As Anthony Fauci prepares to leave his role as chief medical adviser at the White House, the United States — and indeed the world — is in a much better place in the fight against COVID-19. But the infectious disease expert is warning against complacency and says the virus still poses a threat.
"With this virus and its variants that keep evolving, and the lack of durability of protection, either from prior infection or vaccine … we have to continue to address this problem," he told 7.30.
"We can't just look at it as being in the rear-view mirror."
Dr Fauci says despite all the lessons learnt during the pandemic, he isn't confident the world will be better prepared when the next pandemic emerges.
"You're going to have the evolution and emergence of new pathogens; we will always have that," he said.
"I just know human nature. And what happens is that you have corporate memory that lasts for a while, and then other imminent problems take over.
"You forget about the fact that you need to stay perpetually prepared for something that hasn't happened yet. That's a tough thing to get people excited about."
According to Dr Fauci, one of the most important lessons of COVID-19 concerns vaccine equity — making effective vaccines available worldwide which could have prevented the emergence of dangerous variants as the virus mutated.
"The more you have the spread of virus in the community — particularly in low and middle-income countries that may not have access to vaccines the way developed nations do — that gives the virus a great opportunity to mutate enough to form a new variant," he said.
But as Dr Fauci explains, some countries lacked the infrastructure capable of distributing vaccines.
"They said don't send any more … which seems paradoxical," he said.
"That has to do with a larger problem of the healthcare systems globally, and the lack of equity of healthcare provision globally. That is an important problem that transcends COVID."
The tragedy of divisiveness
Dr Fauci has been an advisor to seven US presidents from Ronald Reagan to Joe Biden, and the Director of the National Institute of Allergy and Infectious Diseases for 38 years.
He says he could never have predicted the politicisation of science that occurred under Donald Trump's presidency.
Dr Fauci regularly appeared at White House press conferences with Mr Trump but he fell out of favour with the administration, and sections of the public, when he disagreed with some of Mr Trump's statements about the virus and unproven remedies.
Dr Fauci started receiving death threats.
"I've seen political differences and ideological differences, which, you know, at their best can be very healthy," he said.
"But when that difference becomes hostile and divisive to the point where people don't even cooperate with each other, and as a result, you have unnecessary suffering and death and a pandemic, I never would have imagined, to be quite frank with you, that it would have gotten this bad.
"The intensity of the divisiveness in the United States, in my opinion, is just tragic in many respects, because it prevents you from doing things that should be properly done in the arena of public health."
Asked how much of that divisiveness already existed and how much should be attributed to Mr Trump, Dr Fauci said he believes "it was latently there, and that he just came in and just stoked it and kindled it and turned … a little ember into a forest fire".
As a physician, Dr Fauci was pained by those who refused to get the vaccine for ideological reasons.
"Everything about me, all of my DNA, all of my training, everything I do is to alleviate, prevent, and treat suffering and disease to try to keep people healthy," he said.
"When you see people doing things that actually makes them get in danger, it pains me, because it goes against everything I stand for.
"It hurts me to see that."
Reflecting on the past three years of the pandemic, Dr Fauci says his lowest point came when it became clear the COVID-19 outbreak would not be contained in the way SARS was almost two decades earlier.
"When it got out of China and went into Europe, particularly in northern Italy, and we were looking across the Atlantic … their [healthcare] system was being overrun," he said.
"Once we saw that, we knew inevitably we would be suffering just as much, and it turned out we did.
"In fact, even worse, a country as rich as the United States to have 1 million deaths thus far is just extraordinary and truly tragic."
The pandemic laid bare the deficiencies in the US health system.
"We let our local public health system have a great deal of attrition, which was really unconscionable, but then we paid for it when we needed to marshal local public health capabilities, and we didn't do it well."
Science evolves and self-corrects
Asked if he would change anything in the public health response, Dr Fauci says he would have tried "even harder" to get people to understand the adaptive nature of data and science.
"We tried hard to get the public to appreciate that an outbreak that emerges is a dynamic process; it's not static," he said.
"The data that you gather in January or February is the data you use because it's what you have to make opinions, recommendations, [and] guidelines.
"As you get to March, April, May, June, the virus changes, a lot changes, your knowledge and appreciation changes.
"Science is evolving and self-correcting … it's not flip-flopping when you change. It's keeping up with the evolution of new data. That's a difficult concept to get people to appreciate, but it is the reality."
Despite the pressures of battling the pandemic, rampant misinformation and a sometimes hostile president, Dr Fauci leaves his position with some optimism about COVID at least.
"I don't think we're going to eradicate it but I think we can get it down to such a low level that it doesn't disrupt society," he said.
And on whether faith in public health can recover?
"We can bounce back."
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