Interview with Anthony Fauci on COVID-19 "Helpless Means You Can't Do Anything. There's a Lot We Can Do."

In an interview with DER SPIEGEL, Dr. Anthony Fauci, Donald Trump's pandemic adviser, discusses the anger of his opponents, his relationship with the president, mistakes made in the effort to contain the spread of COVID-19 and his cautious optimism that a vaccine will be available soon.
Interview Conducted By Rafaela von Bredow und Veronika Hackenbroch
Dr. Anthony Fauci: "I never even considered resigning."

Dr. Anthony Fauci: "I never even considered resigning."

Foto: Mark Thiessen / National Geographic

DER SPIEGEL: Dr. Fauci, you once said of yourself that you had "a reputation of speaking the truth at all times and not sugarcoating things." Can we hope to get a few samples of previously unspoken truths from you today? 

Fauci: Of course! I will always give you truth. Just ask the question and I'll give you the truth. At least to the extent, that I think it is, right. (laughs)  

DER SPIEGEL: OK, we'll give it a try! You advised the Trump administration in 2017 to increase its pandemic preparedness. Did you see a pandemic like this coming, a scenario like this with worldwide lockdowns, overflowing hospitals and a rather violent social disruption? 

Fauci: Well, the answer is, I predicted and anticipated an outbreak of a new infectious disease, because we've had so many of them. During my tenure as director of this institute, which is 36 years now, I've seen HIV, I've seen pandemic flu, I've seen Ebola, I've seen Zika. I always knew that we would have the inevitable perpetual challenge of outbreaks in the future. 

DER SPIEGEL: What did your worst nightmare look like at that time?

Fauci: Already 30 years ago, I said my worst fear was the emergence of a brand-new infection, likely jumping from an animal host to a human, that was a) respiratory borne, b) transmitted extremely efficiently from human to human and c) had a high degree of morbidity and mortality, at least in some sets of the population. And now all of a sudden, this perfect storm has given us a pandemic of historic proportions. I mean, it's the worst thing we've seen in 102 years since 1918. 

DER SPIEGEL: As an AIDS researcher, you think that the coronavirus is worse than HIV?

Fauci: AIDS is entirely different. The reason the coronavirus pandemic is so unique is because it exploded upon the world. Because it appears that everyone is vulnerable. In seven or eight months, the coronavirus has immobilized the world. I mean, it has destroyed economies!

DER SPIEGEL: With 5.5 million cases and more than 170,000 deaths, the United States is the worst-affected country in the world. What, in your eyes, are the crucial reasons why things went so wrong in the U.S.? 

Fauci: My country, it's a very large country. And it's very diverse. That is one of our strengths -- but it turns out with an outbreak, it's one of our weaknesses. We had different waves of infection, and cases never went back right to a low baseline like in Germany or Italy. Our baseline remained at about 20,000 cases a day. We have made guidelines for carefully opening up the economy again. Some states listened to the guidelines, and they did reasonably well. But some states jumped over the checkpoints that we had set up, and in other states, the citizens just went ahead and did whatever they wanted to do. So what you saw was, although some parts of the country were doing very well, instead of going down, cases went up to 40,000, 50,000, 60,000 and even 70,000 a day.

About Anthony Fauci

Anthony Fauci, 79, has been director of the National Institute of Allergy and Infectious Diseases in Bethesda, Maryland, since 1984. With a current annual budget of almost $6 billion, his institute is a giant in AIDS, tuberculosis, malaria and autoimmune research. The doctor and immunologist, who grew up as a pharmacist's son in Brooklyn, studied medicine at the renowned Cornell University and made his mark as a scientist with research into the interaction between the AIDS virus and the immune system. Since Ronald Reagan, the enthusiastic runner has advised every U.S. president in the event of a pandemic. He refused the offer to become the head of the National Institutes of Health several times, because he preferred to devote himself to the fight against AIDS.

DER SPIEGEL: Also, the Centers for Disease Control had problems introducing testing, so the virus was able to spread unnoticed at the beginning. 

Fauci: Yes, we had a bad start with the testing, obviously. Another important reason that things are so bad now is that simple public health messages became a politically divisive thing.

DER SPIEGEL: Like wearing a face mask.

Fauci: Exactly. Some people said if you wear a mask, that's a political statement. And some said if you don't wear a mask, that's another political statement. No, it's not! It's a public health principle.

DER SPIEGEL: We have this problem in Germany, too.

Fauci: I know. The problem is, when you politicize the public health response, you can't effectively fight the virus.

DER SPIEGEL: Don't you feel really helpless when you look at the current situation in the U.S.? Don't you get demoralized or depressed? 

Fauci: Well, I never feel helpless. Helpless means you can't do anything. And there's a lot that we can do. It's up to us to actually do it. I don't get depressed. I'm a scientist and a public health official. I don't have an emotional response to an outbreak. I have a public health response to an outbreak and I never get demoralized. I'm a cautious optimist. I'm a realist.

DER SPIEGEL: Is that the reason that you continue working and haven't retired despite your age?

Fauci: (laughs) I never even considered resigning.

Paramedics in Texas transporting a COVID-19 patient: "We had a bad start with testing," says Fauci.

Paramedics in Texas transporting a COVID-19 patient: "We had a bad start with testing," says Fauci.

Foto: John Moore / Getty Images

DER SPIEGEL: Many see a vaccine as the only and perfect exit strategy out of this pandemic. When will a coronavirus vaccine be available to the broader public? How good will it be? And will it really be able to restore our lives to what they were before? 

Fauci: You've asked three questions to which there is no definitive answer yet. Let me tell you where we stand. There are a number of vaccines that are in advanced testing. There are two in the United States, soon to be three. If you look at the projection of how many months it takes to get an answer whether a vaccine is safe and effective, it should be by the end of this calendar year or the beginning of 2021 that we know, if we have a vaccine that works.

DER SPIEGEL: And when would this vaccine be available to a broader public?

Fauci: Since several companies already started producing their vaccine, around the beginning of 2021, tens of millions of doses should be available. By the time you get to the end of 2021, there should be hundreds of millions, maybe even a billion. That's not enough for everybody in the world – but enough to get most people vaccinated that need it.

DER SPIEGEL: What will be crucial, however, is how effective such a vaccine will be.  

Fauci: We don't know this before we have the results of the advanced testing. But my colleagues and I are cautiously optimistic – and I'm not saying confident, I'm saying cautiously optimistic – that we are actually on the right track. Early studies in several of the candidates indicate that these vaccines can induce an immune response in the human – that is equivalent to, if not even better than what you see in people who've recovered from COVID-19.

"It should be by the end of this calendar year or the beginning of 2021 that we know, if we have a vaccine that works."

DER SPIEGEL: You have said that a vaccine with 50 to 60 percent efficacy would be acceptable. And there's also a possibility that the vaccine will not be able to prevent infection, but only pneumonia. If this turned out to be the case, does it mean the pandemic will never really be over? 

Fauci: I really don't believe this is going to happen. We are striving for 70-plus percent efficacy. That's not as good as a measles vaccine, which is 97 to 98 percent effective. But if we get a coronavirus vaccine that is 70 percent effective and we combine it with some elements of good public health practices, then I think you could get enough umbrella of protection over the whole community, that we can get good control of this pandemic within a year or so. I don't think the coronavirus threat is going to be with us forever in a way that it dramatically changes our lives for the next five years. I do not believe that that will be the case. 

DER SPIEGEL: But more than one-third of the population of the U.S. doesn't want to be vaccinated. 

Fauci: Well, that's another challenge. We have a whole program of community engagement and community outreach to try and to convince people of the benefit of getting vaccinated.

DER SPIEGEL: At the beginning of the outbreak in the U.S., you had daily meetings with President Donald Trump. Why, then, did he look so horribly ill-advised, downplaying the pandemic and even giving dangerous advice? Would you say that he's a hopeless case when it comes to understanding science? Or do you have yourself to blame for not making yourself clear enough?

Fauci: That gets the award for the loaded question of the year! You will get a trophy for this.  

DER SPIEGEL: Will you give us the answer of the year?

Fauci: No, seriously, the president is a smart person. He understands. He has his own ideas about things. He expresses them in a different way. But he's a pretty smart guy. And I think I'm pretty clear. I speak to the American public frequently. And here I am, speaking to the international public, certainly in Germany.

Foto: Chris Kleponis / imago images

The article you are reading originally appeared in German in issue 35/2020 (August 22, 2020) of DER SPIEGEL.

DER SPIEGEL: So, what went through your head when you heard that Trump had recommended injecting disinfectant?

Fauci: You know, that was taken a little bit out of context because he never recommended that. If you look at the video clip, he said it more like: "Well, what about that? Would that be it?"

DER SPIEGEL: So you thought: Well, he didn't recommend it – never mind?

Fauci: I thought that that was a very interesting moment, that hopefully we've clarified since then. This is not something you should do. Not something you should even think about doing.

DER SPIEGEL: But people did consume disinfectant. And died as a result.

Fauci: I know. That's why we were out there the next day trying to make it very clear that that's not something you should be doing.

DER SPIEGEL: Donald Trump was pretty impressed by you at the beginning. He praised you as a "major television star for all the right reasons." Then, in April, he started to openly criticize you. He said that you made "a lot of mistakes" and you're an "alarmist." And he stopped talking to you. The last time you saw him was in early June, right?

Fauci: No, actually, I saw him last week.

DER SPIEGEL: Oh, really? And you talked?

Fauci: Yes.

DER SPIEGEL: About the campaign the White House launched against you to make you look bad in the public, to make you look incompetent?

Fauci: I think that was a big mistake that they made. You know, it's a complicated place, the White House. There's a lot of different people in the White House. I think that was really a bad thing. And I told them so. You know, just as I'm not afraid to tell the truth about science, I'm not afraid to tell the truth about other things.

DER SPIEGEL: Did you tell Donald Trump, too, that you were not amused by his rebukes? 

Fauci: Actually, I made clear – not directly to him, but in the White House – that I thought that that was really unfortunate and uncalled for. And you don't say something in the White House that doesn't ultimately get to the president.

DER SPIEGEL: So, what did you talk about with Donald Trump last week?

Fauci: I briefed him about the vaccine we are developing at the National Institutes of Health; he wanted to know a little bit more about it. He asked me the same questions that you asked me.

DER SPIEGEL: Do you secretly hope for a President Joe Biden? Michelle Obama said at the Democratic Convention that Biden would "tell the truth and trust science."

Fauci: One of the reasons why I believe I have been able to effectively and successfully advise six presidents of the United States all the way back to Ronald Reagan is because I stay completely apolitical. I'm a scientist. I'm a physician. I'm a public health individual. I do not have an ideology. I certainly don't express it. And I never, ever, get involved in politics. Once you do that, you can diminish your credibility as a scientist and a public health official! So, I have been neutral throughout the six presidents that I have served. 

DER SPIEGEL: There is a conspiracy theory going around about you that claims that you created the coronavirus and that any vaccine will kill millions. So, while the pandemic has led to tremendous and outstanding research activities, it has also eroded trust in science. Is that damage irreversible?

Fauci: It's a serious damage. I hope it's not irreversible. You're absolutely correct: Along with the political divisiveness, we have some extreme thinking, including conspiracy theories, some of which are totally outlandish. There is such an intense polarization that when I give a public health message and I give recommendations of how we can actually open up the country again in a safe manner, there are some people who disagree so sharply that they start threatening me. I mean, physically threatening me, my life, my children, my family, my wife. That is completely crazy. When you have a public health issue where we should all be pulling together for the common goal of ending this global scourge, that you have people that are so vehemently against the public health message that they actually resort to threats. That's almost inconceivable. But in reality, it's happening.

DER SPIEGEL: Do you have any idea what plague will sweep across the planet next? Ten years from now, we’ll meet again and see if you’ve been right.

Fauci: The one thing that is predictable about pandemics is that they will occur. The one thing that is completely unpredictable is what the heck it's going to be. And that really is the truth, I don't have the foggiest idea. The one thing I hope is that it's not what we're going through right now. I told you why this was my worst nightmare. So, if we do have another outbreak, and history tells us it will occur, I hope that it's relatively insignificant and it can be easily confined. But whatever it will be, it's not going to be in 10 years. Maybe we'll see each other soon, sooner than that.

DER SPIEGEL: Dr. Fauci, we thank you for this interview.

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