On Thursday, November 19th, we attended a webinar with the Hastings Center. In a conversation between Mildred Z Solomon, EdD, President of the Hastings Center, and Anthony Fauci, MD, Director of the National Institute for Allergy and Infectious Diseases, they addressed the conversation about the public’s distrust of science and the scientific process.
Dr. Fauci acknowledges how politics has influenced the public health agenda and explains that “you cannot properly and successfully implement a public health program when you have so much disagreement in society because infectious diseases are not between distinguish one’s own ideologies ”. Dr. Fauci states that there are two options in the future: scientific opportunities and the social opportunity to shed light on inequalities in science that have increased public distrust.
About the social opportunity to address minority populations
Dr. Fauci: We have a situation of minority health inequalities, particularly African American, Latino, Native American, Alaskan and Pacific Islander, where there are two differences. [They are] outside in critical jobs in society that put them in close contact with people during a respiratory outbreak so their chances of getting an infection are far greater [than the average population]. The other thing is that the underlying comorbidities they have, namely diabetes, obesity, high blood pressure, chronic lung disease, and kidney disease, put them at a significantly higher risk of not only going to the hospital, but even death. This is not a racial problem, this is a social determinants-of-health problem that dates back to the time you were born when the environment in which you grow up and the diet to which you are exposed lead to disease. It should be a firm commitment, going back decades, to do something about the social determinants of health. Because if we don’t do that, they won’t go away spontaneously.
Dr. Solomon: The pandemic did [health inequities] so outrageously visible that we have to act. Bioethics as a field can broaden its perspective to examine more structural problems that lead to unsolvable inequalities at the population level and economically in the way we organize ourselves socially.
About vaccines, effectiveness and effectiveness
Dr. Fauci: The primary endpoint of the [Moderna and Pfizer] Studies have been clinically obvious conditions that can be mild to moderate in severity. The secondary endpoint was infection or serious illness.
We have highly effective vaccines. How effective they will be for society depends on a number of factors, including the number of people who choose to get vaccinated.
There were 10 serious events in the Pfizer study: 1 in the vaccine group and 9 in the placebo group. In the Moderna study, they had 11 serious events: 11 in the placebo group and 0 in the vaccine group. We know two things: it is effective in preventing infections that can be clinically recognized, and it is effective in preventing serious diseases. What we don’t know is whether it is effective in preventing infection. If I am infected but have been vaccinated, will the virus level be so low that I will not infect other people?
We know that if you completely eliminate the virus, you will not infect anyone. So what we don’t know yet is the effect it will have on transmission. That is the open question in the discussion.
To explain the vaccine approval process for patients with hesitant vaccines
Dr. Fauci: We need to look at the reasons why people don’t want to be vaccinated. [Some patients] believe the process was either opaque or slippery. I’m trying [to explain to the general public that] The speed itself reflects the scientific advances. In the 21st century, the vaccine doesn’t need to be grown or cleaned. You just need the genetic sequence and put it in the vaccine platform. You can make a vaccine within a few days and have already saved a year. You are now in a phase 1 study.
People hear this speed and believe that it is a threat to safety. Security has nothing to do with it because you haven’t [tested] it in one person. Speed has to do with exquisite technology.[Some patients doubt] the process of deciding whether it will work or not. We have an independent data security and monitoring body that is not obligated to anyone. Not to the president, not to the company. You are independent and evaluate the data. Then they present it to me, the company, and one of the other government agencies. We rate it and then the company presents it to them [Food and Drug Administration] with professional scientists who are not obliged to anyone. And then there is an independent advisory board [the Vaccines and Related Biological Products Advisory]who also evaluate the data independently. By the time you get to the FDA and believe this is a safe and effective vaccine, you will have chosen an independent and transparent process. The process is solid.
However, there is another group of people who don’t even believe this is a phenomenon and who think it is false news. There I have great difficulty getting to this group of people. Despite a quarter of a million deaths, despite more than 11 billion infections, despite 150,000 new infections a day, they don’t believe it’s real. That’s a real problem.
Solomon M, Fauci A, Bolo I. Safeguarding Health at a Troubled Time: Public Confidence in Science. a conversation with Dr. Anthony Fauci. Presented at: The Hastings Center Webinar; November 19, 2020. https://www.thehastingscenter.org/news/fauci-on-public-trust/
This article originally appeared on Infectious Disease Advisor