Podcast: Worried Sick

TRANSCRIPT: Worried Sick

Anthony Fauci:

When you think of a bioterrorist, you think of this person or state that's deliberately trying to release something. Historically, the worst bioterrorist has been nature itself.

Ian Bremmer:

In October, 1982, a pesky journalist named Lester Kinsolving took his seat in the Reagan White House briefing room. A string of deaths had been recently reported by the Centers for Disease Control, attributed to a new disease called Acquired Immune Deficiency Syndrome, or AIDS. Lester couldn't have known then that AIDS would eventually take the lives of 25 million people worldwide, but he knew something was wrong. White House spokesman Larry Speakes fielded his questions. Have a listen.

Lester Kinsolving:

Does the President have any reaction to the announcement of the Center for Disease Control in Atlanta, that AIDS is now an epidemic in over 600 cases? Over a third of them have died. It's known as 'Gay Plague.' No, it is. It's a pretty serious thing. One in every three people that get this have died. And I wonder if the President is aware of it.

Larry Speakes:

I don't have it. Are you? Do you?

Lester Kinsolving:

You don't have it. Well, I'm relieved to hear that, Larry.

Larry Speakes:

Do you?

Lester Kinsolving:

I'm delighted to know. No.

Larry Speakes:

You didn't answer my question.

Lester Kinsolving:

Well, I just wonder.

Larry Speakes:

How do you know?

Lester Kinsolving:

In other words, the White House looks on this as a great joke.

Ian Bremmer:

By the end of 1984, scientists had concluded that AIDS was the product of Human Immunodeficiency Virus or HIV. And by then, nearly 300,000 people had been infected. Another three years passed before President Reagan would deliver his first major speech on AIDS as the number of infections grew to half a million. It was a major public health crisis, which even today still kills hundreds of thousands worldwide. Why it took so long has as much to do with culture as it does with preparedness. How much did public health officials learn from that crisis and others since? If a new and unforeseen disease were to arise, would the world be ready?

Ian Bremmer:

Hello and welcome to the GZERO World Podcast, where you'll find extended versions of the interviews from my show on public television. Today on the podcast, I'll examine pandemics, why the next crisis is a matter of when, not if, and how politics is a key determiner in how bad it actually gets. Help me do it as one of the world's preeminent scientists and a man who spent his career fighting HIV/AIDS and other emerging public health threats. Here's my conversation with none other than Dr. Anthony Fauci, Director of the National Institute of Allergy and Infectious Diseases. Let's get to it.

Announcer:

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Ian Bremmer:

Dr. Anthony Fauci.

Anthony Fauci:

Hi.

Ian Bremmer:

Very good to be with you.

Anthony Fauci:

Good to be with you.

Ian Bremmer:

So we're talking about pandemics. I saw "Contagion." It felt like we really weren't ready. Are we really not ready?

Anthony Fauci:

It really depends on how you define a pandemic and the extent of the pandemic, the mortality associated with the pandemic, and your ability to respond. If you have the most outrageous cataclysmic pandemic, no amount of preparation is going to make you go through that relatively unscathed. There's going to be a lot of morbidity and mortality.

Anthony Fauci:

But when you look about pandemics, there's different degrees of pandemics. For example, in 2009, we had what would be technically classified as a pandemic. We had an H1N1 so-called 'swine flu.' And if you go by the definition of pandemic, it's something that is an outbreak that's "pan," throughout the world, hence the word "pandemic." It is new in that there's very little background immunity because we get outbreaks, for example of influenza like clockwork every season.

Ian Bremmer:

Every year.

Anthony Fauci:

The reason it isn't a catastrophe every season is that there's a lot of background immunity. You get vaccinated each year. Influenza, unlike almost any other virus, continues to drift, or mutates so that it doesn't stay stable the way measles does. So the measles that I happened to get when I was a child is not very different at all from the measles decades later that circulates or that you get vaccinated against.

Ian Bremmer:

Now, how much do you worry? I just saw in California we have the first billboard that they've put out, anti-vaxxer. Don't vaccinate your kids. Don't let them have immunizations. It's bad for them. It's leading to autism. There's celebrities that have promoted this as well. It's not just in the US. How much has that mattered to you?

Anthony Fauci:

It matters a lot. It really does. If you look historically in medicine, one of the most important and effective ways to prevent disease, suffering and deaths through infections is by vaccinations. Clearly, the track record of vaccinations is that they are safe. Now, one of the things that you have to deal with in biology is that any intervention is never 100% without a side effect. But if you balance the protective impact of vaccines versus the rare, rare side effect that's serious, it's overwhelming to get vaccinated. The issue of anti-vax has multiple components to it. There are people who are driven in the anti-vax philosophy by lack of information or by absolutely false information. The most egregious of the false information is the issue of the association of the measles, particularly measles, mumps, rubella, and autism, which was propagated by fraudulent information that came out of the UK years ago that has been debunked multiple times. The person involved has lost their medical license. But given the social media and the internet, it gets out there. So it's misinformation is one thing.

Anthony Fauci:

The other thing is that we are almost the victims of our own success. Back decades, when children and even adults were dying from measles, there were serious problems with rubella syndrome, with congenital abnormalities when mothers, when they were pregnant, would get infected with polio, with a variety of things. People had no problem with vaccines because they were frightened of the disease. Now, particularly in a country like the United States, a developed country in which there is very little, if any of these childhood diseases, at least in an outbreak fashion, there's this-

Ian Bremmer:

Complacency.

Anthony Fauci:

... feeling, well, it's complacency, but it also is what I refer to as libertarianism taken to the extreme, where they feel they don't want any authority, civil or medical, to tell them what they are going to do with their children or with their family. But one of the things that escapes people is that when you're talking about vaccination for diseases with outbreak potential, you obviously have a responsibility to protect your own child, but you also have a responsibility to society because there are people in society, in the community, who for one reason or other, can't get vaccinated. If you take things like measles, from the time you're an infant born to the time you're 12 months old, your immune system is not going to respond very well to vaccines. So you are vulnerable.

Anthony Fauci:

So when measles comes into the community, the way you protect the community is that if you get a certain percentage of people who are vaccinated with measles versus another infection, that varies, but for measles, if you have 93% to 95% of the population is vaccinated, even when measles is introduced into the community, which it always will be, because there's measles internationally. People travel innocently, come in, they can intersperse it into the community. When they do, there's this umbrella of what we call 'herd immunity,' that virus is not going to have the capability of spreading because they're going to be so few vulnerable people, it won't spread. Once you decide that I don't want to vaccinate my children because of these imagined toxic side effects, or even on the principle that I don't want anybody to tell me what I'm going to do with my children, if enough people do that in the community, the level of the herd immunity comes down and then you get a problem. So you ask me, do I worry about that? I absolutely do, because we've seen-

Ian Bremmer:

Do we see those numbers coming down in the US?

Anthony Fauci:

Well, not as a country as a whole, but in certain pockets. And the classic example of that was over the past year and a half-

Ian Bremmer:

The Hasidic community in New York.

Anthony Fauci:

In the Hasidic community in the Williamsburg section of Brooklyn.

Ian Bremmer:

Yeah, I was just about to ask you about that.

Anthony Fauci:

And in Rockland County where you had the level of community vaccination was somewhere around 70% to 80%, which is far below the level of herd immunity. And we had an outbreak with hundreds of people, some of whom got seriously ill.

Ian Bremmer:

Now how do you think... We live in a much more global society? People do travel a hell of a lot faster than they used to, much more frequently. One of the biggest changes happening in the world today is the growth of an extraordinary middle class. Urbanization in China, in India, across Sub-Saharan Africa. These are people who historically were not traveling and now suddenly are. Where does that create vulnerability?

Anthony Fauci:

If you're talking about people traveling, I don't think that creates vulnerability because many of the diseases that are endemic in one area, even when there's travel to another, the conditions in a particular part of the world are not amenable. For example, if you get a lot more people traveling from Africa to the United States, you say, "Well, let's look at Africa. What's the diseases of Africa? Malaria." Well, we don't have malaria in the United States, and you are not going to get malaria in the United States because of a variety of things like mosquito control, the lack of a critical mass of people who are infected with malaria. That's not going to happen.

Anthony Fauci:

So I think that travel itself, middle class versus lower class, who wouldn't be traveling, I don't think there's going to be a major impact. There's enough travel around the world right now that I look at it from another standpoint.

Ian Bremmer:

Which is?

Anthony Fauci:

That if there is an outbreak in one part of the globe, it doesn't necessarily have to be a middle class African who's going to get on the plane and come here. It could be a traveler, who's going to come back to the United States. So if you look how long it takes to fly, that type of thing is quite amenable to the spread, particularly of a respiratory-borne virus.

Ian Bremmer:

Some influenza.

Anthony Fauci:

Yeah, Some influenza-like, something that of what we refer to as pandemic potential.

Ian Bremmer:

Now, you haven't mentioned Ebola once, despite that we're now in the second largest outbreak that we've seen. And certainly in the region, DRC and the like, there's an awful lot of economic devastation as a consequence. Why shouldn't we be as focused on that?

Anthony Fauci:

Well, the reason is the nature by which Ebola spreads. So Ebola... And I've had that opportunity to take care of Ebola patients myself. And it's-

Ian Bremmer:

Where were you, by the way? Was that here?

Anthony Fauci:

Right here in our clinical center. We took care of some of the health workers who got infected accidentally and came here, and we have a special unit here. And we-

Ian Bremmer:

The ones from Nebraska. Was that the story there?

Anthony Fauci:

No. Well, there were three groups at the time. There was Nebraska, Emory, and the NIH. Bellevue then trained themselves and took care of one person. But we took care of a few here right at the NIH. The way Ebola is spread-

Ian Bremmer:

And they all were fine.

Anthony Fauci:

They did very well. They did very well. I still follow the patients and see them. So with Ebola-

Ian Bremmer:

That's a conversation starter in the US. How'd it go? I recovered from Ebola. You don't have many of those.

Anthony Fauci:

No, you don't. And the way the situation is why, although you take Ebola very seriously, there will not be a massive outbreak of Ebola in the United States. There won't be. By the very nature of how it's spread, Ebola is spread by direct contact with the infected body fluids. And that's blood, that's mucus, that's urine, that's feces, that's vomit. When someone gets really sick with Ebola, they are generally incapacitated. They're in bed. And that's the reason why the people who get infected are the family members who don't know and don't have the capability of taking care of them. So they get exposed. People who take care of the body after the person dies. Healthcare workers who are not properly protected with personal protective equipment. It isn't spread casually. And the reason you take Ebola as a very serious scary disease, because once you get Ebola, it's a really serious disease with a high mortality. Luckily, we have treatments for it now, which we've developed, but without treatment, the mortality's very high.

Anthony Fauci:

However, its way of spreading, if you have a healthcare system that can recognize it, isolate a person, get the contacts that are traced, put them under isolation, you won't have an outbreak. I'm not saying you're not going to have one or two or three or four people who could get infected and accidentally, but you're not going to have a massive outbreak when you have a healthcare system that has the capability of doing the kind of identification, isolation, and contact tracing.

Ian Bremmer:

And Liberia could do none of that.

Anthony Fauci:

Well, Liberia-

Ian Bremmer:

It destroyed their economy.

Anthony Fauci:

It was explosive because it was in Monrovia, in Liberia, it was in Freetown in Sierra Leone, and it was in Conakry in Guinea, Sierra Leone with Freetown, and then Monrovia. With Liberia in the middle of a city, in a region of Africa that had never experienced Ebola. So they were not trained about what to do. They were getting infected by burials. They were getting infected by family members trying to take care of individuals. When you have a situation where you're in a system where you can handle that, you're not going to have an outbreak. So although when you look at the motion pictures about "Outbreak," the famous hemorrhagic fever-

Ian Bremmer:

Absolutely. Yeah.

Anthony Fauci:

That's not going to spread.

Ian Bremmer:

And the media at the time in the United States-

Anthony Fauci:

Oh, goodness, I spent-

Ian Bremmer:

Was out of control.

Anthony Fauci:

Well, I spent a considerable amount of my time on television trying to add a degree of calmness to the fact of what are the facts about Ebola? How is it spread, and how was it not spread? And the threshold for panic and rumor spreading in the country is extraordinary.

Ian Bremmer:

No, I knew people that were buying biohazard suits in the US.

Anthony Fauci:

Well, not only that, they were making extrapolations which were completely unreasonable, because remember when one of the nurses from Texas got on a plane to go to Ohio, I think, to arrange for a wedding, she was not sick. She was infected. When she got a fever, she went under the proper isolation. But the fact that she was on a plane and not ill, even though she was infected, she would not spread Ebola. We know Ebola is not spread that way. Yet, anyone who went on a plane within the following month-

Ian Bremmer:

I remember this.

Anthony Fauci:

... ere calling us up here, calling up my colleagues at the CDC saying, "Is it safe for us to get on a plane in Washington?"

Ian Bremmer:

It was like my mother, God rest her. So let me give you a tougher one. Bioengineering. The ability of state actors, terrorist actors, to actually weaponize influenza or other bioweapons to impact populations. We've heard a lot about this. Are we close to having bad actors outside of governments that would have the capacity to develop those?

Anthony Fauci:

The answer is theoretically and maybe even practically, yes, they can. But one of the things that people don't quite understand, and you can figure out why they don't understand that, is that when you think of a bioterrorist, you think of this person or state that's deliberately trying to release something. Historically, the worst bioterrorist has been nature itself. So when you prepare, as we are, for the natural occurrence of a pandemic flu or antimicrobial resistance, the things we work on every day, it's a natural transition into the same type of preparation against something that would be deliberately engineered to be spread. So is it possible that that could happen? Yes. Are we aware of it? Yes. Do we prepare for it? Yes, we prepare every single day for it with the same type of tools that we prepare for a natural evolution of an outbreak.

Ian Bremmer:

I understand that resilience. I'm more interested in, do you see in the near future the potential for that threat to-

Anthony Fauci:

Well, I think that potential for threat has been with us for a while. I don't look ahead to say the potential. The potential is there. People can manipulate microbes in a laboratory relatively easy in this era of molecular biology and recombinant DNA technology. We know that.

Ian Bremmer:

The panic that came from even the anthrax envelopes that were being sent around the country-

Anthony Fauci:

Exactly.

Ian Bremmer:

... was pretty significant. Now if nature does the most effective job of causing these challenges-

Anthony Fauci:

It does.

Ian Bremmer:

And we are doing our best to change nature in ways that we don't-

Anthony Fauci:

Not to change nature, to be able to respond what nature throws at us.

Ian Bremmer:

No, I don't mean that. I'm talking about climate change.

Anthony Fauci:

Oh, okay.

Ian Bremmer:

I'm talking about as society, the global environment, suddenly you're inserting a whole bunch of plant life in places it hadn't been before and the rest. You say one of the reasons we don't worry about malaria in the US is because we don't have the conditions. As those conditions are changing, how much is that changing your job? How much is that making what you do harder?

Anthony Fauci:

It doesn't make what we do harder, but it certainly makes us be aware of, if you talk about a climate getting warmer, the thing that almost immediately is something that tends to be impacted by that is the range of vectors, ticks, mosquitoes, insects that actually are involved in the spread of disease. So if you talk about in the United States, where you have a sort of stumbling block in the way of outbreaks that are vector born, is that through most of the country, we have seasonal winters that essentially interrupt that chain of transmission. If you get [an] increase even of a small amount, you may increase the range or the duration of when these arthropods, these insects that spread diseases are able to do it. You increase it from season... by two or three weeks. Is there going to be a catastrophic change in vector borne? I don't think so.

Anthony Fauci:

And the reason I don't think so is because the amount of temperature change that would require making us like Sub-Saharan Africa, New York City would be underwater as well as Miami and a variety of other cities. So when you talk about infectious diseases, the degree of change that would have an impact on infectious diseases would be at a level lower than the impact on other aspects of how we live.

Ian Bremmer:

Now if you could have your wishlist, what's the single thing that you'd like the resource to do? Both here, the NIH, but also globally that we don't yet have?

Anthony Fauci:

I'm not sure it's an issue of resource. What I would like to have us, to have, since the thing that people always ask me, what keeps you up at night? Obviously, the evolution of a pandemic-like respiratory infection, likely influenza. We are getting more resources to try and get a better and better influenza vaccine with the ultimate goal of developing a universal flu vaccine. Even if it isn't all universal, but mostly universal. I certainly would want the resources to be able to do that. I also would want to continue to get the support that we have to be able to put an end to the HIV/AIDS pandemic, which is something that I've been involved with.

Ian Bremmer:

Working on for decades-

Anthony Fauci:

I've been working on this now. I'm going into my 39th year involved since the very first day of being involved in that. We've made spectacular progress in the treatment of HIV infection, but we want to implement that treatment and we need a vaccine to essentially put an end to that. So if you look at the diseases globally that have the greatest impact that we should really target, and we are targeting them, and obviously more resources would make it easier to target, malaria with the devastating effect, particularly among African babies, but malaria throughout other parts of the world. Tuberculosis, an ancient disease that we tend to forget about, but it's the leading cause of infectious disease death throughout the world. 1.6, 1.8 million deaths per year. So you have malaria, tuberculosis, HIV. These are things that are there.

Anthony Fauci:

And then the other thing that I aspirationally hope to be able to encounter is the ability to rapidly respond to something brand new, whether it's a brand new pandemic or as you mentioned, a brand new attack upon us deliberately by bioterror. That's where we have a ways to go, but we're making progress in that regard.

Ian Bremmer:

Dr. Anthony Fauci. Don't panic. Get your flu shot. Is that fair?

Anthony Fauci:

You bet. And I already have.

Ian Bremmer:

Very good.

Ian Bremmer:

That's our show this week. We'll be right back here next week, same place, same time, unless you're watching on social media, in which case, it's wherever you happen to be. Don't miss it. In the meantime, check us out at gzeromedia.com.

Announcer:

The GZERO World Podcast is brought to you by our founding sponsor, First Republic. First Republic, a private bank and wealth management company, places clients' needs first by providing responsive, relevant, and customized solutions. Visit firstrepublic.com to learn more.