DR. ANTHONY FAUCI, Director of the National Institute of Allergy and Infectious Diseases (NIAID), was interviewed after his speech to the graduating students of the Mailman School of Public Health by Ponchitta Pierce.The following is a transcript of the interview:

 

 

I ENJOYED YOUR SPEECH AND PARTICULARLY YOUR DISCUSSION OF THE GLOBAL IMPACT OF PUBLIC HEALTH.DO YOU THINK MORE PEOPLE WILL CHOOSE TO GO INTO THE FIELD OF PUBLIC HEALTH?

 

Public Health is one of the most exciting fields that one could possibly go into in the early part of the 2lst century. There are reemerging and emerging diseases; there is the HIV pandemic; and there is the fact that we face the threat of bioterrorism in a world that is not equipped to handle public health crises. This makes bioterrorism an even more formidable threat than it would be in a world that could handle public health issues well.

 

 

HAVE WE LOST OUR EDGE IN PUBLIC HEALTH?

 

We have been victims of our success. We have done so well controlling so many of the major killer disease of decades ago that it has unfortunately either resulted in, or at least been associated with, a degree of laxity in our appreciation for local and state public health infrastructure, as well as for how important the discipline of public health is for the health of the nation.

 

 

AS AWFUL AS THE WORLD TRADE CENTER TRAGEDY WAS, DO YOU THINK IT SERVED AS A WAKE -UP CALL FOR PUBLIC HEALTH ISSUES?

 

If the most sophisticated technological and research advances that we have can’t be rapidly and efficiently translated to the local level, which is where the public health departments are playing the major role, then that is a major weakness in the linkages that you need to have for an adequate response, particularly in the arena of biodefense. One of the positive effects of a very unfortunate situation will be a renaissance of interest in public health issues, mainly because now we are under a continual threat of bioterror. 

 

 

MANY OF US FEEL NERVOUS AND TENSE THESE DAYS, WITH SO MUCH NEWS ABOUT POTENTIAL TERRORIST ACTIVITIES. DO YOU SHARE THAT SAME KIND OF CONCERN? HOW DO YOU HANDLE IT?

 

That’s my job. You’re asking the wrong person.

 

 

THEN HOW DOES THE EXPERT HANDLE IT?

 

It will probably still take a while for the American people to realize it, but we will not ever be, and are not, essentially anymore risk-free. The idea of someone deliberately propagating a bioterrorism attack on us is a reality. What is the risk for any given agent? It is likely very small.  Is the risk zero? Absolutely not. Once you realize that and accept it, then you can deal with it.

 

 

PEOPLE WANT ABSOLUTE ASSURANCES, BUT THERE ARE NONE IN THIS WORLD, ARE THERE?

 

Right. We need to strike that delicate balance of appreciating and accepting the fact that we will not be risk-free. Those days of innocence are over. We have been attacked. We are, as our political leader is saying—not to be melodramatic at all—at war. It’s a very unusual kind of war. It involves terrorism in the classic sense and bioterrorism. Rather than just get totally immobilized with fear, we need to accept the fact that there is a small, finite, but nonetheless definite risk that we are in danger.

 

 

WHAT CAN WE DO ABOUT IT?

 

You do whatever you can as a nation, and as individuals, to prepare yourself for how to respond to that threat. The law enforcement people prepare by trying to stop the perpetrators before they do anything. The public health community tries to get the country and the world in a situation where, if there is a bioterrorism attack, we can minimize the impact of it with the response of our public health infrastructure, with the availability and proper use of vaccines, with the development of new and better drugs that can circumvent anyone’s attempt to develop resistant microbes. We need to channel the anxiety associated with the reality of bioterrorism into a productive approach towards trying to protect the country and lessen the impact.

 

 

BUT AS YOU KNOW THERE ARE NO EASY ANSWERS, EVEN ON THE QUESTION OF SMALLPOX. WHAT IF THERE WAS AN OUTBREAK IN MANHATTAN?

 

The stated Centers for Disease Control and Prevention smallpox attack plan is identification, isolation, and doing what we call “ring vaccination,” which means vaccinating the contacts, and the contacts of the contacts of the infected individuals. There’s a lot of discussion right now on whether we should preemptively be doing something a bit more than that.

 

 

 

YOU HAVE CALLED FOR PUBLIC TOWN HALL MEETINGS TO DISCUSS THE ISSUE.

 

They are occurring, and their purpose is to explain to people, for example, what the risks of vaccination are, the risks of a variety of other approaches that one might take, the risks and benefits of vaccinating people who are health care workers versus the general population. They will be open to the public to discuss community concerns.

 

 

I SENSE THAT YOU FEEL WE SHOULD PROCEED MORE CAUTIOUSLY.

 

If I give an opinion right now, that will hinder the debate, because I’m a known public health official. I will do so at an appropriate time, but I feel that right now it’s important for people to have an open dialogue that’s not influenced one way or the other by someone, while they get a feel for what the real risks and benefits are of the vaccination approach, as well as what the risks are of an attack.

 

 

FAIR ENOUGH. HOW CONCERNED ARE YOU ABOUT EBOLA? THAT’S ONE THAT I FOCUS ON A LOT.

 

You can’t give a relative scoring of concerns except to say that Ebola is one of the top six microbes that we are concerned about on the category A risk list of the CDC: smallpox, anthrax, botulism, toxin tularemia, plague, and the hemorrhagic fevers, one of which is Ebola.

 

 

DO YOU THINK THAT NOT BEING ABLE TO BE IN CONTROL IS WHAT WORRIES PEOPLE?

 

Americans are not afraid to get in their cars and drive on the Beltway in Washington. That is a very dangerous road where there are a lot of accidents. They’re not afraid to speed up and down the West Side Highway in New York City, because there they feel they have some control over the risk they are taking. In fact, it’s much more risky to do that then it is to get an anthrax-tainted letter in the mail. Yet the idea of receiving an anthrax-tainted letter creates a great deal of fear and horror in individuals.

 

 

WHAT IS ON THE TOP OF YOUR WORRY LIST?

 

Smallpox is something I’m concerned about. I’m not at all convinced that there are no other stores of smallpox besides the reported, guarded ones that are in the United States and in Russia. It’s very clear that from l972 on, the Soviet Union was making a lot of smallpox for use as bioweapons. They supposedly have destroyed it, or kept it under wraps, but you never can tell, given the instability in that region of the country following the dissolution of the Soviet Union, whether some of that material got out to people who might use it nefariously. There’s always the issue of anthrax. The thought of Ebola is something that will strike terror into individuals, even though its efficiency of transmissibility is not as great as some of the others, such as smallpox.  For me, the top three would be smallpox, anthrax, and Ebola.

 

 

YOU’RE PERHAPS RECOGNIZED MUCH MORE WIDELY FOR YOUR WORK IN AIDS. WE’VE COME SO FAR, BUT WE DO NOT YET HAVE A VACCINE. WHY IS IT SO HARD?

 

The AIDS virus has the characteristic of being able to not be totally suppressed by the body’s immune system. With virtually every other disease, there are countless instances of the body ultimately naturally ridding itself of the microbe in question. That ranges from smallpox to polio to any of the other real, serious viral illnesses that have an important public health impact. Ultimately the body, in a substantial proportion of individuals, has the wherewithal to clear itself of the virus.

 

 

THIS DOESN’T HAPPEN WITH HIV?

 

There are no documented incidents of people who have established HIV infection and disease, who spontaneously cleared the virus and ridded it from the body, which means that the body’s immune system has great difficulty in dealing with the clearing of HIV. That’s one of the reasons finding a vaccine is difficult.  In addition, the virus has the ability to hide within the cells of the body and in a latent form, and it also has a high capability of mutating. All those things put together make the development of an HIV vaccine very problematic--not impossible, but very difficult. We’ve made progress steadily, particularly in the last year or two. I can’t give you an exact prediction for when we’ll get a vaccine. It likely will not be before at least a few years. Hopefully within the next several years, but it’s folly to put a date on it.

 

 

IS THAT WHY YOU STRESS BEHAVIOR MODIFICATION? BUT THERE SEEMS TO BE SLIPPAGE ON THAT.

 

Because we now have some effective therapies, some people have begun to feel that it’s not so serious for someone to become HIV-infected. That attitude has been unfortunately a disincentive for people to be very compulsive about safe sex. Some people in some quarters are being lax, and we’re starting to see the effect of that slippage in the infection rate.

 

 

THERE ARE REPORTS THAT SOME PEOPLE THINK THAT ORAL SEX IS ALL RIGHT, IS “SAFE SEX”-- BUT THAT’S NOT TRUE?

 

 

You have to worry about everything. Any sexual act in which there is exposure to any individual—orally, rectally, vaginally—to material that’s contaminated with HIV, is a risk for transmissibility.

 

 

YOU RECENTLY WON THE ALBANY MEDICAL CENTER PRIZE IN MEDICINE AND BIOMEDICAL RESEARCH, THIS COUNTRY’S LARGEST PRIZE IN MEDICINE. WERE YOU SURPRISED AND WHAT DID RECEIVING THIS AWARD MEAN TO YOU?

 

I was surprised. It’s such an extraordinary award, and when you’re working in science, you don’t think in terms of awards, you think in terms of accomplishing the goal of scientific achievement and furthering the public health. The fact that I was recognized by my peers with such a prestigious prize was obviously wonderful and I was very, very excited and happy about it. But in many respects I was also quite humbled by it, because there are so many people in this country and in the world who are doing very good science, and I was quite gratified that they chose me. It’s just more incentive to continue to do what I’m doing and to get to my ultimate goal, to put an end to the HIV epidemic by developing a vaccine and better drugs. And to protect the country from the effects of any kind of bioterrorism attempt on us over the next several years.

 

 

YOU WERE SERIOUSLY CONSIDERED FOR THE POSITION AS HEAD OF THE NATIONAL INSTITUTES OF HEALTH. WOULD YOU HAVE SERIOUSLY CONSIDERED TAKING THE JOB IF IT HAD BEEN OFFERED?

 

I prefer to do what I’m doing now. I would have given it serious consideration, were I able to do both the job that I’m doing now and the director of NIH, but that just wasn’t in the cards. My first choice has been and always was and still is Director of NIAID because I’m very, very committed to the job that we started years ago, vis a vis emerging and reemerging diseases, global health, and now biodefense. So, I’m very, very happy at the job I’m doing now, and in fact things have worked out exactly the way that I wanted them to.

 

 

YOU HAVE HAD SO MUCH SUCCESS IN YOUR CAREER, BUT I WONDER, WHAT IS THE GREATEST FRUSTRATION YOU HAVE EXPERIENCED?

 

I wouldn’t call it a real frustration. I would just say that the job is unfinished. There’s still a lot to do. It’s difficult, because you want to accomplish the goals, but the goals are formidable.  But I think we’ll get there.

 

 

IS THAT WHAT MAKES YOU RUN?

 

That’s what makes me tick.