Covid-19 is the disease that Dr. Fauci always said would be his “worst nightmare” — a new, highly contagious respiratory infection that causes a significant amount of illness and death.
“In a period of four months, it has devastated the whole world,” Dr. Fauci, director of the National Institute of Allergy and Infectious Diseases, said on Tuesday during a conference held by BIO, the Biotechnology Innovation Organization. “And it isn’t over yet.”
His discussion with a moderator was conducted remotely and recorded for presentation to conference participants. Although he had known that an outbreak like this could occur, one aspect has surprised him, he said, and that is “how rapidly it just took over the planet.”
An efficiently transmitted disease can spread worldwide in six months or a year, but “this took about a month,” Dr. Fauci said. He attributed the rapid spread to the contagiousness of the virus, and to extensive world travel by infected people.
Vaccines are widely regarded as the best hope of stopping or at least slowing the pandemic, and Dr. Fauci said he was “almost certain” that more than one would be successful. Several are already being tested in people, and at least one is expected to move into large, Phase 3 trials in July.
But much is still unknown about the disease and how it attacks the body — research that Dr. Fauci described as “a work in progress.”
He said that he had spent much of his career studying H.I.V., and that the disease it causes is “really simple compared to what’s going on with Covid-19.”
The differences, he said, include Covid’s broad range of severity, from no symptoms at all to critical illness and death, with lung damage, intense immune responses and clotting disorders that have caused strokes even in young people, as well as a separate inflammatory syndrome causing severe illness in some children.
“Oh my goodness,” Dr. Fauci said. “Where is it going to end? We’re still at the beginning of really understanding.”
Another looming question, he said, is whether survivors who were seriously ill will fully recover.
He described the pandemic as “shining a very bright light on something we’ve known for a very long time” — the health disparities and the harder impact of many illnesses on people of color, particularly African-Americans.
The coronavirus has been a “double whammy” for black people, he said, first because they are more likely to be exposed to the disease by way of their employment in jobs that cannot be done remotely. Second, they are more vulnerable to severe illness from the coronavirus because they have higher rates of underlying conditions like diabetes, high blood pressure, obesity and chronic lung disease.
Given the disparities, he said, it is essential to focus more resources to control the coronavirus in the areas with high-density African-American populations. But the longer-term solution will take decades, he said, to address the socioeconomic and dietary factors that contribute to so many of the health problems in racial and ethnic groups that have been most affected by the virus.
The global race for vaccines and treatments by myriad companies and governments has led to calls for nonprofit and government-payment methods to ensure that the drugs would be widely available.
While access to vaccines will be essential, Dr. Fauci said it would probably not help if the U.S. government tried to impose price controls on drugmakers. “If you try to enforce things on a company that has multiple different opportunities to do different things, they will walk away.”
He said he had never seen a successful attempt at price controls, and it would be more effective for the government to work with companies and help them in developing products. Then, he said, companies “will in good faith make it available to those groups, countries, nations that really can’t afford it very well.”
“It’s a profit-driven industry,” he said, adding that companies cannot realistically be expected to give products away.
“You’ve got to have some degree of profit,” he continued, “as long as it isn’t in such an outrageous way that it makes something completely out of the realm of people who need it.”
The U.S. government has already pledged billions of dollars to several companies developing vaccine candidates. Efforts are also underway in Europe and China.