Dr. Fauci Prepares for His Next Steps; Offers Leadership Lessons to Younger Generation

Dr. Anthony Fauci

Marianne O’Hare: Welcome to Conversations on Health Care with Mark Masselli and
Margaret Flinter . This week , we welcome Dr. Anthony Fauci back to
the show, talking about concerning new variants , a fall winter surge
expected , and his own plans for life afte r the National Institutes of
Health.

Dr. Anthony Fauci : I'm not negotiating any position until after I leave the government so
that there i s no question of any conflict of interest.

Marianne O’Hare: We hear from FactCheck.org’s Managing Editor Lori Roberts on , then
we end with a bright idea. Now , here are your hosts, Mark Mas s elli
and Margaret Flinter .

[Music]

Mark Masselli: He has been called ‘ America's doctor ’ , and after almost 40 years he's
stepping down as the top infectious disease adviser in the United
State s. His work has spanned from the AIDS epidemic to the COVID
pandemic.

Margaret Flinter: And we , of course, are talking about Dr. Anthony Fauci, and as you've
heard, Dr. Fauci has decided to leave his post at the end of the year as
Director of the Nat ional I nstitute of Allergy and Infectious Diseases ,
and as the Chief Medical Adviser to President Biden. We'll be asking
him to reflect on his incredible career in a bit, but we're going to start
by asking some questions about the latest on COVID.

Mark Mas selli: W ell, Dr. Fauci, w elcome back to Conversations on Health Care .

Dr. Anthony Fauci: Thank you so much. It's good to be with you again.

Mark Masselli: Yeah . And you know, we know this is your fifth appearance with us
since the pandemic began. And as yo u m ay know, our listeners are
from Federally Qualified Health Centers , free clinics , safety net
h ospitals , all across the country, and so appreciate the opportunity to
hear from you. We know one of the things that you , I think, reminded
us early on in our conversations , was that the Coronavirus mutates .
And we know you're closely tracking the wide range of what are called
Omicron variants, or sub - lineages, including BQ .1 and BQ . 1.1 and
even XBB . That's an alphabet soup. Yet , the current 21 - day moving
averag e of new deaths seems to have decreased significantly
compared with the previous average. Can you tell us where we are at
this point?

Dr. Anthony Fauci: Well, we're really at a point that may be a crossroads here , because
we're entering , as we all know , in to th e much cooler weeks and
months of the late fall and early winter . The numbers are down ,
clearly the number of cases per day , even though the actual numbers
are very likely an undercount. But nonetheless, the trend is down . The
number of deaths are dow n, but not as much as we'd like to see .

Dr. Anthony Fauci

We're still hovering around 350 to 400 deaths. But when you compare
it , to where we were several months ago, when we had hundreds of
thousands of new cases, and there was one period when we were up
to 80 0 ,000 and 900 ,000 cases a day, and 3 , 000 to 4 , 000 deaths per
day , w e're doi ng much, much better than that. Now , however, as
we're entering into the cooler months, we are starting to see the
emergence of sub - lineage variants of Omicron, the ones that you
mentioned corre ctly, B Q.1 , BQ . 1.1 , XBB and others , as well as BA.4.6.

The problem with these is that even though they are sub - lineages,
and likely would be covered by either prior infection, immunity, or
immunity induced by the BA.5 bivalent , nonetheless some of those
v ariants will esc ape the protection from monoclonal antibodies like
Evusheld , which is a very important tool in pre - exposure prophylaxis
for people who are severely immunocompromised , such as transplant
patients , and people on cancer chemotherapy. So that's the thing
that' s of concern to us is that some of our tools in our
armamentarium may be negated if in fact these newer variants
become much more dominant than they are.

Margaret Flinter: Dr. Fauci, it's hard for me to believe that we're going into our thi rd fall
and win ter season with the COVID virus being of such concern. But we
also go into the season as we do every fall, looking at flu , and this year
also what appears to be an increase in RSV virus. And this year, I think
we don't have the protective me chanism that we had in the last two
years of pretty widespread masking, which seemed to have blunted
some of the flu epidemic at least last year that we predicted. What's
the latest on this situation? Are you anticipating a worse than usual
flu season in t e rms of morbidity and mortality?

Dr. Anthony Fauci: Well, flu is one of the more unpredictable viruses that we have.
However, if you look at history, history tells us just what you are
suggesting. Australia had a relatively more severe and early flu
season , and we often fol low what happens in Australia with regard to
influenza. So we should be expecting that we are going to have a
moderate at best and a severe at worst flu season. Also, as you
mentioned correctly, we're starting to see a significant uptick in cases
of Respir atory Syncytial Virus . So it really is almost a negative trifecta .
We're going into the fall, we have new variants, and cooler weather ,
always is threatening when it comes to COVID. We've been through ,
as you mentioned now, the third time we've been through this .
Influenza plus RSV , it's going to be very confounding and might even
stress the hospital system , particularly for the pediatric population .
And that's one of the reasons why we say over and over again, now is
the time to get your updated BA.5 variant for COVID as well as your
flu shot. We don't have a vaccination for RSV, but we do have
vaccines for flu and for COVID. So we need to utilize the
countermeasures that we have available to us.

Dr. Anthony Fauci

Mark Masselli: You know, a s you indicated, we're moving int o that cooler season ,
and obviously this is a time where people are traveling, visiting
families , celebrating together. I'm not sure people are completely
listening, but we hope they are , and it sounds like the vaccination
strategy is somet hing that we should lead with. But what other advice
would you have to people and precautions that they should take?
Have you seen any of these messages working effectively ? I'm sure
you're a connoisseur o f what's resonating with the public.

Dr. Anthony Fa uci: Yeah. Well, we're really challenged right now , because as we all know,
people are fatigued with COVID, fatigued with any kind of restrictions.
We're not talking about restrictions now . We're talking about
common sense public health practices. So , what can we recommend in
ad dition to the vaccines that we've just discussed? First of all, you're
right, people are much, much less utilizing mask wearing. But as you
get into the winter months, remember the reason why we had such a
decrease in influenza and ot her respiratory diseas es because people
were wearing masks in indoor congregate settings . Even though
COVID is at a lower level than it was like a year ago , n onetheless
particularly if you are a vulnerable person yourself, elderly , or an
underlying conditi on, or you have in you r own household people that
you really don't want to bring infection home to them, then you
should consider when you are in an indoor congregate setting,
wearing a mask. I'm not talking about mandating anything because
once you say th at , it's radioactive fo r people. So , we're talking about
common sense public health practices.

The other thing that we should utilize and not forget that we have
these tools , is that we have these r apid 10 - minute tests that if you are
going to be in a situ ation where you're havin g people over your
house , or at a social setting, and you have vulnerable people that are
in your family, or that you don't want to spread infection to , then
utilize testing . We see that now when there are social functions ,
where th e requirement for entering is showing that you had a
negative test that day , t hat is a very good way of making sure you
don't spread infection. So , utilization of tests, wearing masks where
appropriate , and getting vaccinated , t hose are three very importan t
tools we have in our armame ntarium .

Margaret Flinter: Well, I think most of us have added a new tradition to Thanksgiving
d inner called do your test before you walk in the front door , and it's a
very helpful tool to have. But Dr. Fauci, as you know, your words, the
terms that you u se as such a national public health leader , are very
closely followed. So we'd like to ask you, would you say that we're still
experiencing a pandemic , o r are we out of that phase now? And I ask
that in part because there's this question whether the Biden
A dministration will or should extend the COVID - 19 Public Health
Emergency , which of course has expanded access to care for people

Dr. Anthony Fauci

who are ill with COVID because of the continuation of Medicaid
benefits for longer periods, and al so increased the access to
te lehealth for both Medicare and Medicaid.

Dr. Anthony Fauci: That decision is going to be made by the Secretary of Health and
Human Services , Secretary Becerra . But when you ask about
terminology, which sometimes can get caught up in semantics, are we
in th e very fulminant stage of the pandemic where we were having
800 , 000 - 900, 000 cases and 3,000 to 4 , 000 deaths , t he answer is
obviously no . The numbers tell you that. However, when you talk
about do we still have widespread infect ion throughout the world,
inc luding in this country, with 400 deaths per day , y es, of course .
We're still in the middle of this . It is not over . And I believe , and many
of my colleagues , that if we are going to accept endemicity, the word
that people use , or living with the virus, we wan t to get it much lower
than it is right now. 400 deaths per day is not an acceptable level that
I believe we should accept and say, “ Okay, that's not okay . We've got
to get it much lower than that. ”

Mark Masselli: And I want to talk a little bit about economics. As you know,
community health centers care for about 30 million patients, and 90%
of them are living at 200% of poverty and below . And , as we've noted,
Americans are not really rushing to receive the fall COVID b ooste r ,
and now there's news that Pfizer say s the vaccine list price could be
$130 per dose , and Moderna at 60 once their government contract
ends . N ow ultimately experts believe most Americans will pay nothing
out of pocket, but others say this commercializati on will create access
barriers for vacc ines and tests and therapeutics. What's your feeling
about all of this?

Dr. Anthony Fauci: Mark , I don't want to o pine on that because that's not my lane,
economics and healthcare delivery. I'm a researcher and a publ ic
health person. So if I make a stateme nt of that, you'll guarantee those
who like to distort things, will certainly take that out of context. So I'm
going to punt on this one.

Margaret Flinter: Okay . Well , Dr. Fauci, you may punt on this one too , and tha t is
entirely your prerogative. But agai n, as a community health center,
this one is of real interest to us , and we looked at POLITICO ’ s analysis
of how each state performed during COVID in four categories. One
was health and health outcomes. But the other was the economy,
social wellbeing, and e ducation , obviously all big pieces of the social
determinants of health that we’re so concerned about. Minnesota
performed evenly across the board, and its governor said that they
wanted to look at all of the conseq uences, not just the health
outcomes bu t the social implications i n the economy. As we go
forward with, you know, more epidemics and pandemics no doubt in
our future , do you think that that's a fair and useful way of looking at

Dr. Anthony Fauci

impact and judging decisions and options?

Dr. Anthony Fauci: Ye ah . I mean you don't want any one factor to just be the dominant
one , and it has to be a balance . You have to be concerned about
optimally protecting the people by public health measures, like we
had to do in the very acu te stage of the outbreak. But you also have
to consider other aspects , impact on the economy , as well as impact
on the health and wellbeing of people outside of the realm of getting
infected, the negative impact for example of restrictions, particularly
ch ildren, which is why I have alw ays been saying despite people
distorting that, I have always said we need to do whatever we can to
safely keep children in school . And you do that by making sure they're
surrounded by people who are vaccinated, that you have good
ventilation, that you ha ve other things that can safeguard the health
of children while keeping them in school because we know of the
negative consequences of prolonged periods of time keeping children
out of school.

Mark Masselli: Well, I'm going to move my question back to a new lane about the
public health sector . Your service with the Federal government over
the decades has coincided with deadly viruses that have taken really
an incredible toll on our country and the world , HIV, Ebola , and now
COV ID. How can we , in public health , get more ahead of these
threats , a nd what kind of additional support does the public health
sector need? Are we ready for the next pandemic that is probably
around the corner?

Dr. Anthony Fauci: Well, you know, Mark, what I do, and I believe it can clarify some
people, there are separate buckets as it were of preparation for
pandemic and response to pandemic. One is the purely scientific, and
the other is the public health including public health infrastructure.
Historicall y, if you look at what the success story of COVID was, it was
the investment made in biomedical research to prepare us to be able
to respond in absolutely unprecedented record time in the
development of a vaccine. That was the scientific prepare dness and
r esponse because of inve stments in biomedical research . We have not
done as well in public health , mainly because we've allowed our
public health infrastructure, particularly at the local level, to
essentially attenuate over years , probably as a result of b eing a victim
of our own success in the prevention of childhood diseases with
vaccinations and antibiotics and antivirals , so that the infrastructure
that is at the core of a good public health response needs to be built
up substantially over the next few years if we really wa nt to respond
from a public health standpoint adequately to the next inevitable
outbreak, whenever that might be.

Margaret Flinter: Dr. Fauci, among your many and legendary contributions, I think that
your service to the country as a m entor, and somebody who has, I

Dr. Anthony Fauci

think, been developing leaders who will serve us for decades to come,
are among your most prominent . You've served seven Presidents .
You've had this incredibly long tenure as a Federal scientist . What's
your biggest lesson to share in terms of l eadership that you've passed
on to your mentees?

Dr. Anthony Fauci: Well, you know, leadership, there are many aspects of leadership . The
ones that I tend to pass on to the people that I had the privilege of
training , is one, maintain y our highest level of integrity and principles,
lead by example . And that's the point . I mean, a leader that leads
from behind is not a leader. By definition, it would be an oxymoron.
What you have to do is lead by showing that you are willing , able ,
capabl e of doing the things you're asking people to do . Be crystal clear
in what your mandate is . One of the failings of some leaders is that
those who they are supposedly leading , are not really quite sure
where the leader is taking them . You've got to be very, very clear t his
is o ur goal , and this is how we get there. Get good people, and let
them loose . Don't micromanage. But make sure the direction is clear
so that everybody is pulling in the same direction.

Mark Masselli: Well, you're at this inflection poin t in your career, and you've been
careful not to call your departure ‘ retirement ’ . I'm wondering if
there's anything more you can share about what you'll do next . I
not ed that you are also somebody who studies history and
appreciates it. You talked a littl e bit about what wa s just recently
happening in Australia. But I think a lot of people are wondering
whether or not we're going to see some writing as you are taking the
next step in your career. What can you share with us about the next
chapter?

Dr. Antho ny Fauci: Well, I can't because I don't know what my base will be , where I will
be. I mean I will be in Washington DC, everybody, that's for sure . That
I can tell you for sure that I will be in Washington DC. Because I want
to be very strict, and go accord ing to the ethical rule s , I am not
negotiating any position right now until after I leave the government
so that there i s no question of any conflict of interest. But I can tell
you broadly, and you were hinting at it, Mark , is that I want to utilize
the 5 4 years of experience I have at the NIH, 38 of which is as
director , and my experience with seven Presidents , to use that by
writing , by lecturing , by getting involved in advisory capacity to inspire
particularly the younger generation to get involved in s cience and
medicine, publ ic health, and particularly, to seriously consider public
service. I will do that perhaps writing a memoir. I mean I can't say for
sure. But that's one thing that I might do because people might be
interested, particularly the youn ger people , of what the differen t
milestones in a person's career . Because I know when I was a very
young investigator, I would look to people who've accomplished a
certain amount , and want to know what ’ s the story behind how they

Dr. Anthony Fauci

got there , as a guiding p ost for younger people. So I think th ere'll be
plenty of opportunity for me to do that , and I look forward to it.

Mark Masselli: Wonderful.

Margaret Flinter: Dr. Fauci , our familiarity with you, if not your familiarity with us, goes
back a long time , and t o the early days of the HIV epidemic . And
you've been just so incredibly effective and powerful in helping to
move, move us closer to the end of the HIV epidemic. But I know you
have had a longtime goal of seeing us have an HIV vaccine. What does
the futur e look like on that front?

Dr. Anthony Fauci: Well, it's very clear that it is a very formidable scientific challenge, for
reasons that HIV is so different fundamentally from any of the virus
we've had to deal with because of its ability to integrate itsel f into the
genome of a cell , and once you get that initial infection, which other
vaccines can essentially eliminate so that you don't get disease, that's
not the case with HIV. You have to do better than natural infection ,
because natural infection does n ot give you an immunity to prevent
you from r e infection , or even to clear the virus from the body. So , I
don't want to give a pessimistic view, but I can say for sure, because
I've been working on it now for over 30 years, it is a formidable
scientific cha llenge that we may not ever be entirely succe ssful with.
We've done extraordinarily well in the development of drugs not only
to treat infection with HIV, but as pre - exposure prophylaxis to prevent
infection with HIV. Hopefully, some time , and I hope I'm a round to
see that , we will get a safe and effec tive vaccine. But again, it is really
one of the most difficult scientific challenges we've ever faced.

Mark Masselli: Well, thank you Dr. Fauci for always putting science first and leading
us with expert guid ance throughout this pandemic. We look forward
to staying in touch with you about all the activities in your future . And
thank you to our audience for being here. You can learn more about
Conversations o n Health Care and sign up for our email updates at
www.chcra dio.com . Thank you again Dr. Fauci for all the time —

Dr. Anthony Fauci: G oo d to be with you.

Margaret Flinter: Thank you Dr. Fauci.

Dr. Anthony Fauci: Yeah, my pleasure. Good to be with you all. Thank you so m uch.

Margaret Flinter: Best wishes.

[Music]

Mark Masselli: At Conversa tions on Health Care, we want our audience to be truly in
the know when it comes to the facts about health care reform and
policy. Lori Robertson is an award - winning journalist and Manag ing
Editor of FactCheck.org , a nonpartisan, nonprofit consumer advocat e

Dr. Anthony Fauci

for voters that aim to reduce the level of deception in U . S . politics.
Lori, what have you got for us this week?

Lori Robertson: Vaccination requirements for children attending school are set by
state or local officials not the Centers for Disease C ontrol and
Prevention , or the Federal Government . But several social media
posts claimed otherwise days before a CDC Vaccine Advisory
Committee m eeting in October. For example, Fox News host Tucker
Carlson tweeted, “ The CDC is about to add the COVID vaccin e to the
childhood immunization schedule, which would make the vaccine
mandatory for kids to attend school. ” The false claim soon went viral.
Lindsay Wiley, a Law Professor and Faculty Direct or of the Health Law
and Policy Program at UCLA told us that the process for adding a
vaccine to school requirements varies by state, but it typically involves
the state health and / or education departments who are given that
authority from the state legisl ature. In some states, local districts also
can add a vaccine to school requirements. The CDC Advisory
Committee on Immunization Practices held two votes, one on
whether to add COVID - 19 vaccines to the Vaccines for Children
Program , which has nothing to do with school immunization
requirements. Instead, the program pro vides free vaccines to kids
who have little to no insurance coverage. The other vote was on
whether to add COVID - 19 vaccines to the CDC’ s childhood
immunization schedule . That schedule doesn't require states to do
anything. Instead, it's primarily meant to inform pediatricians about
which vaccines the CDC recommends and when th ey should be given
to children.

Ohio Department of Health Director Bruce Vanderhoff told us that the
CDC adding the CO VID - 19 vaccine to its schedule, “ does not mandate
this vaccine f or school children. ” Instead, he said in a statement,
“ Ohio law determines required vaccines for school attendance. ”
Similarly, a spokeswoman for the Vermont Department of Health told
us that under Vermont law, a state convened advisory committee
considers the CDC ’ s recommendations, “ but is not bound by them. ” In
fact, neither of those states requires several of the vaccinations listed
on the CDC Childhood Vaccination Schedule , including HPV va ccine
and the annual flu shot. Wiley told us that the CDC s ched ule can have
a lot of influence on state decisions, and in some states, a vaccine
must be on the CDC’s list in order to be considered for school entry
requirements. But the decision is still up to the states. The CDC ’ s
Advisory Committee did vote unanimously to add information on the
COVID - 19 vaccines to the CDC Childhood Schedule . And that's my fact
c heck for this week. I'm Lori Robertson, Managing Editor of
Fact C heck .org.

Margaret Flinter: Fac tCheck.org is committed to factual accuracy from the country’s
maj or political players , and is a project of the Annenberg Public Policy

Dr. Anthony Fauci

Center at the University of Pennsylvania. If you have a fact that you’d
like check ed , email us at www.chc radio.com . We’ll have
FactCheck.org’s Lori Robertson check it out for you here on
Conversations on Health Care.

[Music]

Margaret Flinter: Each week , Conversations highlights a bright idea about how to make
wellness a part of our co mmunities and everyday lives. Access to
mental health care remains o ne of the great unmet health needs
around the world , b ut the problem is particularly acute in Sub -
Saharan Africa. In Nigeria, for example, there's roughly one
psychiatrist for every five m illion residents. Yale School of Medicine
Psychiatry Professor Theddeus Iheanacho , a Nigerian native , says
there are many reasons . Only 1% of the nation's health budget is
actually dedicated to mental health services , b ut also, there's a deep
cultural stig ma against acknowledging mental health disorders in
many African count ries. He and his team at Yale developed the
HAPPINESS Project. It stands for Health Action for Psychiatric
Problems in Nigeria, including Epilepsy and Substances . It's a research
initiat ive , aimed at increasing access to mental health services by
leveraging the power of local primary care clinicians and community
health workers who are already provid ing care in trusted community
settings.

Theddeus Iheanacho : So our goal is really to train primary care people to treat mental
health in communities. So the prim ary thing we're doing is train m ain
community health workers, primary health care doctors , and primary
health care nurses to address mental health issues in the ir community
and primary care centers.

Margaret Flinter: Dr. Iheanacho says their second goal was to provide a digital and
telehealth component, allowing the primary care clinicians, nurses
and patients to gain access to specialist s when needed for more
pressing diagnoses.

Theddeu s Iheanacho : The second goal is to utilize telemedicine , mobile technology a nd
telemedicine to connect these primary care center to specialists both
in Nigeria and --

Margaret Flinter: This eliminates a significant barrier for patients in n eed . A four to si x
hour journey by road just to see a mental health specialist , that is an
imp ossible trip for most in the region. The HAPPINESS Project has also
launched a public awareness campaign to help destigmatize mental
health care . The HAPPINESS Project, leveraging the power of the
existing primary care infrastructure, and powering doctors, nurses,
community health workers and patients with the proper training tools
and support to access these necessary interventions, eliminating the
challenges of travel and distanc e and lack of clinicians , all to help

Dr. Anthony Fauci
address a long unmet health need , n ow th at's a bright idea.
[Music]
Mark Masselli: I'm Mark Masselli.
Margaret Flinter: And I'm Margaret Flinter.
Mark Masselli: Peace and h ealth .
[Music]
Marianne O’Hare: Conversations on Health Care is recorded in the Knowledge &
Technology Center Studios in Middletown, Connecticut, and is
brought to you by the Community Health Center , now celebrating 50
years of providing quality care to the underserved where healthcare is
a right not a privilege , www.chc1.com and www.chcradio.com .
[Music]