Since Dr. Anthony Fauci retired late last year as head of the National Institute of Allergy and Infectious Diseases, effectively ending his role as America’s Doctor during the Covid-19 public health emergency, he has been reflecting in a series of new interviews on the missteps – and missed opportunities – that characterized the pandemic response.
How could the United States, one of the wealthiest, best-resourced nations on Earth, rack up more than 1.1 million deaths from Covid-19 in just three years, a death toll that outpaced those of most other countries?
In interviews with New York Times science writer David Wallace-Wells in April, and with CNN’s Kaitlan Collins on Wednesday, Fauci gave some of his most extensive answers yet on the decisions that he and others made during the pandemic and how they shaped the country’s response.
An account of the interviews in the New York Times Magazine describes Fauci as defensive on topics about which he felt his own positions had been misconstrued, such as the origins of Covid-19, but “reflective and humble” about the pandemic and his own role in it.
‘We really fell very short’
On “CNN This Morning,” Fauci gave his assessment of the country’s performance during the pandemic.
“We thought we were the best-prepared country in some respects from a scientific standpoint, as manifested by the overwhelming success of the rapid development of the vaccine, that we did very well. But when it came to the implementation of public health, the uniformity of a response, the communication, the ability to get data in real time, we really fell very short,” Fauci said.
Collins asked Fauci about the coming end of the public health emergency for Covid-19 and whether this is the right time to do that.
He said as long as there’s a safety net in place to help maintain access to Covid-19 drugs and vaccines, “I think it’ important to move forward.”
“Everybody wants this outbreak behind us. We want to make sure we don’t forget about it completely because we still have about 150 deaths per day and there’s still a lot of virus out there. So we can’t just completely forget about it, we gotta continue to pay attention to it,” Fauci said.
Two big stumbling blocks
On the whole, Fauci said, he sees two big problems that caused the US to stumble as it tried to control Covid-19.
The first is the divisiveness of our politics, which led many conservatives to distrust public health recommendations to get vaccinated and wear masks in public.
“I understand that there will always be differences of opinion among people saying, ‘Well, what’s the cost-benefit balance of restriction or of masks?’ But when you have fundamental arguments about things like whether to get vaccinated or not – that is extraordinary,” Fauci said.
“Why do you have red states that are unvaccinated and blue states that are vaccinated? Why do you have death rates among Republicans that are higher than death rates among Democrats and independents? It should never ever be that way when you’re dealing with a public-health crisis the likes of which we haven’t seen in over a hundred years,” he added.
The second major problem, as he explained, is the fracturing of the US health care delivery system.
This point is also emphasized in a new book, “Lessons from the Covid War,” published Tuesday by 34 public health and policy experts called the Covid Crisis Group. They came together in preparation for a government Covid commission, envisioned as a blue-ribbon panel that would examine the policy failures of the pandemic in an effort to avoid duplicating those mistakes in future health emergencies.
That commission has not – and may never – come together, so the Covid Crisis Group decided to publish their findings in its stead. They contend that as many as half a million Americans may have died unnecessarily from Covid-19.
Their observation is that the US public health system, an underfunded patchwork of 2,800 state and local health departments, is largely disconnected from the for-profit health care system, which had not traditionally shared data that became vital to the nation’s pandemic response, such as hospital staffing and bed capacity.
Fauci said both arms of this health delivery system have been allowed to atrophy, putting the nation’s health in jeopardy.
Triumph of science
But, Fauci pointed out to the Times, it wasn’t all bad.
Fauci says that US scientific enterprise was a boon to the world, developing vaccines against the coronavirus in less than a year, an incredible scientific feat.
“How much worse would it have been if we didn’t have a vaccine in 11 months? If it took three years to get a vaccine, we would have had five million deaths here,” he said.
There have been an estimated 20 million deaths from Covid-19 around the world, but that number might well have doubled, Fauci said.
“So I don’t think we should throw our hands up and say we could not have done any worse,” he said.
Going forward, he said, researchers are trying to make the development of new vaccines even faster, doing it within 100 days.
Fauci says a lot of the confusion of the pandemic had to do with the surprising nature of the SARS-CoV-2 virus itself.
“We were not fully appreciative of the fact that we were dealing with a highly, highly transmissible virus that was clearly spread by ways that were unprecedented and unexperienced by us. And so it fooled us in the beginning and confused us about the need for masks and the need for ventilation and the need for inhibition of social interaction,” Fauci said.
Scientists never imagined, for example, that people could spread the infection without having any symptoms themselves.
“To me, that was the game-changer,” he said.
When it comes to the nation’s poor vaccination rate – just 68% of Americans are fully vaccinated, making the US 69th in the world – Fauci says he wonders whether mandates ended up doing more harm than good.
“Man, I think, almost paradoxically, you had people who were on the fence about getting vaccinated thinking, why are they forcing me to do this? And that sometimes-beautiful independent streak in our country becomes counterproductive. And you have that smoldering anti-science feeling, a divisiveness that’s palpable politically in this country,” he said.
‘We need to reach out now’
With regard to Covid-19’s origins, Fauci said, until there’s definitive proof of either a lab leak or spillover from animals into humans, it’s important to keep an open mind.
“But I want to highlight the difference between possible and probable. If you look at what’s possible, I absolutely keep an open mind until we get a definitive proof of one versus the other. However, as a scientist, I could not ignore the accumulation of evidence favoring one versus the other,” Fauci said, citing the bulk of evidence that points to a natural origin for the pandemic.
One thing that’s getting lost in the debate, he says, is that we should be trying to take steps now to prevent both scenarios in the future.
“But one other thing that is tough to talk about: Because both are possible, even putting aside probability, we should be strengthening whatever it takes to prevent both – to prevent a new natural occurrence or a new lab leak,” he said.
Finally, Fauci says, it is essential to take a moment now and try to listen to people who pushed back against public health advice during the pandemic.
Get CNN Health's weekly newsletter
Sign up here to get The Results Are In with Dr. Sanjay Gupta every Tuesday from the CNN Health team.
He told the Times that one of the things he is proudest of in his career is that when he was fighting HIV, he got a lot of criticism from gay people because the government too rigid in how it set up clinical trials.
“One of the best things I did in my life was put aside their theatrics and their attacks on me and started listening to what they had to say. And what they had to say was not just a kernel of truth; it was profound truth. It was mostly all true,” Fauci said.
“So I have always felt when there are people pushing back at you, even though they in many respects are off in left field somewhere, there always appears to be a kernel of truth – maybe a small kernel or a big segment of truth – in what they say. One of the things that we really need to do is we need to reach out now and find out what exactly was it that made them push back. Because so many people cannot be completely wrong.”