“What Keeps You Up at Night” – Dr. Fauci’s Newest Concern

“What keeps you up at night?”

It’s a question Anthony Fauci, MD, heard repeatedly throughout his almost forty-year tenure as the director of the National Institute of Allergy and Infectious Diseases under the National Institutes of HealthThe National Institutes of Health (NIH) is the primary agency of the United States government responsible for biomedical and public health research. Founded in 1887, it is a part of the U.S. Department of Health and Human Services. The NIH conducts its own scientific research through its Intramural Research Program (IRP) and provides major biomedical research funding to non-NIH research facilities through its Extramural Research Program. With 27 different institutes and centers under its umbrella, the NIH covers a broad spectrum of health-related research, including specific diseases, population health, clinical research, and fundamental biological processes. Its mission is to seek fundamental knowledge about the nature and behavior of living systems and the application of that knowledge to enhance health, lengthen life, and reduce illness and disability.” data-gt-translate-attributes=”[{“attribute”:”data-cmtooltip”, “format”:”html”}]”>National Institutes of Health

Now a Distinguished University Professor at Georgetown University School of Medicine and the McCourt School of Public Policy, Fauci says he realized his worst nightmare — a twist on the usual question — in January 2020 when the type of virusA virus is a tiny infectious agent that is not considered a living organism. It consists of genetic material, either DNA or RNA, that is surrounded by a protein coat called a capsid. Some viruses also have an outer envelope made up of lipids that surrounds the capsid. Viruses can infect a wide range of organisms, including humans, animals, plants, and even bacteria. They rely on host cells to replicate and multiply, hijacking the cell's machinery to make copies of themselves. This process can cause damage to the host cell and lead to various diseases, ranging from mild to severe. Common viral infections include the flu, colds, HIV, and COVID-19. Vaccines and antiviral medications can help prevent and treat viral infections.” data-gt-translate-attributes=”[{“attribute”:”data-cmtooltip”, “format”:”html”}]”>virus he most feared triggered a worldwide pandemic.

Today, as the COVID-19First identified in 2019 in Wuhan, China, COVID-19, or Coronavirus disease 2019, (which was originally called "2019 novel coronavirus" or 2019-nCoV) is an infectious disease caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). It has spread globally, resulting in the 2019–22 coronavirus pandemic.” data-gt-translate-attributes=”[{“attribute”:”data-cmtooltip”, “format”:”html”}]”>COVID-19 pandemic wanes, Fauci describes a new nemesis – a lack of “corporate memory.”

Lessons from COVID-19

Writing in Science Translational Medicine, as if to help ensure an indelible, collective memory is created, Fauci reviews the key lessons learned from COVID-19 to help prepare and respond to the next pandemic, “whenever that occurs.”

He describes two “buckets” for these lessons: the public health bucket and the scientific bucket.

“If there is a success story embedded in the COVID-19 saga, it is in the arena of basic, translational, and clinical science— the scientific bucket,” Fauci writes. He attributes the success to decades of investment in basic research, noting the scientific achievements of Drew Weissman, MD, Ph.D., and Katalin Kariko, Ph.D., awarded the 2023 Nobel Prize in Medicine or Physiology for their discoveries that enabled the development of effective mRNA vaccines against COVID-19.

Fauci also describes a possible path ahead for future scientific work involving prototype pathogen research.

Public Health Challenges and the Future

Often perceived as the face of the public health response during the pandemic in the U.S., Fauci outlines failures that fall in the public health “bucket” ranging from institutional weaknesses to the disconnect between health care delivery and the public health infrastructure. Specifically, he notes poor coordination between state and governments, supply chain issues, and misinformation and disinformation.

“Fundamental to all this discussion is my comment above regarding the next inevitable pandemic, whenever that occurs,” Fauci concludes.

“Over and over, after time has passed from the appearance of an acute public health challenge, and after cases, hospitalizations, and deaths fall to an ‘acceptable’ level … the transition from being reactive to the dwindling challenge to being durably and consistently prepared for the next challenge seems to fall flat. Hopefully, corporate memory of COVID-19 will endure and trigger a sustained interest and support of both the scientific and public health buckets.

“If not, many of us will be spending a lot of time awake in bed or having nightmares when asleep!”

Reference: “What keeps me up at night” by Anthony S. Fauci, 18 October 2023, Science Translational Medicine.
DOI: 10.1126/scitranslmed.adj9469