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August 17, 2021
America Dissected
A Second Opinion with Dr. Anthony Fauci

In This Episode

Nobody has come to represent the role of science in taking on this pandemic quite like Dr. Anthony Fauci. He joins Abdul for their second conversation about where we’ve been, where we are now, and how to face down anti-science trolls, even when they come in the shape of US Senators.





Abdul El-Sayed: School mask mandates become the latest COVID-19 political battle as millions of students are heading back to school in the midst of the Delta variant surge. The FDA authorizes COVID-19 boosters for the immunocompromised. The Democratic-led $3.5 trillion budget reconciliation package could extend Medicare benefits to people 60 and older. This is America Dissected. I’m your host, Dr. Abdul El-Sayed.


This was Dr. Anthony Fauci in a conversation with we’ll call him another doctor:


[clip of Dr. Anthony Fauci] Senator Paul, you do not know what you are talking about, quite frankly. And I want to say that officially: you do not know what you are talking about. OK, you get one person— [interrupted] can I answer the question?


Abdul El-Sayed: Unfortunately for all of us that doctor is Senator Rand Paul. Though he should know better Dr. Senator Paul has chosen feeding red meat to his political base over following the science that he trained on. We’re fortunate that Dr. Anthony Fauci was there to check him every single time. That said, though, many of us could see it coming, few of us understood just how politicized this COVID-19 pandemic—everything from masks to vaccines to contact tracing—could become. But here we are. A year in, the country’s top infectious disease expert has to routinely spar with another doctor in the Senate over basic science around getting vaccinated or wearing a mask in the pandemic. People like Rand Paul and the legions of vaccine resisters they inspire, have exploited a peculiar aspect of this pandemic, the fact that all of us are trying to interpret changing science in real time. In the earliest days of the pandemic, not even weeks in, people like Rand Paul exploited the seeming contradiction in evolving mask guidelines. Because we didn’t know yet that asymptomatic people could pass along COVID public health officials recommended against masking. When they realized that, in fact, asymptomatic people could pass along the virus, they reversed course. But people like Rand Paul were right there to call this a contradiction. Most of us instead called this evolving public policy to meet changing science. Now exploiting the vaccine hesitant, they ask questions designed to inspire fear and mistrust. For example, if the vaccines are so good, why are vaccinated people being recommended to wear masks again? That one’s easy. Because Delta is a new variant of the virus and it’s spreading like wildfire among people who are not vaccinated! Don’t believe me. Look at where COVID is spreading fastest, in the least vaccinated parts of the country. Anyway, as a result, eight months after safe and effective vaccines become available to the public, nearly half of Americans remain unvaccinated. People like Rand Paul have a lot to do with that. But as we say on our show, science always wins. Our failure to get vaccinated has left us vulnerable to Delta, and whatever could be behind it. But should we choose to finally learn our lesson, we could indeed move past this pandemic entirely, which is exactly what my guest today has been saying all along. In July 2020, I got to speak with Dr. Anthony Fauci in the middle of those first frantic few months of the pandemic. A year later, I wanted to check in with him to get his perspective on how it’s evolved, where we stand now as we battle the Delta variant, and just what it’s like to stand up to anti-science trolls in the Senate and otherwise. My second conversation with Dr. Anthony Fauci after the break.


[ad break]


Abdul El-Sayed: So we always start by asking our guests to introduce themselves. Obviously, you need no introduction, but for the tape, if you could introduce yourself.


Dr. Anthony Fauci: Sure. My name is Tony Fauci and I’m the Director of the National Institute of Allergy and Infectious Diseases at the NIH. And I’m the Chief Medical Advisor to President Biden.


Abdul El-Sayed, narrating: Even before the pandemic, Dr. Fauci was the face of infectious disease science and medicine, dating back all the way to the first outbreak of HIV AIDS in the ’80s. Throughout the pandemic, his honesty, candor and stubborn insistence on science have been a source of confidence and comfort for many of us, even if it’s meant that he’s become a lightning rod to trolls on the right. Our conversation marks one year since our last, a check in on how far we’ve come since the earliest days of the pandemic and how much further we have to go.


Abdul El-Sayed: Well, we’re very excited to have you on the show. I’m really grateful that you’d do our show for a second time. Folks really, really appreciated it the first time. I really want to go a bit deeper, right, because this is a bit of a confusing moment, I think, in the pandemic for a lot of people, simply because I think so many people follow the momentum of this thing. And it feels like certainly two steps forward, but definitely one step back. I want to start by just taking the long view. The last time we had you on the pod, it was July of 2020 and now it’s been more than a whole year. If you could talk to your previous self, right, go back to July 2020 and say, Dr. Anthony Fauci, here’s what you can expect. Do you think your previous self would have been surprised or did this play out how you expected it?


Dr. Anthony Fauci: No, on a number of accounts Abdul. First of all, we are very, very fortunate in that we have highly, highly effective vaccines. I knew that vaccines stood a good chance of being effective. I didn’t realize or think that they were going to be this effective. So it was the combination of the investment in biomedical research which really paid off, the fact that we use new technologies like mRNA, and vector-borne platforms, vector type platforms, the Immunogen design that I might say my team here at NIH developed, at the Vaccine Research Center really turned out even better than we expected. The thing, also on the other side of the coin, is the incredible ability of this virus to adapt. You know, we thought that once you get the vaccine that we would be good and that would be, you know able to, if we did get a good vaccine which fortunately we did—we didn’t know that at the time last July—the incredible ability of the vaccine to mutate and form variants. For example, we are now, you know, even this far into it, see that this Delta variant just came in and just swept through the world. I mean, the world got hit badly by the original and then all of a sudden the Delta variant comes in. And fortunately for us, the vaccines that we made do well against the variant in protecting you from serious disease leading to hospitalizations and death. But it’s multiple times more transmissible. So for the unvaccinated, it makes things really, really bad, because you can really get into trouble. Hence the cases that are skyrocketing not only in our own country, but in the rest of the world. The thing that I’m sup—well, I wouldn’t say surprised because we’re dealing through, we’re living through such difficult times Abdul, great deal of divisiveness that we knew the last time you and I had an interview—but the idea that we have still a year later, these ideological differences where you have people who politicize things like vaccines and masks wearing. It’s, it’s just almost unexplicable that you have a virus that’s killing over 615,000 Americans and you still have people, who for reasons that in my mind I just can’t figure out why other than just not wanting to be told or even suggested of what to do, they’re not getting vaccinated. Which is very bad for themselves, their own health, the health of their families and their community, but it also allows this very wily virus, if you give it the opportunity to continue to freely circulate in society, which you will do if you don’t get vaccinated—we have 93 million people in this country who are eligible to be vaccinated who have not yet been vaccinated. If we got the overwhelming majority of them vaccinated, we wouldn’t be in the difficult situation we’re in right now. So it’s you know, when you ask me, it’s complicated. Would I have predicted that it was as complicated on the good side and as complicated on the bad side? I would have said I don’t think I would have done that, I would have known that back in July of 2020.


Abdul El-Sayed: You spoke to the confluence of a couple of pieces of this pandemic that have really mutually intertwined. One is the adaptiveness of this virus and Delta variant in particular, and then the other is the polarization around very basic public health recommendations that have been norm in this country, frankly, for nearly half a century, if not more. And I want to ask you about the most recent CDC recommendations around masking for vaccinated people in communities with substantial or high transmission. In some respects, this is based on evidence that shows that transmission is possible from vaccinated people, although I think in some respects the media’s portrayal of it and people’s understanding of it, is that possible means probable. Can you speak to what this recommendation says to folks who are looking at the vaccine and saying, I don’t know if this thing works the way that they told me it would. And folks who are now vaccinated, who are worried about whether or not the impact of their vaccination is going to buy them the freedoms that they were promised.


Dr. Anthony Fauci: You know, you asked multiple questions. No, that’s good, Abdul, because what it does is it reflects the incredible dynamic nature of what’s going on. And it is entirely understandable that people expect clarity and immutability. You say something, it’s done, you never can change the recommendation. That would work well if you were dealing with a virus that doesn’t change. So the virus was changing. And when you talk about that, sometimes as it’s changing, you can’t quantitate the degree of change. So we did not appreciate that once—and understandably, because we had no way of appreciating—that if you get a really, really good vaccine, that when you’re dealing with the Alpha variant, if you get vaccinated, the chances ever getting a breakthrough infection are very low. And if you do, the chances of your transmitting it to somebody are very low. Then you get this Delta variant, which has characteristics that are very different from the Alpha variant. It spreads dramatically more readily. When it gets into the nasal pharynx, it’s a thousand times more concentrated. Which means that even though the vaccines are still really good in protecting you from getting severe disease and death, what’s changed is that even if you’re vaccinated and you get a breakthrough infection, unlike the Alpha variant from six months ago, the level of virus in your nasal pharynx with the Delta is high enough that even if you’re vaccinated and even if you have very few or no symptoms, you are still capable of transmitting it to somebody else. So then all of a sudden you’ve got to explain to the public something that’s complicated. You wouldn’t expect them to immediately figure it out that there’s a separation now between the protection against getting sick—which is really what the vaccine is supposed to do, it’s supposed to protect you from getting sick—that there’s now a separation because it doesn’t protect you necessarily as well from getting infected, even though your infection may be without symptoms or it may be minimally symptom, but you can transmit it to somebody else. Now, how probable and likely that is, to be honest with you Abdul, we don’t know yet. We don’t know. I mean, it’s so recent, this realization of the fact that you can transmit it even if you have vaccinated and well protected yourself from disease. So we’re trying to figure that out. So in that context, what the recommendation is, well, if we’re not sure about that, you need to protect the vulnerable. So even though the vaccine protects you fine from getting seriously ill, you’re saying, well, wait a minute, if I’m in a situation in a high or substantial level of infection and I’m indoors and I get infected, I may not know it and then I might go home and inadvertently infect children, infect someone who’s elderly, who may or not be vaccinated, someone who has an underlying condition that even if they’re vaccinated, they’re not well protected. So in order to really doubly protect not only you from getting infected, but you from transmitting it to someone else, that’s where the masking indoors come in. And when people see that, they say, well, why should I get vaccinated if I have to wear a mask? Well, the reason to get vaccinated is not just to keep you free from wearing a mask, it’s to prevent you from getting seriously ill and dying. Because if you look at the number of deaths that have occurred, overwhelmingly, 99 point some percent of the deaths are among unvaccinated people. So you can say, well, wait a minute, why should I get vaccinated if under certain circumstances I still have to wear a mask? Well, look at the 600+thousand people who died because they were unvaccinated. That’s the reason you want to get vaccinated, not for the freedom of not wearing a mask.


Abdul El-Sayed: Yeah, the goal here is not to join one of those 615,000 people. I guess my question then, and you know this better than me, is that public understanding is a real challenge when it comes to baseline science. And so do you feel like the CDC might have jumped the gun when they initially allowed vaccinated people to go without masks per guidelines?


Dr. Anthony Fauci: Well, retrospectively, Abdul, they jumped the gun. But if you put yourself in their position back then, they did not fully realize at the time—they knew that Delta was really a very aggressive virus—they didn’t fully realize at the time, since they were still, we were really doing a great job in vaccinating people, that by the time we got to the summer and we would hopefully have vaccinated most of the people, that there wouldn’t be a spread by vaccinated people. So you could always say, yes, if I knew then or if the CDC knew then what they knew now, they probably wouldn’t have quote “jumped the gun.” So is it jumping the gun when you don’t know the data? You know, it gets tricky. It gets tricky. The other thing that is really, really detrimental Abdul is the amount of disinformation and misinformation there is on the social media and by people who have other agendas, who have these political motivations that are really getting in the way of a really good, unified public health response. There’s no room for that kind of stuff when you’re dealing with a very serious pandemic that’s causing lives and suffering. But it’s happening, unfortunately.


Abdul El-Sayed: I certainly agree with you. One of the interesting pieces is, as public health people, is that early on the pandemic through the first year, we all watched as basic public health was set aside and we thought that technology in the form of these vaccines was going to finally allow us to get a handle on the pandemic. And what sort of happened is that the public trust that was undercutting basic public health has also undercut, right, the lack of public trust has also undercut our capacity to get vaccine out there. A lot of this is driven by the capacity for social media to accelerate disinformation and misinformation. I wanted to ask one more follow up around the new guidance, because so much of the hope was in the idea of herd immunity, the notion that if enough people are vaccinated or otherwise naturally immune, that you could stop the spread of the virus because enough people around you could not pass it on to you. But given the new evidence that suggests that vaccinated people can in fact, can in fact pass along the virus, what does that mean for the way we even think about herd immunity when it comes to Delta and therefore COVID-19 in general?


Dr. Anthony Fauci: You know, great question. It means when you have a virus as transmissible as this, and as mutation-prone as this, you’ve got to get the overwhelming proportion of the population vaccinated. Because remember that even though the vaccine is not 100% protective against infection, it’s about 95% protection against death and hospitalization. But even if it goes down to only 79% or so protection against initial infection, and that initial infection could be without symptoms, if you get enough people vaccinated, you crowd out the virus. You don’t allow it to have as many vulnerable people. So the more transmissible a virus is, the more people you need to get vaccinated to really get good protection. You’ve got to go even one step further when you have a virus that’s able to mutate and get a new variant. I mean, measles doesn’t change at all. And yet you need 90+% of the population vaccinated to get really good herd immunity. So when you have a vaccine—I mean a virus, that not only has high transmissibility, you need to get the overwhelming proportion of the population vaccinated if you want to do it. And that’s what we’re trying to do. You know, it’s really frustrating Abdul, we have the solution to the problem. If everyone who is eligible to get vaccinated get vaccinated, you and I would not be having this conversation.


Abdul El-Sayed: Yeah, and the same distrust, the same disinformation that is preventing people from getting vaccinated, that’s really come out you in a really harsh way. You know, you’re somebody I listened to lecture in medical school and if you’ve long been a household name in medical households, but this pandemic obviously put you in a spotlight in a way that has really sort of opened you up to politicization and the things that you say get parsed and taken out of context. I want to ask you just as someone who trained to be a doctor, who’s fulfilled your responsibilities to the public, and your public service now for much longer than I’ve been alive—how have you dealt with this politicization and this attack on your name? How has it been, and what would you recommend to the rest of us who are not not nearly as exposed as you are, but are finding ourselves caught up in conversations where we’re debating something that really ought to be based on evidence and data, but ultimately becomes extremely ideological and emotionally fraught? What’s your, what’s your advice?


Dr. Anthony Fauci: Well, the advice is to stick with your fundamental principles, the things you’ve learned in medical school, the importance of evidence, the importance of truth, the importance of transparency. Well, I have become obviously sort of the boogeyman for the far extreme crazy theories that people have. But, you know, I don’t like it, I particularly don’t like it because it affects my family. They didn’t ask for this, but they got it. Great, thank goodness I have a phenomenally supportive family, but my job and your job, you know, you went to medical school, my job, same thing. You know, we’re in it. Our job is to, is to preserve the health and the safety of the people that we’ve devoted our careers to and once I keep my eye on that ball, Abdul, the other stuff as a bunch of junk nonsense. You know, they get throw all the swings they want, you stick with the truth, you stick with your integrity, you stick with your honesty, and all that other stuff sooner or later is going to go away. It’s painful while they’re painting these terrible pictures of you, but at the end of the day, the truth will prevail. So I just focus on my job and my job is public health and science and medicine, and that’s what I do.


Abdul El-Sayed: I really appreciate that. You’ve had now a couple of very public conversations written into the senatorial record with somebody else who went to med school, and that’s Senator Rand Paul. And I want to ask you, what’s it like debating someone who you know, knows better but chooses to politicize to a particular base on purpose? I mean, obviously, we’ve seen your frustration, but what’s that like firsthand, and how does that make you feel about the future?


Dr. Anthony Fauci: Well, I, you know, I worry less about myself, Abdul, than I do about the country. When one can at so many different levels, even the level of the Senate of the United States, to propagate nonsense, you know, it is painful. I have a phenomenal degree of respect for the United States government and all the elements, including the august body of the Senate. I don’t take any great pleasure in having that kind of a conversation with Senator Paul, but there’s no way I’m going to let him get away with that in the sense of just propagating nonsense out there. You know, and I don’t like that because I don’t, I’m a person who is very respectful of institutions, and it hurts me more to have to do that when the fact that he’s doing it, you know—I wish I didn’t have to push back like that, but I have to.


Abdul El-Sayed: Well, we appreciate you for doing it. We appreciate you for sticking with your principles and the truth and the science and grateful that we have public servants like you out there fighting this pandemic on our behalf. That was Dr. Anthony Fauci, a man who needs no introduction, but really grateful for having you on the Pod. Thank you again.


Dr. Anthony Fauci: Thanks again, Abdul. Thank you for having me. Take care.


Abdul El-Sayed: As usual, here’s what I’m watching right now.


[clip of Gov. Ron DeSantis] This is a guy who ran for president saying he was going to, quote, “shut down the virus” and what has he done? He’s imported more virus from around the world by having a wide-open southern border . . . His solution is he wants to have the government force kindergartners to wear masks in school.


Abdul El-Sayed: That was Florida Governor Ron DeSantis throwing red meat to his base and putting the lives of Florida’s children on the line. At issue here is, get this, a ban on school mask mandates, in violation of CDC guidelines, right as millions of children go back to school. This is particularly galling because of this:


[voice clip] Right now, the U.S. is averaging more than 109,000 new cases each day. Nearly one in five of those infected is a child. In some places, ICUs are full, even pediatric COVID beds.


Abdul El-Sayed: Children, many of whom simply can’t be vaccinated, now account for nearly 20% of all new cases of COVID-19. As children go back to school, they’re facing the perfect storm with Delta and crowding. Banning schools from requiring masks is simply inviting serious outbreaks. The other group of folks at particular risk with Delta are the immunocompromised. Last week, the FDA announced this:


[news clip] The FDA is expected to authorize a third booster shot for immunocompromised people.


Abdul El-Sayed: It’s critical that we offer more protection for people who are immunocompromised. Those eligible for these booster’s comprise only a small fraction of the population, those who need the most. For the rest, those with functioning immune systems, I really don’t believe there’s a need for a booster. That and it’s still far more important to get unvaccinated people in the rest of the world vaccinated before we offer third doses to people who are vaccinated here at home. Given new data that shows that three doses may offer protection for folks who are immunocompromised, I think this is an important step. Now, if the FDA could get full authorization for these vaccines, we’d be in really good shape. Finally, in addition to passing the bipartisan infrastructure package, the Senate approved the framework for a $3.5 trillion budget reconciliation package. That package could fundamentally change Medicare as we know it, including lowering the Medicare age. This is a big deal, like a very big deal. Most obviously, it would guarantee health care for 20 million Americans. It’s also good politics. Two in three Americans agree with lowering the Medicare age. That said, it’s important to understand why the majority of Democrats support lowering the Medicare age, even if they don’t support Medicare for all. As Medicare stands today, seniors can opt for one of two Medicare options: standard Medicare, or what they call Medicare quote unquote “Advantage.” Advantage is a privately-managed version of Medicare that pays insurance companies to manage Medicare patients. They usually cherry pick the healthiest patients, whom they offer a few extra perks. But every dollar those healthier patients don’t spend in health care, the insurance companies get to keep in profit. The health insurance lobby is extremely powerful. In fact, they spent $150 million dollars lobbying last year alone in the middle of a pandemic. And they’re realizing that including people between 60 and 64 means more and healthier people that they can offer Medicare Advantage products to, and more money in the bank. Look, I deeply support lowering the Medicare age, but I want us all to be clear eyed about what’s at play here.


That’s it for today. On our way out, I want to hear from you. I hear a lot from the anti-science trolls who like to troll our podcast. So do me a favor and respond. Rate and review our show. Let us know what you think about our podcast. It goes a long way to getting it to other folks who believe in science. And if you really like us, go on over to the Crooked Media store and pick up some merch. We’ve got our new logo tees and mugs, our Safe and Effective shirts, and our Science Always Wins shirts and dad caps.


Abdul El-Sayed: America Dissected is a product of Crooked Media. Our producer is Austin Fisher, our associate producer is Olivia Martinez. Veronica Simonetti mixes and masters of the show. Production Support from Tara Terpstra, Lyra Smith and Ari Schwarz. Our theme song is by Taka Yasuzawa and Alex Sugiura. Our executive producers are Sarah Geismer, Sandy Girard and me: Dr. Abdul El-Sayed, your host. Thanks for listening.