“To me, the worst bioterrorist is nature itself”

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Dr. Fauci speaking to reporters Thursday at an Alliance for Health Policy session

It’s HIV, Ebola and Zika that put these white hairs on his head, Dr. Anthony Fauci told a group of reporters Thursday. Still, he remains startlingly recognizable as the face of biomedical science in the early 1980s, when modern medicine seemed to have met its match. Back then, Dr. Fauci recounts, he had to face patients who were in their 20s, who he knew would be dead within the next few years.  What research and resolve have brought about since, he said, “has been truly breathtaking.”

The perseverance that progress required has continued to be called on over the decades since, to meet threats posed by pathogens across an planet increasingly interlinked by travel and trade. Along with back-to-back outbreaks of Ebola and Zika, outbreaks of bird flu, swine flue, and the flu season waning only now, have spelled some of them out. Emerging infections are a perpetual challenge, Dr. Fauci says, “Flu is the mother of perpetual challenges.”

The challenges he recalls the most readily are the ones that highlighted obstacles. In the 2009 outbreak of H1N1, or swine, flu, those were timing and availability of the vaccine, which came out only after the epidemic had peaked. That, he explains, is because the egg-based method of growing vaccines requires six months between identification of the virus, and final product. New DNA-based technology offers promise for much quicker development, but will require both more proof that it will work, and then some incentive for the many factories now making egg-based vaccines to do something different. Time also challenges the effectiveness of seasonal vaccines — with either the virus used for vaccine development, or the virus in circulation changing just enough to critically compromise the outcomes of innocculation.

The result means chasing after, rather than standing prepared for influenza with pandemic potential. While the development of a universal influenza vaccine is gaining prominence as a goal, it remains distant.

“It’s going to be an iterative process,” Dr. Fauci says. “The first version is probably five years out. The home run is many years away.”

Therapeutics, he notes, are gaining ground faster, he says. He points to “a new drug developed in Japan that kills the virus in one day,” as an advance that highlights the value of research funding.

Also highlighting the value of research funding, Dr. Fauci notes, is  “Disease X” a yet-unknown pathogen of pandemic potential, recently highlighted by the World Health Organization, and demanding that biomedical science prepare for an unknown.

While the spectre of a bioterrorist attack may inspire the most fear, he expects a naturally emerging infection to do the most damage. “To me the worst bioterrorist is nature itself.”

Anthony Fauci, MD, current director of the National Institute of Allergy and Infectious Diseases at the National Institutes of Health, at a lab in 1984.

But science remains a formidable adversary, he says, in the fourth decade since he began to confront AIDS. Today, Dr. Fauci says, “even in the absence of a vaccine, theoretically, you can end the HIV epidemic.” He adds, “theoretically is a far cry from reality.”

The need to prepare for, and still to chase disease outbreaks won’t end, Dr. Fauci says, and that’s why he remains grateful he chose to a career of confronting infectious diseases. “If there are any diseases that are truly global, it’s infectious diseases,” he said. “The field is one of the most exciting things you can do, because it gives you something you can do something about.”

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