Coronavirus Update With Anthony S. Fauci, MD - September 25, 2020
Hello and welcome to conversations, with dr bochner once again it's dr bochner howard bachner and i'm here with uh dr tony fauci welcome tony. Good to be with you howard, i think at this point you probably need no introduction. Um, you're the director of the national institute. Of allergy, and infectious, diseases. You've been an extraordinary, public health servant, for almost four decades welcome tony. Thank you very much. So tony before we get started i have to ask you you've probably testified, before congress before, any other physician, in the history of the united states, do you ever get nervous. No um. Not only any of the physician, any other person, any other part right. I tried to count i couldn't find account anywhere but i was wondering if you ever get nervous. You know, the answer is is is no. Howard and the reason is if you're prepared. I wouldn't call it nervous, i mean sometimes. When you go into a hearing. You know that it could be. Politically. Charged that doesn't make me nervous, it's just. Sometimes, hearings are productive, and sometimes, they're not when you have a great degree of divisiveness. You really. That, some of the politicians. Use the hearing. To make a statement, against, either the other party. Or the administration. If you're on the opposite side of the party. Sometimes, you get caught in the middle of that and they, sort of like you know they're, shooting here and. Shooting. Do you ever do you ever leave and then go oh i should have said this or i shouldn't have said that. Yeah a couple of times that would happen i mean i i think it's. It's, more often. I wish i had enough time to have said. This in addition to what i said. Uh, i think only rarely. That you would say oops, you know. Why did i say that. Sometimes. You will say something that is correct, but it's subject to, misinterpretation. And you see you might say to yourself you know. Maybe i should have been a little bit more clear about that but that doesn't happen very often howard. Uh well questions are already coming in so i'll get to the questions in a bit. Um, and i'm assuming, some are going to be about vaccines. Um. Tony it's been a, very difficult, couple weeks in europe, a very difficult, couple weeks the stories the last four or five days talk about. A large, large increase in in numbers. What do you think that reflects, tony and what does it mean for the united, states. Well, i think we have seen, that. What they're seeing, now. We, i mean it's, interesting. Uh howard because it relates to what you and i spoke about the last time we were on, so let me just briefly, say because i'm, fairly certain this has been going on. Remember. Last time i told you that in europe. When they had their peak. Then they came down to a really really, basic slide, yeah. My concern, in the united, states. Was we had a peak. But our baseline, never went down, to really where we felt it should be it was stuck at 20, 000.. Stayed at 20 000 for. Multiple, weeks if not a month and a half or two. Then we tried. Remember. With the, let's try and open, america. Again. Open the economy. And we did. However, there was variable. Adherence. To the guidelines. Among individual. States. And what we saw. Was that, when they tried to open and didn't do it in a way that followed the guidelines. You had a surgence, of cases. That went from a baseline. Of 20 000. To 30 40 50 60, 70.. Yeah and then it started to come down and now it's hanging around at 40 which, is still, an unacceptably. High, level. In europe. Almost, certainly what happened. Is that they got down to a low baseline. But when they, started. To do what we were trying to do of, opening, up, the economy, and opening up the society. We see from the pictures. In europe. Of the bars that are crowded, of people congregating. Very similar. To what they saw, of american. Film. Of people in bars. And what happens. Is that when that happens you start to get a surge so they went up.
Down To a good baseline, and now. They're coming right up, total, to an average among all the countries, of, you know 20 000 infections, a day total of all the european, countries. Tony do you think people are just tired. Yeah, yeah, howard they are. And that's one of the things. That is difficult. To get around, that people. Are exhausted, from being shut down. Sometimes, they see no end in sight. And they say oh goodness gracious, you know i'm just going to try and live my life. That is so understandable. Uh, it's it's. Almost expected. So what we've tried to do, to message. Is that. There is an end to this we just have to hang in there a bit and i think. One of the rescuing. Elements. Is going to be a vaccine. And hopefully. That's only a few months. Away, because i think by the time we get to november december. We'll be able to start. Vaccinating. People. December, january, february. Um. I don't think we're going to get to the point. Where we have. A sufficiently. Effective, enough vaccine. In which. Enough people get vaccinated. To essentially, get back to normal. In a few months it's not going to happen. But what i hope will happen. Is that, the stringency. Of the health. Practices, that would be essential. To keep infections. Down. Will not be that necessary, so you're going to want to always wear masks, you want to do physical distancing. But we don't want to do. Is have to shut down again. I think that's something. That people won't accept, and i don't think it's the best thing to do we've got to be able to gradually. Open up, the society, and open up, the economy. And do it in a prudent, and careful, enough way. That we don't see those spikes, that europe is seeing now. And that we saw. I mean just a couple of months ago when we try to do it. Um. What gives you the biggest concern, for the next few months, tony. Well what gives me the biggest concern, is that we know howard. That, there are four or five, things that we say, if practiced. Diligently. And we know that from experience. That you can prevent, surges. And even turn around ongoing, surgeons. And that's. Universal, adherence. To, mass squaring, face covering. Keeping, physical, distancing. Avoiding, crowds. Washing, hands and doing, things, outdoors. More than, indoors. Because if you look at, some of. The super spreading, type things that have occurred. Almost all of them occurred in indoor, situations. When we get to the fall. And the winter. By the very nature of the climate, in most, parts, of the country, not every part but most, parts of the country. You're going to have to do a lot of things, indoors. At a necessity, of the temperature. And i'm afraid. With that being the case. If we don't, carefully, follow. The guidelines. The other guidelines, the masking, the distance the crowds. That we may see another surge again, so. Um, i was hoping. Would that we would enter the fall in the winter. Baseline. I told you that last time we. And yesterday, i just looked at the. The uh. The numbers, it was like 43. 000, new cases. Yesterday. You don't want to enter. Into, the, fall, and winter. With a community. Spread. At that level. Because, if you do. You got, a difficult, situation, that's going to be really challenging. My lord tony there's like two dozen questions, already but i i want to ask one more and then i'll get to the questions. Um. Is there a bridge. Is there a bridge to the vaccines. Tony, um. You know convalescent. Plasma. Let's start with we know that steroids, are the standard of care for people critically, ill. There's the recovery, trial we publish three clinical, trials, and a meta-analysis. Wh. The two critical care societies, have all changed your recommendations. A very substantial, mortality, benefit. 10, so we know in critically, ill people. Steroids, are clearly. Uh, the the standard of care. Is there. A bridge. To vaccines. And has anything. Else emerged. That you think can really give a benefit a clinical benefit. Outside of vaccines. Well you say something, important, that we have.
Glucocorticoid. Dexamethasone. We have remdesavia. Also in hospitalized. Patients, with. Lung involvement. What we are doing clinical, trials, on. But we don't have yet. Solid. Clinical, trial proven, efficacy. Is in a number. Of approaches. That's the bridge you're talking about. Probably, the most. Uh. I would say important, is a good word but the one that we have the most hope in is monoclonal, antibodies. Because we're looking. At monoclonal, antibodies, now. In people with earlier, disease. And people. Who are in outpatients. In patients. Nursing, homes, as prophylaxis. Families. In which one person, is infected. And you want to prophylact, the rest of the family. To see if you could prevent. Spreading, the family. That's clear. We know we have convalescent, plasma, that has an emergency use authorization. But we haven't nailed that down yet you know now we don't know for sure. Whether that's, going to be effective we're pretty sure it's going to be safe. And that's why the eua, was given, because it was felt that the, benefit, outweighs, the risk, but there are a few studies that are ongoing. You may be seeing some of them, in jama, where they're going to submit it where there are randomized, placebo-controlled. Trials right, so. Convalescent, plasma is one also. Hyperimmune. Globulin. That in fact, is derived. From. Convalescent. Plasma. Um. Those are the things that are being and then there are a bunch of other things, you know for advanced disease some, anticoagulants. That are being used some anti-inflammatories. To see if you can dampen the inflammation. But we are focusing, very heavily, now. On treatment, of early, infection. And or prevention. Of infection. And that's the bridge to the vaccine, that you're talking about yeah it's interesting to see the shift even in what the journals are publishing, you know initially, it's largely, epidemiology. Then it's the early clinical, trials, of seriously, ill, individuals, and then, we begin to think about prevention, and treatment of less seriously, ill individuals. Tony so lots of questions, about the vaccine, i don't think you're. Surprised, about that. 50. Efficacy, you happy with that. Well. It's better than none but i would like to see 70, 75. That's what i'm hoping for.
You Know the trials, fundamentally. Are designed. With all the statistical. Things that go into it to detect. With a certain degree of insurance, is sixty percent. Efficacy. I would, and one at fifty percent but most to sixty percent. I would like to see at least a seventy to seventy five percent efficacy. Any instincts, about what it will be. You know. Howard it's always. Difficult. To guess because the guess. Then gets taken as almost a definitive, statement. Um. I don't know what it's going to be and that's why. You do the clinical, trial. You do a very well designed. Placebo-controlled. Trial. And, you're going to get, your answer. And i believe that answer is not too far away as you know. We had, first, four, and now even one more that's going right into the facts is going into phase. Three trial. Two of them already started, on july, 22nd. That is, the moderna, and the pfizer. Astrozenica. Which is in the united states on hold. Started. In. August. We have, j and j which we just announced, this week, right beyonce, trial. The uh. The, human ad 26, which is a single shot one. And then we're gonna have, the novavax. Coming out soon probably. In october. And then another one later on in december, i believe it would be the saddafi. Trial or merc, so we have we have a bunch of of, um. Of candidates. Going i would believe. That given the rate of infection. That we have in the united states. And the. Fact that these trials. Have a lot of number of people i mean modena, is. Sixty, thousand, excuse, me thirty thousand. Uh. The fisa, has gone up to forty four thousand. And the onsen is going to be sixty, thousand it's a lot of people in the trial. Placebo-controlled. Trials. That hopefully, we will get an answer. In november, or december, by the end of the year there's no guarantee. That you'll have a safe and effective. Vaccine, i'm cautiously, optimistic, as i told you multiple times. That given. What we've seen in animal, studies. With these candidates, as well as. What we've seen in the, induction, of immunity, in the phase 1 and phase 2 trials. That, this vaccine, or these vaccines. Induce. A level of neutralizing. Anybody, which is comparable, to. If not even better than what you see in convalescent, plasma. That is always a good indicator. That the vaccine, would likely, be able to protect, it's not a guarantee.
But It's a good indicator. So you put the timing of the trials. The number of infections. That we've seen. Now, 30 000 infections, 40 000 infections, a day. I believe we'll have an answer. By november, or december, and possibly, how it even earlier i mean if you happen to have. A bunch of infections. That occur within the sites. That are, enrolling, patients. Then you might get an answer earlier, my prediction, would be safely speaking november, and december, but i wouldn't be. Overly, surprised. If you had an answer a little bit before then. Tony is there enough known yet from natural, infection, to have any sense of how long immunity, will last with a successful. Vaccine. The answer is. No. And the reason. Is. That, it depends. On. What the immunity. Durability. Is depending, upon. If you get infected, and the virus stays in your upper. Airway. We know that when you have coronavirus. Common cold infection. That the durability. Of immunity. Is measured, in months, a year at the most not very much longer and that's the reason why. You get repeated, infections. With the same. Common, cold. Coronavirus. Over the years. If you get infected. And you have systemic, disease. Of people who get lung disease and gi, disease and other disease. It is conceivable. That you would induce an immune response that has a much greater degree of durability. Because you're stimulating, the systemic, response, in addition. To, the upper airway, the bottom, line how we've got to be, humble and modest that we don't know the answers to these things. We would hope. That if you give a prime, and a boost. In some vaccines. And the anson one is just the prime. Right that would induce. Enough of a response. That it would be durable, enough for at least, a year or more. And if it turns out you need to get a boost. Subsequently. That's fine. But what i'd like to see at least enough. Efficacy, of a high enough percentage. To get us through at least a full cycle in a cycle and a half i'd be satisfied. I'd like to see it for multiple, years, but we don't know that right now so we shouldn't be, guessing, because then someone will take that guess, and that would be dogma, and we don't want to do that. Tony will we reach a point do you think where there, will be competitive, vaccines, out there and someone will have received vaccine, a and then. They, should continue with vaccine, a or can they switch to vaccine, b or is that all, theoretical, at the moment. It's theoretical. But i do wish. That we have enough vaccines. That we would have that kind of competition. That's the kind of thing, you wish for to have enough, successful, vaccines, i might say. A point that i think is worth making. That there may be different vaccines, for different situations. Let me give you an example, all right. The cold chain requirements. For different vaccines. Might dictate. Where, globally, you might want to use them. Because there are some of the candidates. That have much more stringent, cold chain requirements. Than do others, that's one potential, difference. You might find. When you do a clinical, trial. That you maybe have three or four vaccines. That are, effective. But you may find one. That does better in an older population. Than another. And it could be that you would recommend. That if you're an older person you get this vaccine, versus, that. I mean that's something we, wish for, namely, that we have enough vaccines. That you could tailor. The better one for in each individual, group. Tony are you, comfortable, that we've we've settled on the appropriate, approach to vaccine, approval. Through the fda, they're the world's experts. Um. It's a legendary. Group of individuals, led by peter marx and colleagues. Are you comfortable. Are you. Comfortable, that we, we've set up a system, of, fda. Look at the data but with checks and balances, by the advisory. Panel, committee, at the fda, and and, the, the advisory, committee on infectious, disease practices. Immunization. Practices, asip. The answer is yes, let me give you some details, about, that. That i think it's worth. Our viewers and our listeners, hearing, if they don't already know it.
That The big elephant, in the room. Is is somebody going to try and make a political, end run to interfere with the process let's call it wait it is because everybody, talks about that right so thank you. It's the elephant, in the room. So. If you look at the standard, process. Of how these things work. I think you could feel comfortable. That it is really unlikely, that that's going to happen and here's the reason why. So each of these vaccines. Has a data and safety monitoring. Board. That's independent. Does it is not beholden. To the company, not beholden. To the administration. Not beholden, to fda, not beholden, to me, to nobody. What they do. Is that they are the ones that get the data. They have. Scientists. Clinicians, vaccinologists. Ethicists. And statisticians. And they. At predetermined. Times. Look at the data. Nobody, else has access to that data. So they look at the data and the only one that sees the data. Because you can see a lot of infections. But since it's double blind. Placebo-controlled. Nobody, knows, you may know how many infections there are but you don't know who's getting infected. Right so the unblinded. Statistician. Looks at the data. Intermittently. And that's independent. Of everybody. And there are a few, possibilities. They could say. You're not going to get an answer this is futile so forget the trial. That's not going to happen that's unusual. The other one would be we're looking at the data. And, keep going with the trial we don't have enough data to go one way or the other. Or they can look at the data and say. You know you got a problem here because there are more infections. In. The vaccine. Than in the placebo. So, you may be having enhancement. Stop. Or. Looking at it and say, you know you've reached. The predetermined. Endpoint, of efficacy. At that point. They let the company, know. Then the company. Makes the decision, of applying. To the fda. To either get an eua, an emergency, use authorization. Or if they feel the data is strong enough they go right for a bla, or a biological. Response, a biological, license, application. So remember. That step. Is done by an independent. Group, so now it's in the hands of the fda. So that gets to your question. The fda. Will look at those data, and i trust the career scientist, of the nih, and i trust. The commissioner, excuse me i say, in nh i'm in fda, i'm sorry. Trust. The career scientist, of fda. And i certainly, trust the commissioner. Of fda. Having said that. The commissioner, and the fda. Then discusses, the data. With their own advisory. Group the verpac. Group. Who are another independent. Group that are advisory. To. The fda, and the fda commissioner. When that happens. Those data, become. Public. So that the scientific. Community. Will be looking at the data, so when a decision, is made. To, approve, or not a vaccine. To do an eua, or not. That's going to be, public. So. Any kind of, hanky-panky. There that people are worried about. Is going to be, multiple, checkpoints. You start off with the data and safety monitoring, board. You then go to the fda. Who we trust. Then you go. To the advisory. Committee. To the fda. And then you have, the scientific, community, looking at the data. So i would you know you got to reassure, people who have, concern, and skepticism. There that these are. Professionals. At the fda. That have been doing this their entire. Career. They really know what they're doing this is what they do, every single day. Tony, um. You know. So much noise about, anti-vaccineers. People who are vaccine, hesitant. How do you think the scientific, community, needs to approach.
Individuals. And families. You know i'm a pediatrician. So. You know. Immunizations. Have been a large part of my uh. Clinical, career. You're an infectious, disease, expert, they certainly, have played a prominent role in in your career. But over the last couple years it's become more difficult, not just in the united states around the world. How do you think we get back to, a sense of trust about vaccines. Yeah it's got to be transparency. Howard. Just what i said, about, the process. And that's why i wanted to take a minute. To, explain, that. The process, of the dsmb, the process of the fda, the process of their advisory, committee. Be transparent. Let people know. What the process, is, but you've got to reach, out to them. You've got to be transparent. Consistent, in your message. And you've got to reach out to the community. The community, in general. But maybe specifically. The minority, community. Who have an extra, special, skepticism. About things involving. The government because of the history. Of how in, decades, and decades, ago they've been mistreated, that history. Is not forgotten. So you got to move, a proactive. Effort. To get out and engage, the community. And you do that. By getting trusted, community, people. To interact. And talk to them about the importance, of getting vaccinated. Uh. Many questions, so i'll just uh. Throw out a few, uh. Mutation, of the virus, concern, about whether or not that will affect, uh vaccine, efficacy. You know. Size coronavirus. 2 is an rna. Virus. And we know that rna viruses. Mutate. I mean we've known that forever. Most. Overwhelming. Majority. Of the mutations. Are without any functional. Significance. Every once in a while, you get one, that is. The one that recently, came out. In a paper. We knew about it for a while because this information, anti-dated. The paper. Was, the vex was a mutation. In amino, acid 614. Of, the spike protein. And. That, is. The part of the virus that binds, to the ace2, receptor. And in in vitro, studies, and other studies. It looks like that binds more readily to the receptor. Uh which would suggest. That perhaps. That this means that it's more transmissible. Doesn't say much about. Virulence, but more transmissible. The discovery. Of the dominance. Of that. Mutated, virus, coincides. With big spikes. That we've seen in this country. So you can interpret. That it becomes more transmissible, and the spike is due to the mutation. Or. You can say. That, the virus that spread, so rapidly. Was a virus that led to this mutation, that was going to spread, more rapidly, anyway. But you got to keep in mind. That. There is a possibility. That there will be mutations, that might. Have a functional significance, if you look. At, the binding, site the receptor, binding, site. Of the spike protein, that's going to bind to the ac2, receptor. The mutation. In fact. Is such that the antibodies. That are made by the vaccine. Are not going to be impacted. By that particular. Mutation. Thus far, but we keep looking at it you know keep an open mind, go with the science. When you see virus, and viruses, are isolated, and sequenced, all the time. We know now. What a neutralizing. Antibody, is. We know that we have a lot of people that have been vaccinated, thus far tens of thousands, so far already. We're going to get anybody, from them and we're going to be able to see. If the antibody. Is neutralizing. The virus that's circulating. In the population. So. Rather than guess how we're going to know the answer to your question. I asked you i think two visits ago, about aerialization.
Versus, Droplets. It emerged, again over the weekend. For various, reasons. A cdc, report that was then modified, taken down and then. We'll see what the final report, is who's. Making a specific, recommendation. Cdc, has not yet weighed in your sense of aerialization. Versus, droplets, tony. Well, there's no doubt that it's spread through droplets. I believe. Based on some epidemiological. Observations. That i've seen. Together, with now. Getting, more information, from experienced. Aerosol. Physicists. Who are now trying to help us to understand, the bit just what, aerosol. Eyes is you know, the standard thing that you and i learned in medical school it's the particle less than five micro meters. And anything bigger falls to the ground well it's not that simple. When you talk to people. Who study these things as a career. It's not. You put all of these things together. And here's what i can say right now. I believe. That aerosol, transmission. Plays, a. Role. In, indoor, type spread, predominantly. Proportion. And what percent. Of transmissions. Are that way. Whether it's very minor. Moderate. Or whatever. I don't know the answer to that. So i always admit when i don't know the answer i don't know the answer. But from what i see, and what i'm learning about aerosol, and what i see about epidemiological. Situations. I believe there is at least a. Proportion. The extent of which i don't know. Of transfer. Transmission. A virus, by. Classical. Aerosol, meaning. Something. That's in the air. For, more than just, a few seconds before it drops. The one thing you don't want to scare the public when they, hear aerosol. They think it's in the air so therefore, you go outside man it's in the air gonna work no no no you're talking about something, that usually. Indoors. Can hang around a bit longer before it actually. Dissipates. And that's the reason, why. When you look at the recommendations. We make how would we always say. Try to do things. Outdoors. Preferentially. Over indoors. Because, in that case things get dispersed. And diluted. Very very easily, yeah no that i i mean when i've spoken to other folks that's the concern about the fallen part. Influenza. Coming along with covet 19, indoors, not high quality, ventilation. Uh tony uh. So many questions, some just offering. Love and respect. Um. Vaccinations. Of the two ends of the age spectrum. Children. And the elderly. Just questions, about whether or not we'll have enough information, about, vaccination. For either of those two groups. Yeah i think we'll have, uh information, about the elderly, before we have information, about children. Because in several of these trials, elderly, are already, in there, as part of the cohort, that's going to be vaccinated. In the phase 3 study. Traditionally. And. I'm glad i'm talking to a pediatrician. Because. You understand. That very very easily. That, you want to make sure. When you have a vaccine, that has not been used in humans before. That you make sure you have some degree of efficacy. And safety. In a larger trial before you start. Vaccinating. Children, and there's a delicate, balance. That we've had discussions, about this. Verbally. In, editorials. In perspectives. Is that what is the right balance. For, withholding. It from children, because you're concerned, about safety. And that they can't give an informed, consent. Versus. Providing. It in a way. That you're making them wait too long, and we try to do the delicate, balance so that when you get into a study. And you see some degree of safety that's clear, good efficacy. You go back, you do a quick phase one in the kids and then you bridge.
It, To, the bigger study, bottom line, elderly, will likely. Be getting it more, before the children, do, i mean in this case we're. We're fortunate, in the sense that we do know that children get diseased how much they transmitted, has become. Uh complicated. Younger children less so. 12 14 15 year olds look more like young young adults, but we know that the, number of children getting, seriously, ill is limited, so, some regards, that that that, that's helpful that. Says that, right it influences, that decision. Uh tony vaccinating, 20 million people is complicated. Um. You know and uh you know you you can say uh uh. Vaccines, approved. I think mckesson. Is the, distributor. But where it goes how it gets there and, how it's actually delivered, at that interface, between, a, a nurse a nurse's aide. A physician, and a patient is complicated. Um. Your the various committees, you sit on the various groups you consult, to. Are systems, being put in in place is it going to be easier if it's healthcare workers and it goes to hospitals. What's your sense of, kind of what we need to do around distribution. Tony. Well. There are people who are doing nothing. But thinking about that and working, about that i mean, the primary. Uh, um. Vehicle, for that has always been the cdc. In association. With advisory. Committee on immunization. Practices, right now as part of this operation. Warp speed. Program. That as you know. Uh monsef, slawi, is the scientific, lead, right but you also have the logistic, lead, general gustav, perna. Who is one who is an expert. In supply, chain. Distribution. In the military. But he's going to use, some of those. Skills. To help. With what the cdc's, primary responsibility. Is. In essentially. Using the recommendations. From the advisory, committee as well as the national academy of medicine has weighed in on that, to get the distribution. To people in a priority. Way, the final decision. Hasn't been made. So. What will happen. Is that, if you look at the calendar, of the totality. Of all of the vaccine, doses. That will be produced. Not from one company, but from all, six of the companies. That the federal government, has made, significant. Financial. Investment. That will be a total of about, 700. Million, doses. That we will have by april. Of 2021. We will be have substantial, doses tens of millions and maybe even 100 million by, december. And then as you get into january. It incrementally. Gets more, and more. The question that i think you're answering, they're asking is is important. There may be doses, available. At a time. But the logistics. Of how it actually, gets, distributed. Not only. The logistics, of the people who want it. But the fact that in our society, it likely. Will be that many people will not want to get the vaccine, right away they'd want to wait to see. What happens with the first 10 20 30 40, 50 million, people. And that may mean that in reality. Even though theoretically. You could vaccinate, everybody. By the end of. Four months in the first quarter of the year. In reality, by the time you get enough people vaccinated. So that you can feel you've had an impact. Enough, on the outbreak. So that you can start thinking. About maybe getting a little bit more towards normality. That very likely as i and others have said would be maybe the, third, quarter or so of 2021. Maybe even into the fourth quarter, but the availability. And starting, vaccination. Could very likely start. In november, or december. I was speaking to someone earlier today it's interesting because of healthcare workers are a priority, and i think most of the groups have weighed in and said they. Will be a priority. There at least a distribution, just needs to go to hospitals. Who are very used to vaccinating. Their their staff. I'm a little worried about. Skilled nursing homes and nursing. Facilities. But if the first shipment goes to hospitals, i think hospitals, will have the capacity. To distribute, it to health care workers, who work at those places. That, that will be easier, than for example the frail elderly, who's at home. Or low-income. Families, where where where will those individuals, get access, so. If indeed health care workers are a priority, and i think the estimate, is. Maybe. You probably know what the estimated, i think it's 20 million for health care workers i could be off.
There I think the the first wave of distribution. Will work it's after that work could be a struggle. Yeah and that's something that they're working out right now i mean they are clearly, aware, of exactly. What you're talking about and what the challenge will be. I don't want to keep you too much longer tony but there are a lot of questions, but um. But a slightly different question, um. You've done science, for a long time tony. You're one of the leading scientists. In america. And around the world. Did you and you wrote a viewpoint, for us two years ago i remember about, um, the movement of vaccines. From. From, phase one to people. And you you, have a chart in that viewpoint, about how the time has collapsed. It's, it was pre-estimed. Did you did you, did you ever think. In your lifetime. You would see this, extraordinary. Science, around vaccine, development. You know i was hoping, for it but now. Despite, the pain, and. And angst we go through because we're dealing with a historically. Difficult. If not, you know unprecedented. Epidemic, in the pandemic, in the last, 102. Years. Um. The fact that we're doing these things. Is a wonder to behold. I mean, the idea that you get a sequence. On january. 10th you start developing, a vaccine, you're in phase one. Two and a half months later. And then six to seven months, later, you're in phase three. And it's like. Wow. How did that happen. And it happened because of scientific. Advances. Of platform, technologies. A prototype, pathogen, understanding. That's how it happened. Now tony you you have two loves of your life. The gnats and the yankees. Then that's not so good, the yankees, doing better, so. Uh what's the story on your two baseball, teams. Well, you know i'm still, savoring. Fruits. Of last year's world series champions, so, i still love my gnats, you know, i hawk back to my childhood. When i love. The yankees, but that was you know, with mickey mantle yogi berra phil rizzuto, and those guys, they're not around anymore, so, i think i'll stick with my gnats. Uh this is howard bochner, editor-in-chief. Of john it's been conversations. With dr bachner, my guest has been, a colleague, and a friend, uh. As described, by some of the people. Tony fauci a national, treasurer. Director, of the national institute, of allergy and infectious, diseases. Tony, uh thank you and more than anything, please stay healthy. The united states needs, people like you. Thank you very much howard, as always it's a great pleasure to be with you and i look forward to doing it again. Be well tony take care. Take care of yourself take care. Bye. You.