As the Director of the National Institute of Allergy and Infectious Diseases (NIAID) at the U.S. National Institutes of Health (NIH) for nearly 40 years, Anthony Fauci, MD, had countless sleepless nights, dreaming up one nightmare public health crisis after the other.
And then, in December 2019, Fauci’s nightmare came to life.
“What kept me up at night was the possibility of the emergence of a brand-new pathogen, almost certainly a virus, spread by the respiratory route, with a high efficiency of transmissibility and the capability of causing considerable morbidity and mortality,” Fauci writes in an editorial published Wednesday in Science Translational Medicine. “For the past three and a half years, we all have been living my worst nightmare: a deadly pandemic caused by SARS-CoV-2, exactly the type of virus that I most feared.”
At the peak of the pandemic, the U.S. was seeing 3,000 to 4,000 COVID-19-caused deaths every day. Now, with 2023 nearly in the rear-view, the U.S. is seeing less than 100 COVID-19 deaths daily.
The pandemic may be over, but Fauci is still fearful. Not of SARS-CoV-2, nor of the next “inevitable pandemic,” he says. No, Fauci is most concerned that the public will forget just how deadly the COVID-19 pandemic was.
Vital basic research
In his article, Fauci praises the decades of investment in basic research that allowed a safe, effective vaccine to be produced just 11 months after the novel virus was successfully sequenced. The former NIH director specifically points out Katalin Karikó and Drew Weissman’s contributions to mRNA vaccine technology, for which the duo was just awarded the 2023 Nobel Prize in Physiology or Medicine earlier this month.
Weissman, a physician scientist with an interest in basic immunology and vaccine development, actually began his career at the NIH, where he was a part of Anthony Fauci’s group, investigating how HIV-1 interacts with target receptors on different types of immune cells. Eventually Weissman moved to the University of Pennsylvania, where he teamed up with Karikó on their shared goal of making the mRNA platform suitable for clinical use. Their breakthroughs received little attention, until 15 years later when SARS-CoV-2 kicked off the worst public health crisis since the Spanish Flu.
In addition to this continued investment in basic research, Fauci notes another strategy that could help against the next pandemic: prototype pathogen research. This approach is based on the understanding that of >100 viral families that have been described, only about 25 include viruses known to infect humans. And among those 25 families, less than 10 are thought to pose the highest risk of emergence of a virus of pandemic potential. The strategy is to intensively study selected viruses within a given family and to apply knowledge and strategies from one virus to inform the design of countermeasures for related viruses within that family.
Corporate memory failure
It is estimated that the COVID-19 pandemic killed more than 1.2 million people in the U.S, and over 20 million people globally. But almost two years after the U.S. ditched face masks, Fauci is concerned people will forget those devastating numbers.
“In my almost 40 years in chasing and preparing for emerging microbes, I have experienced the transient nature of ‘corporate memory’ related to affronts on global health,” Fauci concludes in his article. “Over and over, after time has passed from the appearance of an acute public health challenge, and after cases, hospitalizations, and deaths fall to an ‘acceptable’ level be it from an influenza pandemic, HIV, or a coronavirus outbreak, the transition from being reactive to the dwindling challenge to being durably and consistently prepared for the next challenge seems to fall flat. Hopefully, corporate memory of COVID-19 will endure and trigger a sustained interest.”