different.

But when you're dealing with a respiratory virus.

But here's one of the things that you said that struck a chord with me, Judy, is that you can do both at the same time.

You could continue to address this outbreak and make sure we keep it under control at the same time that you implement the pandemic preparedness agenda, the way we're doing it.

So that we are doing the things now, that when you wind up with a new pathogen, you are much better prepared.

We refer to that sometimes as the prototype pathogen approach, where you do the baseline research that would position you much better if you get a virus that maybe has nothing to do with coronavirus.

It could be a filovirus or a flavivirus, or arenavirus... All different types of virus that might actually have potential pandemic capability.

We can prepare for that at the same time as we're responding appropriately to the problem we're in right now with COVID-19.

- Last thing I wanna turn to, Dr. Fauci, is a personal question.

I mean, you've been immersed in this virus of COVID for the last two plus years.

You've spent your entire adult life focused on public health.

What do you think this particular experience has meant to you, has taught you, has meant to you, has it changed you?

- Well, it's certainly has had an impact on me.

It's been an experience.

I mean, I've been dealing with emerging infectious diseases now for 40 years as the 38 years being Director of the Institute, from HIV to Ebola, to pandemic flu, to Zika, this is different.

This is historic, Judy.

We have not seen anything of this magnitude in well over 100 years.

So it has had a different impact on me.

It has just proven the kinds of things that I've been saying all along.

That pandemics occur.

You can't predict them, but they do occur and we've gotta be prepared for them.

The devastation that we've suffered when we look back at this, almost a million people have died in the United States from this, that's just chilling, just the thought of that.

And that's the thing I think that needs to spur us on to not lose corporate memory.

So that 3, 4, 5 years from now, we're onto something else and we could forget that this could happen again.

So we should not ever forget this.

And that's the reason why we need to be perpetually prepared.

- Are you concerned that we may forget?

We live in an era when we move from one thing to the next very quickly.

- I am concerned, Judy.

I would hope that we would not forget such an enormous negative impact on our society, but I'm just afraid human nature focuses on the problem at hand, not the problem of the future.

And I'm just afraid that if we get this behind us and it's in the rear view mirror, then we're gonna start worrying about the next issue.

I hope we don't do that.

I for one will maybe do whatever I can to keep reminding people about what we've been through.

- Dr. Anthony Fauci, thank you very much.

On behalf of the "Crosscut Festival," we appreciate it.

Thank you.

- My pleasure.

Good to be with you, Judy.

(upbeat music)