Anthony Fauci On H5N1 In North America

[niman]

December 4, 2024

 

Why Anthony Fauci Is Concerned about Bird Flu and Public Division

“America’s Doctor” says that our common enemy is the danger posed by viruses, not each other.

By Rachel Feltman, Tanya Lewis, Fonda Mwangi & Jeffery DelViscio

Anaissa Ruiz Tejada/Scientific American

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https://www.scientificamerican.com/podcast/episode/anthony-fauci-warns-of-bird-flu-dangers-and-how-public-division-could-make/

[niman]

Fauci: And that’s the reason why, when you build new structures or when you certify structures, that you keep in mind the importance of good ventilation.

Lewis: Yeah, absolutely. You know, the future of pandemic preparedness and, you know, obviously we’re dealing now with avian flu, H5N1, in dairy cows and poultry in the U.S. and Canada, so can you talk a little bit—I’m just curious, like, what your thoughts are on the current outbreak of H5N1. I know you’ve dealt with this virus before in a global context, so can you talk about how prepared we might be or how we’re handling this situation?

Fauci: And that’s the reason why, when you build new structures or when you certify structures, that you keep in mind the importance of good ventilation.

Lewis: Yeah, absolutely. You know, the future of pandemic preparedness and, you know, obviously we’re dealing now with avian flu, H5N1, in dairy cows and poultry in the U.S. and Canada, so can you talk a little bit—I’m just curious, like, what your thoughts are on the current outbreak of H5N1. I know you’ve dealt with this virus before in a global context, so can you talk about how prepared we might be or how we’re handling this situation?

The somewhat encouraging news is that the H5N1 that’s infected humans now has not generally caused serious illness. It predominantly causes a conjunctivitis and mild systemic symptoms. There’s been one case of a person who actually went in intensive care and was hospitalized, but the overwhelming majority did not have serious disease.

Now let me tell you the sobering news. The sobering news is that that can change because the virus infects more than one species and we know it can infect pigs. Pigs are on farms with chickens and with cows, and chickens and cows can infect, with their virus, a pig, and then a human virus can go into [a] pig, and then you could get a reassortment of a virus that has some of the dangerous qualities of H5N1 and some of the capability of spreading from human to human of a human virus. So that’s what public health officials are concerned about: that when you have the circulation of this virus in multiple species, including a “mixing bowl” species like a pig, you might get a reassortment and a mutation that could make this something we really have to be concerned about. And that’s the reason why the [Centers for Disease Control and Prevention] says although currently the risk in general is low, we still have to pay close attention to the possibility that that might change.

Lewis: Right, and I think you alluded to, there was this one case in Canada that was a teenager who’s currently still in intensive care or critical condition, and that seems to be related to maybe a different strain or, or substrain of the virus ...

Fauci: Yeah, yeah, the mutations in that virus are a bit different than what we’re seeing generally with the bird flu involving the 40-plus human individuals.

Lewis: Right. Do you worry that we are not doing enough to sort of contain ...

Fauci: Yeah.

Lewis: The outbreak in cows and chickens and other animals at this point ...

Fauci: Well, you know, even going back to original COVID, when you listen to what I was saying in the early years of COVID, we’ve gotta flood the system with testing. If you don’t know the extent of the spread, you’re really swimming blindly, as it were, not knowing where you’re going.

My recommendation—and I’m not alone in this; a number of my public health colleagues and my infectious disease colleagues say the same thing—we should be doing more widespread serosurveillance testing for the extent of the infection. Perhaps a large number of people are asymptomatically infected, and you really need to know that if you’re trying to monitor what the spread of this virus would be.

Lewis: Right. If H5N1 were to become more transmissible in humans, and it—you know, the more opportunities it gets, the, the higher the likelihood of that, do you think that we are any better prepared for a potential pandemic today than we were four years ago?

Fauci: Well, I would hope so. I hope that we would learn the lessons that, at the local public health level—you know, when, when I evaluate, retrospectively, how we did with COVID, for the sake of clarity, I put it into two separate categories: what the scientific response was and what the public health response was.

I think anyone who looks at the data would agree that we get an A+ for the scientific response because the decades of investment in basic and clinical biomedical research allowed us to do something that was completely unprecedented: namely, [the length of the period] from the time the viral sequence was made available publicly on January 10, 2020, to the time that we had a very well-tested, in 30,000-person clinical trial, a vaccine that went into the arms of persons that was safe and highly effective. So we need to keep the investment in the science to do the same thing with future pandemics, including the possibility of H5N1.

The public health response really needs to be improved. Particularly, we have, in many cases, at the local public health level some antiquated elements of that—about getting information available in real time to the people, for example, at the state and CDC level who are gonna be making decisions.

So I think we are a bit better prepared, but I think we better continue to learn the lessons that we should’ve and hopefully did learn from COVID.

Lewis: As a follow-up to that, about the public health response, do you think that our disease readiness and our ability to respond effectively is more of a scientific problem or really a human behavior one, and if it’s the latter, how can we address the deep divisions ...

Fauci: Right.

Lewis: And deep skepticism of science that we see in this country?

Fauci: Well, I think you just hit on the most important aspect of our weakness in response. As I just mentioned, I don’t think it’s scientific; I think we’ve done very well scientifically. I think it is a human element issue. I think the worst possible thing that you could have, the worst possible situation that you can have when you’re in the middle or the beginning of an evolving pandemic is the profound degree of divisiveness that we have had and still have in our country.

I mean, it’s like being at war: the common enemy is the virus. And we were acting, in many situations and in many respects, as if the enemy were each other. Political-ideological issues determined whether someone would wear a mask or not; that determined whether someone would get vaccinated or not.

That is really very tragic because someone, for ideological reasons, not utilizing a lifesaving intervention like a vaccine is tragic for that person and their family, and we’ve seen that because red states, which were undervaccinated compared to blue states, which were better vaccinated—the hospitalization and death rates in red states was higher than in blue states. I mean, that is very painful to me as a public health person: that people, good people, got ill and lost their lives because ideologically, they didn’t wanna make use of a lifesaving intervention.

 

Lewis: Mm, yeah, no, it is tragic, I think, and that is probably the challenge ahead of us now if we face any other threat, like bird flu, that the same public health measures are gonna be, potentially, resisted.

Fauci: Yeah, I think we have a ways to go, that we have got to, first of all, mend the, the differences among us to try and realize that we are more alike than different. Even though it looks like we have different major tribes in this country, we really have very, very much more in common than we have differences. And, you know, ideological differences and differences [of] opinion are healthy; it makes for a very vibrant society. But when those differences turn into divisiveness, then it gets in the way of what I would consider the most effective response in a public arena for something as devastating as a pandemic.

Rachel Feltman: That’s all for today’s episode. Keep an eye out for more of Tanya’s conversation with Fauci on ScientificAmerican.com. And don’t forget to check out Fauci’s new book, On Call: A Doctor’s Journey in Public Service.

Science Quickly is produced by me, Rachel Feltman, along with Fonda Mwangi, Kelso Harper, Madison Goldberg and Jeff DelViscio. This episode was reported and co-hosted by Tanya Lewis. Shayna Posses and Aaron Shattuck fact-check our show. Our theme music was composed by Dominic Smith. Subscribe to Scientific American for more up-to-date and in-depth science news.

For Scientific American, this is Rachel Feltman. See you on Friday!

This episode is part of “Health Equity Heroes,” an editorially independent special project that was produced with financial support from Takeda Pharmaceuticals.