Dr. Fauci’s testimony: Pandemics leave lessons

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SAN DIEGO – The first time Dr. Anthony Fauci testified in front of Congress, Purple Rain was topping the charts,  President Reagan was running for a second term, a company called Apple was launching its Macintosh computer line, and the scope of the AIDS pandemic was just being acknowledged.

Newly named to lead the National Institute of Allergy and Infectious Diseases, Dr. Fauci came with a visual aid: A map of Africa with a single dot representing the world-changing public health threat that the emerging AIDS outbreak would become.

Over the 33 years since, Dr. Fauci has returned to Capitol Hill again and again, becoming, in the process, he told an audience here Wednesday, someone who has testified in front of Congress more times than anyone in history.

“Every time,” he added, “in association with an emerging infectious disease.” Every time, he has added dots to the map, with lines connecting them to their names, until now dots and lines cover the map, making national boundaries indistinguishable. “Some of these are trivial curiosities — a few patients,” Dr. Fauci said. “And some are transforming.”

By that he refers not only to the toll those outbreaks took, but the lessons they left behind.

He reviewed some of those. SARS, which in 2003 surfaced in southern China, moved to Hong Kong, and then spread around the world after exposed people there “did what most people who go to Hong Kong do, travel to other places.”

By the time the outbreak was over in 2004, more than 8,000 people had been infected across Europe and Asia and more than 700 had died. Still, this 21rst century outbreak was contained, Dr. Fauci said, the way outbreaks in the 19th and 20th century were, with surveillance and infection control measures.

The H1N1 virus — swine flu — was the next to yield a lesson, outrunning the quest of a vaccine which did not become available until six months after the virus was identified, demonstrating, Dr. Fauci said, the need for a universal influenza vaccine.

Ebola “a storm of lack of healthcare infrastructure in countries with no previous exposure” taught that research, “good credible research,” could be done in the midst of an outbreak. It also demonstrated once again, the value of location — with intensive care saving the lives of desperately ill patients  with access to well-resourced medical centers. And, it demonstrated the value of a quick response, with a delayed international action to contain the crisis and save lives slowing the start of research efforts as well.

Zika spread across the Pacific arousing little alarm, with the numbers affected so small, that the impact of a mutation in the virus not clear until it landed in Brazil. And, as Congress sat on a request for $1.9 billion to contain the spread of the virus over the course of eight months, Zika demonstrated a critical need for a source of secure funding.

These lessons have been acted on over the years, Dr. Fauci said, with the Global Health Security Agenda to build disease prevention, detection, surveillance and control capacities in countries around the world, with CEPI, the Coalition for Epidemic Preparedness Innovations, a partnership of public, private, philanthropic and civil society entities to advance vaccine development, and by prioritizing pathogens for which new medicines are needed.

All will require sustained funding. And still, Dr. Fauci said, more lessons are on the way.

“Emerging infectious diseases have been with us forever,” he said. “They are with us now, and they will always be with us.”


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