In a live Healthline virtual town hall on Tuesday, Dr. Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases, maintained his position that he is "cautiously optimistic" that a COVID-19 vaccine will be available to Americans by the end of this year or early 2021 and said in the meantime the U.S. is improving its contact-tracing efforts.
In a wide-ranging discussion that also touched on school reopenings, Fauci said that, with the need to prove safety and efficacy, a vaccine is never guaranteed. But early results on a number of different vaccine candidates have been encouraging.
"The preliminary Phase I studies are producing a level of neutralizing antibodies that's at least as good as what you see with convalescent plasma," said Fauci. "That's a good predictor that things will go well. There are always potholes and bumps in the road, but there are three candidates in Phase III trial. One, likely by the end of this year, we will know whether it's safe and effective."
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While reports have surfaced that Russia is on the verge of rolling out a viable COVID-19 vaccine, Fauci cautioned that there's scant evidence to date that the Russian vaccine is safe and effective.
"To say you have a vaccine, I could say we have six vaccines, but I wouldn't give them to someone outside of a clinical trial," he said.
In terms of a vaccine rollout in the U.S., Fauci said that one of the investments the federal government has made concerns guaranteed purchases, which basically means that companies have manufactured doses at financial risk before they even know it works.
"If the vaccine is found effective, you have a leg up on the doses, so you've saved a lot of time without the safety risks," Fauci said. "If it's not safe and effective you've wasted a lot of money. But that's the federal government's investment to make things go more quickly. By the end of the year there should be limited doses."
At that point, he said, the next step will be to prioritize who gets access to those first doses, with likely candidates being elders and those with compromised immune systems. The process of prioritization is being done independently of clinical trials, he said, while adding that there are likely to be doses for anyone who wants it sometime during the first few months of 2021.
There likely won't be a mandate that all Americans receive the vaccine; Fauci said that will be an individual's choice to make. But within the healthcare industry, hospitals in coronavirus hot spots may issue policies that prohibit medical professionals who refuse the vaccine from person-to-person contact with patients.
With autumn fast approaching, much of the conversation has shifted to school reopenings and how they should be handled – or if they should happen at all. Fauci said that, generally, the default position should be to try to reopen schools whenever possible, "for the psychological health of the children, and the secondary downstream ripple effects that are negative for families who may have to take time off work to care for the kids.
"You've got to make sure you pay attention to the safety and the welfare of the children."
With such wide variation in infection levels in different regions of the country – which are typically segmented into red, yellow and green zones – the decision has to be local, said Fauci. In green zones, some schools can reopen relatively safely. In yellow zones, which signify community transmission of the virus, schools should have a plan in place for mitigating infections that includes masks, hand sanitizers and alternate classes. In red zones, he said reopening schools would likely be unwise.
"We live in a big country, and we can't take a unidirectional approach," he said. "We've got to have flexibility."
The success of contact-tracing efforts in the U.S. is, at this point, largely dependent on the density of infection rates in any given region. With a steady baseline and a blip of infections, contact tracing is in a much better place than when the pandemic first started, said Fauci.
It gets much more problematic in areas of community spread in which at least 40% of those infected are asymptomatic. That creates delays in when tests can be administered, which mitigates the value of the tests. This is an area that's being corrected in many areas, said Fauci.
He said success in tamping down the virus can be defined as when the percent of positive tests goes down to levels now seen in New York City, where positive cases are around 1%.
"That's where you want the whole country to be," he said.