福奇回應馬斯克的推特攻擊並評價世界對 COVID 的反應
公共衛生負責人建議處於職業生涯早期的研究人員「不要被公眾的刻薄嚇倒」。
資料來源:Max Kozlov / 2022 年 12 月 13 日 / 自然 / 財團法人台灣紅絲帶基金會編譯
即將卸任的美國國家過敏和傳染病研究所所長安東尼·福奇出現在白宮,談論 COVID-19。
圖片來源:Tom Williams/CQ-Roll Call via Getty
本月,安東尼·福奇 (Anthony Fauci) 將辭去美國國家過敏和傳染病研究所 (NIAID) 所長一職,此前他已擔任該職位超過 38 年,並在其上級組織美國國家衛生研究院 (NIH) 任職 54 年。 他曾在七位美國總統領導下領導該研究所,並監督其對愛滋病毒/愛滋病流行、2014 年在西非爆發的伊波拉病毒以及 COVID-19 大流行病的研究和應對。 這位 81 歲的醫生兼科學家在大流行期間成為家喻戶曉的人物,在此期間,他被一些人尊為值得信賴的建議來源,但也遭到其他人的貶低,包括美國前總統唐納德·川普,他認為他的建議前後矛盾且專橫霸道。 12 月 11 日,他在 Twitter 上遭到埃隆·馬斯克的攻擊,埃隆·馬斯克於 10 月接管了社交媒體平台。福奇在接受《自然》雜誌採訪時談到了馬斯克的評論、大流行病和他自己的遺產。
回顧你在 NIH 的幾十年,我們在傳染病的哪個領域取得了最大進展?
其中最重要的一項是在愛滋病毒領域。 1981 年,當我們第一次意識到 HIV 病例時,[它]是一種病因不明的神秘疾病,幾乎殺死了所有被感染的人。那是我或任何人在傳染病領域的職業生涯中最黑暗的時期之一。我們從不知道是什麼殺死了所有這些主要是年輕男同性戀者的淒涼時期,到感染了[潛在病毒]、進行了診斷測試,並在幾年內開發了一系列藥物,當這些藥物聯合使用時,徹底改變了愛滋病毒感染者的生活。我們還開發了高效的預防方法,包括暴露前預防和[可以治療]被感染的人,將病毒水平降低到可檢測水平以下,因此他們不會將病毒傳播給其他任何人。
我們將在哪裡看到下一次傳染病革命?
傳染病研究的聖杯之一是安全有效的 HIV 疫苗。 我們在治療和預防疾病的療法開發方面取得了驚人的進步。 但到目前為止,我們一直未能找到安全有效的疫苗。 所以這是我們期待的事情之一。 另一種可能性是,儘管在某些方面很難治癒 HIV,您可以在沒有任何進一步治療的情況下持久抑制或消除和根除病毒。 我們還沒有達到那個點,但這是一個理想的目標。
「他拯救了無數生命」:美國科學家談福奇離開 NIH
您的前任老闆、前 NIH 主任弗朗西斯·柯林斯 (Francis Collins) 對缺乏行為科學研究以更好地理解有關疫苗和公共衛生其他方面的錯誤信息表示遺憾。 我們是否需要重新思考如何將社會科學納入「生硬的」生物醫學科學?
是的,我們有。 你只是這樣做。 將社會科學學科納入開發疫苗的硬科學學科並不難。 令人非常不安的是,在我國,我們有 68% 的總人口接種了 COVID 初級疫苗。 其中,只有一半得到了一次提升。 重要的是,[儘管]可以獲得有效的 BA.4/5 雙價更新追加劑,但只有 13% 的合格人群接受了它。 這非常令人不安,幾乎讓我們感到尷尬,因為我們對獲得拯救生命的疫苗的熱情如此低下。
除了疫苗猶豫之外,行為科學如何在大流行應對中發揮作用?
COVID-19 突出的另一個方面是心理健康的重要性,並關注[大流行]給社會帶來的壓力:不僅是醫護人員、醫生和護士,而且 對包括兒童在內的一般人群。 [他們的] 成長和發展受到 [影響] 的不僅是錯過了學校的面對面,還有失去祖父母和父母的壓力,以及看到他們童年的正常流動被打亂。 所有這些都對心理健康產生了重大的負面影響。
COVID 是否教會了我們有關大流行病防範的任何知識?
在 COVID-19 大流行期間,我們看到政府審查科學家、歪曲數據和以其他方式惡意行事,這使得預防大流行的國際合作變得困難。 研究人員如何遵守這條棘手的路線?
這是不可能回答的。 如果有不透明的國家或團體,那將是全球公共衛生努力的一大障礙。 我希望世界上所有國家都意識到我們必須在我們所做的每一件事上完全合作、協作和透明,因為沒有大流行這樣的東西,尤其是透過呼吸道病毒傳播的傳染病。那將留在一個國家。 我們非常痛苦地看到 COVID 如何在世界範圍內傳播並且已經導致近 700 萬人死亡,這可能是一個嚴重的低估。
您如何評價世界對這一流行病的反應?
很難給出一個公平的回答 [answer],因為當你面對如此強大的病毒時,你將會死亡。 但包括美國在內的國際社會當然可以做得更好。 一個成功的故事是疫苗的快速開發和部署。 不太成功的是公共衛生應對措施。 以這個國家為例。 幾十年來,我們讓我們的公共衛生系統[透過]不替換離開的人、不更新設備、不實時獲取[信息]而萎縮。 我們不得不去其他國家獲取實時信息:英國、以色列、南非。 而在我們的報告系統中,各州不必向 CDC [美國疾病控制和預防中心]報告——CDC 必須要求他們參與響應。 這真的必須改變。
週日,企業家埃隆·馬斯克要求起訴你,聲稱你向國會撒謊並資助了導致數百萬人死亡的研究。 你如何回應這些推文?
我不注意那個,麥克斯,我覺得我不需要回應。 我不發微博。 我沒有 Twitter 帳戶。 很多東西只是錯誤信息的垃圾場,我不會浪費一分鐘來擔心它。
「我希望你死」:COVID 大流行如何引發對科學家的攻擊
考慮到馬斯克在推特上的巨大影響力,你是否覺得自己的安全受到威脅?
當然是有風險的。 這就是為什麼我一直帶著武裝的聯邦特工。 這激起了很多不知道自己為什麼討厭的人的仇恨——他們的討厭是因為有像這樣的人在發推文。
在這一點上,對於那些在大流行期間看到一些針對您和其他公共衛生官員的尖酸刻薄之後可能正在重新考慮他們的職業選擇的早期職業科學家,您有什麼建議?
我會鼓勵他們不要被嚇倒,因為透過進入公共服務和公共衛生領域,你對社會的滿意度和貢獻程度是無法估量的。 真是了不起。 它克服並抵制了所有其他不好的東西。 不幸的是,我們正在經歷對公共衛生官員的襲擊。 但是您在該領域可以 [實現] 的滿足感和成就是巨大的。 它肯定會取代所有其他東西。
我知道你離開主任職位後還在製定計畫,是嗎?
好吧,我要寫作和演講,並且可能 [寫] 回憶錄。 但我當然不會在傳統的意義上退休。
doi: https://doi.org/10.1038/d41586-022-04432-7
為了篇幅和清晰度,對這次採訪進行了編輯。
Fauci responds to Musk’s Twitter attack and rates world’s COVID response
Public-health leader advises early-career researchers ‘not to be deterred’ by public vitriol.
Max Kozlov / 13 December 2022 / Nature
Anthony Fauci, outgoing director of the National Institute of Allergy and Infectious Diseases, appears at the White House to speak about COVID-19.Credit: Tom Williams/CQ-Roll Call via Getty
This month, Anthony Fauci will step down as director of the US National Institute of Allergy and Infectious Diseases (NIAID) after more than 38 years in the post and 54 years at its parent organization, the US National Institutes of Health (NIH). He has led the institute under seven US presidents and overseen its research and response to the HIV/AIDS epidemic, the Ebola outbreak that began in West Africa in 2014 and the COVID-19 pandemic. The 81-year-old physician-scientist became a household name during the pandemic, during which he was revered as a trusted source of advice by some and disparaged by others, including former US president Donald Trump, who saw his advice as inconsistent and overbearing. On 11 December, he was attacked on Twitter by Elon Musk, who took over the social-media platform in October. Fauci spoke to Nature about Musk’s comments, the pandemic and his own legacy.
Thinking back on your decades at the NIH, in which area of infectious disease have we made the most progress?
One of the most important is in the area of HIV. In 1981, when we first became aware of the cases of HIV, [it was] a mysterious disease of unknown etiology that was killing virtually everybody who was infected. It was one of the darkest periods of my or anybody’s professional career in infectious diseases. We went from that bleak time of not knowing what was killing all of these mostly young gay men to getting the [underlying virus], a diagnostic test and, within a few years, an entire series of drugs, which when used in combination, have completely transformed the lives of people with HIV. We also have developed highly effective prevention methods with pre-exposure prophylaxis and [can treat] people who are infected, bringing the level of virus to below detectable levels, so they don’t transmit it to anybody else.
Where will we see the next revolution in infectious disease?
One of the holy grails of infectious-disease research is a safe and effective vaccine for HIV. We’ve made spectacular advances in the development of therapies, both for treatment and prevention of disease. But the one thing that’s eluded us up to now has been a safe and effective vaccine. So that’s one of the things we look forward to. The other is the possibility, although it’s a stretch, in some respects, to have a cure for HIV, where you can have durable suppression or elimination and eradication of virus in the absence of any further therapy. We have not reached that point yet, but that is an aspirational goal.
‘He has saved countless lives’: US scientists on Fauci leaving NIH role
Your previous boss, former NIH director Francis Collins, lamented the lack of behavioural-science research to better understand misinformation about vaccines and other aspects of public health. Do we need to rethink how we incorporate social science into ‘hard’ biomedical science?
Yes, we do. And you do it by just doing it. It’s not that difficult to incorporate a discipline of social sciences into the discipline of the hard sciences of developing vaccines. It is very disturbing that, in our country, we have 68% of the total population vaccinated with the primary vaccine for COVID. Of those, only half have received a single boost. And importantly, [despite] the availability of an effective BA.4/5 bivalent updated booster, only 13% of the eligible population has received it. That is very disturbing, and almost embarrassing for us that we have that low an enthusiasm about getting a life-saving vaccine.
Beyond vaccine hesitancy, how can behavioural sciences play a part in pandemic responses?
Another aspect that has been brought to the fore by COVID-19 is the importance of mental health, and paying attention to the stresses that [the pandemic] has put on society: not only on health-care workers, doctors and nurses, but also on the general population, including children. [Their] growth and development has been [shaped] not only by missing in-person school, but also by the stress of losing grandparents and parents, and seeing the disruption of the normal flow of their childhood. All of that has had a major negative impact on mental health.
Has COVID taught us anything about pandemic preparedness?
During the COVID-19 pandemic, we’ve seen governments censor scientists, distort data and otherwise act in bad faith, which makes international collaboration on preventing pandemics difficult. How can researchers toe this tricky line?
That’s impossible to answer. If there are countries or groups that are not transparent, that’s a big hindrance to the global public-health effort. And I would hope that all the countries of the world come to a realization that we’ve got to be completely cooperative, collaborative and transparent in everything we do, because there’s no such thing as a pandemic, particularly of an infectious disease spread by the respiratory route, that’s going to stay in one country. We saw that very painfully with how COVID spread throughout the world and has already resulted in close to seven million deaths, and that’s probably a gross underestimate.
How would you score the world’s response to the pandemic?
It’s very difficult to give a fair [answer], because when you’re dealing with a virus as formidable as this, you are going to get deaths. But the global community, including the United States, certainly could have done better. The one success story has been the rapid development and deployment of vaccines. What has not been as successful is the public-health response. Take this country as an example. Over the decades, we have let our public-health system atrophy [by] not replacing people who leave, not keeping the equipment up to date, not getting [information] accessible in real time. We’ve had to go to other countries to get real-time information: the UK, Israel, South Africa. Whereas in our system of reporting, the states don’t have to report to the CDC [US Centers for Disease Control and Prevention] — the CDC has to ask them to participate in the response. That really has got to change.
On Sunday, entrepreneur Elon Musk called for your prosecution, claiming that you lied to Congress and funded research that killed millions of people. How do you respond to the tweets?
I don’t pay attention to that, Max, and I don’t feel I need to respond. I don’t tweet. I don’t have a Twitter account. A lot of that stuff is just a cesspool of misinformation, and I don’t waste a minute worrying about it.
‘I hope you die’: how the COVID pandemic unleashed attacks on scientists
Do you feel that your safety is at risk, given Musk’s enormous reach on Twitter?
Of course it’s at risk. That’s why I have armed federal agents with me all the time. That stirs up a lot of hate in people who have no idea why they’re hating — they’re hating because somebody like that is tweeting about it.
On that note, what advice would you give to early-career scientists who might be rethinking their career choices after seeing some of the vitriol directed at you and other public-health officials during the pandemic?
I would encourage them not to be deterred, because the satisfaction and the degree of contribution you can make to society by getting into public service and public health is immeasurable. It’s really extraordinary. It overcomes and counters all of the other bad stuff. It’s unfortunate that we are going through the attacks on public-health officials. But the satisfaction and the accomplishments you can [achieve] in the field are great. And it certainly supersedes all that other stuff.
I understand you’re still formulating your plans after you leave the director post, is that right?
Well, I’m going to write and lecture, and possibly [write] a memoir. But I’m certainly not going to retire in the classic sense.
doi: https://doi.org/10.1038/d41586-022-04432-7
This interview has been edited for length and clarity.