A Global Shot in the Arm, With Anthony Fauci

It’s March, and it’s been nearly a year since COVID-19 was declared a pandemic. There’s no two ways about it, it’s a bitter anniversary, but it’s also a time to think about how far we’ve come.  

There was so much confusion at the start about how to protect ourselves. Now, a year later, we’ve learned a lot about how to stay safe, and we’ve developed highly effective vaccines in record time. 

We’re starting to see the light at the end of the tunnel. But there is at least one more hurdle that threatens to undo our progress. All around the world, wealthy countries are hoarding vaccines, leaving huge swaths of the global population without access. Global health officials say that this could be a lethal mistake for rich and poor countries alike. 

I’m Gabrielle Sierra, and this is Why It Matters. Today, why a global pandemic needs a global response.

NBC News: 0:02 “It’s been almost a year ago when the country began shutting down from Covid and for the first time, there seems to be a real reason to have cautious optimism.” https://youtu.be/5-Kf4FnPfB0?t=2

PBS NewsHour: 0:00 “Who gets vaccines and when are not only serious questions in the U.S but also around the globe.” https://www.youtube.com/watch?v=CfmMMo7lVS8

DW: 0:56 “In the global fight against Covid-19, its mutations have been proving to be the next great challenge.” https://www.youtube.com/watch?t=56&v=3Nz-qZzJAtA&feature=youtu.be

SIERRA: So we have a lot of really important stuff to talk about. But I feel like one of those important things is that both you and I are South Brooklyn children. And I feel like it was really important to just get that out of the way.

Anthony FAUCI: Where were you? Where were you in South Brooklyn?

SIERRA: I'm from Manhattan Beach.

FAUCI: You are?

SIERRA: Yeah. 

FAUCI: I'm from Bensonhurst.

SIERRA: I know. Yeah. Well,  you need no introduction, but I'll just start the way we always start, which is what is your name? And what do you do?

FAUCI: My name is Dr. Anthony Fauci. And I'm the director of the National Institute of Allergy and Infectious Diseases at the National Institutes of Health.

SIERRA: Alright. So, let’s say that the majority of Americans were vaccinated tomorrow.  Would we be fully in the clear?  

FAUCI: So if we got let's say 70 to 85 percent of the people in the country vaccinated, then we would be very much better off than we are now. But there's a real catch to your question. Because even if we got the overwhelming majority of the population vaccinated, there is a big wide world out there. And that's the global pandemic. So if the rest of the world did not get COVID-19, or SARS-CoV-2, under control, there would always be a looming threat over us that the virus would be mutating, would be changing, and we would get new variants that even if we felt ourselves protected in this country, sooner or later, a variant or a mutation could come here, and essentially circumvent the protection of the vaccine. So I think when you think in terms of a pandemic, you have to remember it is global. And it requires a global response, not just a single country response. 

Richard HAASS: In the old days, when we used to get on airplanes, you remember that? When we could all travel? One of the first things you get is this disembodied voice that would say, in the event of a loss of cabin pressure, oxygen masks will come down from the overhead.

This is Richard Haass, president of the Council on Foreign Relations, former director of policy planning for the State Department, adviser to two Presidents, and...my boss. 

HAASS: And you are instructed by this voice to put it on yourself. And then only after you yourself are safe and taken care of, then you turn to your children, your neighbors and others. And that's our instinct here. We've got to jettison that instinct. Unless the rest of the world gets vaccinated, it doesn't just threaten their lives, that threatens ours too. Because if we don't take care of others, variants will continue to break out. And when variants break out over there, they will figure out a way to come here. So then we end up in a race that never quite ends, and that we never quite win. 

To stay ahead of the curve we have to understand variants. And in order to understand variants, we have to understand mutations. And in order to understand mutations, we went to the country’s medical explainer-in-chief. 

SIERRA: So what is a mutation? Where do they tend to come from? Why do we need to worry about them?

FAUCI: When viruses replicate, which they do very, very rapidly, particularly when you have literally 100 million people infected, which is what we have right now in the world with, you know, over 2.4 million deaths. When you have that amount of replication, as the virus replicates, it makes mistakes in reproducing itself. That's called a mutation. 

Mutations are alterations to a sequence. A lot of people explain this by comparing it to a misspelled word. So, let’s say you’re sending a text. You’re moving fast, and you spell something wrong. Probably not a big deal. Your friend understands what you mean. But what if that misspelled word actually changes the meaning of your sentence? Now your friend is upset, and you have to deal with the fallout. A virus mutation is similar. As viruses replicate quickly, mistakes are made. Most of these mistakes won’t matter much, but sometimes the change allows a virus to become something very different. 

FAUCI: When you get a constellation of mutations, then you can get what's called a variant, namely, a strain of virus that varies considerably from what the original virus was. That's very important. Because if you make a vaccine against one of the iterations of the virus, and it changes, mutates, and becomes a variant, you may either weaken or even lose the protection of the vaccine.

Mutations that can’t be stopped with current vaccines are worrisome, but they aren’t the only concern. Epidemiologists are also on the lookout for strains that are more deadly, strains that are more contagious, and strains that are not detectable with our current tests. No matter where they arise, variants can travel and become a problem for the entire world. And this isn’t hypothetical; new variants that developed in California and New York are spreading as we speak, as are several that emerged abroad. 

CBC News: 0:03 “The new coronavirus variant identified in the UK has now made it into Canada.” https://www.youtube.com/watch?t=3&v=Q0SbsgQ-D_E&feature=youtu.be

ABC News: 0:02 “News this evening of the dangerous South African variant has now been detected in a patient here in the New York City in a hospital.” https://www.youtube.com/watch?v=Qs1j-7ra8RU&feature=youtu.be

KHOU 11 News: 0:02 “We begin with the Brazil variant of the coronavirus detected in Minnesota. Scientists say this variant spreads more quickly” https://www.youtube.com/watch?t=2&v=-YboyE1NkJQ&feature=youtu.be

FAUCI: Any place where you have a lot of viral replication with a lot of infection is by definition a hotspot for the evolution of mutations. It's a very firm axiom of virology, that if you're not replicating, you can't mutate. So the best way to prevent a virus from mutating is to dampen down dramatically its spread from person to person, because the more it spreads, the more opportunity it has to mutate. 

SIERRA: So...could this set us back to square one? 

FAUCI: Well, it is unlikely that it would set us back to square one, but it certainly could interfere with the progress. Let me give you the scientific explanation for that. So right now, there are two major variants that we are concerned about. One of them is a variant that evolved from mutations that occurred in the strain in the UK. And it is now dominated in the UK. It transmits from person to person more efficiently than the original virus. And it is even more dangerous, that it could potentially make you more ill and even lead to a greater degree of hospitalization. Right now, that variant is in the United States. And modelers projected that by the time you get to the end of March, that it could be the dominant strain in the United States. That's sobering news. The good news is that the vaccines that we are distributing now in the United States happen to work very well against [it]. However, there's another troublesome variant that is dominating in the Republic of South Africa. That one is replicating rapidly and causing a lot of disease in South Africa. It is also in the United States, but in a very minor way. The reason we're more concerned is that the vaccines that we're using are diminished multiple folds in their capability of controlling that. It hasn't eliminated the ability to control it. But it considerably diminishes its capability. So that's the one that we really need to watch out for. 

As the virus replicates scientists know that it’s only a matter of time until other variants emerge. And the possibility is always there that a new variant could be more deadly, harder to trace, and perhaps even immune to existing vaccines. This is why vaccinating your own country isn’t the real finish line.  

FAUCI: The entire global community needs to have access to vaccines, if we really are going to durably control this outbreak, which brings us to the point of the fact that the United States and other developed nations, like the UK, and the EU, and Canada, and Australia, and Japan, and other countries that have resources, very well would likely have to put in whatever it takes to get that part of the world that doesn't have the resources to develop and or administer vaccines. So in other words, it's got to be a global effort that is involving countries that have the resources to be able to contribute to the overall effort.

The process for obtaining vaccines is complicated. Most of it has been done through a bidding process in which wealthy countries competed with each other to secure as many doses as possible directly from manufacturers. This distribution model is based on money, rather than population or need. As a result, a small number of nations were able to secure a majority of doses.  

CBS News: 0:09 “A few rich countries, including U.S. and Canada, have 14 percent of the world population but control 53 percent of the vaccine supply.” https://www.youtube.com/watch?t=9&v=kKgKfy8iM1k&feature=youtu.be

CNA: 0:00 “40 percent of the world would not have widespread access to vaccines until 2023. That’s more than eighty-five countries.” https://www.youtube.com/watch?v=qtqnRK87PXY

CNN: 0:49 “The basic problem is in how the vaccine is distributed around the world, not based on whether there is most need, but the most money.” https://www.youtube.com/watch?t=49&v=-4Lmp5b0toc&feature=youtu.be

There is a global effort to share and distribute vaccines more equitably. It’s called COVAX. It’s a joint effort of three international organizations, the WHO, GAVI, and CEPI, and it aims to provide at least two billion vaccine doses to the world’s most vulnerable populations by the end of 2021. It’s already begun sending doses to West Africa. 

But COVAX is only a start. It’s not clear if it will meet its fundraising goals, and even then, COVAX will only be equipped to deliver vaccines to the world’s most vulnerable people over a period of years. That’s nowhere near enough to achieve herd immunity globally and end the pandemic. Without increased production capacity and the donation of actual doses, it’s going to be years before poor countries get vaccinated. And that means years of gambling on new variants.   

In order to better understand how things are playing out in the developing world we talked to Tidjane Thiam, a former CEO of Credit Suisse, who has been appointed by the African Union to solicit international support for the bloc’s fight against COVID. 

SIERRA: So how might things play out if Africa doesn't receive international support in this battle against COVID?

Tidjane THIAM: Oh, it would be terrible. Of course. We've all said many times, but nobody's safe until everybody's safe. I mean that is absolutely the case for something like for Coronavirus, as contagious as COVID is. And really Africa had been doing well, going into this crisis. The last twenty years have been a period of huge growth and progress for Africa. And we feel that there's a real risk that Africa falls back by ten or fifteen years in terms of its development, and for a part of the world where you have 1.2 billion people that would be catastrophic.

SIERRA: So how did African nations fare in the race to secure vaccine doses?

THIAM: Well this race is ongoing. A number of initiatives have been taken. The most visible is COVAX. And the objective of COVAX is to cover about 20 percent of the population. And you know that the key number to achieve herd immunity is about 60 percent. So we still have a big gap there. 

You know, Africa has honestly reacted reasonably well, the heads of states are very involved. The African Union has played a key role. But one thing, the health systems are very weak. The second wave, which we are in right now has been much worse than the first one. And you are starting to see the health systems cracking at the seams. So for the same level of contagion, you are likely to see a much higher level of mortality in Africa, which would be really tragic. And we don't want to renew the experience we had with HIV AIDS, where for ten years we were not able to provide treatment to Africa, and people died by the hundreds of thousands when treatments were available.

SIERRA: So are there other important ways that countries like the US can support the battle against COVID in Africa beyond providing the doses themselves?

THIAM: I think the first issue is resources, money. We have worked hard to have a kind of debt deal with the G20 to create some fiscal space for the African government so they can spend their scarce resources on procuring for vaccines and paying back with it. So this is an ongoing process. And there are negotiations underway, country by country, including for the first time China as a creditor and also the private sector. So if we get that done, then there will be enough resources to vaccinate Africans to a level that provides herd immunity, or 60 percent. So what we want from the U.S. is support from that initiative and mobilization to ensure that we get a physical supply of vaccines.Plus the delivery, which is also hampered by the weakness of health system, plus the issues of storage. So we need help in buying the vaccines, but we also need help in ensuring that there's a delivery system to keep the doses effective so that people are actually protected.

SIERRA: So you have a lot of experience in finance. What do you see playing out economically if the world does not move to address rampant COVID transmission in Africa and elsewhere?

THIAM: I mean, Africa today is very well integrated into the world economy and plays a big role today for GDP of Africa is $2.5 trillion. It's as big as India's. So it's a very large player in international affairs, and any significant deterioration in Africa will then reverberate across the world. And you don't want a situation where we keep fighting fires, and this virus travels around impacting region after region, because also in the end, this will translate into political instability, conflict and situation that will impact everybody around the planet.

SIERRA: Do you have any security concerns about the countries that are fighting COVID without vaccine access and without economic support?

HAASS: The short answer is yes. What worries me about COVID is that in countries that can't get the vaccine, this becomes a form or source, rather, of state weakening. This becomes one of those things that will weaken the ability of the state to perform the functions we expect states to do, provide public services, among which is security. So there's a recession going on in much of the world, this will prolong and deepen a recession, it will infect security personnel, it will make it harder for people to go to their jobs to stay in their jobs to be in schools. This is classic of a weak state. And weak states, by definition, become territories where bad things happen, where terrorism, drug cartels, pirates and others set up shop.
 

SIERRA: How are we going to find the political will? Because, even me, right? I'm counting the days until my friends, my family, especially my parents can get the vaccine. I want the vaccine. I mean, protecting your own is a strong impulse. How do we convince people to support the delivery of vaccines to strangers in other countries?

HAASS: Look, it’s a question I ask myself, it's totally legit. And I expect it's the reason that thus far, the Biden administration, which wants to be helpful, has limited its help to economic help. It has not been willing to make any commitment as the French president has urged that maybe even a small percentage of vaccine produced here to be sent overseas.
 

The Biden administration has pledged $2 billion, with another $2 billion to come, to COVAX. But it has not yet committed to the more politically sensitive idea of sending American vaccine doses abroad. 

HAASS: It's a hard sell. It's a counterintuitive case. But let me suggest at least two arguments. That one is the one we've been talking about. It's the argument of enlightened self-interest. Don't think of this as a form of just helping others, not that there's anything wrong with that. But think of this as a way of helping ourselves. The other thing we could do is ramp up supply overestimates and say we're going to produce, for argument's sake, enough for two million doses a day here in the United States, which is a fantastic level. If however, we're able to get above that, we will make those available elsewhere. Because if we can give doses at the rate of two million a day, you can do the math, that's sixty million a month. That gets us to where we need to be when we want to get there. So I think if the President could explain that, people wouldn't think that we're taking it out of our own pockets or literally out of our own arms and putting it in the arms of others. 

If things continue on their current trajectory, and the U.S. continues to meet its ambitious goals for vaccinating its own population, we need to start to think about the point at which sending vaccines abroad becomes a better way of protecting ourselves than simply using them at home.   

FAUCI: You can do both. By the time we get to July, we will have the contractual arrangements fulfilled by at least two of the companies to get a total of 600 million doses, for 300 million people. 

In fact, the outlook has gotten even better since we spoke with Dr. Fauci. The Biden administration now says the U.S. will have enough doses to cover its entire population by May. 

We should not have to stop there, nor should other developed nations, nor should other companies say we're done, we've made enough vaccines. We're knee-deep and solving our own problem right now. But that does not mean that we should not join the rest of the world, and maybe lead the rest of the world in addressing the globality of this pandemic, as opposed to focusing only on our individual countries.

It means that you have to dramatically increase the global capacity to make vaccines. Because we have considerable vaccine-making capability, but not enough for the whole world. And so what we need to do is we need to build the capacity in the form of factories and plants that can make vaccine in the billions and billions of doses, for the billions and billions of people who live on this planet. So that would require putting up physical facilities, getting them fitted to make vaccines, making them in large quantities. And that is based upon the investment in resources to do just that. So what we're going to need is a global commitment, including by “we” the United States.

SIERRA: You've written recently about the United States’s diminished global reputation. I mean, do you think this is an opportunity to start earning that back?

HAASS: Well, absolutely. This is a real chance to show that the United States is back on the playing field, that this is a country of capacity. But it’s also a country of care. It's a way of not leaving the playing field simply to others, it gets us back in the game. Look it's one of those chances to do good and do well. You know, you don't often get twofers like this in foreign policy. But this is a twofer. We can help others, we can enhance our prestige overseas, it’s a threefer, and we can make ourselves safer at the same time. And the challenge will have less to do with doing it. I actually think doing it in this case is not all that hard. It's explaining it. And it's not having it be a political liability. But that then is a communications challenge. That's an educational challenge. It's an explaining challenge. And I think we are up to it.

SIERRA: Won’t we need help? How do we get places like Japan or Canada or the EU to do their part?  

HAASS: This should not be and cannot be a U.S.-only effort. But in my experience, you're much more able to talk the talk, much more persuasively, if you walk the walk. So if the United States is doing what it needs to do at home, but also producing and making available a percentage of what it is we generate here in the way of vaccines, it makes it so much easier for this government to go to other governments, hey, follow our lead.

SIERRA: Right.

HAASS: Otherwise, it's called hypocrisy, and hypocrisy doesn't do you any good in foreign policy any more than it does you good in your day-to-day life. But if we're acting consistently, and we're not asking others to do more than we ourselves are prepared to do, then I think we've got a very strong hand.

SIERRA: What is your definition of success? When it comes to COVID? What would life look like? What will it take to get there? You know, and besides vaccines, what else is required?

FAUCI: Success for me, as a medical doctor, a physician, and a scientist, at a public health service, is the elimination of COVID-19. Namely, where there are so few cases in the country where you don't even notice it, there are so few. And that you get to by a successful vaccination program. And as we've been discussing, you want to make sure it stays that way, by vaccinating the entire world and getting the entire world protected.

SIERRA: Well, this was wonderful, hopefully someday very soon I'll be able to run into you at, you know, L&B Spumoni Gardens or somewhere, and things will be right back, sir. 

FAUCI: Yep, I hope so. Without masks. 

As we move through the tunnel and out towards the light, we have to remember that there are a lot of people moving along with us. More than seven billion people, in fact. If we’re going to make it to the end, we have to get there together. 

The first lesson of COVID was that what happens somewhere far away can change every part of your life at home. It may turn out to be the last lesson too. Helping your neighbors, whether a state over, a country over, or an ocean over, isn’t just the right thing, it’s the smart thing.  

For resources used in this episode and more information, visit CFR.org/Whyitmatters and take a look at the show notes.

For a delicious Sicilian slice from my old South Brooklyn neighborhood visit L&B Spumoni Gardens. 

Have a question or some feedback? Just feel like saying hey? Send us an email at [email protected]. 

Subscribe to the show on Apple Podcasts, Spotify, Stitcher, or wherever you get your audio. And, please please, if you are a fan of the show, show us some love! Give us five stars and leave a review on Apple Podcasts. It means so much to us, and it really does help us to get noticed.

Why It Matters is a production of the Council on Foreign Relations. The show is created and produced by Jeremy Sherlick, Asher Ross, and me, Gabrielle Sierra. Our sound designer is Markus Zakaria. 

Robert McMahon is our Managing Editor, and Doug Halsey is our Chief Digital Officer. Our intern for this semester is Zoe Han. 

Original music is composed by Ceiri Torjussen. Additional research and extra help were provided by Elena Tchainikova and James McBride. Special thanks go to Richard Haass and Jeff Reinke. 

For Why It Matters, this is Gabrielle Sierra signing off. See you soon!