Partnership with the new england journal of massachusetts. Here we are days away from the close of 2020 and we are at an inflection point. While the news around vaccines are promising the daytoday headlines are as grim as they have ever been. An american is dying of covid19 every 90 seconds and we have recorded 4 million new covid19 cases in november and more than 1 million cases in december just nine days into this month. Covid19 has just passed Heart Disease as the number one killer of americans. As of this morning more than 286,000 americans have died due to covid19 and in just one day, just one day yesterday, we lost 2600 of our fellow americans to covid19. To put those numbers into context we are experiencing a tragedy on the scale of pearl harbor every single day, right here at home. From an Economic Security standpoint we are facing the greatest threat to Value Creation since world war ii. If there were ever any doubt about the seriousness of this virus these facts should cast the doubts aside. Simply put, we have been brought to our knees by an invisible enemy. I have to be honest, i have wondered how we gone numb to these numbers . All across the country i see photos and i see film footage of people in malls and at birthday parties congregating in large numbers without masks and without physical distancing. I think hard about the lives behind the numbers of lives lost and i wonder if perhaps being numb, numbness is the way we are coping with this epic Public Health challenge. How could we be acting so recklessly otherwise . At the very same time im astounded by the enormous successes of science, vaccine Genetic Technology has brought forward a whole new class of vaccine and while the development of these vaccines occurred in record time it took years of the search to lay the groundwork for these astonishing rate clues to service. Science was prepared even if we were not. As a lifelong Public Health educator i wont lie to you, i grapple with the fact that so many of us especially some of our leaders appear to be so unwilling to follow the science. I think we must all recognize that this resistance to science, this resistance to evidence is a clear and present danger to all of us. We have already witnessed how reluctant some people are to wear masks and to socially distant. We also know that Vaccine Hesitancy is a challenge that we must confront. According to the november pew survey just 60 of americans said that they would definitely or probably get the covid19 vaccine. We also have to remember that while that number is up from 51 in september it is still down from the 72 who said that they would get the vaccine back in the survey conducted in may. What is even more troubling is that 20 of americans say that they are pretty certain that they will never take the vaccine, no matter what new information they learn about it. Inc. About it, that is one in every five people who wont take into account the safety of their families, their friends, their neighbors, your and my health. Some of the skepticism is understandable, especially among those who have not historically been well served by our medical and Public Health institutions. But Vaccine Hesitancy and skepticism are also what will turn this in flexion point into an even greater tragedy. It is incumbent on all of us, scientists on the public alike to work in tandem with Public Health plane essential role as the spearheading leadership voice in a vaccination campaign. The race to end this pandemic involves each and every one of us. We cannot work in silos, we must Work Together and what we do now our triumphs and our failures will become the very foundation for how we feel the Global Public threats are ahead of us. As a covid19 vaccine begins to be deployed i am reminded quite strangely enough of something a famous military leader, napoleon said to his valet ahead of the battle, he said, dressed me slowly because i am in a hurry. Saving lives is now a race against the clock. So, lets each of us slow down, contemplate the role we can each play to protect our loved ones and strangers alike and do the right thing because we simply cannot afford to go numb. Lets leverage the tools that science and Public Health offers us to save lives and lets do this with a sense of urgency and urgency as though every life depends on what we do now because, quite frankly, every life actually does and so with this introduction i want to say how grateful i am to doctor Anthony Fauci and doctor cooped up for helping us continue this important conversation, doctor group to come over to you. Thank you very much, im so honored to be here so honored to be with you and honestly doctor Anthony Fauci. We get one of these conversations earlier in the summer and i think it would be all but the highest impact conversations we had throughout this pandemic so thank you for inviting us back. I could not agree with you more that science is leading us forward and has done so much in addressing this pandemic. You know, ive been reminded lately that we are this quickfix shortcut sort of society. We are always hoping for the magic cures and potions instead of leaning into the simple effective tools which may require more work. Our human spirits may do so innovative and creative and resourceful and tenacious but it is our Human Behavior that will dictate i think, how deep these wounds ultimately will go. As good as the science is no amount of science [inaudible] that is a theme i like to talk about today. I would like to remind people that were doing this in an academic environment, this conversation today, one that is training the next generation of public leaders and popular to buy hardworking Public Health experts and many of whom are watching and are helping us get through this crisis. We are honored to be joined by doctor Anthony Fauci, director of the niaid and everyone in the world knows him by now. We are also streaming on cnn. Com and showing on cnn in certain markets as well. Please submit your questions to doctor Anthony Fauci at the address at hsp fh. Harvard. Edf you. Or on the Facebook Comments at harvard Public Health. But now onto our distinguished guest, doctor fauci, welcome s sir. Thank you for having me. Appreciate it. These conversations are so important. I would like to cover a variety of topics but let me ask about the news today. You heard about these two people in the uk who received the Pfizer Vaccine yesterday and to health care workers, nurses, i believe, with significance allergic reactions in response to the vaccine, pretty clearly within moments of having received the vaccine. How concerning is this . Well, it obviously is of some concern because there are people who have what is called allergic diathesis or attendant get allergic reactions but both of those individuals, i believe, did in fact have that tendency. What we need to do looking forward and these are the kind of things that happen when you implement large Vaccine Programs. Remember, we had 30000 people in the moderna trial and 44000 people in the pfizer trial but once you start implementing the actual utilization of the vaccine in a clinical setting youre talking about millions of individuals getting vaccinated so you may start seeing effects in some that might not have been picked up when you are dealing with thousands so it likely is an unusual and rare effect but clearly everyone now is aware of that and will be looking at that at a particularly taking care of people who do have underlying allergic phenomenon that they might be cautious about vaccination or at least be prepared to respond with some sort of anecdote to the allergic reaction so if i were a person that had an underlying allergic tendency i might want to be prepared that i might get a reaction and therefore be ready to treat it. The guy, as you probably no, served in the uk is people who had severe reactions to food, to medicines or to previous vaccines should not take this vaccine. If you have a significant percentage of people. It good. You know, that is one of the reasons why it is important to cover the waterfront with different vaccine platforms. You know, you and i have had that discussion that there are many vaccines throughout the world that are being tested and that we in the United States are supporting, developing and facilitating the testing of at least six candidates so, it is in fact if you do find out that there is a consistent issue of certain subset of people like those with allergic reactions will always have other vaccine platforms that you can use and hopefully you will not see that with those other platforms. I want to ask about schools as well, we will take video questions here in a few moments but you know, i was surprised at how well most schools have done in terms of keeping overall infection rates down. I was skeptical thinking that flu viruses transmit easily, respiratory viruses transmit easily but so far positivity rates in schools pretty much have stayed low. What you think that means Going Forward . I know you said keep school open but bars closed but the time we started decided to shut down there were 5000 people infected and now theres 15 Million People who have been confirmed and its spreading significantly and just about every place in the country. Should schools stay open an mid all of that . The answer would you and i have discussed before is our position will always be exceptions and there is never onesizefitsall but in general the position should be we keep the schools open and get children back to schools who are not in school as best as we possibly can. The data that you are saying that imc also is that i agree with you. I was in the same vote as you. When you look at it the number and percentage of children who are getting infected, even when they are in immunity infections to a certain degree, is less than you would have expected. By extrapolating from the General Community which is really good news for keeping the children in school. Obviously, if you want to do that you want to make sure that you take into consideration the safety and health of the children as well as the teacher but in general it looks like we can keep the children in school and get them back to school safely. I believe strongly that as we influence vaccines and get the level of infection in the community lower than it is not which, as you know, is very high it will be even easier to keep children in school and protected. What to say to teachers and faculty members and adults who work in the schools . Ive gotten some emails after the backandforth in new York City Schools from teachers who are basically saying you know, what about us . Are we at greater risk as a result of these schools been open . Apparently not. Obviously, we continued to collect data and continue to modify if necessary policies based on the data as it comes in but right now given the level of infection that we are seen in children and schools it doesnt not appear that the risk for the teacher is any greater then the risk they would face by being in the community in general. I will ask you about testing before we talk about vaccines. Were not talking a lot about testing over the years and i thank you have said we had this conversation a few times that there has not still been adequate testing in terms of overall numbers in this country. I want to frame the question differently. Dr. Fauci, for people who dont have symptoms and just want to get tested to find out if they are, in fact, positive, what exactly should they be looking for . If you have symptoms you should stay home. If you find virus on one of these tests it could be active virus and may not be an active virus but if you are just trying to find out whether or not you are contagious which seems to be the question theyre trying to answer, and no symptoms and i want to get tested to make sure that im not contagious to other people and i dont care if the tests come back positive but i want to know if im contagious. Can we answer that question for the average person was seems to be a fundamental question at this point . In order to answer that question completely accurately i think that our viewers need to understand that there are tests for different purposes. You mentioned one of them. If you been exposed either symptomatic or not and you want to find out if you are infected specifically at this moment in time then you want the most sensitive, most cumbersome, more expensive pcr test that you cant get in ten or 15 minutes but will get, at best, a day or sometimes two, three days. If you are looking to get a feel for what the infection is in a particular group, and a college, in a factory, in a nursing home even though there is no one there that is having symptoms you can get a feel for that by doing a less sensitive test more often. Let me explain what i mean. So, lets take the test which isnt as specific or is accurate as the pcr test. If you get tested two or three times a week the lack of sensitivity of the test will be made up for by the frequency with which you get it. The other point i believe you were referring to is that even though the sensitivity might be lower in the antigen test that is more of a screening test, if you wind up getting a level of virus that is not picked up by the antigen test because it is so low you could be infected but your virus is so low that you are not infective, namely, you are not going to transmit it because it is not picked up by the antigen test and you likely would pick it up by the pcr but what we call the cycle threshold would be at such a level that even though you pick up virus it is not at a level that you would transmit. I think that assuming we are learning more and more about and the more information we get in the more confident we will be asked whether or not these tests will be used on a basis of a screening to tell you at least im not infective to someone else. This is such a fundamental point because ultimately how do you make this sorts of tests actionable in peoples lives, someone that taught me a lot just from reading his work, you know him as well and as it turns out hes joining us right now and has a testing question. Are you there . Testing is one of most crucial Public Health tools inside a pandemic so in the u. S. Review all tests through a single lens which is clinical, medical diagnostics so is it because we have only a single pathway for evaluation of tests throughout the fda . For tackling public of problems we need to have tools tailored for Public Health and test must be accessible and fast and frequent. Is there a role for a new pathway for evaluation of tests focus squarely on Public Health metrics which is distinct from medical diagnostics . Well, he has asked the question after i gave the answer. [laughter] no, his question is totally relevant. I know because i listened to doctor mina make that point about the differences between testing for a medical reason and testing for a Public Health reason and that is an important issue that i think we need to pay it much attention to because we really address the question you asked me about, not necessarily definitively knowing if this symptomatic person is or is not infected versus from a Public Health standpoint what is the level of infections in a college dorm or in a factory or in a prison or in a place of employment . That is what the doctor is talking about and thats a Public Health question as opposed to a specific medical question. Do you think that we would ever get to the point where we would be able to have the type of testing, doctor mina is talking about . Hes describing doing regular at home testing, antigen testing and again low sensitivity and may be or because youre doing so many of them able to give you information of actionable in terms of whether you are contagious but i bring this up not to keep belaboring this point but we heard the three pillars the president elect biden talked about yesterday, masks, vaccines, schools and i feel like testing again has been inadequate all along and still very important especially over the next few months. Could we get to that point where we have tens of millions or hundreds of millions . There is absolutely no reason why we cannot get to that point. We have done things infinitely more, gated with that and we have the technology and we can do it and we can get home tests that are pointofcare, sensitive, specific, cheap without the necessity for a prescription. That is imminently doable and when we get there we can have yet another dimension for being able to control this outbreak by understanding, literally in real time, what the extent and the penetration of infection is in any given segment of the community. But lets talk about the vaccines for a minutes. The subtle questions coming in about this as well. First of all, just to define terms here 95 , 9095 effective or efficacious at preventing covid19 and that is what we know about it and preventing the symptoms of this disease but not necessarily at preventing infection or transmission. Do i have that right . Does that make when you think about the flu shot, does that event infection or present people from getting sick . How will this work if it doesnt necessarily prevent infections . Its very similar to the blue flu. You get a flu shot and it can prevent you from getting infected but as often as not it prevents you from getting symptomatic because the efficacy of the flu vaccine is how it prevents you from getting sick enough to require medical care that is the efficacy of the flu vaccine so that is something i think people dont fully appreciate. Very similar so the primary endpoint of the two vaccines in question the mrna from both phis and madrona are the prevention of symptomatic diseases and the secondary endpoints are the prevention of severe disease and the prevention of infection. Lets take a look. The primary endpoint was met fades, 9495 effective in preventing you from clinically recognizable disease. With r