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Yahoo Finance Presents: Director of the NIAID Dr. Anthony Fauci

In this episode of Yahoo Finance Presents Director of the National Institute of Allergy and Infectious Diseases, Dr. Anthony Fauci, talks to Yahoo Finance senior reporter Anjalee Khemlani about the ongoing coronavirus pandemic.

Video Transcript

ANJALEE KHEMLANI: I'm Anjalee Khemlani. Welcome to "Yahoo Finance Presents." In this episode, we'll be speaking with one of the world's top infectious disease experts and the face of the coronavirus outbreak in the US, Dr. Anthony Fauci. We discussed the current status of the outbreak in the country as states continue to reopen, despite the problem areas, as well if the US relationship with the World Health Organization, and his thoughts on the global vaccine race.

Dr. Fauci, thank you again for joining me. And I want to start with one of the most hotly debated topics right now which is asymptomatic transmission. I'm sure you've heard the World Health Organization yesterday I gave out some information from member states data that suggested that possibly asymptomatic people are less likely to transmit the disease and they were differentiating between asymptomatic and presymptomatic. So I'd like your thoughts on that.

ANTHONY FAUCI: Yeah, I think a lot of confusion has emanated from this issue of an asymptomatic person and asymptomatic transmission. When you look at the number of people if you look at all the cases of coronavirus infection, about 25 to even up to 45% of the people are asymptomatic. The real question is, what is the percentage of infections that go from an asymptomatic person to an uninfected person?

And that's something that we know what occurs, but we're really not sure exactly what the extent of it is, because it's very difficult to measure that. You can determine how many asymptomatic people are merely by doing screenings and finding out. But when you're doing epidemiology-- so what the WHO said yesterday, that although there are asymptomatic infections, and although asymptomatic people can transmit, they are not the drivers of the outbreak.

The drivers of the outbreak are people who are symptomatic and transmit to others. That doesn't mean that asymptomatic transmission doesn't play a role, but it isn't the major driver of the outbreak. And yet there's this confusion when people talk about who's asymptomatic infection and who's driving it. But that's really what the show meant.

ANJALEE KHEMLANI: OK. When talking about confusion, one of the things I'm sorry I have to ask you about is hydroxychloroquine. The retraction of that study in "The Lancet" last week, which caused the World Health Organization to pause their trials was based on questionable information. So I'm curious, on your-- has that changed your opinion of it at all? I know you've called for more trials. And is there a difference between you know the treatment version-- treatment option or the way the president is using it as a prophylactic?

ANTHONY FAUCI: The answer will come with the clinical trials. I think there's a lot of back and forth about what is a good trial like the one that was retracted or not. I think the important thing for us all to do is that I've said for so long and so many times, is that the definitive proof whether something is safe and effective, whether it works or not is a randomized controlled trial. Those trials are being conducted and we will know the answer and we will go with the science rather than going back and forth on things that are sort of suggestive, but not necessarily definitive. As scientists, we want to go with the definitive trial.

ANJALEE KHEMLANI: Fair enough. Speaking of the World Health Organization, the president did announce that we are ending our relationship-- the US-- with it. Is it your sense that this is affecting the scientific community? We've obviously had collaboration globally for such a long time, either through the organization or outside. How is this disrupting that?

ANTHONY FAUCI: Right. You know, the WHO is an imperfect organization, but it's an important organization. I've dealt with them over many outbreaks over many years. We still interact with them. We have a weekly conference call where they bring together all of the different countries, who talk and update us about exactly what's going on in their individual country. And that's important for us. That's not to say that they haven't made mistakes and missteps in the past, but in general, it's an important organization.

ANJALEE KHEMLANI: One of those missteps based on the US interpretation is the way that they handled the outbreak in China and holding them accountable. That is the reason behind President Trump calling for an ending that relationship. But their vaccine candidate is pretty far ahead, even though we have Moderna as the frontrunner. So if they do make it to production and you know successfully get that out there, is it possible will feed their vaccine used in the US?

ANTHONY FAUCI: Well, you know, the answer is that there are a number of candidates that look really quite favorable that are in various stages of clinical trial. My prediction would be that we would have more than one candidate that ultimately gets to the point of proven to be safe and effective. So I don't think we're going to have a situation where one country or one organization has a vaccine that they are or are not going to share with others. I believe that there will be enough favorable responses to the large clinical trials and that the plans now to make hundreds of millions, if not billions, of doses will actually come true. How that-- when that happens, it's very difficult to predict.

We're on a course right now where we believe at least in a couple of the candidates that when we start the phase 3 trial, let's say in the first week or so of July of this year, that by the time we get to the early to mid fall, there will be enough people accumulated in the trial and enough infections that we might have an answer by the end of this calendar year. That's for one of the candidates. There are other candidates that are ahead of that, behind that. We'll just have to wait to see what happens. But I'm cautiously optimistic.

And I know that's a reasonable question that you ask-- is this one going to beat that one or the other one going to beat. But that's not what it is. It's a group of candidates most of which actually have pretty good preclinical data. So we're counting on having success with more than one we hope.

ANJALEE KHEMLANI: Dr. Fauci, your favorite phrase, cautiously optimistic, and you just used it. It's something you're very, very keen on using. And I understand why. But another thing you also say is that, like you just said, you're looking for that indication of being proven as a vaccine. And they think that that sometimes get condensed to there is going to-- there's going to be a vaccine this year.

And while that is technically true, I think we should differentiate and I'd like your thoughts on the differentiation on what that means for the general public. Even if it is at risk, even if you produce that risk and you do get that indication, what does that mean for the general public versus, say, you know, health frontline workers and essential workers?

ANTHONY FAUCI: OK, so thank you for giving me the opportunity to answer that. It's a complicated question, but it's an important question. So first of all, everyone should understand when either I or other people talk about projections of vaccines, when you may or may not get it, you've got to realize there is no guarantee at all that we are going to have a safe and effective vaccine. We feel-- and I'll use my terminology-- cautiously optimistic that we will actually be successful. So we're counting on being successful.

The rate at which we do it is something important. We say we're doing it very quickly and at risk. It isn't risk of safety. We're not compromising safety. We're not compromising scientific integrity. What we're doing is that we're going along at a pace where under the normal development of a vaccine, you would go to one step, wait to see if you're successful, then make an investment in the next step. Then when you're successful, make an investment in the next step.

The reason for that is caution, because if you get stopped at this step, you don't want to have to waste all the money of the investment. Companies do that because they can't risk resources. Given the urgency of this situation, we've made a decision with the support of the federal government that we will proceed at risk. We will start making doses of the vaccine before we even prove it was effective. If it isn't effective and isn't safe, then the only thing that would have been lost is money. But we feel it's worth it to gain those extra months.

And that's the reason why we're moving more quickly than usual. Because when people hear quickly, they say, oh my goodness, so are we compromising safety, are we compromising scientific integrity? The answer is we're not. Given that, we project that we will be able, if we're successful, Anjalee-- that's the big underlining-- if we're successful, it is likely that we will have doses to be distributed to people by the end of this calendar year or the beginning of 2021.

And then you ask, well, who's going to get it? Obviously, ultimately, you want everyone who needs it to get it. But the prioritization has always been you give it to the health care workers who are going to be deliberately putting themselves in harm's way to help people. They need to be protected. Then you have a number of vulnerable people, the people who have a greater chance of getting the complications of infection-- the elderly, individuals who have underlying disease. And then you go down the line until ultimately, you get everyone.

That's what it is. And it's something that, again, we're aspiring for that. But when you're dealing with the development of vaccine, there's never a guarantee that you're going to get it.

ANJALEE KHEMLANI: Really quickly on that compressed timeline, do you see that being a change that might be adopted, you know, after we get out of this-- is something that changes in R&D?

ANTHONY FAUCI: Well, you know, it depends on the urgency and the need for a particular product. If you have three or four interventions, be they drugs or vaccines, and people are being well treated with it, and you want to add an additional one, it's very likely that that would not be on an accelerated speed because it isn't necessary. When you have nothing like we have now, we need a vaccine, we need therapeutics. Then you do the balance of proceeding quickly, but always safely with attention to the scientific integrity of the study.

ANJALEE KHEMLANI: Fair enough. I know that your work with the White House task force is ongoing, you've said that, even though we're not getting those daily briefings. So are you still regularly in touch with the president? Is it just the vice president showing up? And what is the main concern right now? What's the focus?

ANTHONY FAUCI: Well, it's both. I mean, obviously, I was with the president last week. I'm going down today, literally, in a couple of hours to meet with the vice president and the in the coronavirus task force as well as meeting with the subgroup of doctors who are a component, but not the entire task force. So we still do it.

I mean, the number of-- when things were at their most intense during the major issue that we had with New York's metropolitan area was dominating with infections, we were at the White House Coronavirus Task Force, like, every day, including Saturday and Sunday. That's not what we're doing now.

We certainly still have a very strong presence in the task force, but it isn't as visible. You don't see it as much because things that are concentrating on right now are how do we safely reopen the government. How do we get these cities, these towns, these counties to try to get to some sort of normality to get the economy back. That's most of what's being discussed.

But the behind the scenes activity, concentrating on the health and other issues-- that is as good as it's been.

ANJALEE KHEMLANI: OK. What about testing? I know that's one of the issues we've seen-- you know, the ramp up of production of swabs, labs are increasing their capacity, all of the numbers are increasing, but we still hear anecdotally about sort of conservative use of these PCR tests, specifically. So I'm curious on your thoughts on what the biggest hurdle remains to access the testing as well as the at home component, which some people are saying could address those health inequities that we're so focused on?

ANTHONY FAUCI: Well, I think the testing situation, first of all, is orders of magnitude better now than it was if we were having this discussion a couple of months ago or even last month. It gets better and better. We have more tests available. We have the associated material necessary for the test more available than they were.

You know, I screen a lot. I mean, in addition to the visible things you see me at, usually late at night, I'm calling up people in different cities and different counties, and trying to find out how things are going. And the beginning, there was a concern that they didn't have this or they didn't have that.

But now more and more, we're seeing that the kinds of things that were problems before are being solved. They're not all solved, they're never all solved. But it's significantly better than it was. In fact, I have a call tonight with constituents from a number of cities throughout the country who are in the trenches doing the things that we're talking about to try and get a feel for how it's been compared to a week or two ago.

ANJALEE KHEMLANI: OK. And mass gatherings is obviously something that you're focused on in this reopening concerns. Are you concerned about the protest becoming super spreader events as the CDC director suggested last week? And does allowing them-- you know, is it harder to reinforce sort of those social distancing measures as a result? Is that a concern?

ANTHONY FAUCI: Well, obviously, it's a public health concern. I mean, we all recognize the constitutional right, and even the compelling reason, given the situations now of people expressing their thoughts in a demonstration. So it's not anti-demonstration at all. But you have to balance that with the public health imperative that we have to not-- to not spread infections.

So you could tell people that it is going to be risky to demonstrate. But people will demonstrate anyway. You've got to be realistic. You can't live in your little cocoon and say, well, you shouldn't demonstrate. And yet they do. So as public health officials, what we say if you are going to demonstrate in a non-violent way, a peaceful demonstration, please be sure to wear a mask all the time. To say, keep physical distance is a non-starter, because the very nature of a demonstration, you see people in crowds. But wear a mask.

And I know when things get animated, people start to chant and shout. Please resist the temptation of pulling your mask off. Leave your mask on if you do that.

ANJALEE KHEMLANI: Fair enough. And looking at-- a little bit of a pivot-- but looking at your experience of HIV, I know that's something that has been easy for you to follow that playbook when it comes to knowing what to do about contact tracing, what the HIV treatment cocktail-- the idea of using Gilead's Remdesivir in coordination with others. What are some of the other sort of experiences that you're applying from your time then?

ANTHONY FAUCI: Well, I mean, there are so many aspects of these outbreaks that are similar and so many that are very different. If let's take the scientific side. You know, when we first saw the result of Remdesivir, which was a significant effect, but modest in effect-- so it was statistically significant. But it was a 31% diminution in the time it took to get back to recovery in the sense of leaving the hospital, because this was a study that we did in hospitalized patients with lung disease. It reminds me back way back in the '80s, when I was doing the same thing with HIV, and we had a single drug that looked like it was giving a good effect, and it did. But it was a single drug and we needed to do better.

And subsequently over that period of time, we had a second drug, then a third drug. We did it in combination with two. And then finally, we landed on the triple combination that completely transformed the lives of HIV-infected individuals. And then from that, we developed a prophylactic or a drug that if you give a single pill a day, it is highly successful in preventing the acquisition of HIV.

So if you look at the analogies that what we see now is a step by step improvement in the treatment, potential prevention, and then ultimately, a vaccine. So there are analogies. One is a chronic infection that lasts over years. One is an explosive highly transmissible. So they're very, very different. But the development of interventions really do have somewhat of an analogous pattern.

ANJALEE KHEMLANI: What about right now where we are? You know, you've been watching, you've been updating us on every single issue or update that we've needed. But are there things that maybe didn't pan out the way you expected or things that you're still waiting to pan out?

ANTHONY FAUCI: Well, I mean, you know, that's a very broad question-- just very, very difficult to apply it. I'm not really sure exactly what you mean when you say pan out. I mean, we're in a very difficult situation that we're dealing with literally, a highly, highly transmissible virus that it is so different from other viruses. When it was doing public health interventions, was modestly or relatively easy to contain.

We know now that-- and this came out yesterday in the news-- that the shutting down of a nation the way we did here in the United States in way virtually every other country with few exceptions did was to lockdown was responsible for preventing tens and tens and tens of millions of infections. We've never been in a situation like that ever in history, where we had to essentially shut down the planet-- is what actually happened.

I mean, if you look at the globe and the more than 200 plus countries that have been afflicted, almost all of them had that shut down. That is unprecedented. Right now, we're faced with a real challenge. You can't stay shut down forever, so it's going to have to be a balance between containing the potential resurgence, which we will hopefully have the capability of doing, at the same time as we March forward to some sort of normalization and reopening not only our country, but the rest of the world.

Because if you look at what's going on, so many other countries are trying to do the same thing we're trying to do. The question is needed to do it prudently and safely in the context of our ability to respond when you do see these bit of resurgences.

ANJALEE KHEMLANI: And a final question. Are you breathing a sigh of relief yet?

ANTHONY FAUCI: A sigh of relief? No. I never get ahead of myself. I'll breath a sigh-- you know, as Yogi Bear used to say, it ain't over till it's over. And that's when I'll breathe a sigh of relief-- when we're really completely out of this, right?

ANJALEE KHEMLANI: Dr. Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases. Thank you so much for joining me today. It was a pleasure.

ANTHONY FAUCI: Good to be with you. Thank you for having me.