The White House medical adviser Dr Anthony Fauci, has spoken about the challenge of containing more infectious variants of Covid-19 even as vaccines are rolled out, in an online conversation with Australia’s chief medical officer, Prof Paul Kelly.
“Here is the challenge: are we going to chase each variant in an almost whack-a-mole way, or are we going to try and get a vaccine that has a good degree of protection against several strains and get the level of virus so low that we don’t really have an outbreak?” he asked. “Both strategies are being pursued in the United States.”
In the online discussion hosted by the US Center for Strategic and International Studies, Fauci said the US was working with Moderna to develop a vaccine specific to the variant identified in South Africa, and Pfizer was exploring whether a booster shot if its vaccine might offer additional protection against the variant first identified in the UK.
But the best thing countries could do was to contain large outbreaks, he said, because the more a virus circulates, the more opportunities there are for mutations to occur, eventually leading to more virulent variants.
“The best thing that we can do really is to get as much control over the existing replication and dynamics of the virus,” he said. This was something the US had not managed to do in the same way as Australia, he said, because Australia’s lockdowns were more stringent and effective. The US reopened after lockdowns while cases were still in the tens of thousands, which meant control of the virus was impossible.
“Just this past winter and late fall we were averaging an extraordinary 300,000 to 400,000 cases per day, and 3,00 to 4,000 deaths per day. That’s just a completely different galaxy than what Australia was experiencing.”
He said he was concerned that even as vaccines were rolled out in the US and new cases fell, the case numbers may plateau “at an unacceptably high level” – still high enough to give the virus more opportunity to mutate.
“Viruses don’t mutate unless they replicate,” he said. “And the more spread that you have in the community, the greatest chance you’re going to have of the initiation and propagation of variants. And that’s what we’re seeing in the United States.”
Kelly said Australia had recorded 140 cases of the variant first identified in the UK and 25 of the variant identified in South Africa – “but mostly they’ve remained in hotel quarantine”.
He warned: “In many ways, we can only go one way with this, which is to have more cases eventually, and as we start to open up that will be an issue.”
Kelly acknowledged some “hiccups” in the Australian rollout. He said in its first two weeks 100,000 people had been vaccinated with the Pfizer vaccine, but he added: “This is the first vaccine and not the last vaccine that people will have, and people are understanding the need for a booster at some time.
“We had a bit of a hiccup there for a while about whether Pfizer was was better than AstraZeneca but I think the real-world experience now from the UK, in particular, has shown that that’s not an issue. People are embracing the vaccines.”
While there had been some import issues with the AstraZeneca vaccine, “that hasn’t changed our plans at all”, Kelly said, adding that epidemiologists had become “rock stars” in Australia and that he was confident there was overall public support for the vaccines.
Fauci said vaccine hesitancy was a concern, and that vaccine rollout success would depend on understanding why people are hesitant and respecting their experiences. There were a number of different hesitant groups, he said.
“In our minority population [there is] understandable hesitancy due to the history of mistreatment on the part of the federal medical initiatives, dating back to the infamous Tuskegee incident,” he said. “So the first thing we need to do is to respect that hesitancy … and say that we understand why you are hesitant. And we have, now, ethical constraints in place, that would make something like that impossible to happen again.
“Then, we need to address the concerns that the process has gone too fast, and explain the speed did not compromise safety, it was merely a reflection of its spectacular advances in the science of platform technology, then to explain and articulate this clearly by people who they trust in their community.”
It was essential to respect distrust of government, he said. It had to be communicated to people that the decision to make the vaccines available due to their safety and efficacy had not been made by the federal government or by the drug companies, but by independent data and safety monitoring boards and advisory committees.
“Once you get that through to them you will convince a considerable proportion of the people who have hesitancy, and we’re starting to see that,” Fauci said.