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In The '24th Mile' Of A Marathon, Fauci And Collins Reflect On Their Pandemic Year

Mar 9, 2021
Originally published on March 10, 2021 12:37 am

A year ago, everything changed for Americans as a new, highly infectious disease began spreading across the country.

Two scientists, longtime friends and colleagues became two of the most public faces of the U.S. efforts to fight what ultimately became the coronavirus pandemic: Dr. Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases and a member of former President Trump's White House coronavirus task force, and his boss, Dr. Francis Collins, director of the National Institutes of Health.

As they reflect on the past year, they both express surprise, and disappointment, at the unanticipated challenges they faced in getting public health messages out effectively.

"I think one of the diagnoses that comes out of this last very difficult 12 months is that we seem to be in a society that is so polarized that even objective truth doesn't necessarily have a chance," Collins tells All Things Considered in a joint interview with Fauci.

"That is a very disturbing aspect of what we've learned over these 12 months. And if our nation has a path forward to get into a better place, it has to take that on, that we have to be a nation that actually values truth and not just opinions," he says. "We didn't do very well with that over this last year."

Fauci, who now serves as President Biden's chief medical adviser, notes that the spread of misinformation continues.

"One of the things that I'm stunned by, this idea that some people don't want to get vaccinated because they actually think that Bill Gates and I have put a chip in the vaccine and we want to control their thoughts," he says. "I thought that this was just a few people who felt that. But when you go around in the community of people who are hesitant about that, they read that and astoundingly, they believe it."

As scientists, Fauci says, they never would have anticipated "such an egregious distortion of reality."

"That is very frustrating from a scientific standpoint and becomes extremely problematic when you're trying to implement a public health effort that could be lifesaving," he says. "And when you don't implement it, well, people die. That's serious."

In a wide-ranging joint interview, Fauci and Collins detail the biggest hurdles they faced as they fought the emerging virus, whether his old friend would have fired Fauci and what lies ahead in the pandemic. Here are excerpts, which have been lightly edited for length and clarity.

Was there a low point for each of you as this last year played out?

Dr. Anthony Fauci: The low point for me was the fact that we were trying to deal with a true public health crisis of unprecedented magnitude and impact, and the data were evolving in real time. And as scientists, we had to — I know I had to, I'm certain Francis was in exactly the same boat because we were speaking to each other literally every night during that period of time — whereas the science evolved, you wanted to make recommendations and/or guidelines that reflect the science. When the science changes, in the sense of the data is new data and new information, what you try to do is modify things and be humble enough and flexible enough to be able to give information.

The low point is that when you try to do that, we were doing it in an arena of such divisiveness in society, where anything that was said undertook a political connotation, whether that was avoiding crowded places or wearing masks. And it was extremely frustrating and, quite frankly, painful to try and get a public health message out that would be lifesaving. And yet you see people throughout the country in different areas turning it into more of a divisive ideological cleft between people.

Can you give an example of a message you were trying to get out there, and you could see it was not landing?

Fauci: Here's a typical example that I think most people know about now. We put a lot of effort, when we realized that the economy was in serious trouble, that we had to very carefully open up the economy, open up the country, but we needed to do it very carefully. So Dr. Deborah Birx [the White House coronavirus coordinator] and I and others put together these guidelines, that people had to have an indication that there was a decline in cases before they opened up. We carefully articulated that to the American public.

And then unfortunately, soon thereafter, [President Trump] said, "liberate Virginia," "liberate Michigan." And people took that as a signal that they didn't have to pay attention to the carefully crafted guidelines. That's one concrete example of the frustration that we felt.

Dr. Francis Collins: I think Tony has outlined it very well, the frustration that we all felt. Tony and I are not political figures. And to see the way in which this whole set of public health recommendations took on a very strong political overtone that didn't belong there was incredibly disheartening. Gosh, we were all working 100 hours a week — and in many ways still are — trying to do everything possible to come up with the solutions for this crisis, in terms of therapeutics and vaccines, and yet the simple measures that really should have been adhered to were so difficult to get people to actually appreciate and that really was one of the hardest parts of this whole sad year.

Dr. Collins, I remember interviewing you more than once over this last year and asking you more than once, is Dr. Fauci's job safe? Because it was clear that however diplomatically he was trying to contradict the president, it wasn't going down well.

Collins: It wasn't. And yes, many people asked me, have you been asked to do something to get Dr. Fauci to stop contradicting the president? And I would say no, and I never would either. I was never asked to come forward with a plan to fire Dr. Fauci, and I would never have done that to Tony, as the most important voice for the truth on infectious diseases. If I had been asked to do that, I would have had to resign myself first.

There's been a fair bit of criticism of these latest CDC guidelines [on safe activities for vaccinated people], that they are too timid, too limited, including from scientists and doctors. Are you sympathetic to that view? People are desperate for some glimmer of normal life.

Fauci: I am sympathetic with that feeling. And we're in constant discussion with the CDC. They have a large group of experienced epidemiologists who are trying to make these decisions based on a combination of real data, which they collect in real time every day with modeling studies, as well as a good dose of what we refer to as real-time common sense. These guidelines that came out are not the final guidelines at all, and in pretty quick succession, I believe you're going to be seeing updating of these guidelines.

Collins: This is, after all, one of those circumstances, though, so you don't want to make mistakes, just as we're beginning to see a way forward here. We have been on a marathon since this all started a year ago. And you know, when you're running a marathon, you don't want to stop at the 24th mile. You want to be sure you finish well. I think that's kind of the picture we have right now. Everybody is incredibly frustrated and tired of all of this, we just have to stick it out here for a few more weeks and months to make sure that we get to that finish line in a way that saves the maximum number of lives.

So patience, I hate to say it, is still needed, But I think give us the summer, the early fall, this is going to be a very different country, in a very good way. And we will all be able to sort of look at that and say, "We got through it together." And boy, am I ready for that.

Copyright 2021 NPR. To see more, visit https://www.npr.org.

MARY LOUISE KELLY, HOST:

Earlier today, we invited two old friends to come to the phone.

ANTHONY FAUCI: Hello.

KELLY: Dr. Fauci - and on the other line, his colleague and boss, Dr. Collins.

FRANCIS COLLINS: I can hear you fine, yes. Good morning.

FAUCI: Hi, Francis.

COLLINS: Hey, Tony.

KELLY: Tony Fauci is chief medical adviser to the president. Francis Collins is director of the National Institutes of Health. They talk every day. And we invited them to talk together to us as we all mark one year since the pandemic upended our lives. Dr. Collins says he remembers exactly when he realized things were about to get really hard.

COLLINS: The moment for me was having to tell 40,000 scientists working at the National Institutes of Health that we were going to have to close down most of our operations that were not absolutely essential for patient care. And I sent a lot of really talented young scientist trainees back to their places of residence for quite a period of time, and that was heartbreaking.

KELLY: For Dr. Fauci, the moment when everything changed, he was in the Oval Office. A handful of advisers had gathered one year ago this week to tell the president it was time to ban all travel from Europe.

FAUCI: President Trump was behind the Resolute Desk, and we were in chairs, movable chairs that were essentially circled around the desk. And I remember very clearly, he turned to me and said, Tony, is this something that you really feel we have to do? And I said, yes, Mr. President, we have to do that. And he agreed.

KELLY: Well, what followed, I don't need to tell either of you, has been - it's been a year. And I keep thinking what it has been like for you two to be the public face of the fight against a virus that you both were trying to understand in real time. We'll get to hope and that maybe we're starting to see a glimmer of light at the end of the tunnel. But if I may ask, was there a low point for each of you as this last year played out?

FAUCI: Well, the low point for me, Mary Louise, was the fact that we were trying to deal with a true public health crisis of unprecedented magnitude and impact. And the data were evolving in real time. And as scientists, we had to - I know I had to. I'm certain Francis was in exactly the same boat because we were speaking to each other literally every night - whereas the science evolved, you wanted to make recommendations and/or guidelines that reflect the science. When the science changes in the sense of the data is new data and new information, what you try to do is modify things and be humble enough and flexible enough to be able to give information. The low point is that when you try to do that, we were doing it in an arena of such divisiveness in society where anything that was said undertook a political connotation of it.

KELLY: Can you give an example of a message that you were trying to get out there and you could see it was not landing?

FAUCI: Well, here's a typical example that, I think, most people know about now is that we put a lot of effort when we realized that the economy was in serious trouble - that we had to very carefully open up the economy, open up the country, but we needed to do it very carefully. So Dr. Birx and I and others put together these guidelines that people had to have an indication that there was a decline in cases before they opened up, as it were. We carefully articulated that to the American public. And then unfortunately, soon thereafter, the president said, liberate Virginia; liberate Michigan. And people took that as a signal that they didn't have to pay attention to the carefully crafted guidelines. That's one concrete example of the frustration that we felt.

COLLINS: Yeah. This is Francis. I mean, I think Tony has outlined it very well the frustration that we all felt. Gosh, we were all working a hundred hours a week - in many ways, still are - trying to do everything possible to come up with the solutions for this crisis in terms of therapeutics and vaccines. And yet the simple measures that really should have been instituted much more broadly and adhered to were so difficult to get people to actually appreciate. And that really was one of the hardest parts of this whole sad year.

KELLY: Do you think, though, either of you, that scientists did enough to speak up, to set the facts straight, to make sure that the public messaging was as accurate as you were able to make it? - again, underscoring we were learning about this virus in real time, all of us.

COLLINS: I guess you could say we didn't do enough because the message never really completely settled in the way that you would have hoped, and I don't think any of us quite expected it was going to be that hard. You know, Mary Louise, I think one of the diagnoses that comes out of this last very difficult 12 months is that we seem to be in a society that is so polarized that even objective truth doesn't necessarily have a chance. That is a very disturbing aspect of what we've learned over these 12 months. And if our nation has a path forward to get into a better place, it has to take that on, that we have to be a nation that actually values truth and not just opinions. We didn't do very well with that over this last year.

FAUCI: No, not at all. In fact, one of the things that I'm stunned by - this idea that some people don't want to get vaccinated because they actually think that Bill Gates and I have put a chip in the vaccine, and we want to control their thoughts. I mean, I thought that this was just a few people who felt that. But when you go around in the community of people who are hesitant about that, they read that. And astoundingly, they believe it. And as Francis said, we never, as scientists, would have anticipated that there would be such an egregious distortion of reality. That is very frustrating from a scientific standpoint and becomes extremely problematic when you're trying to implement a public health effort that could be lifesaving. And when you don't implement it well, people die. That's serious.

KELLY: I wrote on Twitter that I was going to be interviewing you two, and I asked what questions people had. A lot of people - I will say the most common response was a lot of people just want to say thank you. They want to thank you for your service, so I pass that on and add my own thanks. Thank you. They also want to know, do you sleep?

(LAUGHTER)

KELLY: It sounds like the answer is no.

COLLINS: Tony, I think you sleep even less than I do, and I sleep less than almost anybody I know. So (laughter) the answer is not so much.

KELLY: There was one gentleman who wants to ask Dr. Fauci if you have plans to redeem yourself with a better first pitch at Nationals opening day this spring. He says that might...

FAUCI: Well...

KELLY: ...Indicate we're in a better place this spring than last.

FAUCI: Well, I hope so, but we'll see what happens. I hope that as the vaccines become more readily available and that the level of infection diminishes dramatically, that we do have a really healthy, enjoyable baseball season. But that remains to be seen. I hope we're going in that direction.

KELLY: A lot of people look to you both for cues on what it is OK to do. You have both now been vaccinated, both doses. Have either of you booked travel, planned a dinner party, started to think about what it will look like to emerge from lockdown?

COLLINS: Well, this is Francis. With the CDC guidelines having coming out yesterday encouraging people to begin to think about that, I had my first conversation with my two daughters just two days ago about whether maybe, since they are both on line to get vaccinated because they're health care professionals, we might be able to get together - my two daughters and my wife and me - in the same place after everybody's gotten through their two weeks post the second dose and actually hug each other. And I would be so happy for that moment to come. So, yeah, that - in that regard, a little planning but not getting into a big travel plan myself just now.

KELLY: Dr. Fauci, how about you?

FAUCI: Yeah, same thing. You know, the CDC recommends that you only do necessary travel and you do it very carefully. Right now everything that I'm doing and that I'm consumed with is right here in the Washington-Bethesda area. You know, as my role now as the chief medical adviser to the president, I need to be right where I am right now.

KELLY: You will have seen there's been a fair bit of criticism of these latest CDC guidelines that they are too timid, too limited for - including from scientists and doctors. I'm looking at Dr. Leana Wen's Twitter feed saying, quote, "we're missing a critical opportunity to incentivize Americans to be vaccinated." We have to give people some hope. Are you sympathetic at all to that view, you know, that the guidance is still - you can't get on a plane even if you've been fully vaccinated? You know, people are desperate for some glimmer of normal life.

FAUCI: You know, Mary Louise, I am sympathetic with that feeling, and we're in constant discussion with the CDC. They have a large group of experienced epidemiologists who are trying to make these decisions based on a combination of real data, which they collect in real time every day with modeling studies, as well as a good dose of what we refer to as real-time common sense. These guidelines that came out are not the final guidelines at all.

COLLINS: Yeah. You know, Mary Louise, this is, after all, one of those circumstances, though, so you don't want to make mistakes just as we're beginning to see a way forward here. We have been on a marathon since this all started a year ago. And, you know, when you're running a marathon, you don't want to stop at the 24th mile. You want to be sure you finish well here.

I think that's kind of the picture we have right now. We just have to stick it out here for a few more weeks and months to make sure that we get to that finish line in a way that saves the maximum number of lives. So patience, I hate to say it, is still needed. But I think give us the summer, the early fall, this is going to be a very different country in a very good way. And we will all be able to sort of look at that and say we got through it together. And boy, am I ready for that.

KELLY: Boy, am I ready for that. I think we all are. Well, thank you to you both.

COLLINS: Thank you.

FAUCI: Thank you.

KELLY: That's Dr. Francis Collins, director of the National Institutes of Health, and Dr. Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases and chief medical adviser to the president. Transcript provided by NPR, Copyright NPR.