NOEL KING, HOST:
The FDA is going to announce soon its decision on whether immunocompromised people should take COVID-19 booster shots. Dr. Anthony Fauci is with us this morning. He's the country's top infectious disease doctor and President Biden's chief medical adviser.
Good morning, Dr. Fauci.
ANTHONY FAUCI: Good morning.
KING: Immunocompromised people have diseases that damage their immune systems. Transplant patients are also in this group. Is there evidence that the vaccine's efficacy is waning for these populations?
FAUCI: It isn't a question of waning; it's that they never really got a very good immune response to begin with. And I think that's the thing that people need to understand to avoid confusion about the durability of response. Rather than - in these individuals whose immune system is compromised, they never got to a level of protection as a whole, as a group. Some have, but when you examine them as a group, people who are immune-compromised, they never really got up high enough to feel that they were protected. That's the reason why it is so imminent to make sure that we get them boosted so that they would be in a protected zone.
KING: That is interesting. Thank you for clarifying that. And I think you may have answered my next question, but let's try it. What about other people at high risk, like people in nursing homes or care homes? Are they still protected from their first doses earlier this year?
FAUCI: Well, right now there's a great deal of variability because some of the people in the nursing homes are people who are immune-compromised.
KING: Yes.
FAUCI: We don't know. But taking people as a whole - namely elderly people, people who are younger, people in nursing homes - we are following - the CDC is, that is - following cohorts of individuals in those different categories on a weekly to monthly basis, as it were, to determine the durability of response so that if it looks like the response and the protective levels starts to attenuate, that we are prepared and will be prepared to give those individual boosts if they need it. But right now, like today, at this particular time, it is not as imminent as what we've been discussing about the immune-compromised people. But we will be prepared, if necessary, to give the booster to those people.
KING: OK. The World Health Organization has asked richer countries to forego boosters to help poorer countries that are struggling with supply shortages of vaccinations and with outbreaks. What are your thoughts on this balance there?
FAUCI: I believe we can do both. I feel very strongly - and I've been very vocal about that - that we have a responsibility as a rich nation - and other rich nations - to make sure there's equity in the ability to distribute and the accessibility of vaccines. However, the United States is really doing both. If you look at what we are doing, we've essentially done more than virtually all the other countries combined. A half a billion doses that have been promised - have already now given 110 million doses to 60 countries. We also have the 80 million of our own that we're distributing and the $4 billion to COVAX. That's good, but I believe it's not enough, and the administration knows that. And that's the reason why we're planning to do even more.
So the short answer to your question is that you can do both. You can get people vaccinated with the appropriate boost that they may need at the same time as you go a long way to getting equity for the rest of the world.
KING: Let's talk about kids. Schools are reopening, and the delta variant, we understand, is sending more children to the hospital. Why is that happening?
FAUCI: Well, this variant is really very problematic. It is very much more transmissible than the variant that we had been dealing with, let's say, six or more months ago, the alpha variant. And when you have a variant that can spread so readily, you are going to see more people in general infected, particularly children who are not yet eligible to be vaccinated. So it isn't surprising. It's unfortunate. We're very concerned about it. But it's not surprising that you are seeing more children getting infected. And as more children get infected, you're going to see more children hospitalized.
KING: For families living in states where lawmakers are banning mask mandates, what is the best way to keep children under 12 who can't get the vaccine yet safe?
FAUCI: Well, there are a couple of ways. First of all, you surround children with the people who are eligible to be vaccinated. Make sure they are vaccinated. That's teachers, personnel in the school, as well as children who are old enough - eligible to get vaccinated. For the children who can't get vaccinated, that's the reason why the CDC recommends that in the school system, everyone wear a mask. And that's the reason why we're really quite concerned when there are mandates to prevent the local authorities from masking the people in the school system. That just doesn't make any public health sense because that's an important tool to protect the children.
KING: Let me follow with a question directly from an NPR listener. If your own kids were still young - under the age of 12 - would you send them back to a school where the other kids were not wearing masks and teachers were not wearing masks?
FAUCI: Well, you know, I would be very concerned about that. And I would do every - I mean, that's not the situation I'm in. But I would try as best as I can to really change that and to get the CDC recommendations to be implemented. There is no reason not to do that. We're dealing with the safety of the children, not any theoretical, libertarian thought about telling people what they can do or not to do. The safety of the children comes first.
KING: OK, so parents might want to put a little pressure on their lawmakers, it sounds like, is what you're saying...
FAUCI: Exactly what I'm saying.
KING: ...And on schools.
FAUCI: Yes, that's exactly what I'm saying.
KING: Given how much of a problem the delta variant has caused - how fast it's spreading, how much we are struggling right now - how much is your mind going to another bad variant that might spread and take hold?
FAUCI: You know, that's a great question, and that's one of the reasons why you hear us talking why it's so important to get the 93 million people in this country who are eligible to be vaccinated who are not yet vaccinated. If you give the virus the freewheeling capability of spreading uninhibited throughout the community among the unvaccinated, you give it ample opportunity to mutate. We all know in virology that a virus will not mutate if you don't allow it to replicate. You have to replicate to mutate. And when you have people getting infected and spreading it through the community, the virus has ample opportunity to do that. And what that would mean that if you give it enough opportunity, sooner or later, it is going to mutate to the point where you might have another variant, and that's what we're concerned about.
KING: A last question for you - many of us now know people who have the vaccine but have gotten sick, these breakthrough cases, and that's anecdotal. But I want to know, are you confident that breakthrough cases are being tracked and counted appropriately?
FAUCI: Well, I mean, obviously, it is difficult to do the tracking of people who are asymptomatic - that's breakthrough and then is - don't know they're infected and then infect someone else. So we need to do better with the tracking. But you're absolutely correct. They're a situation - we've got to do much better on that.
KING: Dr. Anthony Fauci, thank you for your time. We appreciate it.
FAUCI: Good to be with you.
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