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Anthony Fauci, the country’s top infectious disease expert who himself has become a something of a Rorschach test for people’s views on the pandemic, warned that the politicization of the Covid-19 response threatens the country’s ability to withstand future health emergencies, even at a time of great scientific progress.

“How do you change a mindset in a country that is completely antithetical to a response to an outbreak?” Fauci said Tuesday at the STAT Summit. “If ever there was any phenomenon that required people pulling together in a society, it’s an outbreak that’s killing hundreds of thousands of people. I don’t know how we’re going to get that divisiveness behind us.”

Fauci noted that there are scientific preparations for a pandemic, as well as public health ones. The country’s years of work on improving vaccine platforms allowed scientists to develop Covid-19 shot in record time — a demonstration of the value of that scientific preparedness.

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The pandemic, however, exposed the country’s cracks in public health: problems like how limited resources are for contact tracing and isolation, and issues like the scarcity of diagnostic tests or issues with lab capacity. Public health officials have been relentlessly undercut by politicians and attacked by people they’re trying to serve, and countless public health or health care workers have departed their fields.

Still, Fauci said, the country can invest in improving its public health infrastructure.

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But Fauci cautioned that the “much more nebulous” factor that could undermine the country’s response to the next pandemic is some people’s staunch opposition to measures meant to protect their communities. Fauci said he’s received threats for urging people to wear masks indoors and get vaccinated — the results of a divide that has been cited as the “new normal.”

“It’s the normalization of insanity, I think,” he told STAT’s Helen Branswell in the video interview, which was prerecorded Friday.

Fauci noted the association between partisan divisions and vaccination rates as evidence of how politics is shaping the U.S. epidemic, with more conservative areas seeing drastically lower immunization coverage. Fauci says he tries to stay out of politics — he has, as the director of the National Institute of Allergy and Infectious Diseases, served under presidents of both parties —  and that “the thing that matters is the common enemy, which is the virus. And it just doesn’t make any sense to be essentially fighting with each other when we should be fighting with the common enemy.”

Fauci also spoke about what the country could face in its second pandemic winter as Thanksgiving and other holidays approach. The U.S. case count that had been falling earlier this fall stalled out at around 70,000 to 75,000 daily infections — and has started to tick up again.

But Fauci said that “it is within our power to influence that greatly.” If the country can reach more unprotected people with vaccines, get boosters to people whose waning immunity has left them susceptible to infection again, and keep up with some precautions like masking in public indoor spaces, “we can get through the winter reasonably well. If we don’t do that, I think we’re in for some trouble.”

Branswell noted that the country has tallied about 85,000 deaths from Covid-19 in the past two months, even with a surfeit of vaccines. If that level of death wasn’t enough to sway the tens of millions of people who remain unvaccinated, what would?

“It is painful and frustrating to me as a public health person, as a physician who takes care of people and sees firsthand what disease and death is, repetitively,” Fauci responded. “As you said, it just doesn’t make any sense, it’s almost inexplicable. But it is what we are dealing with.”

But Fauci said that a portion of the remaining people aren’t hardcore holdouts. Some will still get vaccinated if they get the right information from people they trust.

Beyond that, Fauci said he was supportive of vaccine mandates for adults because people who remain unimmunized aren’t just putting their own health at risk, but posing a risk to others as potential transmitters of the virus. The Biden administration’s vaccine mandate for large employers is tied up in court battles.

Fauci said it’s a different situation for mandates for schoolchildren to get Covid-19 vaccines, at least right now. He said authorities could wait for more safety data and noted that pediatric shots have emergency authorization at this point, while the Pfizer-BioNTech vaccine for people 16 years and up has full Food and Drug Administration approval. But he said he could potentially see mandates in the future, noting that schoolchildren are already required to get vaccines for pathogens less dangerous than the SARS-CoV-2 coronavirus.

Because data indicating vaccine-elicited immunity starts waning some six months after the shots, there are questions about whether booster doses will be required regularly into the future — that perhaps there’s something about the mRNA vaccines that most immunized Americans have received or the immune response we generate against the coronavirus that will require a regular jolt.

But Fauci said there was a “reasonable possibility” that a booster dose will provide a “durability of protection that goes well beyond” what’s been seen after the first round of shots — though he stressed that scientists will have to keep watching to see if that is indeed the case. He said that extra dose after six months will allow the immune system’s memory to mature to the point that the resulting protection could last longer, and argued that third doses of the mRNA vaccines from Pfizer-BioNTech and Moderna should be considered an extension of the primary series.

“A booster isn’t a luxury, a booster isn’t an add-on, and a booster is part of what the original regimen should be,” he said.

Boosters are currently authorized for seniors, adults at high risk of contracting Covid-19 or developing serious disease, and anyone who received the one-dose Johnson & Johnson vaccine as their primary shot. But some states, trying to dampen any potential winter surges, have called on everyone to get boosters — even as many scientists continue to argue that boosters aren’t necessary for many younger adults at this point.

The interview ended on a bright spot, with Fauci saying that his daughters are coming home this year over Christmas. 

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