A future pandemic is ‘almost guaranteed,’ Fauci says

Dr. Anthony Fauci: It’s a mixed bag globally. For the most part, developed nations like the United States and the UK are progressively doing better and better. But as you alluded to, there are other countries that are in very difficult straits, including India, a large country of about 1.4 billion people, where they only have about 2% to 3% of their population that are fully vaccinated, and about 10% to 11% that have received partial vaccinations. So, we have a long way to go. It’s a big planet. There are countries that are very diverse in their resources and their capability of responding to this outbreak. So, we have a long way to go before we get the equity that’s important throughout the world to get this under control from a global standpoint, not just an individual country standpoint.

As long as there’s disease elsewhere in other countries where you have viral dynamics that continue to allow transmission at a high degree in different countries, there’s always, not only the difficult time for the countries in question, but also the generation of variants, which can then come back. And even in a country that has the outbreak under very good control, it can actually set you back if you do get a variant that’s not really covered very well by a vaccine. Thank goodness for us, and we’re very fortunate in that the vaccines that we are now distributing in the United States and in the UK and in other developed nations, handle the variants really quite well. For example, the B.1.1.7, which is dominant in the United States right now, is handled very well by the antibodies that are induced by the vaccines that we use. But that’s not a guarantee that all the variants that might potentially arise are going to be handled as well.

That is true.

That’s true.

Well, we’re doing a lot. There’s always [more that can be done]. We would like to see other countries chipping in. As you know, we are part of the COVAX consortium. We have either given or promised $4 billion. We’ve given to India a considerable amount of supplies in the form of oxygen, oxygen generators, PPEs, antiviral drugs, sending advisers from the CDC to India. We are going to be giving, by the end of June, the beginning of July, a total of 80 million doses. Obviously, there are other ways of getting even more done. And that is by discussing with and partnering with the pharmaceutical companies to see if we can get them to scale up their manufacturing so that they could supply billions of doses to the rest of the world, particularly those countries that don’t have the resources to do so. But also, to get involved in what’s called transfer of technology to allow the developing world, certain countries such as those in Africa, South America or in certain countries in Asia, to be able to produce vaccines that are made by the larger pharmaceutical companies that have already developed successful vaccines. So there [are] a lot of ways to approach this, and we certainly feel a commitment to help out on the global problem.

Discussions are certainly going on, as a matter of fact, and that’s the whole purpose of it. To see if we can really scale up the manufacture of enough doses to the tunes of several billions of doses. We know from the pharmaceutical companies, Moderna and Pfizer, that have already said that they’d be able to do that in at least a couple of years to get up to a few billion doses. That’s a very good start, together with all the other things that we’re talking about.

Theoretically, it could. But we are really quite fortunate in that the vaccines that we’ve used, particularly the mRNA vaccines, but also the [Johnson & Johnson] vaccine, are really good enough that they seem to cover the variants really quite well. If not for actual infection, certainly for the prevention of severe disease. So, although theoretically, it could always be a case where you get a really problematic variant, but thank goodness, thus far, that has not happened.

Well, the easiest way to relax is to stop the virus from replicating. There’s a very firm tenet in virology that viruses don’t mutate unless they’re allowed to replicate. So, if you can suppress, to a great degree, the virus replication throughout the planet, you would give the virus a very, very small chance of mutating, and within that scope, an even smaller chance of mutating to a variant that’s problematic.

That’s exactly my point.

Well, I’d like to see the details of it. I mean, I’m not sure exactly what they’re talking about, an international pandemic treaty. You’re saying that the United States and Russia do not want to be part of it. I’d like to see what’s in that and why we don’t want to, before I would comment on it.

We have a plan that’s in place and we’re fine tuning that plan, literally in real-time, as we go on, because even though we’re still in the midst of fighting this pandemic, we’re acutely aware that this may not be the last one we see. In fact, it’s almost guaranteed. We can’t say when, whether it’ll be a year from now or 50 years from now or 100 years from now. So, you’ve got to be prepared, even though you do not know when the next one will occur.

One of the things is to do what’s called a prototype pathogen approach, where you pick out 10-20 families of pathogens that likely would be within the scope of where a pandemic would arise. And you start doing things in preparation by looking at developing vaccine platforms that would be suited to those families, making a pilot lot of a vaccine that could be universal. For example, we’re working on a universal corona vaccine, namely a vaccine that would protect against all coronaviruses, because we’ve already had three pandemics of coronaviruses since 2002, starting with SARS, then MERS, and now SARS-CoV-2. We want to do that with other families of pathogens that might have the potential of breaking out into a pandemic. So, that’s something that’s going to cost a considerable amount of money. But we’ve already started in the planning process for that.

You know, you can’t answer a yes or no to that. It’s going to depend on what country you’re going to and whether or not you’re vaccinated. There’s a lot of negotiation going on right now as we get more and more people vaccinated. Other countries are looking at the possibility of opening up their travel borders to us. And I think as we get into the fall, and into the summer — and [in] the fall more and more people will be vaccinated — you’ll see more and more opening up of travel possibilities. But, I don’t think you can answer yes or no. Is it too early? It depends on a lot of other factors.