Yesterday, after weeks of reports about political interference in the efforts of government scientists and public-health experts to inform Americans about the pandemic, Anthony Fauci, the director of the National Institute of Allergy and Infectious Diseases, directly addressed the two Trump-administration officials at the center of the recent controversy: Michael Caputo, a spokesperson for the Department of Health and Human Services, and Caputo’s former science adviser, Paul Alexander, who attempted to censor what scientists, including Fauci, said about the coronavirus.
“Caputo enabled Alexander,” Fauci told me over email. “Alexander is the one who directly tried to influence the CDC (he may have succeeded, I cannot really say) and even me (I told him to go take a hike).”
Fauci’s comments came after his appearance at The Atlantic Festival yesterday evening.
As first reported by Politico, Alexander tried to directly intervene in the publication of the Centers for Disease Control and Prevention’s well-known publication Morbidity and Mortality Weekly Report, and wrote scorching emails about CDC officials. He also tried to prevent Fauci from advocating for children to wear masks. Caputo ranted on Facebook Live about “deep state” operatives in the public-health infrastructure.
The interference from Caputo’s team had drawn sharp rebukes from the public-health community, especially as it does indeed appear to have been at least partly successful at influencing the CDC’s messaging. Caputo is now on medical leave, and Alexander was dismissed from HHS last week. (Alexander and HHS did not immediately return requests for comment.)
Watch: Atlantic staff writer Alexis Madrigal in conversation with Anthony Fauci
At the festival, Fauci urged Americans to maintain faith in the nation’s public-health institutions, despite the battles between political appointees at HHS and CDC researchers. “I think we could put that behind us right now,” he said. “I would trust the CDC, and I would trust the FDA.”
The agencies’ troubles haven’t disappeared with Alexander’s departure: This week, the CDC again ran into controversy when it posted, then retracted new guidance on how the coronavirus spreads. But the most serious problems of the American response to the pandemic, Fauci asserted, were much broader and deeper. With at least 200,000 Americans now dead from COVID-19, he said, “obviously the numbers speak for themselves.”
After the virus hit the Northeast, exacting a fearsome toll, Fauci said, states across the Sun Belt allowed case numbers to grow over the summer, which meant the U.S. was never able to get the baseline of cases low enough to mitigate the risks of reopening. “We’re looking at 40,000 new cases per day,” he said. “That’s unacceptable, and that’s what we’ve got to get down before we go into the more problematic winter.”
Fauci’s message conveyed a new level of urgency about the challenges ahead. Two weeks ago, he told The Atlantic that the country had to get new daily cases down to 10,000 over “the next few weeks” to guard against surges in the winter, when containment will be even harder in many parts of the country as the weather grows colder. Cases, however, have remained near that 40,000-a-day plateau. There are signs that some states, such as Wisconsin, may be on the verge of bigger outbreaks. Time is running out to bring down viral spread.
How might the U.S. get those cases down? The path is well known, and Fauci ticked off the public-health mantras: ubiquitous masking, physical distancing, avoiding crowds, doing things outdoors when possible, and washing your hands. What’s less clear is how anything might change in the U.S. over the next few months, because public-health officials have long been saying that these things were necessary to constrain the virus. Fauci pointed out that their advice continues to be met with furious resistance and violent rhetoric from America’s right-wing fringe. “People have been threatening me as a public-health person, literally threatening me and my family,” Fauci said, “because I’m saying we should be doing public-health things like wearing a mask and physical distancing, as if I’m doing something that is harmful to them … not that the virus is hurting us.”
Fauci is much more optimistic about the development of a vaccine, which has progressed at an unprecedented speed. He cited the large-scale, Phase 3 clinical trials currently under way in the U.S. “The results that we have actually do look good,” he said. (One trial, AstraZeneca’s, remains partly on hold after two participants developed serious neurological illnesses.)
The federal government’s investments in vaccine development and production are a bright spot in the American response, which otherwise has been uncoordinated, chaotic from the top down, and predicated on pinning blame on individual states. By contrast, Operation Warp Speed, a name Fauci often decries because it sounds reckless, has been well funded, organized, and effective. In normal circumstances, vaccine makers would wait until after clinical trials conclude to begin manufacturing, but government funds have allowed them to begin over the past several months. “If we get an answer, let’s say, November, December—it’s possible it could be earlier, but I think it’s going to be likely November, December,” Fauci said, “we can then start vaccinating people, starting with the health-care workers, … the elderly, and those with underlying conditions.”
The Trump administration’s political rhetoric about vaccine development has raised alarm among other public-health experts. In the lead-up to the election, Trump has begun teasing that a vaccine could be available in weeks. Some have wondered whether the design of the current trials, released after substantial public pressure, will actually reveal the information that’s needed about these new vaccines. “The trials need to focus on the right clinical outcome—whether the vaccines protect against moderate and severe forms of COVID-19—and be fully completed,” wrote Eric Topol, a molecular-medicine professor at Scripps Research, and Peter Doshi, a professor at the University of Maryland School of Pharmacy, in a New York Times op-ed yesterday.
People across the political spectrum also are expressing uncertainty about taking the vaccine, which could blunt the positive effects of its availability.
So, as we approach winter, there are two wildly different stories to tell about what might happen. In the storybook ending, a vaccine becomes available, more testing reduces the number of contagious people, and the country brings the virus under control. In the darker scenario, vaccines are delayed, or even if one arrives, few people accept it as safe. Testing is ineffective, and collapsing social cohesion leads to less adherence to simple, effective public-health measures.
Throw in a presidential election, flu season, climate chaos, rampant misinformation online, and the path the country may end up on is not at all clear. “What the general public needs is a message that’s consistent, and that they can believe,” Fauci said. “And what’s happened, unfortunately—and I think you’d have to be asleep not to realize this—is that we are living in a very divisive society right now; there’s no doubt about that … It’s politically charged, and what’s happened is that public-health issues and public-health recommendations have taken on a we-versus-them approach.”
Can America’s science-and-technology infrastructure save us from a crumbling politics of grievance and anger? Not even a public servant with a record like Fauci’s can predict that.