On Thursday, November 19, we attended a webinar with The Hastings Center. In a conversation between Mildred Z Solomon, EdD, president of the Hastings Center, and Anthony Fauci, MD, director of the National Institute of Allergy and Infectious Disease, they tackled the conversation about the public distrust in science and the scientific process.
Acknowledging how the politics has influenced the public health agenda, Dr Fauci states that one “cannot properly and successfully implement a public health program when you have so much disagreement in society, because infectious disease doesn’t distinguish between one’s ideologies.” Dr Fauci states that there are 2 opportunities moving forward: scientific opportunity, and the social opportunity to shed light on inequities in science that have accentuated public distrust.
On the Social Opportunity Addressing Minority Populations
Dr Fauci: We have a situation of health disparities among minority populations, particularly African American, Latino, Native American, Alaskan Natives, and Pacific Islanders, where there is a 2-fold disparity. [They are] outside in critical jobs in society that put them into close contact with people during the time of a respiratory-borne outbreak, so their chances of getting infected is far greater [than the average population]. The other thing is that the underlying co-morbidities that they have, namely the diabetes, obesity, hypertension, chronic lung disease, and kidney disease puts them at a significantly higher risk of not only hospitalization, but even death. That is not a racial issue, that is a social-determinants-of-health issue that goes back from the time that they were born, where the environment in which you grow up and the diet you’re exposed to leads to diseases. It should be a firm decade-long commitment to doing something about the social determinants of health. Because if we don’t, they’re not going to spontaneously go away.
Dr Solomon: The pandemic has made [health inequities] so egregiously visible that we have to take action. Bioethics as a field can broaden its lens to look at more structural issues that create intractable inequities at the population level and economically in the way we organize ourselves socially.
On Vaccines, Effectiveness, and Efficaciousness
Dr Fauci: The primary end point of the [Moderna and Pfizer] trials was clinically apparent disease, which could be mild to moderate disease. The secondary end point was infection or severe disease.
We have highly, highly efficacious vaccines. How effective they will be on society will be determined by a number of factors, including how many people decide they want to get vaccinated.
In the Pfizer study, they had 10 severe events: 1 in the vaccine group, and 9 in the placebo group. In the Moderna study, they had 11 severe events: 11 in the placebo group and 0 in the vaccine group. We do know 2 things: It’s efficacious in preventing infection that is clinically recognizable, and it is effective in preventing severe disease. What we don’t know is whether it’s effective in preventing infection. If I’m infected, but was vaccinated, is the level of the virus going to be so low that I will not be infecting other people?
We do know that if you completely eliminate the virus, you’re not going to infect anyone else. So what we don’t know yet is the impact it’s going to have on transmission. That’s the open question in the discussion.
On Explaining the Vaccine Approval Process to Vaccine-Hesitant Patients
Dr Fauci: We have to look at the reasons people don’t want to get vaccinated. [Some patients] believe that the process was either opaque or slippery. I try [to explain to the general public that] the speed itself is a reflection of scientific advances In the 21st century, you don’t have to grow the vaccine or purify it. You just need the genetic sequence and stick it into the vaccine platform. Within days, you’re making a vaccine and you already saved maybe a year. Now you’re in a Phase-1 trial.
So people hear that speed and they believe it’s compromising safety. Safety has nothing to do with it yet because you haven’t [tested] it in a person. Speed has to do with exquisite technology.
[Some patients doubt] the process of deciding if it works or not. We have an independent body of data safety and monitoring board that is beholden to no one. Not to the President, not to the company. They’re independent, and they’re the ones that evaluate the data. Then they present it to me, the company, and one of the other government agencies. We assess it, and then the company presents it to the [Food and Drug Administration] with career scientists who are beholden to no one. And then there’s an independent advisory committee, [the Vaccines and Related Biological Products Advisory], who also independently evaluate the data. By the time you get to the FDA deeming that this is a safe and efficacious vaccine, you’ve had an independent and transparent process decide. The process is sound.
However, there’s another group of people who don’t even believe that this is a phenomenon, who think it is fake news. That’s where I have a big difficulty in how to get to that group of people. Despite a quarter million deaths, despite more than 11 billion infections, despite 150,000 new infections a day, they don’t believe it’s real. That is a real problem.
Solomon M, Fauci A, Bolo I. Securing health in a troubled time: public trust in science. a conversation with Dr. Anthony Fauci. Presented at: The Hastings Center webinar; November 19, 2020. https://www.thehastingscenter.org/news/fauci-on-public-trust/