‘Making our way back toward some version of normalcy.’ Q&A with Dr. Fauci and Dr. Webb

Our readers in North Carolina and South Carolina submitted more than 275 questions for our question-and-answer session with Dr. Anthony Fauci, the nation’s leading doctor on infectious diseases.

I was able to pose about a dozen of them to Fauci and Dr. Cameron Webb, a member of President Joe Biden’s coronavirus response team.

This conversation has been edited for clarity.

Q: The first question is from Steve in North Carolina. He says that he’s a dermatologist and talks to a lot of his patients about the COVID vaccine and that he’s disheartened that so many are not going to get the vaccine. Do you guys have an example of someone you’ve been able to convince to get the vaccine? And how would you help Steve try to go about convincing some of his patients to get it?

Dr. Cameron Webb: I’m an internal medicine doctor in Virginia, and I’ve had so many similar conversations. What I found is if you take a posture of listening, just asking people what they’re concerned about, and then responding with facts and real data, I think that it at least gives people a moment of pause to, to kind of, question some of the misinformation and disinformation that’s out there. And then give people time to come around. I think there is such robust science and data that’s out there, that people who are operating in their best interest will arrive at at that answer that, hey, vaccination is a really good way for me to prevent the bad effects of COVID. So that’s how I’ve approached it with my patients, with my community and even with my family — and it’s had pretty good success rate.

Q: North Carolina has about 50% of its (adult) population that’s gotten the first shot. South Carolina is about 40% (of all residents). Obviously the federal government’s done a lot to try to get people interested in taking the vaccine. What are the next steps? How do you reach some of those communities that are not getting the vaccine?

Dr. Anthony Fauci: Well, there are a couple of things you can do. ... What we use as part of the program is trying to get trusted messengers to get to them. People that they respect, that they look up to. That could be sports figures, entertainment figures. Importantly, clergy can play a great role as well as your own family doc. Because most people really trust a doctor that’s been taking care of their family for a long time. And we’re trying to get the information to those people who will be serving as the trusted messengers.

The other thing is to make it as easy as possible for a person to get vaccinated. That’s really an important thing. You know, back when we were doing priorities, you had to be in 1A or 1B or 1C. People would get confused of where they are, when it is available to them. Right now, we have walk-in processes. There are 40,000 pharmacies throughout the country in which you could just walk in without an appointment, and say, I’d like to get vaccinated. I think if we make people aware of the ease with which you can get vaccinated, that a lot of the people that you see are hesitant, really just need a little nudge to know that it is really simple to get vaccinated.

Q: We got a lot of questions about masks and when they can start loosening some of those restrictions. Let me get to this question from Michelle in Aynor, South Carolina. She said that recently, the governor of South Carolina made a statement that it should be a parent’s choice on masks in schools. She says knowing the science behind masking, how much risk will that pose to a vaccinated teacher?

Fauci: So if the question is, “How much risk to a vaccinated teacher?” I think the important thing is that we all know that vaccination dramatically diminishes the risk under any circumstances that you’re at. So you’ve got to understand that depends upon what level of risk you’re willing to take. So in a situation in a school, if you’re talking about a child who is unvaccinated, doesn’t wear a mask, what kind of a risk it is to a vaccinated teacher? It’s quite low, you have to admit it’s quite low.

Q: In North Carolina, (Gov.) Roy Cooper has said that once the state can get to about 66% (of adults getting at least one shot of) vaccinations, then he’ll loosen some of those mask mandates. We got a question from Lauren in Chapel Hill, who says it could be possible that 35% choose not to get vaccinated. What does it mean then to the prevalence of the virus and herd immunity? Does North Carolina need to keep its mask mandates forever if it doesn’t get to that 66%?

Webb: Keep in mind, there’s no magic number here. .... What’s important to note is that we’re not going to have a moment when we say we crossed this number and therefore you can get back to exactly how things were at some point in 2019. Instead, we’re going to go through this process of making our way back toward some version of normalcy. And I think that that’s going to be what people should expect. I think with regard to masks specifically, we want to get as many people vaccinated as possible.

And there are a lot of huge benefits to folks being vaccinated, including having access — you saw the CDC guidelines — being able to do more things out in public. But again, this is completely up to the people, how well that we’re able to move toward that future with fewer of these public health guidelines. It’s gonna be important for folks to get vaccinated, but also continue to follow the public health guidance — wear masks, keep your distance — in the meantime, so that we can get case rates down lower. That’s also going to be a part of the dynamic.

Fauci: That’s the one thing that we are certain of. We don’t have a magic number of what herd immunity is. We know what the concept of herd immunity is — it’s enough people either vaccinated or recovered from infection with now durable immunity so that the virus really doesn’t have any place to go. They can’t find a vulnerable person because there are so few. The threshold for herd immunity is a number that we don’t know what that number is, as Dr. Webb said. But there’s one thing that we absolutely are certain of: That the more people that get vaccinated, the less and less infection you’re going to have in the community. That’s an incontrovertible, an absolutely slam dunk fact. And that’s the reason why we want to get as many people vaccinated as we possibly can.

Q: Probably the most popular question, out of all the questions we got, had to deal with booster shots. This one from K Allison, in South Carolina. When do you anticipate fully vaccinated people will be offered a booster shot to give immunity for variants? And will they have to stick with the original vaccine type that they got?

Fauci: We don’t know the answer to that. We know that the durability is at least six months, likely a year. It is conceivable, and probably likely that at some time, we’ll need a boost for one or both of two reasons. One, for the durability of the actual response, that it wanes and comes down, you want to keep it up. And then also there might be some problematic variants that evolve that you might want to specifically vaccinate against the variant. But right now, the issue of boosting is being very seriously considered. And we’re preparing with clinical trials to determine what kind of an increase in both the level and the durability of the responses. So the answer to your question is, I wouldn’t be surprised that somewhere down the line, we would need to get boosted.

Q: Given your answer on the school question about masks in school, would you encourage schools to to lift the mask mandates if their teachers are vaccinated?

Fauci: I would encourage the schools to follow the CDC guidelines, which will be upgraded and changed, according to the level of infection in the community. That’s the thing that I think people need to understand. It’s really a dynamic process, and just follow the CDC guidelines. And as things get better in the sense of more people vaccinated and less infections in the community, you’re gonna see a loosening of those guidelines at every level, including the level of the schools.

Q: This is from Tom in Greenville, (South Carolina). I know some states, including West Virginia, have offered savings bonds for people willing to get vaccinated. Have you seen any evidence that offering incentives to those who have not yet been vaccinated might help us reach higher levels of vaccination?

Webb: I think Krispy Kreme has seen some evidence. So the idea here is that it’s something different that gets folks to get vaccinated. Sometimes it’s listening to somebody who they trust. And if you think of the first of 55, 56% of adults who got vaccinated, they were more interested or more willing or had more access to vaccines or health care in general. You as we move forward, it’s gonna require some different tools to get folks vaccinated. So incentives may be one way to move the needle. But I think you ought to be thoughtful about what kind of incentives (you) are offering, and different states are coming up with different ideas along the way. So I think that’s certainly something that we’re keeping in mind, that states are keeping in mind. It’ll be an important part of the process to get us to that 70% that President Biden’s aiming for by July 4th.

Q: Along those lines, one of the incentives for a lot of people is the ability to travel. This question comes from Sol in Chapel Hill. She says, if my whole family is vaccinated, is it safe to travel and visit friends and family in other states like normal?

Fauci: The answer is that vaccination dramatically diminishes the risk of getting infected while traveling. Traveling is a risk of infection. The CDC has made that very clear. You dramatically diminish that risk when you get vaccinated. So I could say that if you have an entire family that’s fully vaccinated, there still is a risk. It’s not zero, but the risk is markedly diminished for them. So if they feel they need to travel for one reason or another, I would say the level of risk you’re willing to take, know it’s markedly diminished, it’s not zero and make your own choice.

Q: This question from Anne Marie in Indian Trail says, when will the COVID vaccine or a booster receive full FDA authorization? She says she’s not going to take one until it does. That may help with some of the hesitancy, right, if it gets full authorization? (Note: Three vaccines have been given emergency use authorization in the United States.)

Fauci: Well, you just mentioned the boost. I mean, if you’re talking about vaccine in general, you know, the data are so strong that this is a safe and effective vaccine that getting the full authorization really is almost a formality in this. That the data of this vaccine is so strong with safety and efficacy, I wouldn’t wait at all for the full authorization. The emergency use authorization is really pretty good.

Q: This question comes from Ray in Durham: Are there many new vaccines in the pipeline? Can we expect to see more vaccines coming online?

Fauci: Right now, the federal government in the United States has been sponsoring the development and/or testing of six separate vaccines. We already have three that have received emergency use authorization and three others are in various stages of clinical trial.

Q: And this one comes from Stephen in Charlotte: We all know that COVID-19 isn’t the last pandemic. What specifically should we do as a society or as an individual to prepare for maybe the next one?

Webb: One big thing is investing in our public-health infrastructure. And that’s something that the president’s spoken to pretty strongly, that idea of really building up our public-health workforce. He’s aiming for 100,000 new individuals, and this is public-health infrastructure that has been decimated over the last few decades. And so that investment, a lot of those resources were in the American Rescue Plan. And we’re already making those investments right now to prepare for future pandemics, but also prepare for the everyday public health challenges that Americans are still facing. And so I think that’s the key. It’s really making sure we have the infrastructure in place. And so we’re able to respond swiftly and effectively.

Q: There are a lot of colleges in North Carolina and South Carolina. Martha in Raleigh asked: Do you think that colleges should require that students get vaccinated if they’re taking college classes on campus?

Fauci: We know that’s something we leave to the individual universities and colleges to make up their mind. Many of them are actually requiring that students get vaccinated if they want to be (in) on-campus classes. But that’s something that certainly is not going to come centrally. We leave that up to the individual universities. But I can tell you, many of them are very seriously considering that.

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