Investment in applied science has placed the world in a good position to respond to the COVID-19 epidemic, America’s top infectious disease expert Dr Anthony S. Fauci has said.
In conversation with the UNSW Centre for Ideas last week, the senior public servant who has overseen the US response to the COVID-19 pandemic, said that scientific infrastructure must exist in order to respond swiftly to an emerging infection. Doing so was part of a long-term plan that recognised the spread of viruses would become an ongoing issue for the global community, he said.
“New infections have always emerged; they are emerging now and they will continue to emerge.
“The lesson learned [in my career] is that to the extent possible, prepare yourself as best as you possibly can,” Dr Fauci said.
In addition to a transparent reporting system, which includes ensuring that countries disclose all information to the international community about emerging infections as soon as possible, Dr Fauci said investing in a functional global health security network was key.
He added that these kinds of strategic, ongoing investments would ensure countries were best placed to respond to new outbreaks, such as the development of effective vaccines.
“It’s that kind of investment in research that generically forwards and advances all of the things that you can do, so that when you get confronted with an outbreak [it] doesn’t turn into a global pandemic,” Dr Fauci said.
The SARS-CoV-2 virus is covered in spike proteins that allow it to enter human cells via our airways. It is the spike proteins that scientists have targeted using some vaccines and other potential treatments.
It took the collective efforts of structural biologists, x-ray crystallographers, cryo-EM experts and others to study the conformation of molecules that would allow scientists, by mutating the molecules, to keep them in a stable form, and be used as an immunogen in vaccines. This research facilitated the development of mRNA vaccines against COVID-19 (such as those developed by Pfizer and Moderna), Dr Fauci said.
“Interestingly in the United States, we’ve let the local public health be a victim of attrition,” he added.
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Under the leadership of former US President Donald Trump, Dr Fauci often butted heads over the best approach to wrestle with America’s outbreak.
“I had to come out and essentially contradict what the [former] president was saying, which is a very difficult thing to do and it led to some strain and stress between us.
“Even now, after the former president is no longer in office, he still talks about that, which is unfortunate,” Dr Fauci said.
Things are now turning around for the US, with the establishment of community vaccine centres across the country and the rollout of vaccines to pharmacies and mobile vaccine units. According to Centers for Disease Control and Prevention, to date 25% of the US population has been fully vaccinated and 39% have received at least one dose.
On the first day of office for Trump’s successor, Joe Biden, the 46th president asked Fauci to notify the World Health Organisation (WHO) that the US would re-join the UN agency. Trump notified the UN last July of his intentions to withdraw support and funding from the WHO, although the process did not finalise before he was voted out.
“President Biden wants science to rule. He said that behind the scenes to us on his medical team, and he has said it publicly: that we are going to be driven and ruled by science and facts, and when something goes wrong we’ll try and fix it and we won’t blame anyone. That has worked extremely well,” Dr Fauci said.
With a recent record in April of 4.6 million jabs in American arms in a single day, Dr Fauci expressed relief about the effective vaccination program the US has implemented this year. He also lauded one of the strategies to get the US population vaccinated, which is to dispatch a team of ‘vaccinators’ — among them, retired physicians, nurses, military personnel and medical students — to poorer neighbourhoods where access to healthcare is limited.
“If we keep doing that over the next few months I believe we will finally get the overwhelming majority of the people vaccinated in the next several months, which I hope will then turn things around and get that level of daily infections down to a manageable level,” he said.
For over 40 years Dr Fauci has held the position of director for the National Institute of Allergy and Infectious Diseases at the US National Institutes of Health. In that role he has served under seven US presidents and worked on public health response to HIV/AIDS, Ebola and anthrax.
Fauci underscored the importance of having established clinical trial sites around the world, which can be attributed to groundwork of research funding and mobilisation for the HIV epidemic.
Because disease can present differently depending on the country which has experienced an outbreak, Fauci explained, there are benefits to being able to call upon the experienced investigators who have successfully done prevention trials, vaccine trials, and drug-therapy trials.
“You have to have a broad umbrella of clinical trial types and capabilities of studying very different aspects of the outbreak and the different conditions,” Fauci said.
“It was that investment and that experience that was gained, very successfully, with HIV/Aids that allowed us to spring out of the box quickly and very effectively in clinical trials with COVID-19,” he added.