Mikhail Varshavski, DO, who goes by “Doctor Mike” on social media, is a board-certified family medicine physician at the Atlantic Health System’s Overlook Medical Center in Summit, New Jersey.
In this video, Varshavski has a one-on-one with NIAID Director Anthony Fauci, MD, the chief medical advisor to President Biden. The pair discuss vaccination rates, early-pandemic mask messaging, and how Fauci thinks this will end.
Following is a rough transcript (Note that errors are possible):
Anthony Fauci, MD: If anyone who is involved in science — to say, “You should never change your mind,” doesn’t understand what science is.
Mikhail “Mike” Varshavski, DO: Dr. Fauci, thank you so much for joining us on the YouTube channel again. It’s been a year since you and I have spoken. We’re doing it now in person without masks on, thanks to the vaccine. How amazing is that?
Fauci: Indeed, it’s really, I think, one of the most important contributions in biomedical research to so quickly and effectively get a vaccine that right now is performing in the real world even better than it did in the clinical trials.
Varshavski: So you feel more confident in the vaccine now than perhaps you did in December of 2020?
Fauci: Oh, yeah. The reason is that in December 2020 we had the results of the clinical trials, which were very impressive — 94%, 95% — but often is the case is that when you get into the real world of how the vaccine performs outside of the pristine conditions of the clinical trials, it doesn’t usually look as good as it looks in the clinical trials. On the contrary, we’re seeing the opposite now. We’re seeing that when you get data, not only from the United States — I mean, when I say data, I’m talking about hundreds of thousands of people being followed up in prospective cohort studies — the data are at least as good if not even better not only against what we call the wild-type virus, namely the one that’s the standard one, but when variants appear, the vaccine seems to do quite well against them also. It really is very good news with regard to vaccines.
Varshavski: In this year, how do you feel where we are in our current battle with the pandemic?
Fauci: Overall, I think it’s very positive, but one of the things that we get concerned about is declaring victory prematurely. Because even though if you look at all of the parameters, particularly most recently over the last month or two, is that the 7-day average of daily cases continues to come down and down. One of the issues with that is if we see the numbers go down and people say, “Well, then why should I get vaccinated? Everything seems to be going well,” that’s a mistake. If you don’t really get the level down very, very low, there is always the concern and the real concern, not just theoretical, that you could start getting more infections.
At least in this country, we’re in a very fortunate situation that we have enough vaccines to vaccinate everybody. When you look at other countries where they’re literally and figuratively dying to get vaccinated because they don’t have enough vaccines. I mean, take India. It has 2% to 3% of their population is fully vaccinated and about 11% to 12% have received at least one dose. I mean, that is not good.
Varshavski: Absolutely, and I have heard you say numbers 70% to 80% might be a target that we’re looking for for individuals to be vaccinated in order to reach this level of herd immunity. Are you still confident in these figures?
Fauci: Yeah. One of the things we want to re-emphasize because people say, “Well, you’re changing.” We’re not changing any numbers. We don’t know what the threshold of herd immunity is. We know what it is for measles. We’re estimating that it’s somewhere between 70% and 85% for SARS-CoV-2, but we don’t know for sure. When you don’t know for sure, the thing to do is just forge ahead.
Fauci: Yeah! Just get as many people vaccinated as you possibly can. When you get that level of protection that turns out to be the threshold of herd immunity, you’ll know it because you’ll see the infections almost disappear when you get it to that level.
Varshavski: Where does natural immunity play into this? Because the last time you and I spoke, one of the major questions we were answering, granted it was April 2020 at the time, was that we believed — and I think we still believe — that reinfection is very rare.
Fauci: Yes, it is.
Varshavski: Where do those individuals fall on that 70% to 80% spectrum? Do we factor them into that number?
Fauci: Well, we’re talking about vaccines now when we talk about the President’s goal. If you’re talking about this somewhat elusive term of threshold of herd immunity, you put them into the same bucket. Because if you have someone who has been infected, recovered, has a good immune response, that person can be protected for a considerable period of time. We still don’t know. I mean, people ask, “How could you not know?” The reason we don’t know is because we’ve only been doing this for about a year or more.
Fauci: You know? I mean, the whole thing has been about 16 months. But the vaccine plus infected people, we don’t know. We hope it’s considerably longer than 6 months, a year. The companies have said, “Well, you’re probably going to need it.” We don’t know what’s going to be in a year.
Varshavski: Exactly. I have seen no evidence to show that we need a booster.
Varshavski: Yet, the Pfizer CEO…You think that’s a business decision more than a…?
Fauci: Well, I think what they want to do is they want to be prepared and that’s the reason why. That’s the reason why we, the federal government, in collaboration with industry are actually doing trials to give boosts to people from the original clinical trials to determine how high up you get their response and how long it lasts. We’re anticipating the possibility, maybe the likelihood, but certainly the possibility of needing to boost people at some time or other, both for the durability of the response, but also to get maybe a variant-specific boost.
However, the good news about that, as I mentioned a little bit ago, is that many of the variants, particularly the dominant one for us right now is B.1.1.7, the vaccine works extremely well. A number of studies now have looked at what it does to some of the other variants. Although it diminishes your effectiveness a bit, it’s still well within the realm of some reasonably good protection.
Varshavski: Because ultimately our goal, at least the way I view it, with the COVID-19 vaccination is really to target severe illness, hospitalizations, and deaths. Because if we can control those numbers, turning it into a perhaps less lethal virus, more like the flu, it becomes more manageable. Is that sort of…?
Fauci: Absolutely. And see, that’s one of the things that we’re working with now, trying to get a good handle on what the right approach would be with the variants. Because we are going to continue to see variants until the rest of the world is essentially well controlled, which it won’t be for a couple of years, even if we push to get people that. We want to get the rest of the world vaccinated as quickly as possible. I believe we have a moral responsibility to do that not only because we’re a country that has resources, but other rich countries should do that.
But it’s also with our own self-interest. Because when you have a lot of dynamics of viral replication in whatever country in the world, it will generate variants, and when it does sooner or later, because of the inter-connectivity in the world, we’re going to see variants here.
But one of the things that we really want to nail down, but, as I mentioned, it looks pretty good, that if you get a high level of immunity against the original virus, it does spill over to protection against several of the variants.
Varshavski: For individuals who are vaccine-hesitant, they’ve seen CDC guidelines change a lot of times rightfully so because the evidence evolved and we needed to make different recommendations. What do you say to those individuals who are vaccine-hesitant right now?
Fauci: Well, first of all, you don’t want to be pointing a finger at them or making them feel guilty. You want to try and explain to them why it’s important for them to get vaccinated by giving them two things, giving them all the facts that they need to answer any questions that they have. Was it too quick? No, we have an answer to that. It’s the culmination of decades of research that got us there. It wasn’t the 11 months from January to December . Then they ask, “Well, did you test it enough? I want to wait and see.” Well, hundreds and millions of people have gotten the vaccine now. We’re past the time of “let’s wait and see.”
The other thing is to make it extraordinarily easy for somebody to get vaccinated because there sometimes is a combination of hesitancy and what they consider inconvenience. Remember back early on people were trying to negotiate computers, getting an appointment, and this 1A group, 1B, 1C? That’s gone now. Right now, the way it is it’s extraordinarily easy to get a vaccine. You got 40,000 pharmacies that can do it. You have pharmacies where you don’t even need to call up and make an appointment. You just walk in and say, “I want to get vaccinated.” You have community vaccine centers. You have mobile units. It’s very easy to get vaccinated right now.
Varshavski: Yeah. I work a lot with Senate Majority Leader Chuck Schumer in pushing out some of the information about the vaccine to help individuals who are perhaps vaccine-hesitant or just want more information on the subject. They are also asking a repeated question about vaccinations in their children. Pfizer has the approval, at least the EUA [emergency use authorization], for 12 and up now. What do you say to someone who is vaccine-hesitant for their children when they are saying, “Well, you know, children seem to experience a milder case perhaps of COVID-19. They’re not perhaps spreading it as often.” Should children be vaccinated?
Fauci: Yeah. I mean, there is no doubt. It’s the chain of transmission. Even though children statistically don’t get as serious disease, they can. They can. If you look at the hospitalizations, it’s absolutely correct. It’s very low for the children and then it gets some more and more and more as you go up for the elderly.
But if you look now today, where the overwhelming majority of the elderly are protected, I mean we now have about 80% of the elderly have at least one dose. I mean, that’s pretty good. The hospitalizations and deaths among the elderly dramatically diminished. Then you’re starting to see, well, young people do get infected and some of them do get sick. It’s, again, the health of the person. Even if you get mild disease, kids and young people get long COVID. There is no doubt. That persistence of that really sometimes almost incapacitating symptoms of fatigue and muscle ache, temperature dysregulation, and things like that.
Then there is the chain of transmission that you’ll see papers that say kids don’t transmit it much. Kids can transmit it. Anybody that says that they don’t, they’re not looking at reality. They may, at certain levels, not transmit it as efficiently as the crowding that you get as you get older and the kind of things that people do indoors, but it is part of the chain of transmission.
Varshavski: If you are vaccinated, whether you’re 50 years old, 20 years old, 65 years old, what can you feel comfortable doing once you are vaccinated?
Fauci: Again, there is a variability. I think people who are significantly immunosuppressed, transplant patients, people who are on immunosuppressive therapy, they may want to be a little bit more careful with regard to masks. But the general average person who is vaccinated can for their own safety do almost anything. I mean, indoors or outdoors.
The question is when you’re in a mixed environment, where you’re in an establishment, there are people who were vaccinated, people who are not, that people who might be infected that might be infecting others, there is the question of what is the establishment going to do? Are they going say, “If you want to come into my,” whatever the establishment is… it could be a college, you know. It could be a workplace. That person has almost the right, if you want, to say, if you want to do that you’ve got to wear a mask. Which then it will have the vaccinated person will say, “Well, wait a minute. I’m vaccinated. Why do I got to wear a mask?” That’s where the confusion comes in, which they’re trying to sort out.
Varshavski: Once everyone is vaccinated or the 70% to 80% numbers are hit for herd immunity, what happens? Does COVID-19 go away?
Fauci: It certainly will go to a level that would no longer be a public health hazard as it were in this country. But, again, it’s a global pandemic and we do require a global response.
Varshavski: What level do you think that we should start saying, “Our supply is bigger than demand here. We need to start taking our supply and sharing it with the world”?
Fauci: We’re going to do it. By the end of the June, the beginning of July, we’re going to be giving out 80 million doses for a starter — just for a starter — and there is more coming after that.
Varshavski: As far as our handling of the pandemic as a nation, as a scientific community, if you could change one thing or make an improvement on one thing on our response so far, what would it be?
Fauci: Well, to me, as I have said often, it’s that there has been an extraordinary amount of divisiveness in this country. That’s the worst possible thing. I mean, there are differences of opinion, but the intensity of the divisiveness has, in so many respects — and one can’t deny it — the politicization of a public health approach. I mean, when someone does or does not want to do things like wear a mask in a congregate setting for reasons that don’t make public health sense. They’re more ideological than they are public health.
If we were going to do something different, we could say there are differences of opinion, there are differences of ideology, fine. But when you’re facing a public health challenge of this magnitude, why don’t we put that aside for a minute, take care of the pandemic, then you could go back to ideological differences?
Varshavski: We’re talking about masking right now with the pandemic and the public health setting. I have heard you say in an interview before that masking can potentially continue past the pandemic. What role do you see…?
Fauci: That role was taken completely out of context by people that like to “gotcha!” you know? No. What I was saying, I was… Thank you. Let me clarify this.
Varshavski: I love it.
Fauci: I was asked. People were saying it’s interesting in Australia, during their flu season, they had almost no flu. They called us up and said, “Wow! We think that’s due to the fact that we were wearing masks, we were avoiding congregate settings in order to prevent the spread of COVID-19. And we had a secondary effect that we almost had no flu or other respiratory illnesses, RSV, parainfluenza. We had almost nothing.” Then our winter came and we noticed the same thing, that wearing masks, avoiding congregate settings, et cetera, et cetera.
I was asked in an interview that “Do you think that some people might elect…” elect! “… might elect that they might want to wear a mask during the winter season to avoid flu or other respiratory illnesses?” I said, “You know, it seems reasonable if some people feel that they want that extra protection, they could do it. It’s not going to be mandated.”
Varshavski: My question is more so not for that gotcha purpose, but in terms of protecting yourself using a mask, in March of 2020 and April 2020, even on my own YouTube channel as a family medicine doctor, I was urging people to not rush to buy masks at that time because the information we had at the time wasn’t focused on asymptomatic or presymptomatic spread. There were shortages of PPE. Like I was seeing patients in March with no masks, not because of inadequate PPE, but because we didn’t think that was mandatory. So…
Fauci: Yes. That’s what I was saying then. Then when we found out three things… I mean thank you for bringing that up because that’s when I get accused by people who want to do a “Gotcha!” That flip-flopping. There is no flip-flop. Back then there were three things: we were told that there was a shortage of PPE and masks. We felt we don’t want to take it away from others. Secondly, there were no data, meta-analysis, at the time that masks were effective outside of the hospital setting. Then three, importantly, we didn’t fully realize how pervasive asymptomatic spread was.
So what changed? a) It was clear there was no shortage of masks. Cloth masks work. Meta-analysis showed that, in fact, even outside of the hospital settings masks work. Third, we were hit with the realization that anywhere from 50% to 60% of transmissions occur from asymptomatic people. That’s the reason why we went from saying you don’t really need to wear a mask to you should really wear a mask. That’s not flip-flopping. That’s taking evolution of data and then making your recommendations based on the data.
Varshavski: Yeah. In fact, if we didn’t make that adjustment, that would be worse for us because then we’re not looking at the data and evolving with the science.
Fauci: Well, anyone who is involved in science to say “you should never change your mind,” doesn’t understand what science is.
Varshavski: You’ve become a champion of science. On social media, you’ve become a meme. Your face has been put on T-shirts, socks, cupcakes. I have seen everybody celebrate the work that you’ve done leading the way with humility and honesty, treating science as it deserves to be treated. How does that feel?
Fauci: Well, I focus on what I’m doing and not basking in that because that’s balanced by the other side of people who attack, who are not science-related, who are anti-science. It comes from everything from verbal attacks to ad hominem nonsense, to threats to my life and my family, so it’s balanced.
Varshavski: How does that negativity affect you? That’s got to be hard. I mean, as scientific communicators… I mean, if you look over the course of history, scientific communicators weren’t really celebrated. Researchers were almost frowned upon when they would spend a lot of time in media. How do you balance that?
Fauci: No, I mean, right now you have to communicate because there is an absolute need on the public to know and understand the truth. This is something that’s threatening their lives, their family, and the economy. When you politicize that, when you take it out of the realm of public health and make it become almost a political statement, that’s very damaging to the overall effort.
The other thing is that if you want to really get into and understand the evolving science, you’ve got to realize that things change. You’ve got to be humble enough and flexible enough that when you get new data, that you then change what you’re doing based on the data. If you say, “I really want to never change, because if you change, your flip-flopping,” then you’re back here and you don’t take advantage of the new data that every week, every month comes by. That’s the thing that some people don’t seem to understand.
Varshavski: Well, it’s like the idea that scientists can’t be wrong. That’s part of being a scientist, testing a hypothesis. But science itself is a process that can never be wrong. Right?
Fauci: As we’ve learned in medical school when you do these kinds of things, the mentors always told us that science by definition is self-correcting.
Varshavski: You said that beautifully. I want to read to you a statement that one of my colleagues shared with me late last night when I mentioned to them that I was going to be interviewing you. She is a cardiologist on the West Coast. I want just to read this to you to highlight the impact that you’ve had on individuals, that perhaps you may not come across in your everyday life. “I got redeployed to a COVID unit for my last 3 months of my cardiology fellowship. I went to work every day before we had adequate PPE and I was putting people my age on ECMO daily. I was constantly worried I was going to die. I was so scared, but I would come home from work and see Dr. Fauci on television and he honestly made me less scared.” Hearing that, how do you feel?
Fauci: Well, that obviously makes you feel good. I mean, because that’s what I do. That’s what my job is. I’m a physician. I’m a scientist, trying to get accurate information out to people. If I can make a cardiology fellow feel good, that makes me feel good.
Varshavski: You’ve been doing this for a while. You’ve served under many presidents. You’ve worked with administrations of left, right, in between. Is this the highlight?
Fauci: We’re still in the middle of it. I’ll tell you that when it’s over. We’re still in the middle of it. We still have a way to go. It looks like we’re going to nail it. I think we are. Science will come to the rescue, but I believe we’re going to get out of this. This is going to end and it’s going to end. Hopefully we’ll learn a good lesson and be better off for it.
Varshavski: For sure. Everyone at home get vaccinated. That’s the goal. We need to get everyone vaccinated, so that we don’t have to play the game of who is vaccinated and who is not.
On a final lighthearted note, in 2015, People magazine named me sexiest doctor alive, it’s kind of the joke of how I got started on social media. I use that as an opportunity to go on television, talk about primary care, prevention, and vaccinations. Since then, they haven’t given the title to anybody else. In fact, before me, it was Dr. Sanjay Gupta.
Varshavski: How would you feel about me passing on that title to you?
Fauci: No, thank you. You’re definitely sexier than I am. You can keep it. I’m 80 years old. It’s enough.
Varshavski: I just think that would be a great culmination. You’ve done all this amazing work. You’ve kept people like my friend, Dr. Belardo, calm during a very stressful state. You’ve given us the best information with the most humble approach, but I think it would be a funny top into the story.
Fauci: It would.
Varshavski: Maybe we can get People magazine to throw you on for 2021.
Fauci: Yeah, we’ll see. Let’s get this over with first.
Varshavski: Thank you so much for your time, Dr. Fauci, for all of your work.
Fauci: You’re welcome. My pleasure!
Varshavski: Seriously, everyone from the medical community, my hospital, Atlantic Health System, Senator Schumer, and everyone we’ve been working with so tirelessly to get people vaccinated, and you’re leading the charge on that, so thank you.
Fauci: Thank you. Thank you for being here.
Last Updated June 16, 2021