CHICAGO: "The race is on," Anthony S. Fauci, MD, said while delivering the Martin Memorial Lecture during the opening ceremony of the American College of Surgeons (ACS) virtual Clinical Congress 2021 on Monday. "Namely, the race to get as many people vaccinated as we can, so we can outstrip the virus, which is highly transmissible."
Dr. Fauci is director of the National Institute of Allergy and Infectious Diseases (NIAID) at the U.S. National Institutes of Health (NIH), Bethesda, Maryland, and a member of the White House COVID-19 Response Team, Washington, D.C.
"We still have about 68 million people in this country who are not vaccinated, and we will prevent another surge if we successfully vaccinate the overwhelming proportion of the population of this country," Dr. Fauci said.
Dr. Fauci began his lecture, which was introduced by ACS Regent Anthony Atala, MD, FACS, a urological surgeon and director, Wake Forest Institute for Regenerative Medicine, by recognizing the efforts of surgeons on the frontlines of care. "I thank you all for your tireless and important work during this pandemic," Dr. Fauci said.
He went on to provide an overview of the history of coronaviruses and how scientists were able to build upon what they had learned from previous experience to react quickly to the COVID-19 pandemic.
"We have known about and been involved with coronavirus research literally for decades before COVID-19," Dr. Fauci said. He discussed the first known experience with a pandemic coronavirus, the Severe Acute Respiratory Syndrome (SARS) (2002-2003) and the Middle East Respiratory Syndrome (MERS) (2012-present), before addressing the unique nature of COVID-19.
"With regard to the transmissions [of COVID-19], very uniquely among viruses, at least one-third of the patients who develop infection never develop symptoms at all," Dr. Fauci said. "And, very importantly, between 50 to 60 percent of all SARS-CoV-2 infections are transmitted by someone who is without symptoms—35 percent from pre-symptomatic individuals, 24 percent from individuals who never develop symptoms."
Dr. Fauci also discussed the multiple ways to manage COVID-19, starting with controlling the symptoms, which can be conducted as an outpatient regimen. This stage of treatment can sometimes be followed by end-organ support, which requires hospitalization for mechanical ventilation, dialysis, and other organ system support. He also discussed treatment using antivirals and immunomodulators, two major approaches. "First, target the virus itself, and this generally needs to be done early. There is a drug, Remdesivir, which must be administered intravenously and has been approved by the FDA," he said. He also noted that monoclonal antibodies also have been shown to be highly effective when given early in the course of the disease.
Much of Dr. Fauci's lecture focused on the efficacy of vaccines and the current approach to booster shots. He addressed concerns that COVID-19 vaccines were developed more quickly than previous vaccines by saying, "When SARS-CoV-2 came along, investigators were well-prepared to immediately use the knowledge over the previous several years to develop and apply the precise mutations to stabilize that spike protein in the optimal, prefusion confirmation, which was highly immunogenic. Now, that had to be married with the right vaccine platform, some of which we are familiar with and some of which are new. Originally, we had live, attenuated, and killed vaccines, and now we have platforms like genetic immunization, viral vectors, recombinant proteins, and nanoparticles."
He went on to say the story of mRNA vaccines goes back approximately 16 years when researchers showed that if you modify an mRNA molecule so that it doesn't trigger a key inflammatory pathway, which would nullify its potential as a vaccine, that hurdle could be overcome to pave the way for current vaccine platforms.
"In the United States, now, after literally hundreds of millions of doses have been administered, even in the era of the Delta variant…a person who is fully vaccinated has a reduced risk of infection that is five-fold, a reduced risk of hospitalization that is more than 10-fold, and a reduced risk of death that is more than 10-fold."
As for booster shots, Dr. Fauci said, "In Israel, which is about a month ahead of us with this, it shows that the rate of infection following a boost was lower by 11-fold compared to the non-booster group, and the rate of severe illness was diminished by a factor of almost 20-fold with the booster."
Immunity from the vaccines appears to be waning over time, Dr. Fauci said. He noted that six to eight months after vaccination, effectiveness against infection has diminished, according to the cohort studies that have addressed waning immunity. Further, effectiveness against hospitalization may be waning in some cohorts, as well.
"The real question is going to remain, 'Is the booster shot a commodity—is it sort of a bonus—or is it really necessary?' The thinking now is leaning much more towards the fact that the booster shot may actually be part of the original vaccine regimen," Dr. Fauci said.
He concluded his lecture by addressing the current disparity in vaccine distribution throughout the world: "At the same time as you talk about boosts, you have to talk about the responsibility of getting the rest of the world vaccinated. The United States takes that very seriously," he said.
The Martin Memorial Lecture was established in 1946 to honor Franklin H. Martin, MD, FACS, founder of the College and his wife, Isabelle Hollister Martin.
For more information on ACS Clinical Congress 2021, visit https://www.facs.org/clincon2021.
