tv The David Rubenstein Show Peer to Peer Conversations Bloomberg March 27, 2020 7:00pm-7:30pm EDT
david: you are the leading infectious disease person in the united states, maybe the world. how many times a day do you wash your hands? dr. fauci: i would say at least seven, eight, nine times a day. david: is there any evidence that vaccinations cause these diseases? dr. fauci: absolutely not. david: president george w. bush asked you what you could do about hiv and aids in africa. dr. fauci: he felt that as a rich nation, we have a moral responsibility. david: the best way to prevent getting an infectious disease and having to have you as my doctor is what? dr. fauci: the normal low-tech, healthy things are the best things you can do to stay healthy. >> would you fix your tie, please? david: people would not recognize me if my tie was fixed. but ok. we will leave it this way.
all right. ♪ david: i don't consider myself a journalist. nobody else would consider myself a journalist. i began to take on the life of being an interviewer, even though i have a day job running a private equity firm. how do you define leadership? what is it that makes somebody tick? we are here today with dr. anthony, also tony, fauci, who is the director of the national institutes of health, which he has led since 1984, 34 years. that is a long time to be leading the institute at nih. is that a record? dr. fauci: it is. david: you haven't gotten tired of doing this? dr. fauci: no, because things keep changing. we get new infectious diseases, new outbreaks, new challenges. it is almost like a different
job every year or two. david: i always worried about getting a flu, so if i want to avoid catching the flu, should i take a flu shot? dr. fauci: yes. influenza vaccination clearly protects you. it is not a perfect vaccine. it does not protect you 100% and it varies from year to year, but the best way to avoid influenza is to get your flu shot every year. david: do you get one every year? dr. fauci: i do. i do. david: i usually don't get them, and i will tell you why. i am often afraid i will get the influenza shot for a different flu than the one that comes out this season. is that a problem? dr. fauci: influenza tends to drift or change from season to season, but essentially every year you get vaccinated with a vaccine that we hope matches well with the circulating virus. but it is possible that you make a vaccine against one and it will change a little by the time the season comes and then it isn't the best match. but it is still always better to get vaccinated.
david: 100 years ago, about 100 million people in the world were killed by influenza. why was that? dr. fauci: it was a pandemic. a pandemic means that it is a virus that no one had any previous experience with. it was a brand-new influenza, and it happened to be one that spread very rapidly and was very virulent. it was a catastrophe. david: is something like that not likely to happen again? dr. fauci: hopefully not as severe as that. we had a pandemic in 2009. h1n1, the swine flu of 2009. it was a pandemic because it was a brand new virus. the good news is that it was not particularly virulent. although it spread rapidly, it did not kill as many people. david: you are the leading infectious disease person in the united states, maybe the world. how many times you wash your hands a day? dr. fauci: at least six, seven, eight, nine times. david: does that look bad if you shake someone's hand and wash them right away?
[laughter] dr. fauci: don't take it -- make it obvious. i avoid embarrassing people. david: i have a theory that when someone is ready to cough, they get close to me. whenever i am in a movie theater or i am walking somewhere, as soon as they walk past me, that is when they cough. or i'm in the movie theater, i've got the bubonic plague right behind me. do you ever have this problem where people are coughing on you all the time? and what do you say to somebody? dr. fauci: that is very tough. to the extent you can do it within social norms, you try particularly in a flu season , and the winter where there is a lot of virus going around, to try to distance yourself, we call that social distancing. sometimes you get trapped. in the middle of last winter, i was literally trapped on a transatlantic flight with a woman who was doing just that. she was sneezing and coughing. i couldn't tell her to get out of there. we were sitting next to each other. sure enough, five days after i got back to d.c., i got sick. david: let's talk about humans in the background and infectious
diseases. when humans first came out of caves, more or less, let's say, homosapiens, around 300,000 years ago, they had an average life expectancy roughly of 20 years old. today, average life expectancy is 80 or something like that. were infectious diseases a large part of the problem? dr. fauci: it was not just infectious diseases, it was survival under severe environmental circumstances. however, if you look at the 17th, 18th, 19th centuries, there were infectious diseases before the vaccines. vaccines and antibiotics greatly increase the life expectancy, because many children died. when children die, the average life expectancy goes down. david: what was the bubonic plague? that was in europe hundreds of years ago. what was that? dr. fauci: that was a bacteria. it was a bacteria that was spread, interestingly, through
fleas that were in situations in which hygiene was not very good. they would bite somebody, they would get infected. there were two types of plague. there was the bubonic plague where people would get swollen lymph nodes, they could die from that. they generally don't spread it from person-to-person. then there was the pneumonic plague, in which it disseminated through the body and you could cough and transmitted to somebody. it devastated europe in the 14th century. one third of the population of europe died from the plague. david: the chance of that happening again is remote. dr. fauci: not with that microbe, because it is easily treatable with an antibiotic. david: when did vaccinations first start? i remember reading what the revolutionary war period, some people would get inoculated against smallpox. how did they do that? when did people first realize you could be inoculated against a disease? dr. fauci: that was in 1796. that was edward jenner, who noticed a very interesting phenomenon, that smallpox was
rampant in society then, and he noticed the women who were the cowmaids, who would be milking the cows, they would get a relatively mild disease called cowpox, which was very much related to smallpox, and he noticed they would get cowpox, they would recover from it, but then be immune to smallpox. he put two and two together and said if we could deliberately infect people with a version of smallpox, namely cowpox, that they actually would be protected against smallpox. he actually did an experiment on a young boy, which quite frankly, retrospectively, was an unethical experiment, because he vaccinated the boy with this cowpox, then challenged the boy with smallpox and he was protected. that all started at the end of the 18th century. david: in the modern era, there has been some concern about vaccinations. some people think it causes disease or could cause autism. is there any evidence that being vaccinated causes these
diseases? dr. fauci: no, the answer is absolutely not. it is unfortunate, because there is a lot of misinformation being spread widely, leading to a diminution in the percentage of parents who vaccinate their children, particularly against measles. that is why today we are seeing completely avoidable measles outbreaks throughout the country and even throughout the world. there is currently one now in new york city, in the williamsburg section of brooklyn that is quite alarming. david: let's talk about a few other infectious diseases. tuberculosis? is that still a big problem in the united states and around the world? dr. fauci: less in the united states, but globally it is a big problem. it is a terrible problem. there are 10 million new cases of tuberculosis each year and 1.6 million to 1.8 million deaths. david: how do you catch tuberculosis? dr. fauci: predominantly, it is a respiratory spread. if you get close and prolonged contact with somebody who has tb, that is how it gets transmitted.
david: how about malaria? how does one get malaria and how do you prevent getting malaria? dr. fauci: malaria is a parasite that is being transmitted by mosquito. you get it by mosquito bite and only by mosquito bite. rarely can you get it from being transfused with blood of someone who has malaria, but that is very unusual. mostly it is a mosquito bite that transmits malaria. david: you avoid mosquitoes, you are not going to get malaria. dr. fauci: exactly. david: president george w. bush asked you what you could do about hiv and aids in africa. dr. fauci: he felt as a rich nation, we have a moral responsibility. can we actually give treatment, care, and prevention? that has saved now about 14 million to 15 million lives. ♪
jumped species from the chimpanzees to humans. david: is jumping species a common thing? dr. fauci: 70% to 75% of all new infections that man gets infected with come from an animal. it is called zoonotic. mainly, it is predominantly an animal virus, but for one reason or another, encroaching upon the environment of an animal, or mutating a bit, influenza is fundamentally an infection of birds. hiv, we said, came from chimpanzees. a variety of other infections. zika and other infections came from an animal. david: in africa, the health abilities we have in the united states are not prevalent, so hiv and aids are still a big problem there. dr. fauci: right. we better not downplay it in the united states. there are 38,000 to 40,000 new infections in the united states. it is very concentrated both demographically and geographically.
it is very interesting that 12% of the population of the united states is african-american, and yet 45% to 50% of new infections with hiv are among african-americans. david: i guess a few years back, when president george w. bush was president, he asked you to come to the oval office and asked you what you could do about hiv and aids in africa. what did you tell him? dr. fauci: well, he sent me to africa to do a fact-finding and come back with the feasibility of doing something. because he said and told me that he felt that as a rich nation, we have a moral responsibility now that we have drugs that can treat and prevent infection that other individuals, who because of where they live, they don't have access to that, and they will essentially die from a disease merely because of where they were born and raised, i.e. in the developing world, so he sent me to africa to figure out, can we actually give treatment, care, and prevention? we put together a program called
the president's emergency plan far.aids relief, or pep that is probably one of the most important parts of the george w. bush legacy, because that has saved now about 14 million to 15 million lives thus far, and more coming merely by providing sub-saharan africa and other developing countries with the proper drugs that can save lives as well as prevention. david: who is paying for this? the u.s. government? dr. fauci: the u.s. government pays completely for the program, then we also have the global fund to fight aids, tb, and malaria, and the u.s. pays one third of that. david: we are at the nih offices, and one of the buildings we are in is one where research is done on ebola. dr. fauci: correct. david: can you explain what ebola is, what the problem is right now in the congo? dr. fauci: ebola is another virus. it happens to be a particularly lethal virus. if left untreated, it has a high rate of mortality.
you know, depending upon how you get treated or cared for, it can be anywhere from 60% to 90%. it is spread by direct contact between an individual who is very sick and has body fluids that are easily contaminating the people who take care of them. it is highly lethal. it is now a major outbreak in the democratic republic of the congo. it is still not under control. david: when some people with ebola came to the united states a few years ago, you were involved in treating them? dr. fauci: i took care of two patients. one was a nurse who got infected in texas when she was taking care of a person who came from liberia. i took care of her. and then another person who got infected in sierra leone was air evac'd here to the nih, and my team and i took care of him. david: when you take care of them, i remember pictures you have to wear like a spacesuit, astronaut outfit.
dr. fauci: it is very difficult. they are very sick. you have to take care of them under intensive care circumstances. you have to put on literally a spacesuit to protect every single square inch of your body from being exposed to the contaminating fluids. david: you are the head of the division, you are the head of the institute. wouldn't it have been easier to get someone below you who is not so valuable to do that work rather than you doing it? dr. fauci: that was the exact reason i did it. we all knew that health-care workers in africa at the time were getting sick in large numbers and dying. 800 health care workers got infected in africa during that outbreak, and 500 died, so i did not like the idea of asking my staff to put themselves at risk of getting infected if i was not willing to do it myself. david: what did your wife and three daughters say about the fact that you were going to be doing this? dr. fauci: they were not happy. my wife, she is a nurse, so she understands disease.
she supported me but asked, but she asked with a quizzical look, do you really want to do that? i said, i think i have to do it because it is my team and i did not want to put them at risk for something i was not willing to do myself. david: the best treatment is liquids, flushing out? dr. fauci: it is essentially intensive care. the patient we took care of here at nih was one of the sickest patients i ever treated. i have taken care of thousands -- david: what happened to the patient? dr. fauci: he is alive and well, and back home right now with his family. this is the ugly ebola. this is what ebola looks like. it is called filovirus, because it is like a thread. filo, the latin word for thread. in 1995, there was an outbreak in the democratic republic of the congo. a person who survived ebola, this man here, came to the nih. we took his b-cells, cloned them
and make the antibody, which means we made his cells produce an antibody in large amounts that actually binds to this lipoprotein right here. david: right. dr. fauci: this antibody as we are speaking is being tested in the democratic republic of the congo as one of the potential treatments for ebola. david: somebody comes to me and says i had ebola and i am ok now, it is ok to shake their hand? dr. fauci: yeah. david: they are safe? dr. fauci: well, you may remember when we discharged the young nurse who got infected in texas and i discharged her from the nih and we had a press conference, and i put my arm around her and hugged her and it made the front page of the washington post. the reason i did that deliberately was to show the rest of the world that when you recover from ebola -- david: what did your wife say? dr. fauci: she thought it was fine. david: all right. this is something you decided you wanted to do in medical school?
>> when i was in graduate school, i worked on hiv. and nobody knew much about ebola then, but i noticed that the glycoprotein that hiv uses had some similarities, we thought, to the glycoproteins that ebola uses. so i thought this would be a good opportunity to make headway into a new disease that people did not know much about. and dr. fauci gave me that opportunity. david: the best way for me to prevent getting an infectious disease and having to have you as my doctor is what? wearing a mask? dr. fauci: no, no, no. david: if someone is getting ready to sneeze or cough, walk away? dr. fauci: you avoid the paranoid aspects and do something positive. a, good diet. b, you don't smoke, i know. get good sleep. i think that the normal low-tech, healthy things are the best things you can do to stay healthy. ♪
david: let's talk about your background. you grew up in brooklyn. dr. fauci: i did. david: you went to catholic school. dr. fauci: catholic elementary school, regis high school in manhattan, holy cross college. david: did you always know you wanted to be a doctor? did you think you wanted to be something more important like a lawyer, a private equity investor, something like that? dr. fauci: [laughter] well, i can't say i always felt i wanted to be a doctor. i was very interested in the humanities. i took classical background courses, likely because i went to a jesuit school, greek, latin, philosophical, psychology, the philosophies. but i also had an aptitude and interest in science.
i figured the best way to combine an interest in the humanities with science is to be a physician. david: you first came to nih in 1968. dr. fauci: correct. david: when you were here, there were a lot of other people entering the class with you. some of them, many of them, have gone on to win nobel prizes. dr. fauci: right. mike brown. joe goldstein. they all won nobel prizes. david: how come you have not won a nobel prize yet? dr. fauci: [laughter] i am the stupid one in the group. no, actually, my work did not -- i probably would not have won one anyway, but my work was on broader global health issues. they discovered really exciting, specific things. david: you have won the presidential medal of freedom. dr. fauci: i have. david: and the lasker award. is there any award in medicine you have not won? dr. fauci: the nobel prize. david: ok, that is the only one. i would nominate you if i knew how to do that. dr. fauci: [laughter] david: let me ask you, you have written i think it is 1200 articles, co-authored, edited. how do you have time to do 1,200 articles in your career and run the institute and treat patients?
dr. fauci: one, my career has been quite long, so that is one of the reasons for so many articles. but doing all of that, taking care of patients, running a lab and a big institute, getting involved in global health policy , i just explained it, i work a lot of hours. i am an unapologetic workaholic and i really love what i do. david: how do you stay in good shape? dr. fauci: i used to run. i used to run marathons and 10k's. about two or three years ago, i stopped running every day. i used to run about six miles a day, and now i power walk three miles to four miles every day. david: you are generally not sick? dr. fauci: generally pretty healthy. thank goodness. david: if you do get a little sick and you go to a doctor's office, you are sitting in the office, do people get nervous if you are sitting there? dr. fauci: they don't get nervous, but it is a good advertisement for the doctor i go to because they say, if this guy is going to the doctor, he must be pretty good. david: many people have come to you and said why don't you leave and do something more lucrative?
i came to you once and said, why don't you come into private equity? in the health-care world, you would be perfect. you resisted all of those. why? dr. fauci: i would have loved to work for you, david. just like everyone else, i felt that i love what i am doing and it is so exciting that that is what drives me. it isn't as if i think those other professions are not worthy. i just like what i am doing. there are still many challenges. we need an hiv vaccine. tuberculosis and malaria are still major killers. particularly in the developing world. those are things we have the opportunity to do something about, so i would like to continue to work until i can't work anymore and concentrate on those problems. david: you have worked under many different presidents. who was the most impressive? dr. fauci: they were all different. i don't want to be pitting one against the other. i enjoyed very much the clinton administration, really quite
enjoyable working with not only president clinton, but hillary clinton. but the person who was the warmest of them all, an amazing, amazing gentleman, was george h.w. bush when he was president. he was the first one that i really got to know as a president. i got to know reagan, but not much. but george h.w. bush extended himself to me when he wanted to learn about what hiv was because he wanted to do something about it. david: as you look back on your career, what would you say are the characteristics that make somebody a leader? dr. fauci: one of the things i tell people, because i feel it strongly, is if you are leading an organization of some sort, that has a purpose or a mandate, that as the leader, you have to articulate to the people you are leading exactly what your vision is and where you want the organization to go, because i have seen issues in which there was not good leadership, where an organization is almost rudderless. they don't know where they are supposed to be going.
you don't dictate to people but if you let them know what your vision is, hire the best people, and don't get in their way, that is the quality of a good leader. david: let's suppose i get an infectious disease and want to be one of your patients. how do i get to be one of your patients? just call you? how does somebody become one of your patients? dr. fauci: you get your doctor to give me a call or send me an email. if you have a disease that falls under one of the categories that we study, then we would be happy to see you. david: the best way for me to prevent getting an infectious disease and having to have you as my doctor is what? wearing a mask? dr. fauci: no, no, no. david: i can see somebody is ready to sneeze or cough, walk away? dr. fauci: you avoid all the paranoid aspects and do something positive. a, good diet. b, you don't smoke, i know. i know you don't drink, at least not very much. so, that's pretty good. get some exercise. i know you don't get as much exercise as you should. david: that is correct. dr. fauci: get good sleep.
i think that the normal, low-tech, healthy things are the best things you can do, david, to stay healthy. david: i'm going to try to do that, and hopefully when i next see you, i will be even healthier than i am today. dr. fauci: i would imagine you would be, and i look forward to that. david: thank you very much. dr. fauci: my pleasure. ♪
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