Fauci. What’s to be done

NO nation likes to lock itself down but an “immediate” shutdown for a “few weeks” could put an end to the cycle of transmission in India, Dr Anthony S Fauci, one of Covid’s most trusted global voices, told The Indian Express. That will provide a window, he said, to take critical “immediate, intermediate, and long range” steps out of this “very difficult and desperate” situation.

Fauci, chief medical advisor to the Biden Administration and who has worked with seven US Presidents, spoke exclusively to The Indian Express on Friday from the National Institute of Health in Bethesda, Maryland.




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To the extent possible shut down the entire country for a few weeks: Dr. Anthony Fauci to India

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Dr Fauci, I would like to focus this interview on prescriptive solutions when you look at the situation in India. If you were, hypothetically, hired by the Government, what would (you say) are the top things that need to be done?

The one thing I don’t want to do and I hope it doesn’t turn out this way, is to get involved in any sort of criticism of how India has handled the situation because then it becomes a political issue and I don’t want to do that since I’m a public health person and I’m not a political person.




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It just seems to me that, right now, India is in a very difficult and desperate situation. I just got off, in preparation for this interview, I watched a clip from CNN… it seems to me it’s a desperate situation. So when you have a situation like that you’ve got to look at the absolute immediate.

I mean, first of all, I don’t know if India has put together a crisis group that would meet and start getting things organised. I heard from some of the people in the street bringing their mothers and their fathers and their sisters and their brothers searching for oxygen. They seem to think there really was not any organisation, any central organisation.




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India should go into a war-like mode to counter Covid second wave: Dr. Anthony Fauci

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The first thing to do is to first look at what is the immediate thing you can do right now. What is the intermediate thing that you can do in two weeks? One of the things that you can do to prevent this prolonging — you’ve got to look at it in multiple different phases.

For example, vaccinating people right now, which you absolutely must, must do — it’s essential — is not going to alleviate the immediate problem of people needing oxygen, needing hospitalisation, needing medical care. That’s not going to fix it now because vaccinating people today, it’s going to be a few weeks before you alleviate the prevention of other people getting sick.

So take care of the people right now. I would think that you’ve got to get some sort of a commission, or an emergency group to make a plan how to get oxygen; how do we get supplies; how do we get medications, and call — maybe with help from WHO — countries.

And the US, thankfully, I’m very pleased to see, they have now moved to make a major commitment for medications, for oxygen, for PPE, and for ventilators. But we’ve got to get other countries to come in and help India right now because India has been very generous in the past crises in helping other countries. Now is the time other countries to try to alleviate the immediate problem that India has. That’s the first thing.

Then the intermediate. I think you need — what the Chinese did when they had a crisis, you might recall, literally, within a few days to weeks they built these emergency units that served as hospitals to take care of people. It was an accomplishment that everybody marvelled at. It just seems to me, what I was viewing on television, what people were looking for a desperate need for hospital and care. That’s the first thing.

The second thing, you can mobilise different groups of government. For example, what is the role of the military? Can the military come in and help? I mean, you can immediately get military help the way we, in the United States, have used our National Guard to help us distribute the vaccinations.

I think it should at least be seriously considered. The intermediate — to get hospitals built quickly. I mean really quickly, within a matter of — you know, they put up these field hospitals that they built during war. You should think of this, in some respects, like a war. The enemy is the virus. So you know where the enemy is, so I would make it almost like wartime because it’s an emergency.

And, finally, in the longer range, in a matter of a couple weeks, I would do whatever you can do to get vaccinated. To have a country like India, where two per cent of people are vaccinated, is a very serious situation. You absolutely have to get more people vaccinated.

So that’s my take on it. Address the absolute immediate problem, get the intermediate things going, and then take a look at the longer range in regards to vaccines.

When you think about the early signs of something like this, the second wave, were you surprised? Was it inevitable? Should it have been anticipated? What were you seeing, what were the early signs?

Well, again I don’t want to get into a criticism of the response of the Indian government so I would prefer not to do that.

Without criticising…in general, across the world, not just for you, were there early signs?

It isn’t necessarily an early sign. It’s a realisation of what the capability of what this virus is. This virus has shown us that if left to its own devices, it will explode in society. It happened to us in the US. You might recall, I am speaking to you as an American. But, in fact, the United States, for a while, was the worst-hit country in the world and the United States is the richest country. We were supposedly the best prepared and we got hit very badly. So you know, the reason is that the virus doesn’t care how rich you are. Or how advanced or developed you are. If you don’t respect its ability to cause serious damage, you are going to get into trouble.

I think one of the things that maybe should have been recognised, that victory was declared maybe too prematurely.

Has the Centers for Disease Control and Prevention (US national health protection agency) asked to help in genome sequencing of the Indian variants? Has CDC obtained samples of the variants?

Well, we absolutely need to study it intensively to find out if the vaccines that are being used are inducing a response that would be protective against this variant. We heard some preliminary announcements that the vaccine appeared to be okay. But there are another announcements that were saying we aren’t so sure about that. So what I think needs to be done very, very quickly is to get specimens and material outside of India and sent to the CDC of the United States, the NIH (National Institute of Health) of the United States, to the Wellcome Trust in the UK. There are a lot of groups that would like very much to help out and they can help out by doing the sequencing and the surveillance and the determination if the virus is, in fact, sensitive to the antibodies that are induced by the vaccine.

On vaccines, we have a 50/50 for open market and government ownership. There’s debate over costing. What is your view on this, when you look at the US model? What is the best way to get the public interest served on the vaccination front? How do we ramp it up?

You’ve got to get supplies. You’ve got to make contractual arrangements with the various companies that are out there in the world. There are many companies that now have vaccines. I think you have to negotiate with them to try and get a commitment. India is what, 1.4 billion people? You have a lot of vaccines that you need to get, and I would go to multiple different companies and try to get contractual arrangements so that you can get vaccines as quickly as you possibly can.

So getting it from China, getting it from Russia, making the vaccine basket larger. Is that the route to take in the situation?

Absolutely, absolutely. You only have two per cent of your people vaccinated. This is what I heard. I don’t know if that’s accurate but that’s what I’m hearing (2% is the number of those who have got both doses, 11% have got at least one dose). And, if that’s the case, you have a long way to go if you really want to protect the people in India. I would leave no stone unturned in getting as many companies as you possibly can to be able to make a contractual arrangement to get vaccines. And also, India is the largest vaccine-producing country in the world. That’s the thing — you should rev up your own capabilities to make vaccines.

You have seen (tackling Covid) from the frontlines in the US, but what does it take in a billion plus, developing country? With the US model, some things work, but when you are looking at a billion-plus, what are the public health challenges?

Well, one of the things you really need to do that to the extent that you can — is shut down temporarily the country, I think is important. If we want to time out and go back to what I said. There is the immediate, the intermediate, and the long range. I think the most important thing in the immediate is to get oxygen, get supplies, get medication, get PPE, those kinds of things but also, one of the immediate things to do is to essentially call a shutdown of the country.

We know that when China had this big explosion a year ago, they completely shut down. And if you shut down, you don’t have to shut down for six months. You can shut down temporarily to put an end to the cycle of transmission. So one of the things to be considered is to temporarily shut down. Literally, lock down so that you wind up having less spread. No one likes to lock down the country. Well, that’s a problem when you do it for six months. But if you do it just for a few weeks, you could have a significant impact on the dynamics of the outbreak.

I would be remiss not to ask you about the situation in the US right now. I’m also curious how your job has changed under the new administration as compared to the previous one.

The current status of the United States, you probably know, we are doing a very, very good job of getting our people vaccinated. We now have 100 million people fully vaccinated and we have about more than a third — close to 40% of the country fully vaccinated. More than 50% of the country has received at least one dose.

And if you look at the elderly who are the most vulnerable, now about, 50% of who are elderly — 65 years of age or older — have received one dose, and about 65% of the elderly population has been fully vaccinated.

So the very vulnerable people in the country who are really getting into trouble and having a higher rate of death, that has dramatically diminished. So if you look at the hospitalisation rate, the death rate of the elderly people in our country. That has gone down anywhere from 75 to 85%. We are doing much, much better.

But you know that several months ago we were doing very poorly. In fact, last Fall and early winter, we were doing as bad as India is doing now. We were having 300,000 new cases per day. And we were having 3-4000 deaths per day. But we turned it around. We turned it around with a really concerted effort.

So as far as what I’m doing now (under the Biden administration)…I’m not going to compare it to the previous administration…But I can just say that what we are doing is very much based on science. President Biden has promised that his policy will always be based on science and evidence and data. And that’s what we’ve done. I mean one of the great successes of his first days is the extraordinary success of the distribution of vaccines. That has really been very, very successful.

You are known as the voice of hope and calm. Do you have any words on the way forward, to those suffering here?

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Yes, first of all, I say that the entire world is pulling for and in solidarity with India, for sure. We are very pained to see India suffering so much. And that’s the reason why the rest of the world really needs to chip in and help. But to the people of India, I’ll say, hang together. Everybody is in this together. And just as I said in the Senate hearing, it will end. We will get to a normal. There is suffering now but I guarantee that we will get it back to normal. Hang in there, help each other. Take care of each other and things will get back to normal.

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