Dr. Anthony Fauci in conversation with Sean Penn at Live Talks Los Angeles

[Music] hi I'm Ted hapag gabber founder and producer of live talks Los Angeles thanks for joining us since we started over a decade ago we have brought you hundreds of conversations with story tellers writers actors musicians humorists chefs and thought leaders in business and science you can watch and hear most of these in our YouTube channel and our podcast for details visit livet talks la.org and now here's the show you've tuned in to see well I guess I got to start this when I got the call about this it really was you know an overused word to say that I was very honored to be asked to do this um I am moved most by uh people who are cellularly of service and um and that is Dr fouchi U you know many of us didn't uh come on to to him until uh things got bad and uh it was a voice of uh sanity and sense that uh made bad days better and so I wanted to start by talking about that because service is something that um you talk about in the book where what was the origin of that for you you know Sean I think it relates back to my my my really early childhood I was born and raised in a working class section of Brooklyn uh Benson Hurst in New York and uh it was in the 1940s and 50s and my father was a pharmacist and back then pharmacies sh were not the way they are now where you have like large corporations the pharmacist of the drugstore in the neighborhood served as kind of a surrogate physician for the neighborhood marriage counselor um psychiatrist for people and the whole tenure of my family uh and remember now I'm seven eight nine years old at the time was service to others and he was a terrible businessman because he would always If people could not afford to pay he would either let them have the medicines free or put it on a bill that they never paid which at the time annoyed my sister and I that but one thing I learned for them what the most important thing was to take care of people and then just on a series of you know the circumstances I went to Catholic elementary schools and then I went to um a Jesuit High School in Manhattan called Regis High School it was an old boy school and the the the motto of the school was men for others so it was kind of a fortification and an underscoring of what I learned at home so that it was actually the natural thing for me to want to do I I was very much liking to be with people um and yet when I went to school it became clear that I liked science also so I figured what's the best way to combine an affinity for wanting to be with people and do things for people at the same time as liking science so that led me into the field of medicine getting into public health and public service was almost an accident because when I was when I was going through medical school and did my multiple years of residency training and Internal Medicine what I thought I wanted to do was to stay in New York City and be a practicing physician I knew exactly where I wanted to go was at the New York Hospital Corell Medical Center but in order to train more I wanted to take a fellowship in infectious diseases and the best place to do that was at the National Institutes of Health in in Bethesda Maryland so I took a three-year Fellowship there and that just opened up a whole new Vista of me for research and the impact of not only seeing patients which I continued to do until literally I stepped down from the NIH at the end of December of 2022 but also to do research that might have an amplifying effect so that if you made a discovery of some sort and developed a therapy it would be impacting a lot more people than what you have time to do with a single patient and that led into the next phase which really got me into public health and was HIV uh I mean that was really the core of my identity as a physician so it wasn't linear I didn't say like I woke up and said you know I really want to do Public Health I didn't even know what public health was I knew there was individual treatment of patients but I wasn't aware of the impact of taking care of a large number of people as a public servant and a public health little bit of a long-winded answer to your question but that that was the way it happened I want to talk about the HIV of it because in in your book you talk about that period being one that represents if you if you you identify post-traumatic stress in your own experience it was from that period could you talk about that yeah so um from 1972 when I came back to the NIH from the final year of my clinical training uh until 1981 fortunately I had a great mentor who put me on a good project I had developed um remission inducing Therapies for unusual not rare but unusual inflammatory autoimmune diseases inflammation of the blood vessels which had a 100% fatality rate and we got the idea that if we treated individuals with lower doses of drugs that have been used for cancer that would suppress the immune system just enough to suppress the disease but not enough to make them uh susceptible to opidis infections which can patients have when you give them chemotherapy and it was phenomenally successful it was a 93% remission mate I did that from 72 to 81 then in 1981 um I was sitting in my desk at the NIH in Bethesda and a morbidity mortality weekly report from the CDC landed on my desk June 1981 and I looked at it and it was a report of five curiously young otherwise healthy gay men man from La um who had a strange disease that was giving them infections that you would never get if you were healthy I thought it was a fluke Sean so I said you know nothing no big deal a month later um in July of 1981 another report from the CDC came only Now 26 amazingly all young otherwise healthy gay men who not only were from LA but from sanan Francisco and New York who not only had this strange pneumonia but had other opportunistic infections and a strange cancer called Kishi saroma that day when I looked at that changed my entire professional career because I looked at that and I and for the first time in now I had been a physician already for you know about 12 years or 15 years I I got goosebumps looking at it course I said oh my God this is a brand new disease and why is it only affecting young gay men so I made a decision to completely turn around the direction of my career and put aside this successful trajectory to admit these desperately ill young almost exclusively gay men to see one if we could find out first of all it didn't have a name was called gay related imun deficiency a terrible name um it didn't have an ideology and all of my patients were desperately ill and I spent Sean from 1981 until we developed Therapies in the mid to late 990s spending you know 10 hours a day hoping to develop which we ultimately did um therapies that could suppress this virus but every one of my patients with very few exceptions died and died a terrible death um and I was trying to do research at the time I was taking care of them and when you do that day after day after day in order to be an adequate physician and comforter to the patients you have to suppress that that Darkness you can't let it get you down that was from 1981 to around 1987 when we first had the drugs and the point I made in the book is that for the and there were a lot of physicians in LA and in San Francisco that were having the same experience that when you're trying to take care of people and provide the comfort that they needed without necessarily doing anything definitively to cure them those years in order to do it well you had to suppress it and I didn't realize it that day after day and week after week we were doing that and the reason I said in the book was post-traumatic stress because whenever I think about it sometimes now uh many many years later this was 40 years ago it's still you know I get I get emotional about it and I try when I talk about it to G myself to be able to get through the discussion but something happened fantastic during that time that's why I'm wondering why people were yelling about drugs the fact is in 1987 the first drug that was able to bring down the level of virus partially but not completely had some positive effect but my patients still continued to deteriorate at a less rapid rate but they continued to deteriorate in 1996 with the combination of triple drugs was the first time remember we started started in 1981 and it wasn't until 1986 where my Institute with the collaboration of the pharmaceutical companies developed drugs that for the first time brought the level of virus to below detectable level and kept it there and then from 1996 until the present period of time we got better and better with less toxic drugs drugs that were easier to use with one pill instead of 25 pills and when you look at the effect of that that resulted in the saving literally of millions of lives not only here but the point is that um when the therapies were developed and were perfected something incredibly good and important happened uh for people at risk for and those who are living with HIV because we got to a point uh several years after the original uh development of the drugs that if you put someone on therapy and got the level of virus below detectable and durably not only did you save the life of the person which you can now if you do the modeling that if a 25y old person uh gets infected or lives with HIV uh and you put them on therapy and adequate therapy and they take it and you get the level of virus below detectable you can actually tell them honestly and predictably that all other things being equal they could live essentially a normal lifespan maybe a year or two less which that in fact that's the best part of it for the individual but for the community is that that person then then it would be virtually impossible for that person to spread the virus to their sexual partner and that is really phenomenal because all of the stigma that's associated with HIV is really now gone because a person living with HIV who takes their medicines is essentially no threat to anyone and that by anybody's imagin I don't know what she was yelling at what they were yelling at but that may be one of the most important and impactful medical advances in our lifetime so let's talk about that and I think the key here is something I've thought about a lot and I've always wanted to ask you about what is the remedy you know we as you know we could get hit by another pandemic tomorrow What is the remedy for the breakdown of trust in public health you know I don't have the the you know the the precise Bullseye answer for you Sean but I think it has to do at least in part with we were confronted there have always been naysayers about I mean there was antix and anti- mask and anti- this and anti- that that back in the 1918 pandemic 100 and plus years ago that killed 50 to 100 million Americans there have always been those people who just were against anybody doing anything that they felt was you know telling them what to do um as I describ in the book I had the privilege of of being at the NIH and being in public health and public service for more than half a century for 54 years and I was the director of the in insute for almost 40 years and I had the privilege because of circumstances of dealing of dealing and Advising seven presidents of the United States starting with Ronald Reagan and one of the things I learned I have been completely apolitical because that's the only way that you can function in a scientific and Public Health Arena because you can't allow any political considerations to get involved in the kinds of advice you give for the total purpose of saving people's lives and the one thing I did experience is that whether it was Ronald Reagan or George HW Bush or Bill Clinton or Obama that although there were ideological differences you know which ideological differences um your Center your Center left your far left your center right far right has always been differences in the context of Civility and respect for institutions uh and the reason I say that is is that one of the most important I mean there was difficulty under Trump obviously we we we can get to that but but George W bush who was a Conservative Republican and his father George HW Bush with two of the people that I was closest to as close as I was with Obama and with and with Clinton and with Biden and even though they may be ideologically different because ideological differences make for a very healthy Society so long as there's respect for the other person's opinion the trouble is in answer to Shan's question that things went arai when social media Amplified radical views where someone who's you know a minority but very vocal can have that amplification with no no editing of an opinion um George W bush did something that was absolutely phenomenal he asked me to go when and it was clear that these drugs were life-saving and people in the developed World went from an almost inevitable death sentence to literally living essentially a normal life and I had felt very strongly I have a very strong feeling about Equity that rich countries and countries with a lot of resources have somewhat of a moral responsibility if they have the resources to help other nations so I felt we should be doing something in southern Africa luckily for me and the world and southern Africa George W bush a very strong Conservative Republican sent me to Africa and said would you see if we could put together a program that would be transformative and that would be accountable because and these were his words that he feels that we have a moral respons responsibility to not have people die of a preventable and treatable disease merely because of where they have to been born namely in a relatively poor region so in 2002 and I described that in the book in 2002 I went to S I had been to Southern Africa multiple times I went to Southern Africa and I looked around at what the people were doing and that was like in 2002 which was Tony fouchy in 1982 where all of my patients were dying because there were no drugs now fast forward to 2002 all of their patients were dying not because there were no drugs because they couldn't afford the drugs so I came back to the United States and I presented to President Bush and his staff that I think if we put together a program it would cost a lot of money um but I think we could turn things around in southern Africa and he said let me worry about the money go ahead and put together the architecture of a program that at first was about $15 billion aimed at saving treating 2 million people preventing 7 million infections and caring for 10 million people including AIDS orphans um and it was going to involve 14 countries to his enduring credit it took me about eight months to put the program together I presented it to him and some of you may remember he announced it on January 28th 2003 at the State of the Union Address the program was called the president's emergency plan for AIDS relief or pepar fast forward 20 years and in December of 2023 we had somewhat of a anniversary uh uh dinner with President Bush and Laura and the staff that helped me put together the pepar program and we look back at the numbers and over the 20 years that program saved 25 million lives now the reason I emphasized the part about him being a quite Conservative Republican is that that gives you an example of what leadership can do that doesn't have that divisiveness because I cannot imagine that we could do something like that now with the profound divisiveness we have in our country and you know when people see the interaction that I had in the White House during covid they in incorrectly think I was trying to undermine someone politically that absolutely nothing to do with it because my relationship as I mentioned with the bushes and with Reagan were as as good and productive as we so when people do things like that I don't have any idea what they're talking about to be honest with you I really don't but that's me what one of the things that that people who I I would assume this this sort of person by the way the pattern of um lack of imagination and their complaint uh should let us all feel feel confident that that our gut about this is is on point um one one of the one of the things that had come up you know there was a maybe the most innocent of them the most um understandable was how quickly the the vaccine came out on Co on Co but that was not necessarily the way that I saw it and I I'd like you to talk about the history of the MRNA technology and and how adaptable and how quickly not withstanding testing of it not withstanding getting to efficacy but how quickly was it essentially what became the vaccine identified yeah well Ju Just as a as a background uh of the question that Sean asked in general even in the best of scientific Endeavors it takes about um 7 to 10 years at best to develop a success uccessful vaccine at at very very best what happened with covid is that because of the Investments and basic and clinical biomedical research that anti-ed covid by about 15 years the MRNA technology was an emerging technology two people one of which was actually a fellow in my lab for about six years Drew Weissman and Katie Caro won the Nobel Prize for doing that and and and what they did is that they were able to show that this particular platform it's called that's what the RNA is as a platform was easily adaptable and could be easily flexible in getting the right Imogen and which is sort of the business end of the of the U of of the vaccine so as soon as it became clear what the sequence the virus was that came out on January the 10th of 2020 I asked my team which was the vaccine Research Center which actually was built with the help of Bill Clinton again doesn't matter who you are good stuff happens when people collaborate is that the group in our vaccine Research Center who had been developing really eloquent ways to get the right confirmation of a molecule partnered with the mRNA people there fizer and Mna and others to get a vaccine going and in an amazing series of events Sean that five days after the sequence became available they started working on the vaccine 69 days later they had a Phase 1 trial going about 10 some odd days later that had a phase 2 trial and then about 250 days later that had a phase three trial and they had tens of thousands of people and in a feat that has never ever before even been anticipated that we could do this that in 11 months we had vaccine going into people's arms that was highly highly effective and safe if you look at unvaccinated people early on in the outbreak the hospitalization and death were like this if you look at vaccinated people during those times it was like this so the amount of the difference was unequivocally without a doubt totally transformative uh and the number of lives that was saved that unbiased people have done uh estimates using reasonably good modeling measures that in the period from December the December 2020 when the vaccine first came out to February of 2021 2022 in the United States there were 3 million lives saved 18 million hospitalizations and $1.2 trillion was saved globally about 14 million lives were saved by the vaccine and that's just a fact it's not maybe it's a fact so I'm so in Los Angeles many many of us are involved in storytelling and in this story there's um i i a hero who is has put his his will his commitment his credibility on the line for years working through difficult bureaucracies working against a tide of of of people's pain and suffering and disease and the Night Comes that you get the call about the efficacy right that's a big scene in the movie could you talk about it yeah I uh it was November of 2020 and um like everybody else um we had our little pod and we were trying not to do anything indoors so I we were outside with my nextdoor neighbor um having a meal in freezing weather you know outside you know eating with gloves on it was just um and I was there and we knew that the that the trial was was coming to an end that the results were were going to be U known soon and in the middle of the meal um I got a a phone call from Albert borer from fiser and I was in the backyard with my nextdoor neighbor and he said the phone rang i s it I got up and he said Tony are you sitting down I said oh you know uh um all of the effort that we put in wasn't going to work so I walked out into the street this is Washington DC I walked out in front of my in front of my house and vaccines like with influenza in a very very good year a flu vaccine is maybe 50% effective or 60% at most in a bad year sometimes it's 10% effective it's not good most of the times you try to get it a right match so I'm walking out and he says Tony you're not going to believe it but the vaccine is more than 90% effective and [Music] uh you know it wasn't exactly post-traumatic stress but I started to cry uh I I was so you know moved and stunned by it um and that's when we you know started to get the vaccine campaigns going U and and the rest shows you know the extraordinary effect that's how I started I started the book with the preface with that and I remember I said to myself in in the book in the first page I said um boy I've been what an incredibly fortunate life I've had I'm a few weeks from my 80th birthday and and this and this is what we have and all of this started and then the next page is me getting born in Brooklyn and and as we sit here today and this is to whoever the other one that's waiting for their appro their moment I I probably have about 3 seconds to get this in before they start if if if if you want proof of The credibility of Dr fouchi on health this guy's 8 fucking2 and look at him 83 83 so with with the dot and this is a little bit of a tangent and this is excuse this is a personal Indulgence because there I I discovered we had a mutual friend reading your book did you talk about Paul Farmer yeah so for those of you who don't know who Paul Farmer is there are there are some people who um you know uh kind of wish they could go out and and and really live it the you know walk to walk and talk to talk Paul Farmer was uh one of the most altruistic talented Physicians I knew um I met him because this was in the early years of HIV AIDS um and he was a medical student at Harvard and I was giving a lecture in the early years of HIV and this tall gangly guy comes up to me after the thing and started asking me some really probing questions about HIV and I said uh you know this is something you might want to get involved in um well he didn't need my inspiration for that because even before we went to medical school he started a um uh an organization called Partners in Health which um he spent the greater part of year as a very well-trained physician a Harvard professor in Haiti in the very rural parts of Haiti personally taking care of of patients building hospitals and doing it essentially for nothing um he did that in Haiti and then he decided he would go to Rwanda and do the same thing in Rwanda and he did that in Peru um he when he writes uh often says that I was his mentor because I'm considerably older than he is but um the fact is I tried uh and I don't think I was as successful as his to be as amazingly devoted to to personal care of patients that he was fortunately he died a younger at a very young age but he is a person uh that you know if you ever want to read another book besides my book mountains Upon A Beyond mountains uh by Tracy K is the story of Paul Farmer who was really one of the most amazing amazing human beings and you you did you got to know he's just each other pretty well an amazing guy yeah um so I'm going I'm kind of going back to the original question and in 2014 and I was reading about uh what you were doing at that time I was driving from um Liberia to sier Leone when we started to hear the first reports of the Ebola outbreak and so we didn't eat much on our way um and I and and in that time and of course Co for all of us I but I remember with the Ebola which is it's such a horrifyingly um violent virus given the public trust issues the where we stand today as as a country what can you help us understand because I of course you would have thought about this deeply what do we do to find that kind of unity that it would take to take one of these things on in this incredibly divisive atmosphere or is that just a silly question and that we're going to get caught una awes and it's is that going to is that an if or a win you know Sean i i as as I said towards the end of the book I I am a cautious Optimist and I do believe um that um ultimately the better angels in us will come out and people will realize that we are much more the same as we are different and and and that that doesn't look that way here I mean U you try to examine what is it that has a group of people um who have such hate for someone else who was trying to do something good for society and you know you can't figure it there's no logic to it uh and and I it it's tribalism in this country where U I give you an example and I think you are you aware of the example when there's such divisiveness um that the far extreme people are saying that when someone disagrees with you look at the people like Steve Bannon and and Alex Jones that they say the people that you disagree with we should get rid of them we should kill them we should prosecute them um for any of you who've seen the Congressional hearing I was at a couple of weeks ago um where the purpose of the hearing should have been to figure out we've been through a terrible ordeal we've lost 1.2 million people in the United States certainly when you had this tsunami of cases people were trying their best to save lives we didn't do everything right but we did a lot right and we saved a lot of lives but there are things that if we knew then what we know now we clearly would have done things differently and there were lessons to be learned instead of trying to dissect out the lessons to be learned by a bipartisan group that should have been pulling together the way we pull together during Anthrax and the way we pulled together during World War II um it was it was just a phenomenon that was unbelievable because on this side of of the screen and on on the on the aisle on that side of the aisle you had people who weren't asking any questions it was all at haminim vitriolic attacks and Sean if we keep that up um and our elected officials do that it's only going to get worse um and it gets fueled by the the silos of social media um if you turned on MSNBC after the hearing they would say just what a bunch of idiots those people were screaming you know go to jail kill you hang you up then you turn on uh Fox News oh they were right they should kill him you know I mean really so I I wish I could give you an ex a good a good solution to it Sean but but let's look at history and what happens when we are living in in an arena of untruth conspiracy theories and the normalization of untruths that people say things that are so outlandishly incorrect and they say it and it gets Amplified in social media that after a while people who are busy with other things shrug their shoulders and say you know we don't know what's true I mean we have no idea what's true because this person's saying that and that person is saying that and you only listen to the echo chamber of where you're in you know and there there are Echo Chambers and the only way to get rid of that is to get people to start listening to each other you know a very good example and and and I you know it's a long time ago during the during the early years of HIV the the the the the gay population the young gay men who were suffering a afraid and they found themselves ill and their loved ones dying the The Establishment understandably but incorrectly had a system of clinical trials with exclusion and inclusion criteria with rigidity of of how you would do the experiments the regulatory authorities would take years to get a drug that was that was approved whereas The Afflicted group was saying this is not working for us it may have worked for other disease we want a seat at the table and we were not listening to them the scientific and Regulatory community so they started being very iconoclastic theatrical and disruptive but that was as John Lewis said trouble but good trouble not the kind of trouble which is just disruptive and ultimately when you listen to them what they were doing they were making perfect sense and I said to myself if I were in their shoes I would be doing exactly what they were doing so they were trying to make the system better and as a matter of fact because of their pushing back they did it for the good purpose of making the clinical trial system the regulatory system how we handle patients better we learned a lesson from people who were protesting if people are disruptive Sean purely for the sake of disruption that's going nowhere at all and that's the thing that I'm very concerned about I mean we we all saw it I mean regardless of what your ideology is I mean to storm the capital of the United States of America and to try and tear down the Constitution really I mean is that where we're going I I I hope not I hope not this's something I'm I'm not going to organize I'm not going to organize this thought so allow me to circle into it the um you you talk about in the book uh one of the problems of the institutionalized testing was that it was U that it was predicated on um a consistently symptomatic disease right versus something like Co right can you can you talk about that and I'm thinking of it that it's also a metaphor for this other part of the conversation yeah no I mean one of the issues with covid which was so stunning to everyone is that the model of an infectious disease that's respiratory born is that you stay away from someone that's coughing or sneezing you know droplets you want to stay away from them so the trouble is that unlike any other respiratory born illness covid about 50 to 60% of the spread of covid comes from someone with no symptoms that had never before so we had a situation where it would be was in the beginning was very confusing because you would have people who remember the the reports of choirs of people that were singing and nobody was sick and yet all of a sudden everybody got sick in the choir how could that be because this virus has the capability of essentially coming out even when you breathe when you talk louder when you sing it happens you don't have to be sneezing and coughing and that was one of the things that was very confusing early on which led to confusion about West wearing masks and social distancing and things like that and that but the the particular issue I think was related to the the the CDC protocols well the CDC protocols were based on and and and quite frankly they were not correct for covid because they used a syndromic approach so that if you want to do contact tracing that you don't test somebody unless they have been um Associated or near someone who has symptomatic disease well if you think about that since most of the transmission is by people who don't have symptoms what we should have been doing early on is testing everybody literally flooding the system with testing and the way things were set up we didn't do that we did contact tracing that was you know the tip of the iceberg but everything that was below the iceberg were the asymptomatic people and before we knew it we had infection all over the place the um is it true that you would not be here tonight had basketball come through for you it's true it's true so in New York City it's a really hot good basketball City there's some really great players in in New York City okay so I played high school basketball I was the captain of my basketball team and um back then it was a different kind of a game so it was a lot of transition game fast break so I I inherited from my father speed he was the New York City 100 yard and 440 yard champion in high school unfortunately I also inherited his height from him so I played basketball in high school and was really a very good basketball player and had aspirations the way young people did but I really wanted to make it big I wanted to go to college and I wanted to really you know be a really good basketball player and then I started playing against college players um because when we were in high school the the the the high schools in New York City would scrimmage against the Freshman teams of the colleges like St John's in the Big East and Sean Hall and schools like that so it would give them the opportunity to scrimmage with someone other than an inra squad team and would give us the opportunity to actually play against above what we were and even though I was really very good in high school and scored a lot of points and did all that sort of stuff I learned a lesson and the lesson is of really really fast good shooting 57 point God will always be destroyed by a really fast good shooting 63o guard so then I said I'm going to go to science so um I I think we have to to talk about the um the what the relationship like was with asterisk president Donald Trump okay so you know unbeknownst to people who said he should have fired me the the the the um the relationship early on was quite a good relationship I mean he's a he's a very charismatic guy but he's unusual okay so um but early on um we had a very good relationship and I describe it in the book I think it was that kind kind of Rapport that you get a guy from Queens and a guy from Brooklyn that has that little New York Swagger that you get along so we got along really very well in the beginning um um what he had hoped and and I do describe it pretty well I believe in the book in simple language he had hoped that the covid outbreak was going to do like influenza in fact he had trouble and Confused influenza with Co a a lot uh and he thought it would do what what Influenza does that it would Peak and then somewhere around March or April it would essentially go away like flu does and he was hoping for that and when I was telling him it's not going to happen he would then start saying well it's going to go away like magic it's going to go away like magic and then when it didn't go away like magic he started to invoke um magical things like hydroxy chloroquin that could be the Cure of it um and then when that didn't work he brought in other people like Scott Atlas who just told him everything he wanted to hear but the issue that really turned things around and that's you should hear this is that I felt a responsibility uh for my own personal integrity and for my responsibility to the American public not to undermine him because I did not I'm not a political person I didn't want to undermine him but when he was saying things that clearly scientifically were not true and the Press would ask me directly is it going to go away like magic I say no it's not going to go away like magic does hydroxy chloric work no it doesn't so I had to find myself in the painful position that I did not enjoy of contradicting the president of the United States and I have a great deal of respect for the presidency of the United States I have advised seven presidents the people around him the extremist took that as a sign of declaring war and then all of a sudden I became the target he did not make me the Target early on he was okay by me well into the year at the time that I was being discredited and undermined by his people out there including people in the white house so it was a very complicated relationship there's a chapter in the book called love me love me not in the sense of where he would be really very friendly with me and then he would start yelling at me for saying these things and I would say Mr President I'm sorry but I have to tell the American public the truth and he would get upset and then at the end of it he would say we're still okay aren't we and and I would say fine it was only at the very very end when we were getting towards the election did did it really split where he started really very actively criticizing me but I was not his enemy when I was in the White House even though people who do this sort of stuff think that I was I was not his enemy I just felt I needed to tell the American public the truth [Music] so I I know that we're going to be taking some uh questions from the audience and I I I wanted to sort of maybe finish this part of it uh with this counterterrorism experts will watch political Trends fundamentalist Trends around the world they will identify uh what might be flash points what might radicalize certain populations and and under and start to identify impending threats in virology what are the threats today that keep you up at night well what keeps me up at night is is what five or six years ago people would always say Tony what keeps you up at night and what's your worst nightmare and I would say you know and and I'm on record for this way back saying you you know the emergence of a res the jumping of a of a of a of a virus from an animal to a human which is 75 80% of all the new infections of zoonotic of a respiratory virus that is very efficient and spreading from Human to human and that has a degree of morbidity and mortality that is really very worrisome that's what was my big nightmare unfortunately my big nightmare came you know in 2020 and we lived through it for several years my biggest nightmare from a infectious disease standpoint is the same thing is yet again because there are viruses out there that will adapt themselves ultimately to people if we don't do something about it like right now even though the risk relatively speaking is low you have this bird flu which we've been following for decades h5n1 it just destroys bird words when it jumps into human it is not efficient in going from Human to human but when it does infect a human the mortality is horribly high like 40% or so now it's infected in cows in the dairy farms and when it infects mammals it allows itself to adapt more and I hope which is not happening that the dairy industry is doing that kind of broad sweep of testing and Broad sweep of addressing both the dairy workers and the cows so it may not be that that may just go away but the next pandemic whether that's two years from now or a 100 years from now almost certainly is going to be a respiratory born virus that's easily spread almost certainly so we'll do a letter writing campaign to the Dairy Farmers right um all right so now I'm going to turn it over to Ted and he's going to read some of the questions that were sent in all right thank you thank you Sean thank you Dr fouchi thanks to all of you who sent in questions uh first question uh what are your thoughts on the potential success or pitfalls of the international pandemic treaty yeah the international mic treaty is something that The Who and others have been trying to do to get the entire world all the countries of the world to agree on not only transparency if something arises but some degree of equity of distribution of interventions when they become available because there was a great deal of lack of equity when the the developed world had all the vaccines even vaccines and boosters and countries in southern Africa and other areas of the world didn't there is a reluctance to sign a treaty uh and in fact you're going to see a lot of semantic word smithing that it can't be a treaty um so we'll call it an agreement um and if an agreement is a little bit too strict in other words country don't want to feel obligated to give away a scarce Resort for equity in the world so I think we need some sort of an agreement but somehow or other it's very difficult to get a commitment that if we have another big outbreak that rich countries are going to start giving away things that their own citizens would need so that the rest of the world could have some degree of equity good idea not sure where it's going so Donald Rumsfeld famously once said there are things we know there are things we don't know and there are things we don't know we don't know um clearly at various points particularly early during the pandemic you must have been in one of those moments how did you process yeah well that that's a great question and it leads to a lot of confusion because when you're dealing with a moving Target and God knows Co was a moving Target moving not only in reality moving because we had different variants we've never seen that ever that in one disease you have Alpha Beta Gamma Delta Omicron multiple multiple subgroups of Omicron but importantly as the information was coming out we didn't realize how well it was transmitted because the the the the Chinese was saying oh it's you know virus that's not very well trans because remember SARS kov1 in 2002 some of you may remember 8,000 cases 781 deaths it was easily suppressed by good Public Health measures why because it didn't readily spread from Human to human so when this new Corona virus came out from China the Chinese thought oh well it's just like SARS K1 it doesn't spread very well from Human to human so the first week we thought it didn't spread very well then all of a sudden it became clear it spreaded pretty well and then it spread very well and like it spread like nothing we've ever seen before so in the first weeks you make recommendations based on the data that you have so the public wants to know what should we do should we worry about this should we wear a mask should we do this and the information is here when the information changes science is self-correcting so you have to change your recommendation and then when other things change so that led to a lot of confusion in the public say where the scientists they keep flip-flopping we weren't flip-flopping the situation was changing and the only way you're you're people think about science in general as immutable science is a mechanism whereby you gain information evidence and data and then you can make your decision or not people in the beginning thought that the science of covid was like math so in math 2 + 2 = 4 in January of 2020 in June of 20 24 2 + 2 still equals 4 is the virus the same in 2024 as it was in 2020 not even close so you got to be careful that you don't mix up things when you're dealing with a moving Target so that's an example Ted of back then we didn't know we didn't know we didn't know when Magic Johnson announced in 1992 that he had tested positive for the HIV virus how did that change your work in HIV and AIDS well you know when magic announced uh I had the privilege of of of you know dealing with with magic after he got infected um when he announced that he was infected that changed a lot of the perception of people who was stigmatizing predominantly young gay men who were infected because if if magic the great magic could get infected you you can't stigmatize magic you know magic is Magic um uh and I think that I'm sorry that that he got infected he's doing great I know that as a fact um but um he then started speaking out about um HIV and the importance of lack of stigma the importance of getting medication so in some respects he contributed and thank goodness he's doing well he contributed a lot to the field of getting people to appreciate the importance of getting medications and the importance of not stigmatizing people with HIV Dr fouchi which president would you say you had the closest working relationship well I can't tell you that um and I'll tell you why because it's an unfair question because my even though I had the privilege of um advising seven presidents as you'll see from if you read the book which I hope you do that you my relationship as a physician and a son scientist only relates to what the level of involvement during a given presidency uh so if if if there's something really important going on that I'm contributing to the agenda to the scientific activity during a certain president's presidency then it maybe looks like I have more of a relationship with them so it was a better relationship no it just depends I mean like Ronald Reagan um you know he disappointed me a bit I really liked him but he waited until well into his second term before he even mentioned the word AIDS and he lost the opportunity um of the bully pulpit of the presidency to call attention to this emerging plague but you know I don't hold it against him but I think could have done better George HW Bush was the first president that really befriended me because when he was getting ready to run for president he felt he really needed to learn more about HIV so he came to the NIH and I had the opportunity to show him around and we just hit it off together and he started asking me a lot of questions and promised that if he became president he would really listen to me about getting more resources for AIDS and he did um again he was a real gentleman and I I write a chapter only on him about you may or may not agree with his his ideology but he was a very very decent man um and then you get you know George W bush I told you about pepar I mean talk about somebody who did something for health wow I mean that was great you know you have Clinton who really broaden the acceptance of the community you know activists lgbtq community of minorities he really brought it in so I had to do with Kim but it wasn't any brand new disease so as much I had more interaction with Hillary Clinton during his presidency than him but he was the guy that started the vaccine Research Center that fast forward multiple years led to the covid vaccine seen so that was great President Obama I had a lot to do with because during his presidency in the first few months we had the 2009 swine flu the first pandemic of the 21st century followed by Ebola followed by zika so I spent more time in the situation room and in the and in the in the Oval Office with Obama than I did with Clinton not that I liked Obama any better than Clinton it's just that during Obama's administration I had to be there whereas in Clinton things were moving smoothly and we've already spoken you know about the the the Trump years which I didn't have much to do at all with him until the final year when Co came and then I spent two years um as the chief medical adviser to President Biden who I knew President Biden when he was vice president for8 years so I had a very good relationship with him and you know he was very much driven by empathy and integrity uh that was you know a sharp change from the SL from no but no but I don't mean about Trump I mean about the the uh the the attacks I was getting from the staff in the white house when they were essentially undermining my credibility and when I became the chief medical advisor for for President Biden as I showed there you know it was the kind of thing of just tell me what the truth is and we we'll go by the truth and that was different you know time for just two more questions uh Dr fouchy if there's one or two things you could do over from 2020 what might they be one of two things I would do over yeah in my life in that period of time decisions maybe you made oh my goodness um you know it it's a tough question because if I knew then what I knew now what I know now there was so many things that we would have done uh you know better I mean what what became clear is that we the people who who sharply criticized and I can understand criticizing seem to forget that at the time that we had to make the decision to essentially physically separate you know flatten the Curve that 15 days we were losing 4 to 5,000 people per day the freezer trucks were parked in front of New York hospitals because there were too many bodies that couldn't fit into the morg we would this close to having to say you're going to get a ventilator and you're not that's a decision that Physicians never ever ever want to have to make so something dramatic IC had to be done and that's when the shutdown would Sav millions of lives what to be reexamined is how long and how intense that could have been including with the schools I think it's important we should re-examine and rethink about when you made a decision true it save lives but look at the collateral aspects of it could we have done things a bit different you got to be humble about it and you've got to be honest with yourself about it it turned into a total blame game as opposed to figuring out what we were trying to do was save lives that was what we were trying to do and you know you go back and look at Lessons Learned there were things for example mandates I mean mandates are interesting if you have I mean mandates are done all the time I mean uh when I went to school I had to get vaccinated with measel mumps and all that s stuff otherwise you couldn't go to school you have to have a driver's license don't you I mean there so their mandates but the idea that the country was so divided that I think there was almost an unintended negative effect on some that allowed for divisiveness in the country so yeah there are a lot of different things that I think retrospectively but the way to make it better is to examine what you did why you did it and what the positive and negative consequences are not try and you know attack people which is what happens and our final question for the evening Dr fouchy of all your years as an esteemed physician and researcher what has been your most proudest moment H you know um I say this and I say it sincerely I mean I I've been doing it for many years there are so many things that we did developing of the drugs for HIV the pepar program vaccines and things like that I will let others judge what my legacy would be the thing that I feel very comfortable about is that in the more than half century that I was in public service and the moment 40 years that I was the director I gave it 110% every day and I left it all on the [Applause]