In his role as director of the National Institute of Allergy and Infectious Diseases, Anthony Fauci has advised seven U.S. presidents on preventing the spread of a range of diseases. Over the last two years, amid the deadliest pandemic in our lifetimes, Fauci has also become the public face of the United States’ coronavirus response strategy, explaining rapidly changing developments and rules to an increasingly polarized nation.
Fauci mostly speaks about U.S. regulations but agreed to sit down with Foreign Policy for a more global look at the pandemic. I spoke with him on an episode of FP Live, the magazine’s platform for live journalism, on Monday, May 2. Some of the questions below were selected from submissions from FP subscribers. The following transcript has been edited for clarity.
Ravi Agrawal: You said last week that we are out of the “acute component” of the pandemic phase. In real terms, what does that mean for Americans?
Anthony Fauci: We are still in the middle of a pandemic, to be sure—there’s no confusion about that. But when I say we’re out of the acute fulminant stage right now, what I mean is that cases have gone down dramatically. Our numbers of deaths per day are down to one-tenth of what they were. We have many less hospitalizations, and the case numbers went way down from 900,000 to around 15,000 per day. Now, as we’ve seen before, we’re starting to see an uptick in cases, particularly with the new BA.2 variant. But what we are seeing is something that our colleagues in the United Kingdom and in some of the European countries have seen, where although the cases are starting to go up, they’re not going up in a very steep, fulminant way and they’re not associated with a concomitant increase in hospitalizations or the utilization of intensive care unit beds.
What that’s telling us is that 90-plus percent of our population has either been vaccinated and boosted or has gotten infected—or both. This is not protecting us specifically from infection, but it seems to be protecting us from that surge of hospitalizations that stressed the health care system during previous eras of this pandemic.
We hope that we don’t see a major uptick [in cases] as we get into the fall, but that remains to be seen. We’re going to have to wait and see, which is the reason why we’re still encouraging people to get vaccinated. If you’ve not been vaccinated or if you have been vaccinated and are eligible for a booster, make sure to get it. Now.
RA: Dr. Fauci, you chose not to go to the White House Correspondents’ Dinner last weekend. President Joe Biden made the opposite choice. I imagine there is no right or wrong here. But what does this example tell us about individual choice? What do regular Americans take away as they choose how much risk to take on in their everyday lives?
AF: As long as there is virus that is circulating, people need to evaluate either themselves or with the help of their physician or their health care provider what the level of risk would be if they get infected.
I made a decision because I was weighing the risk and the benefit. You know, I’ve been to several White House Correspondents’ Dinners for fun, but it’s not a big deal if I don’t go, which I didn’t go this year. I’m 81 years old, I have a number of very important commitments that are coming up in the next week or so, and if I wound up getting infected, even if I didn’t get terribly ill, I’d have to cancel all of those commitments. So I made a personal decision based on my own evaluation of my risk, and that decision was not to take the chance.
RA: What’s your current guidance on mask-wearing? Is the United States easing up too quickly?
AF: Well, my guidance on that is really very much in parallel with the U.S. Centers for Disease Control and Prevention. When you are in what we call a “green zone,” the level of infections, hospitalization, and hospital capacity is such that masking is not required. So I would not necessarily wear a mask if I were in a room with a few people and I knew what their vaccination status was.
But if I go into an unknown place, an indoor setting where there are a lot of people around, and I have no idea what their status is—again, given my age and my risk aversion because of my other responsibilities—I would wear a mask.
So I wouldn’t say it’s absolutely necessary and you must regulate someone to wear a mask. But I would say you make a personal decision that if you’re in a setting like that, wear a mask.
RA: I’m going to channel some of the questions we’ve received from our subscribers here. It’s fair to say the United States performed relatively poorly on the pandemic despite having one of the world’s most advanced health care systems. Knowing what you now know, what would you recommend America did differently?
AF: Well, what America could have done differently would have taken decades to fix. It isn’t a one thing for this pandemic that was specific. Our health care system has a great deal of disparities.
We have a very heterogeneous population, many of whom have a much greater risk of developing severe disease—mostly minority populations or brown and Black populations. Not only are they in occupational situations that put them at greater risk of getting exposed, but they have underlying conditions that are much more likely than you see in the general population: hypertension, diabetes, obesity, chronic lung disease. And that’s why they’ve suffered desperately greater than the general population.
Also, we have an uneven health care system. The access to good health care isn’t evenly distributed throughout the country, where it is in other nations that have more uniform health care systems. They’ve done much, much better than we have. Those are just a few of the reasons why, even though we’re a very rich country, even though we were deemed to be as well or better prepared than anyone else for a pandemic, we did quite poorly. We have almost a million deaths over a two-and-a-half-year period. That is very serious.
RA: Dr. Fauci, we’re Foreign Policy, so it’s only natural that we’re going to try to get you to look at other parts of the world as well. And I want to ask you about China and its so-called “zero-COVID” policy. Quite frankly, is it too stringent?
AF: Well, I think so, because if you are going to shut down a country and lock down, the reason to lock down is first to realize that’s a temporary measure, to give you enough time to properly vaccinate the overwhelming proportion of your population with a good vaccine, particularly the vulnerable, such as the elderly.
China apparently did not do that. They locked down, but the vaccine uptake, particularly among their elderly, is very poor. And the vaccines that they used, quite frankly, are not as effective as vaccines that are used in other parts of the world. So I understand the strategy of locking down, but you’ve got to do it with a purpose. If you just lock down and wait for the virus to disappear, it’s not going to happen. There has to be a purpose for that. And that purpose is to prepare yourself for the inevitability that the virus will enter your community.
RA: Given what you say, Dr. Fauci, at some level the United States and the West failed to vaccinate the rest of the world—or at least failed to deliver on some of the promises that were made. The World Health Organization (WHO) had set a target of about 70 percent of the world being vaccinated by the middle of this year. It’s way behind those targets. What do you make of that? Do you have regrets in terms of America’s response?
AF: That is a much, much more complicated situation than people realize. It goes well beyond providing doses to the developing world. The United States, quite frankly, has done very well.
We’ve given now, you know, hundreds and hundreds of millions of doses to 114 countries. We’ve pledged and/or given 1.2 billion doses by the end of this year. We’ve given $4 billion to COVAX.
What we found out, much to our dismay, is that the vaccine doses that were made available to the developing world were not being utilized. We’re in the somewhat paradoxical situation where the countries that need the vaccine are saying, “Don’t send us any more because we’re not able to implement and get it into people’s arms.” So what we need to do is go well beyond a plan to get vaccines in numbers to people but to help them with their infrastructure, to be able to get those vaccines administered to people.
RA: But of course, the infrastructure you’re describing globally could take decades to build around the world.
AF: Exactly. That’s why I said it’s not a problem you’re going to solve overnight by giving more vaccines. The infrastructure situation is going to take much, much longer than one season.
RA: So let me ask you a related question then. Turning to Ukraine, given the relatively low vaccination rates there, are you now worried about the conditions of war acting as an incubator for the next dangerous variant? And this holds true not only for Ukraine but also many other parts of the world, such as Yemen or Afghanistan.
AF: Well, you’re absolutely correct. And that gets back to the saying that we in public health have said for so long that a global pandemic can only be solved by a global response. You can’t have just some countries responding because then you give the virus the opportunity to proliferate, expand, and mutate and develop variants.
Whenever you have the disruption of anything from a natural disaster to a disruption of society by conflict, in this case the Russian invasion of Ukraine, that always leads to a disruption of health care systems, including how one can respond to a pandemic. But it goes well beyond Ukraine. You mentioned some of the other countries, even in sub-Saharan Africa, where you have, you know, less than 20 percent of some countries vaccinating their people, particularly when you have a high level of other diseases such as HIV/AIDS, in which the virus can have a particularly greater impact on people. That has secondary effects throughout the world because it gives the virus the opportunity to continue to spread from person to person. And the more the virus replicates, the greater the opportunity you give it to mutate. And when it mutates, that’s when you get new variants.
RA: What can the developed world and global bodies such as WHO do to ensure that if there is a new variant, it’s detected quickly?
AF: Well, that is part of the pandemic preparedness and response plan, to be able to communicate and provide throughout the world the capability of doing rapid, real-time, real-world sequencing of variants as they arise so that one can prepare by modifying the vaccines to get an appropriate response.
The South Africans are doing an incredibly good job of being able to pick up these variants in real time. I mean, they’re as good as anyone throughout the world. In doing that, they’ve been able to point out the evolution of the omicron variant as well as the sublineages of omicron.
Other southern African countries, maybe not so well, and maybe in other areas, the Middle East and other parts of the world, they don’t have that capability. And as you suggested, and I agree with you, it really is the responsibility of the developed world to be able to partner with those countries, to provide with them and for them the ability to do real-time sequencing and surveillance.
RA: It strikes me that assessments of various countries and how they’ve handled the pandemic are essentially judgments based on snapshots in time. I remember a couple of years ago there were early winners in Asia, but then they ended up with disasters in the second year of the pandemic. And now that we’re in year three, it seems as if the decks are moving around again. Given that you’ve had so much time to take this 30,000-foot view of the performance of different countries at this point of time, which countries do you think have done best?
AF: I would have named a couple that are now in real trouble. China did well in the beginning. It’s a disaster now, in Shanghai and likely in Beijing. Same with Taiwan.
Singapore did very well in the beginning. I think Australia and New Zealand have done very well. But remember, they have very special circumstances. When you have an island, you can actually close things off and be self-sufficient for a while until you get your people vaccinated.
RA: Many of our subscribers have been asking about the role of partisan politics and the polarized media. How did that impact your role as a scientist?
AF: Terribly so. I think if there was one fact that when people ask me, what was the thing that got in the way of an adequate response, certainly in the United States, it is the profound divisiveness in our society, where we seem to have forgotten that the common enemy is the virus. It’s really the propagation of untruths. And that’s very disturbing, where normalization of untruths becomes something that’s accepted, that people can say things that are completely false and completely misleading. It hurts me to say it even here in my own country.
RA: What was it like to be undermined and often contradicted by your own boss, former President Donald Trump?
AF: Well, that was very uncomfortable, obviously. I would have hoped that there would have been cooperation in addressing it as opposed to opposition. I took no great pleasure in having to be at odds with the president of the United States, but I had no choice.
RA: Do you worry about his reelection?
AF: No, I don’t get involved in politics, so I don’t worry. I worry about public health, not people’s reelection.