[...] [COVID-19, Where Do We Go from Here? Thursday, Nov. 12, 7 pm.] [Dr. Anthony Fauci, Dr. Francis Collins, Dr. Luciana Borio] [Footsteps] [...] [Randy Hollerith:] Good eveningand welcome to Washington National Cathedral. My name's Randy Hollerith andI'm the dean of the cathedral. On behalf of MariannBudde, the bishop of the Diocese ofWashington, and all of us who serve thiscathedral. Welcome. We're so glad thatyou've decided to join us for this importantconversation this evening. Convening conversations,bringing people together to discuss some of the mostimportant issues of the day, is one of the cathedral'score priorities. Since 2008, the Nancyand Paul Ignatius Program has given this cathedrala wonderful opportunity to focus on manyimportant issues, issues that sit at the intersectionof faith and public life. The Nancy and PaulIgnatius Program Fund was established by Nan andPaul's children, David, Sarah, Amy, and Adi Ignatius, theirfriends, and other relatives as a recognition of Nan andPaul's service and commitment to WashingtonNational Cathedral. While we said goodbyeto Nan last year, her legacy lives onhere at the cathedral. And we are sopleased to have Paul as the mainstay of ourcathedral community. Not to mention that this year'sIgnatius Program is especially important because yesterdayPaul Ignatius celebrated his 100th birthday. Happy birthday, Paul, andGod bless and keep you. Thank you for all thatyou have done for so many. [Applause] [...] Our topic for tonight couldnot be more relevant or timely. The impact of this pandemic onour nation has been immense. Every week this cathedralholds a service specifically to pray for thoseby name for many of those who have losttheir lives to COVID-19. And who among usthis time last year could have imaginedthat we would see 230,000 Americanswho have lost their lives and the number only growing? Over the past 10 monthswe have experienced a lot of loss and heartbreak. Yet, at the same time,we have witnessed the self-sacrifice and heroicefforts of first responders, and medical personnel,and front line workers. Moreover, we're beginningto see the fruits of the incredible efforts madeby scientists around the world to find a vaccinefor this virus. And to do so at a pacenever seen before. The truth is there has beenmuch suffering and loss. But there is also muchto be thankful for. So where do we go from here? My thanks to Dr. LucianaBorio, and Dr. Francis Collins, and Dr. Anthony Faucifor being our guest tonight to tackle thatquestion and so many others. So if you willpermit me I'd like to begin this eveningwith a prayer. If prayer is somethingmeaningful in your life, I hope you willjoin us --join me. Let us pray. [...] Oh, God, our refuge andstrength. A very present help in trouble. We pray for all those affected by COVID-19around the world. Remove the presence of fearand anxiety from our hearts and heal all those whoare sick with the virus. Give skill, and sympathy,and resilience to all those who are caring for thesick. And your wisdom to those searching for a cure. Strengthen them all with yourspirit that through their work many will be restored to health. All these things we prayin your holy name, Amen. And now it's my pleasureto turn this over to the oldest of the Ignatiuschildren, David Ignatius. [...] [David Ignatius:] I'm DavidIgnatius, a columnist for The Washington Post. On behalf of all ofthe Ignatius family and with thanks to thiswonderful cathedral. I would like to welcome you to aspecial discussion of the topic that our nation andthe world are thinking about more than any other. "COVID-19, Where DoWe Go From Here?" We've had some hopefulnews in the past week with the announcement of avaccine whose phase three test results, our keynote speaker.Not a man given to hyperbole, described as really quite good. I mean, extraordinary. And we've had thechilling news of what appears to be a wintersurge of the virus. With infections-- infectiontotals rising every day and hospitals around the countrystraining to treat patients. We're blessed tonight to havethree of the wisest doctors in America, andindeed in the world. Help us think aboutwhere we're going, and how to protect our families,our country, and the world from this scourgeof the pandemic. A word about our format tonight. We'll open with a conversationbetween my brother, Adi Ignatius. Editor in Chief ofThe Harvard Business Review, and Dr. Anthony Fauci. Now, many of you may nothave heard of Dr. Fauci. So I will explainthat he's Director of the National Institute ofAllergy and Infectious Disease. That for decades he's beenour nation's leading expert on infectious disease. And a person who gives us faiththat science and reason will prevail in the end. Following theirdiscussion, my sister, Amy Ignatius, a superiorcourt judge in New Hampshire, will moderate a response toDr. Fauci from Dr. Francis Collins, Director of theNational Institutes of Health, and Dr. Luciana Borio,who served in the Obama administration as ActingChief Scientist at the FDA. Then directed medical andbiodefense preparedness for the Trump administrationfrom 2017 to 2019. And is now a member ofPresident-elect Joe Biden's Coronavirus Task Force. Finally a word aboutthe Ignatius Program. As Dean Hollerithsaid, my siblings and I helped establish thisevent 12 years ago to honor our parents,Paul and Nancy Ignatius. Who havecherished their relationship with this cathedral. Over these dozen years we'vehad many important speakers. Including Zbigniew Brzezinski,Brent Scowcroft, Bill Perry, John Kerry, SusanRice, and many others. But we've never had amore important topic or more compellingpanelists than tonight. As you know from Dean Hollerith,Paul Ignatius, our father, celebrated his 100thbirthday last night. If you want to think about howto stay healthy in these COVID times, he's your man. It's fitting that his birthdayis Veteran's Day, because he spent a lifetime servinghis country. As a combat veteran in World War II. Lateras Secretary of the Navy, and truly in everything he does. My brother, Adi, my sister,Amy, and my sister, Sarah who runs the NationalAssociation of Armenian Studies and Research and isthe only Ignatius you won't see onstage tonight. We would like to dedicatethis program to our father and to the memory of his wifeof 71 years, our late mother, Nancy Ignatius. So now to Dr. Fauciand my brother, Adi. [...] [Adi Ignatius:] All right,thank you very much David, and Dean Hollerithfor getting us started. So David hasintroduced Dr. Fauci. I won't add to that except tosay he left out two key things. He has his own Topps baseballcard and a bobblehead doll. That somehow in thisweird year that is 2020, America's leading rockstar is an epidemiologist. So here's my first question. President Trump hassuggested he might fire you. President-elect Biden hassaid he might promote you. You're a 79-year-old man, whichsounds like a better deal? [Laughter] [Anthony Fauci:] Well, I thinkthe important response to that, which I get asked often, is thatmy job as a director of an NIH Institute and as apublic health official. Is to focus entirely on what mymission and our goal is. Which is to use scienceand health to preserve the health, the safety, and thewelfare of the American people. Regardless of whatthe administration is. As you know andmany people know, that I have had theprivilege of serving six presidents since I becamedirector of the NIAID in 1984. And that's what wefocus on as scientists. I know we're living in acharged political environment, but that's something thatis not primary for us. We just continue to do ourjob. To foster public health, but also to do thescience that leads to the things like thevaccine that you mentioned in the introduction,that was just mentioned by the deanin the introduction. So that's what I focus on. So when you hear thosethings in the newspapers, many people think I getshook back and forth by that. To be honest with you, I don't. [Adi Ignatius:] Well, let mefollow up a little bit on that. So I think if people saw thatthe program, that you were going to be featured, theyprobably thought, that's great, this is my guy, Fauci. Those people areprobably Democrats. You have this very high approvalrating among half the country, among Democrats. Not so high among Republicans. Although 'The Independent'did a survey and said you're the only person servingunder President Trump whose approval ratings have goneup instead of gone down. But on a serious note,you and your family have had threatsagainst your life because you've defendedscience instead of defending the White House. So how did sciencebecome so politicized? [Anthony Fauci:] Well, that'san important question, but also sad that youhave to ask that question. Because that iswhat we have seen a lot in the United States,but not just restricted to the United States. Because we're also seeing itwith my colleagues in the UK, and in Europe, and inother regions of the world. I don't think there's asimple explanation for it. But I think there hasbeen an anti authority component to this. We have anti vax. People don't like to betold to be vaccinated. Scientists are oftenperceived as authoritarian. And sometimes, in fact, they'vemade that perception themselves by the way they act. I think we can improve on that. But right now ithas been just lumped into the politicsof what's going on. We live in a divisive society. And even if we didn'thave a pandemic, it would be a divisive society. And the fact that wedo have a pandemic, and a pandemic is apublic health issue. And public health isintimately related to science. That all of a suddenscience gets caught in a lot of this divisiveness. And that's unfortunate. And what we, asscientists, hope-- I know that my colleague FrancisCollins feels the same way-- that when we getpast this, science will resume itsreally rightful place in being something that's foreveryone without divisions. [Adi Ignatius:] Willwe get past this, meaning COVID-19 orwhen we get past this-- [Anthony Fauci:] No, COVID-19. I think when we get out of thecharged nature of the stress and the strain that's putupon us by an outbreak. People will realize theimportance of science. [Adi Ignatius:] So let's talkabout where we are now. There has been really aterrifying spike in new cases, hospitalizations, deaths. As you look at this andthe spread of this thing, where are we in the cycle? [Anthony Fauci:] Well,data speaks for itself. We are in a very, verydifficult situation. It's quite problematic. I have said, that publicly manytimes, not to scare people, but to bring a realitycheck to where we are. If you look at it, wehave 10 million infections in the United States.Almost 250,000 deaths. We've had 60,000hospitalizations. And now, last count, wehad 143,000 infections in a single day. When I testified before theCongress four months ago I said if we did notget control of this that we could reach100,000 infections a day. And people thought Iwas being hyperbolic. And now look what's happening. That's the bad news. I think the encouraging newsthat people need to understand. That public health measures,not lockdown of the country. But public healthmeasures that are rather simple and easy to understand. The universal wearing ofmasks, the physical distancing, the avoiding congregateand crowded places. Outdoors better thanindoors. Washing hands. It sounds simple in the contextof this ominous outbreak, but, in fact, itcan turn it around. And that's what wereally need to do. [Adi Ignatius:] So to be at thislevel now, of this new spike, is that just alethal pandemic kind of working its way through thecountry, through the world? Or are we doingsomething just horribly wrong to be at that place again? [Anthony Fauci:] Well, I wouldn'tsay it's horribly wrong. I think what we have not done-- and it isn't justthe United States. I think if you look at what'sgoing on in Europe and the UK now, they are, in manyrespects, in the same boat as we are with major surges. But would you look at whathappened in our own country, that we did not actin a unified way. I always say one ofthe wonderful things about our country that Ilove so much is that we're the United States of America. And we're a federalist country. And we have states'independence. And they have--in some respects, important thatthey are that way. However, when you're dealingwith an infectious disease, the infectious diseasedoesn't know the difference of the border betweenMississippi and Louisiana, or between Florida, andGeorgia, and South Carolina. And an infectious diseasemeans the entire country. We did not approach it that way. We are too muchindividual approaches towards how we were goingto handle the outbreak. So our baseline nevercame down to the low level that we wanted it to be. So when communityspread came in, as we tried to open thecountry. It just soared right up. And it's aself-propagating issue. Because the morecommunity spread you get. The more difficultit is to contain it by identification, isolation,and contact tracing. Because there's somuch of it going on it becomes verydifficult. That's the problem we're in right now. We have an enormous amountof community spread. [Adi Ignatius:] So if your modelwas telling you a while back that we could have100,000 cases a day. What is it telling you now? As you look forward tothe winter, cold weather, what are we facing? [Anthony Fauci:] Well, modelsare as good as the assumption you put into the model. I have been one tochallenge models. Not challenge the validityof the modeling process. But to challengethe assumptions that are put into it. If we all literally pushedtogether as a group and did it in a uniformway. We do not necessarily need to see the 1,000to 1,300 deaths per day. We don't need to see the140,000 infections per day. We can turn it around. So if we stay the way weare, you do the simple math. 1,000 deaths a day,140,000 cases a day. You multiply it by 31 daysin December. Two weeks more left in November. By the time youget to January 1st, we have a really,really bad situation. So what I'm saying as apublic health official, and as my colleagues say, wedon't need to accept that. And I want to make one pointif I may that's important. I know you're going to getto it in the questions. But one of the thingsabout a vaccine, which is really important, notonly in and of itself as being a tool that'sessential to end this outbreak. When people know thathelp is on the way-- and what I mean byhelp is on the way is that we will startgiving vaccines in December. And then as we getinto January, February, March we'll get theprioritization of the people who need it the most. If we can focus thatis there, there's light at the end ofthe tunnel. I hope we can get over what wecall COVID fatigue. Where people are so exhausted withthe public health measures that they really feel likethey almost want to either give up and say, let's dowhat you want to do. Which is not thetime to do that now. Now we need to double downon the public health measures as we're waiting for thevaccine to come and help us out. [Adi Ignatius:] Sothere's COVID fatigue and there's COVID resistance-- or resistance to taking themeasures you're talking about. Is there-- in your mind, isthere hard data, hard evidence that these behaviorsthat you would call reckless, big politicalrallies where people aren't wearing masks, motorcyclerallies, whatever. Is there clear data that thosehave led to outbreaks? [Anthony Fauci:] Yeah, I thinkit's pretty clear when you've seen congregate settingswhere people gathered indoors without a mask. There's no doubt that you see. We've seen that withthe Sturgis Rally. We've seen that with anumber of other situations. We have seen it inclear-cut examples of people getting together ina congregate way, particularly indoor. Where you trace after that,there's clear outbreaks. [Adi Ignatius:] All right, soyou talked about vaccines. So let's talk about vaccines. [Anthony Fauci:] Let'stalk about vaccines. [Adi Ignatius:] Pfizer got ourattention with its announcement recently, about 90%efficacy for its trial. Tell me what you-- thereare a lot of tests. What are you seeing? You said you thought there'dbe vaccines being rolled out in December. Talk a little bit aboutwhat you're excited about and maybe specificallywhat you're seeing. [Anthony Fauci:]Well, I mean if you look at infectious diseasesin general. What you need to get society protected.You need a certain number of the people who areprotected because they're immune from the virus. There are a coupleof ways to do that. One way is very painful. Is that everybody gets infected. That leads to a lot of deaths. That is unacceptable way toget this virus under control. The other way is to havea highly effective vaccine that the vast majorityof the population takes. So in other words, if you havea 50%, 60% effective vaccine, that even if themajority take it there's still a largesegment of the population that is not immune. But we are fortunate becausethe first one out of the gate is more than 90%, probablyclose to 95% effective. So what we'rehoping is that those who have vaccine hesitancy. Whoare skeptical about a vaccine. Will see that theefficacy of this is so high that they maychange their mind about wanting to get vaccinated. The other part ofthe good news is that there are othervaccines. Some that are almost identical. Suchas the Moderna product, which will be evaluated in thenext week to a few days. That we anticipate,though you never want to get ahead ofyourself, that it will be as good or close to that. If that's the case, thenyou have two of them. So we have the capability--what science has done in an unprecedented way. If this were 15,20 years ago, it would have taken a few yearsto get to where we are now. The idea that you went froma recognition of the virus on July 9th, with the sequence.To a phase one trial. Literally 60-some odd dayslater, to a phase three trial a few months later.To a vaccine that we're going to be giving to peoplenext month is extraordinary. And that's what Isaid when you-- when we said how I described it. I mean, I've beendoing this for 40 years and this is reallyextraordinary. But as extraordinary as it is,what we don't want people to do is to say, oh, we have avaccine now so we're done. We're not done. We still need to implementpublic health measures in a very intense way. [Adi Ignatius:] But when you saythe vaccine will be rolled out in December, that means forfrontline workers, people at risk-- I mean, what do you-- [Anthony Fauci:] Yeah. [Adi Ignatius:] What'syour time table? [Anthony Fauci:] The standardway that this happens when you have a vaccinethat isn't readily available to everybody all atonce. Is you do prioritization. That's the responsibility ofthe Centers for Disease Control and Prevention, the CDC. They rely heavily on an advisorycommittee called the Advisory Committee on ImmunizationPractices, ACIP. They help them makethe prioritization. They're only advisory. The CDC makes the ultimate. This year, we complemented thatby asking the National Academy of Medicine to also weigh in. Now, I'm not going to get aheadof them in their decision, but likely it willbe frontline workers, like health care workers whoare taking care of individuals. People who haveunderlying conditions that make them susceptible to asevere outcome were they to get infected. Peoplein nursing homes, for example. People withunderlying conditions. Then children in school. Adults, teachers inschool. Fundamental people who are responsible for makingsociety run in an orderly way. That's the kind ofprioritization you get. We hope by the time we getinto the second quarter of 2021 we will have enoughvaccine that we will have progressivelyvaccinated people so that when we get April, May,June, we'll be able to get people in thegeneral population starting to get vaccinated. [Adi Ignatius:] So aguy like me who's not in a particularhigh risk level, middle of the year you think? [Anthony Fauci:] Yeah,I would think probably by-- anywhere between theend of the first quarter and the end of thesecond quarter. [Adi Ignatius:] So thenwe have the problem of the people who say theywill not or probably will not take the vaccine. And that number has actuallyincreased rather than-- [Anthony Fauci:] Right. [Adi Ignatius:] --decreased Inthe past six months or so. I think for the people whoare resistant because they didn't trust what anybody wassaying, you talked about that. [Anthony Fauci:] Right. [Adi Ignatius:] That showing anearly efficacy of these trials, but the people who justthink, no, I don't want to take a vaccine, I don'twant anybody to tell me to take a vaccine, how do you-- how do we move theneedle on that? [Anthony Fauci:] Well,you've got you've got to continually try andoutreach them and do what we call community engagement. There are going tobe a core of people who will not take a vaccineno matter what you do. I don't think youshould give up on them, but I don't think youshould necessarily expect. But there's a largergroup of people who just probably havemisinformation and don't understand the process. And what we've beentrying to do, myself, Dr. Collins, and others, we'vebeen trying to explain clearly what the process is of makinga decision that a vaccine is safe and effective. It's an orderly process. It's done byindependent groups that have no allegianceto an administration, or to a company, or to anyone. They make that decision. They look at thedata and determine is it safe and effective. Then there are layersof advisory committees. There's the career scientistsat the FDA that I trust. There's thescientists like myself and Dr. Collins who willbe looking at the data. So it's going to be avery transparent process. I don't think people who areanti vax fully appreciate how transparent that process is. They may think there'ssomething that's being people, are trying toput something over on them. We need to reach out tothem and make them realize that that's not the case. And it's to their benefitand the benefit of society to get vaccinated. [Adi Ignatius:] So if 50% ofthe population or some-- maybe not that many, but alarge chunk of people do not take the vaccination.What does that mean? How does that play out? What does that meanfor me if I take-- what does the world look like? [Anthony Fauci:] I think thatwould be quite problematic. And it would not be goodfor the country in general. Because if you reallywant to essentially crush, that word they use,an outbreak. To get the level of transmissionso low that it is no longer a publichealth problem. If you have 50% of the peopledon't get vaccinated, there's a lot ofinfection that's going to be goingaround the community. If you get a 90%-95%effective vaccine, and 80% of the populationget vaccinated, you have an umbrella ofprotection already that the virus has no place to go. It would be lookingfor vulnerable people and not finding it. That's when it goes way down. And then it's nolonger a threat. Now, if 50% of the peopledon't want to get vaccinated. It's going to take quite awhile to get to that point. [Adi Ignatius:] SoCOVID-19 seems to be mutating in concerning ways. Is there anything thatwe do not know yet about COVID-19, a mysterythat, I don't know, that either continuesto surprise you or that we need to unlock? [Anthony Fauci:] Yeah,let me count the ways. There is a lotthat we don't know. And I think wehave to be humble. That we have learnedan extraordinary amount over the last 10 months.But there's a lot that we do not know. And that's the reason whythe studies, the cohorts, the research thatwe're going to be doing. Is going to go onfor quite a while. Even after we have theoutbreak under control. [Adi Ignatius:] Yeah. So we actually solicitedquestions from viewers and a lot of them were about-- I've had COVID, am I safe?Both for myself, and in terms of infecting anybody else? I have theantibodies, am I safe? What do we think aboutthose questions now? [Anthony Fauci:] Well,at this point in time, we do not know thedurability of protection. We know that if you getinfected and recover it is very likely fora finite period of time that you are protected. It's almost certainthat that's the case. We've already seen specificinstances of reinfection. People who were infectedrecovered and got infected with another SARS-CoV-2. We don't know how extensivethat's going to be. So even though antibodiesare present in a lot of the people who recover.We don't know what level is related to protection. We don't know howlong that lasts. Now, we don't want to scarepeople to think, oh, my God, I've got infected and now I'mgoing to get infected again. Unlikely. But, what we havea lot to learn is what the durabilityof protection is. The one thing I can say asan infectious disease person is that it is very unlikelyit's going to be like measles. If you and I-- I got infected bymeasles as a child. I'm sure you did also. And the fact is you'reprotected essentially for life. It likely is notof that magnitude, because of what we know aboutthe common cold coronaviruses. That keep re-infecting people. We feel it's likelymeasured in several months to a year or more. But it doesn't looklike it's going to be 20, 30 years. Whichmeans that people need to get vaccinated even ifthey've been infected before. Which we think isgoing to happen. And it is conceivable,though not absolute, that you may needto boost people every once in a while afterthe vaccine, which is fine. [Adi Ignatius:] Yeah. So more generally, are we,and by that I mean the planet, more susceptible nowsomehow to global-- I mean, this seems like aonce in a lifetime occurrence, but is it? Should we be braced for more? [Anthony Fauci:] No, no.They will continue. As we've said, pandemicoutbreaks over history have occurred beforeeven recorded history. Before understandingwhat a pathogen is. They've occurred inour own lifetime. Within the memoryof some people, 1918 was a disaster for theworld with the flu pandemic. We have seen outbreakssome of which have been trivial, some ofwhich had had major impact. Right now this is themost serious outbreak that we've had in thisplanet in 102 years. Will it happen again? Yes. Will it happen 10,15, 20 years from now? We don't know. The thing about outbreaksare they are unpredictable. So as scientists, what we say.You would likely cannot prevent the emergence of a new microbe. What you can preventis that emergence from becoming acatastrophic pandemic. And that's what we meanby pandemic preparedness. To prevent the inevitableemergence of microbes. As long as we have an interface with the animal world.You know the one health. That 75% of all the newpathogens that have emerged have jumped from ananimal species to a human. They were zoonotic andthey jumped to human. So that's going tocontinue to happen. The question andthe challenge for us is to prepare enoughso that it doesn't become a catastrophic outbreak. [Adi Ignatius:] So, we didn'tdo very well this time. [Anthony Fauci:] No, we didn't. We didn't. [Adi Ignatius:] So how do we-- more specifically, how do weavoid or mitigate the next one? [Anthony Fauci:] Well, there area number of things we can do. First of all, we'vegot to think globally. Pandemics are global. So we have to pulltogether globally. There's a thing calleda global health security network or agenda that wasestablished several years ago. We need to strengthen that. We need to strengthen ourinternational collaborations. We need to have people speakingto each other in surveillance. It's got to be openand transparent. When you do that, you can detectit early and respond early. Scientific approaches,technologies, are going to allow us to dowhat we did with this outbreak. Rapidly make a vaccine. We can do even better than that. But you can't do science alone. It's got to be publichealth and classic science. [Adi Ignatius:] So are therecountries that you-- there are countries that seem to bedoing well that weren't doing. So, are the countriesnow that hold up as models for prettygood response to this? [Anthony Fauci:] You knowthe answer is yes, but right now it seems thatevery country is suffering. We are often comparedwith countries that are not comparable to us. We are not a littleisland of 5 million people that we can shut off. We're not a country that wouldaccept if a ruler tells us you must do this. I was talking withour UK colleagues just today, who was saying theUK is very similar to where we are now in outbreakbecause each of our countries have that independentspirit but we we don't want to be told what to do. Well, I understand that,but now is the time to do what you're told. And I think itreally is something that we should bedoing right now. [Adi Ignatius:] So, all right,what you're talking about is walking the fineline between lockdown at one extreme and open activityon the other extreme, you, as a professionalmedical person probably err on the side ofcaution and health. [Anthony Fauci:] Right. [Adi Ignatius:] But if you werePresident-elect, how would you balance those two priorities? [Anthony Fauci:] Ibelieve you have to be sensitive to the stressand the strain of lockdowns. The economic andpsychological consequences. I do not believe at this pointthat we do need to lock down. We have to leavethat on the table. We're not going to justpush it off the table. I don't think we need to doit because my experience is that when you as agroup, as a nation, implement the public healthmeasures that I mentioned to you. We can turn thisaround without locking the country down. [Adi Ignatius:] So you'veanswered the question I'm about to aska million times, but it's probablyuseful for people who are tuning in to hear. There are those who thinka herd immunity strategy is a good strategy. [Anthony Fauci:] Right. [Adi Ignatius:] Comment. [Anthony Fauci:] No, it is not. I mean, it just is not. I don't want to disrespect anyof those who feel that way. That's their opinion. But it's just not the case. Because if you look now,25% will say, of the people in this country, that got hitbadly in New York are immune. Ten percent of the country as a whole. The CDC did a very goodstudy and said about 10% of the people in the countryquote, "have gotten infected and are therefore protected." We have 245,000to 250,000 deaths and 10 million infections. You're not going toget to herd immunity until you get somewhereup to 70 or so percent. Now, if you want to go from10 to 70, multiply that by 7 and look at thenumber of people who will have to have died toget to natural herd immunity. It's not feasible andit's not acceptable. [Adi Ignatius:] I'veread a lot about people who feel that they'resuffering kind of long-term effects,survivors of COVID-19, who are having secondarylong-term effects. Uh, you know fogginess, other things. Does that-- what's themedical view on that? [Anthony Fauci:] Well,it's a real phenomenon. We are, right now,literally as we speak-- in fact, this afternoon I thinkit was about 3:30, Francis-- we had a phone callabout the approach that we're going to betaking from a scientific to try and investigate that. It's a phenomenon wherepeople clear the virus, but for variableperiods of time-- and we don't know what thepercent is, whether it's 20%, 25%, 30% of people-- have the persistence ofsymptoms that are bothersome to their function. Fatigue, shortness of breath,muscle aches, dysautonomia. Inability to controltemperatures. What they call brain fog.Which means a real difficulty in concentrating or focusing. It sometimes can beincapacitating to people. We need to figure out what thatis and what we can do about it. So we're doing a very biglook at what we can do. And it likely will besome very large studies. [Adi Ignatius:] Yeah. So another studythat seemed hopeful was this one, thenasal spray, that seemed to block infections. I think it wastested on ferrets-- [Anthony Fauci:] Right. [Adi Ignatius:] --thatparallel us somehow. Is that something thatyou are taking seriously? [Anthony Fauci:] Of course. Whenever you havea study that looks favorable in an animal you arealmost obliged in many respects to go ahead and carefullydo a phase one study in a human, then a phase two,and then a full efficacy study. So we're going tobe studying that. But I think weneed to warn people that often we findthat things look really promising in an animal,but it doesn't hold out in a human. [Adi Ignatius:] Yeah. So, again, the questionsthat we received from viewers before we started this, so manyof them were very personal. Everyone's experienceeither with COVID or with fear of contractingit is very personal. And people have movingand personal stories. But I know you'vetalked about this a lot, but I think peoplewould love to know what do they do at Thanksgiving? You've talked about whatyou will do and won't do, but any general, but stillrelevant advice you can give? [Anthony Fauci:] Yeah,I think every family unit needs to doa risk assessment and a risk-benefit ratio. If you have people in yourfamily who are elderly or who have underlyingconditions that make them susceptibleto severe outcomes. You've got to make a decision. Do you want people totravel, to spend time in a crowded airport,to get on a plane and maybe not havetime for quarantining after they get here? Or not have the abilityor understanding how they can get atest quickly enough? You may want to make adecision that you're just going to forestall it. Now, whenever I say that I'm theGrinch that stole Thanksgiving. I'm not saying that. I'm saying everyoneneeds to seriously think about the risk-benefit. And you might say I hada wonderful vaccine-- excuse me-- I had awonderful Thanksgiving last year, I'm looking forwardto a wonderful Thanksgiving next year. But maybe rightnow's not the time to have 25 people in a housewhen you take your mask off as you're eating. [Adi Ignatius:] So we have timejust maybe for a couple more questions. But you mentioned that thisis the most serious pandemic we faced in over 100 years. And I think we go back to 1918. Looking back at that,and I'm sure you've looked a lot at that. Is theresomething to learn from that? How it plays out, and whetherwe go the path A, or path B, and there's a goodpath and a bad path. Learning from 1918,what do we need to do? [Anthony Fauci:] Yeah, whatwe need to do right now is that we know from historicallittle anecdotes that actually became studies. That whenpeople took seriously the kind of thingsthat I'm talking about, wearing of mask,physical separation. They did much better in citiesthat did that than in those that just said,the heck with this, I'm going to dowhatever we want to do. So history is kind of repeatingitself 102 years later. [Adi Ignatius:] Yeah. So last question. You started to talk aboutthis at the beginning, but you've worked formany, many presidents. You've worked formany, many years. What keeps you in this game? It's not like youjust get adulation. You also get a lot of grief. Again, you have bodyguards. What keeps you going? [Anthony Fauci:] Eachof us choose the path we want to take in our lives. I've chosen publicservice in the context of medicine and science. And there's nothing moreexciting to me than that. Or more challenging. So it totally energizes me. So when, people talkabout my age, and how long I've been doing it. You know italmost seems like I've only been doing it for a short time. I have a long way to go. [Adi Ignatius:] All right. Well, I want to thankyou very much for-- [Anthony Fauci:] Thank you. [Adi Ignatius:] --for your workand for being here tonight. [Anthony Fauci:] Thank you. [Adi Ignatius:] Itwas fascinating. [Anthony Fauci:] Thankyou for having me. [Applause] [...] [Footsteps] [...] [Amy Ignatius:] Good evening. I'm Amy Ignatius and happyto be able to continue the conversation with twoextremely knowledgeable people. These are long days for youand we appreciate so much your willingness to keep onworking a few extra hours, and share with us, andcontinue the conversation that Adi and Dr. Fauci began. I also want to say, thinkingabout somebody who's dear to all of us who'srecently left. Our treasuredJustice Ginsburg once said, "I am a very strongbeliever in listening and learning from others." And the Ignatius Program wascreated for that very purpose. To listen and to learn. And so it is agreat pleasure to be able to work with the two of youto continue that conversation. You have such expertise, eachof you, in such difficult times. So let's get right to it. There's so much to talk about. We could spend all night. And I won't make youdo that, don't worry. President-elect Biden hasjust created a new task force. And he has named you, Dr.Borio, to be on that task force. I don't know if you'reallowed to say much about what your mission is going to be.What your particular role will be, and whether it hasstarted its work or not. But what can you tellus about the task force? [Luciana Borio:] Sure. The President-electmade very clear that he wants to beready on the first day to begin to establishprograms to counter this horrific pandemic. That he's going towork very closely with state and local officials.With the American public. To turn around the explosivenumbers we're seeing. Because we need to be able toreopen schools and businesses in a safe and sustainable way. We do want to go backto our way of life. And that's the work ahead. So the task force has met. It is going to meet regularlyto advise the President-elect. The Vise President-elect andthe transition teams that are working really hardto get the administration ready to govern in January. [Amy Ignatius:] AndDr. Collins, you, as head of all of theInstitutes of Health, are you able to coordinate yourefforts with the task force? How does that work for youin the next couple of months? [Francis Collins:] Well,I think the good news is that thecoordination, the ability to work together on thispublic health crisis, has been truly amazing. When you look at thescientific effort, and as the directorof NIH I have a lot of opportunitiesto try to steer people in coordinatedfunctions, and it has been phenomenal to seethe way in which people have decided to dropeverything and work together. Back in March, we had afew initial discussions, and in just twoweeks put together the largestpublic-private partnership on an infectious diseasethat's ever been assembled. Something calledACTIV which stands for AcceleratingCOVID-19 Therapeutic Interventions and Vaccines. And this is about half industrypeople, and about half NIH and academics. It's FDA, it's CDC, it'sthe Veterans Administration, it's the Department of Defense. It's being managed bythe Foundation for NIH with extremely highlevels of skill. And that has done somethingin just a few months that I didn'tthink was possible. We've had partnershipslike this before. Usually, they take about twoyears and at least 39 lawyers to sign off on everything. And this just got done. And people actually werewilling to drop everything. Put the rest of whatever theywere doing aside. Work 24/7. Designed masterprotocols that we could test therapeutic agents. Prioritized thetherapeutic agents to pick the ones that are mostlikely to have some promise. Figure out how to dothese clinical trials, like overnight.With the networks that were out there that hadnever really been organized in this way. All of that happened in thisspace of just a few months. And where we are now,with vaccines and also with therapeutics, monoclonalantibodies now causing a lot of excitement asa treatment for people who are infected and whomight be able to be kept out of the hospital withthis intervention. That's just exhilarating to see. And I get to work withpeople like Tony Fauci, who's the leader of allof this effort, but lots of other people joiningin from other parts of NIH and making this their passion. It is remarkable. The science hasbeen breathtaking. [Amy Ignatius:] Well,it's interesting that you describe thistremendous coordination because I think from thepublic's perspective, and all we know is whatwe're seeing on the news and reading in thepaper. It's felt disjointed with multipledifferent speakers. People in charge, anddifferent committees, and different policy groups. And it hasn't felt likea coordinated effort. And I don't want to put youon the spot for any of that, but it's really gratifyingto hear that the side the you see, of scientists workingwith both public and-- private and government providersthat there has been tremendous coordinated effort. [Francis Collins:]Yeah, I think you heard some of those same wordsfrom Tony, that the science has been zeroed in withgreat effectiveness and moving at a pacenever seen before. Meanwhile, there's a lot ofnoise around all of this. And probably what comesacross in the evening news has more noise than it has science. And we would love,of course, to see that ratio change a little bit. And maybe now thatwe're starting to see these kinds of results,with vaccines that have 90% plus efficacy. That willstart to be more of the news that people are anxious to hear. And let's be clear, thisis a very polarized time in our country and inother countries as well. And that tends to bewhat makes the news. That people aren'tagreeing with each other. Well, that's breaking news. The fact that you had anadvance scientifically and you ran a trial that had agood outcome, well that's nice, but it's not wherepeople are fighting. So we have our ownissues, I think, in terms of the way in whichinformation gets shared. Scientists could do abetter job of portraying what we do in afashion that makes it more digestible, and lessoff-putting and jargon laden. And we need to workon that as well. [Amy Ignatius:] Dr.Borio, a moment ago you said one of the things thetask force will be looking at is not a full lockdown, butthe right kind of controls to get us back on track. Can you tell us a little moreabout what you're thinking? It's almost strategic decisionmaking about what to restrict and what to keep open. [Luciana Borio:] Well, I can'tspeak for the task force. We just began to do our work. But I think that Dr. Faucireally delineated the issues. That when we implementpublic health measures that are prudent andconsistently, we're able to contain the outbreak. In the absence-- withouthaving to do lockdowns. In a lockdown, alot of measures are curtailed that do not needto be curtailed because they don't really offer an advantageto the containing the epidemic. But I think it's a fact thatthe American public is tired and they're confusedabout what really needs to be done. Thecommunications haven't been-- Dr. Fauci has beenvery consistent. But you know we haven't seen acrossthe government consistent, clear, actionable recommendations. And I think it's justnatural for people to be tired, and fatigued,and just confused about what's the best course ofaction for them. And the measures, againit's about clear, consistent communications sopeople understand what measures they canfollow to help themselves, their families,their communities. And we need to really develop amuch stronger strategy for how we use diagnostictests and augment the use of diagnostic tests. We need to think about howwe amplify the public health workforce to do contact tracing. We need to also increase thedelivery of medical care, and capacity, andthe access to care. We've seen the healthdisparities have really been a significant-- a very sad story for us to seethe increased number of cases, and morbidity andmortality associated with people of color andlower socioeconomic status. That's a very disturbing number. We need to be able to turnthis around and gain the trust of the American public. The work ahead is-- there's a lot of work ahead. But I'm confidentthat working together that we can replicate thesuccess of the science response and the other domainsof this comprehensive response. [Amy Ignatius:] There is somuch to follow up on there I don't know where to begin. It seems like one of the mostcritical questions and so hard is to deal with thedisproportionate impact that we've seenon people of color and people of lowincome in this country. And I'm sure there's other-- globally, other targetedcommunities that are harder hit than others. As we think abouttreatment and vaccines. How do we targetpeople in a way that makes them want to embraceearly use of vaccine? Because it's outof caring and not for them to assume thatthey're being experimented on. I think sometimespeople say, well, I'll take a vaccine afterwe've had plenty of time to see how it works, but I'm notgoing to be the one early on. And so to betargeted in a vaccine may be the last thingthat certain people want. Dr. Collins. [Francis Collins:] It's a reallyimportant question and one that has occupied theattention of a lot of us in the course ofthe last few months. Now that these large-scaletrials for vaccines are underway, do you reallywant to just test them in young, healthy white people? No, you want toparticularly find out do they work in vulnerablegroups. In people over 65. People with chronic illness,African-Americans, Latinx, Native Americanswho have shouldered an undue amount of the burden. And yet, this happensat exactly the moment, as you're pointingout in your question, where there's a distrust aboutwhether medical researchers really have the bestinterests of those minority communities at heart. The first thing that oftencomes up in a conversation is Tuskegee. We have this long andreally unfortunate history of how medicalresearch has not always behavedethically when it came to underrepresented groups. And we have to get out thereand explain that and apologize for that, asPresident Clinton did. And then try to make the casethat this is not like that. This is one of those thingswhere we're not targeting-- we want to be inclusive. We want to be able tooffer the opportunity to be in these trialsso that we can find out does this workfor all the people who might need it the most. And I can tell you, havingme as the head of the NIH say that. It doesn'thelp that much. What really helps isengaging the communities. Finding who arethe spokespersons in those communities,who are trusted, and who can look at theevidence and can say we really should be part of this. We're doing a lotof that right now. The Moderna vaccine thatDr. Fauci mentioned, which you'll behearing some news about in the nextfew days, I guess, because it seemslike they're getting to that same point of findingout what the efficacy is. We worked really hard with theleaders of that company to take what was going to be apretty unimpressive diversity of enrollment. And by pushinghard, bringing on board a whole group, called CEA. Whichstands for Community Engagement Alliance. We were able atthe end of the enrollment of 30,000, more than 10% ofthose were African-Americans. More than 20% were Latinx.Total 37% of that group were people of color. It could be even better,but that is so much better than where it was. We learned a lot oflessons from that. Tony was a big partof that with me. And I think we could nowapply that more broadly and other exampleslike this to try to turn the corner so we'renot talking about Tuskegee as the only example. Where people can point tosomething and say, well, that time they did it right. We want to do it right. [Luciana Borio:] If I mayadd, these trials that are being done, they'rethe gold standard. The double-blind placebocontrolled studies. And they offer reallyvery high quality data about these vaccinesafety and effectiveness. But it's stilllimited to information to the trial population. So it's going tobe really important after these trialsare completed, and as these vaccinesare rolled out to a larger segmentof the population. To continually monitorfor their safety. Because communications can be-- trust can be built onstrong safety data. And to continue looking forsafety signals, adverse events, how this vaccine is performingacross different populations is going to be critical. So the work doesn't end oncethese trials are completed. [Amy Ignatius:] Both of youhave worked through Ebola and the response to that. How transferable is thesocial science aspects of that, of how toprepare for people to be willing to be vaccinated? How to get into a community thatmight be skeptical worldwide. In order to make it aseffective as possible? Or is each one of these eventsso different from the other that it's hard to translatefrom one to another? [Francis Collins:] Since Ebolanever became a major threat to the United States, despitethe intense population anxiety about it. Wedidn't have the experience of trying to see if peoplewould be willing to roll up their sleeves for that vaccine. The vaccinations weredone where the disease was happening in West Africaand more recently in DRC. So I'm not sure we learnedabout the social science part. We did learn aboutsome other things. The monoclonalantibodies that now are showing promisefor COVID-19. Similar approach for Ebola,in a very challenging trial that was run essentiallyin a war zone. Showed that those monoclonalantibodies could be lifesaving. And gave additionalconfidence to the idea that this might work forother infectious diseases. I think when it comesto the social science part in our own country, youhave to look at other examples. And there's really nothing quitelike what we're looking at now in terms of something that isso devastating-- as Tony said. The most horrible pandemicwe've had in 102 years-- and all of the publicattention that comes with it, it's a little hardto extrapolate. We can look at thefact that there's been growing, in somequarters, a vaccine hesitancy. But this has certainly given anopportunity for those anxieties to expand. And social media hasbeen great at promoting conspiracy theoriesthat have added to that. I don't know if you'velooked at conspiracy theories on social media. Some of them arejust really creative. But there are people I'vetalked to who say, well, I'm not going to have thatvaccine because Bill Gates put a chip in it, and it'sgoing to go into me, and then it's goingto wire my brain. And people have read that. And they thinkthat's probably real. So come, on people, let'slook at the evidence of what's really happening here. I am hopeful, as Tonyarticulated a little bit ago, that when people actually havethe data in front of them-- it's been hypothetical. It's been very muchoverridden by various claims about timetables andpolitical agendas. Let's get past all of that. Look at the data. Tell me why would you not wantto take advantage of something that might protectyou, and your family, and other people you lovefrom a terrible disease. If you have a good answerto that, that's good. Let's hear the answer. But let's not have it bebecause Bill Gates has put his chip in that syringe. [Amy Ignatius:] Speaking oflooking at the disease, you brought a wonderfullittle show and tell piece. Do you want to tell us-- we've been talkingabout the coronavirus now for 10 monthsor something and we don't really know what we'retalking about, most of us. [Francis Collins:] Well,you see this symbol in almost everything now. We were just talking about it'son every pumpkin this year. This is what it looks like. This is the coronavirus. It's a spherical virus. But it has these spikeproteins on the surface. Which are really importantbecause they're the ones that enable thisvirus to get inside your cells. That spike protein finds amatch in a protein on your cells called ACE2. And that lets itjump into the cell and start copyingitself like crazy. So what do we want to do interms of developing a vaccine? You want to get a wayfor your immune system to make antibodies thatwill attach to those spikes. Like chewing gumstuck all over them, and keep them from beingable to get into your cells. So that's whatwe're trying to do. So all the vaccinesare basically trying to raise antibodiesagainst these spike proteins. This is a fancy versionwhere the spike proteins have two different colors becausethey have an open and a closed configuration. That's a fine point. But basically it'sthose spike proteins that we are all tryingto immunize against, and which looks like it'sworking pretty well, at least with the first one ortwo out of the gate. And there are six nowthat are in the works. Operation Warp Speed, whichtaxpayers are paying for, and well they should be becauseof the critical need for this. Is not only helpingsupport many of the trials, but also supportingmanufacturing. Imagine if we didn't do that. We ran the trials and wehad a big announcement, guess what, we've got avaccine that works great, but you're going to haveto wait six months for us to build a factory and makeenough doses for people. Well, that's not happening. Warp Speed is doing what youcall "at-risk manufacturing." Making millions, tensof millions of doses even before you know if thatvaccine is going to work. And if that one doesn't,you throw them out. But if it does,you're ready to go. Which we hope to be in December. We've saved probably manymonths and many lives by that investment. And that is unprecedented. It's one more thing that we'vedone in this country that has never been done before. [Amy Ignatius:] That's remarkable. Dr. Borio, I'm going toswitch gears a little bit. Because you come to thiswith both experience in working in the Obamaand Trump administrations. But also your focus has beennot on, so much on pandemics as health crises-- they are health crises, but notas purely the medical issues, but coming at it from theperspective of a bioterrorism threat to our countryand to the world. A very different kind of focus. So tell us a littlebit about that. How do you how do you assessa biological agent like this? And how does theresponse differ when you're thinking of it froma security point of view as opposed to a health crisis? [Luciana Borio:] Well,fundamentally it's a health issue. And I have to saythat every time I was working on a policydocument or an effort, it really was withthe eye to the patient who is going tobe in the hospital and what would make adifference at the bedside. And how do we prevent themfrom getting to that point. So it's a health issue. And the NationalBiodefense Strategy that was published in2018 makes it very clear. That biological threats, weare agnostic to the origin of the threat. That the deliberatethreats, accidental threats, and naturally occurringthreats are equally important. And again, fundamentallyhealth issues that can have significantdisruptive power to our economy, thefabric of our society, confidence in political systems. A lot of other impacts, butfundamentally a health issue. I think the big-- perhaps one of themost concerning factors is that, one, of course, createsother geopolitical risks. Because we're talkingabout somebody deliberately developing and usinga weapon to cause harm to the healthof a population. So there is that layer. But we can't let thatdistract from the fact that, at the end of the day,it's about saving lives. [Amy Ignatius:] Well, andI think the early stages as we were all grapplingwith what this was. Involved a lot of conversationabout whether this was an intentionalrelease of something in order to harmother countries. Was it an accidental release? Was it just something that-- bad luck and it's jumpedfrom animal to human? Was it created in a lab? That seems to havesort of gotten in the way of at least thepublic's understanding of what was going on formany, many months. Maybe for some people stillis getting in the way of being able to trust the information. Do you have a sense of that? [Luciana Borio:] Sure, Ithink it validates my point that ultimately we can'tlet that distract this from the work that needs tobe done to develop a science response, to work on thepublic health measures. Because at theend of day, all we need to do is focus on thepatient, at the bedside, and how to prevent themfrom getting there. Right, the doctor at thebedside and the patient. How do we preventthat from happening? How do we minimize themorbidity and mortality? And there'll be atime where then there will be looks to see ifthere was any possibility-- something we maynever really know. And I think the mostscientists do not think that this was adeliberate or accidental-- I think that it'sbeen pretty ruled out that this was adeliberate issue. But we may never know. But it doesn't really matterat the end of the day. But I'll just say thatit really shows also how important it is forus to be ready to address these biological threats. Because this is not goingto be the last epidemic. We hope that it doesn'tgrow to be this significant in the future, but it won't. The way we behave today,the way we encroach in animal habitats,the speed of travel, there are so many--urbanization, population density.This creates a milieu, that really makesit easier for there to be spillover of virusesfrom animals to humans. And we need to bealways vigilant. And I hope that this-- going forward, we'll continueto apply more technology and strengthen oursystems, end to end. Not just in drug discoveryand medical response, but also ability toforecast, and predict, and do surveillance more effectively. [Amy Ignatius:] President Trumpwithdrew us from the World Health Organization. And President-electBiden has said that he wants to putus back into it again. What's the practicaleffect of that? Is that going to be usefulon what you describe as being ready, Dr. Borio,ready to go when something does become apparent? Or is it coordinationof data, of research? To the public-- I don't know what that means. It just sounds like a good idea,but I don't really know why. [Luciana Borio:] So-- [Francis Collins:]Go ahead, Luciana. [Luciana Borio:] So the WHOis very important to all this response, clearly. [Francis Collins:] It's a goodthing that infectious disease research has beeninternational for many decades. And even with thetensions with the WHO, I think it's fairto say a fair amount of international exchangehas been going on. And we still interact with staffat the WHO almost every day. So it has not beena severe downturn. In the internationalattention to this. And this is a time where weneed international attention. It will be interestingto see what happens next. [Luciana Borio:] And what happensoverseas. Epidemics that happen overseas, matter to us. We have-- because we want toprevent them from coming here and also becausesometimes they may impact areas thatare of interest to our national securityor economic security. So really, it does matter. And WHO, I think thatmost people don't even appreciate here is that thereare instances where they are on the ground, working to-- boots on the ground tocontain an epidemic that it's very difficult for Americans tobe because of conflict zones, war zones-- difficult. Sothe WHO is essential in being leaders and to helpcoordinate the global response to these types of crises. [Amy Ignatius:] Are we gettingbetter in our preparedness? Do you think that yousee a upward trajectory of improved responsecapability year to year? [Francis Collins:] Lu,you should answer. I know you're part of thisCommittee On Foreign-- Council on ForeignRelations efforts to talk about preparedness. [Luciana Borio:] Yeah,so my full time job is at In-Q-Tel, which weinvest in technologies as a non-for-profitstrategic investor. And our chief technologyofficer told me the other day, he says, you know, Lu, wedo more than technology. Our business is optimism. And I thought that was verygood because it's actually true. I think the future is brighter. It's remarkable what has alreadyhappened in the last few months. With the diagnosticspace, for example. [Francis Collins:] Yeah. [Luciana Borio:] And thanksa lot to your efforts in bringing that to where it is,taking that low hanging fruit. Maybe you want to talk a littlebit about where we are today with diagnostics? [Francis Collins:]Sure, I'd love to. Because we all would agree thatif we could snap our fingers and have a home-base test thatyou could take every morning and find out whether you havegotten infected, in which case you probably shouldn'tbe going to work, and you should be isolatingyourself, and thinking about contacts. Thatwould be fantastic. My thought experiment issuppose it's on your toothbrush, and so you just find out as soonas you get your day started. Well, we're not quite there yet. But we've had a focus,until very recently, where testing is forpeople with symptoms. And we need that. And we're prettygood at that now. But what we reallyneed is testing for people whodon't have symptoms. Because that's where thecommunity spread is happening. That's what collegesneed in order to be able to keep theirstudents and their faculties safe, and keeptheir classes going, and not send everybody home. And now we aredeveloping, I think, a whole lot of new technologiesthat are like that. They are point ofcare. Which means you don't have to dothe swab and send it off to some central lab andhope you get an answer back in a day or two. You get the answer rightthen or in 30 minutes. At NIH, we havethis program called RADx. Which I like the name. It stands for RapidAcceleration of Diagnostics. And with funds from theCongress that were only provided in April, we set upessentially a venture capital system. To look at academiclabs and small businesses that had really cool ideas abouthow to do rapid detection of this SARS-CoV-2 virus. And in the space of thatvery short period of time we've now funded 22 of thesetechnologies that collectively are about to get to the pointof three million tests a day. More than half of whichour point of care. And we're starting very soonto try this in home testing, because that's wherewe really want to get. This is an example about howthis crisis has absolutely lit a fire under what otherwisewould have been technologies that would have happenedover a few years, but have now happenedover a few months. And that's going tohave a lot of spinoffs for other applications as well. And that's my hopeof what we can really push hard on in thenext few months. Is to get the testingsituation where it needs to be so that aswe're waiting for the vaccines to get available to everybody,and we're still dealing with this winter season.We have a better chance of capturing the pandemicbefore it gets even worse. [Amy Ignatius:] It's anamazing period of time. And the anxiety that people aredemonstrating is so extreme. The press covers a lot ofthe people who are resistant, but we asked forquestions from people before, in advance of tonight,and you've heard about a little of those. It was remarkable to me-- therewere over 100 questions that came in and many,many of them just expressed a genuineuncertainty about what to do. You know, what to do forThanksgiving is one example. But much more than that. They have a child witha preexisting condition. Should they sendthem back to school? They want to be able to visittheir aged aunt before she dies and they are afraid to do it. They don't know whetherthey can travel. And they have just been planningon a trip for the past two years. And it was reallykind of sad to read how many people are reallytroubled and wondered where do you go for good,reliable, unbiased information? Is there a place that thegovernment is collecting all that kind of information? Does NIH do that? Is that something the taskforce is thinking about to help people be smartabout decision making? [Francis Collins:] That'sreally the job for the CDC. And if you go totheir website, there's lots and lots ofinformation there that people can sift through. And of course, they'renot the only place that's offering this up. Dr. Fauci is, I think,probably the source of this kind of informationthat most people have heard and depended on. And has always said it justexactly like it should be said. Because these are the facts. But yeah-- and thefacts are changing. Let's be clear about that. We're getting newinformation all the time. If people feel like,hey, they said something different this time thanthey did the last time. It's probably becausewe had new information. And so the recommendationneeded to change. But yeah, I wouldsay start with CDC. And then all of us whoare in the middle of this are getting barraged byquestions many times a day. And they don'thave easy answers. People who reallydesperately want to get together for a holiday,maybe because they think this might be the last Thanksgivingfor the grandmother, and you're going to say,you know, that's just not safe. That's a hard thing to hear. I get that. I'm not going to haveThanksgiving with my family this year because of peoplein the family who are at risk. And I'm going to miss that. First time in 27years there has not been a gathering of 30 orso people around the table. But it just-- when you putall the evidence together, we can get by thisyear without that. This is like we're going toget through a serious world wide crisis. And it will have an end. And as Tony said, if we canstart to appreciate that there is a light up theresomewhere. Maybe that will allow us to redoubleour efforts to get through in the meantime and cancome out to the point where we can finallysay, OK, that one's in the rearview mirror. We're stronger as a result.We've got a lot of work to do to pull ourselvesback together again. We made it. We can do that. [Luciana Borio:] Iwould second that. [Amy Ignatius:] This is all partof your working in optimism. Is that what you saidat the beginning? [Luciana Borio:] That's right. [Amy Ignatius:] One of the thingsthat one of the questioners, that I thought was sointeresting, said-- and I know Dr. Collins,you're a man of faith, and you've written alot about your faith-- the question was,is there any data that shows that people'soutcomes are better if they have animportant faith whatever it may be in their lives? Are you aware ofany kind of research that would support that? [Francis Collins:] I don'tknow about COVID-19. That's a good researchquestion that somebody should be pursuing ifthey're not already. Pay attention here,you all, you just got a great tip of apossibly fundable NIH grant. But in othercircumstances, yeah, there is evidence that peoplewho have a spiritual part of their daily life seem tohave more resilience when it comes to healthissues and other things. It's not a huge effect, butit's certainly in there. The dean thisevening started off with Psalm 46.Which has certainly been very much on my mind-- God is our refuge andstrength, an ever present help in trouble. And we're in trouble. And to have that sense thatwe're not all alone here. That God is ourrefuge and strength, and is going to providehelp-- although it's up to us to figure out how to helpourselves and not just say, well, OK, I'm justgoing to let it happen however it's going to. We have a lot of strengthsand capabilities. Let's use those. But also, havingthis confidence, that there's something morethan what you can see here, that, for me, is agreat source of comfort. [Amy Ignatius:] Well, I thinkthat couldn't be a better way to invite the dean back onagain to wrap things up. We could go on forever,but our time is limited. I thank you somuch for your time, for your wisdom. Forall of the work you're doing to advance our response,and for keeping us safe. So thank you. [Luciana Borio:] My pleasure. [Applause] [...] [Randy Hollerith:] If you allwould join me up here and we'll spread outacross the front. My thanks to the Ignatius familyand to our wonderful guests for being with us tonight,and for the incredible conversations that we had. We're blessed by having allof you with us this evening. Thank you. And God bless and keepall of you out there. I hope you will stay safeand sound, and well. And with theblessing of our Lord, Father, Son, and theHoly Spirit be upon you and remain with youthis day and always. Good night, everyone. Thank you for being with us. [...] [COVID-19, Where Do We Go from Here? Thursday, Nov. 12, 7 pm.] [Dr. Anthony Fauci, Dr. Francis Collins, Dr. Luciana Borio] [Washington National Cathedral, 2020] [...]