"Science Vs." Podcast: Dr. Fauci Talks Monkeypox

  Defending and explaining science is like siting in a dunk tank with people standing in line to splash you in the water. We have people taking horse dewormer because an anchor on a news network told them to do so. We have others sweltering in the heat, watching entire forests burn up due to drought, deny that the climate is changing at all. 

Then we have those who believe a man who tells them that windmills cause cancer and low-flow toilets are damaging your health.

Out of all those dark ages images, however, we have Science Vs. from Gimlet that dares to set the science record straight.

This week, Spotify’s Gimlet podcast Science Vs. has released two new episodes diving into monkeypox, the outbreak that has been spreading around the world. In the first episode, Host Wendy Zukerman breaks down exactly what the disease is, how worried we should be, and how people can stay safe. In the second episode, Dr. Anthony Fauci returns to Science Vs. to provide some clarity in discussing monkeypox and what has gone wrong in controlling the outbreak. Some key highlights from this episode are below:

• Dr. Fauci shares his initial thoughts when he saw how this outbreak was starting and numbers rising, and what we could have done differently to tackle it: 
• “I said, uh oh, if this is efficiently spread from person to person, that those are the kind of things that’s very reminiscent of what we saw in the early days of HIV. When you have a lot of people, you know, and it's celebratory areas where there's multiple sexual partners that this thing is going to get bigger than just a few cases. It was sort of a gradual oh my goodness. But from the very first beginning, the epidemiological circumstances under which it occurred was very troublesome to me, having been there 41 years ago with HIV.”
• “I think a more rapid mobilization of the countermeasures that we have. Right from the very, very beginning, from the very first day.”
• Dr. Fauci on how this situation with monkeypox is different to the beginning of COVID:
• “The differences are really rather substantial. In Covid, there were many unknowns, but we had a very important task of developing diagnostics, therapeutics, and a vaccine. With Monkeypox, it was, you know, by some strange quirk of circumstances, we had experience with the virus - we knew a lot about it. And in an attempt to develop countermeasures against smallpox associated with the bioterrorist scare following 9/11, we invested an extraordinary amount of money to stockpile both vaccines, namely the ACAM2000, as well as a lesser amount of Jynneos, which was really supposed to be for people who couldn't tolerate the ACAM2000 - like kids with eczema and people who were immunocompromised. So right from the very beginning, we had countermeasures, having diagnostics, therapeutics and vaccines for monkeypox. And then what we were faced with was more of an implementation issue.  
• Dr. Fauci speaks further on the vaccine implementation issue: 
• “We were involved in testing the vaccine and showing that it worked and in developing the drug, which is now known as Tpoxx. We have 100 million doses of ACAM2000 ready to go right now, here. And that was the original reason. This is not an excuse. This is just the fact. That was the original reason, is that if we had a smallpox attack, that the danger to the general population would be – that the benefit / risk ratio of giving a vaccine that had a significant amount of adverse events, myocarditis, possible spread to people who might be immune compromised. But the people who made it felt that that benefit would be worth the risk. And the Jynnneos which was then contracted to be made outside of the United States - was for an exception for those who could not tolerate the 100 million doses that were readily available for everyone. Now what happened by a quirk of fate, is that those people who were vulnerable to this, namely the men who have sex with men, many of them fell into the population, that it would be risky to give them the hundred million doses that we have at the tips of our fingers ready to go. So we had to rely on what was the backup vaccine – was Jynnneos. Which was the opposite of what the plan was.”
• Dr. Fauci on the ACAM2000 vaccine and Tpoxx treatment: 
• “It is a vaccine which was against a historically horrible disease that influenced societies throughout the centuries, smallpox. And so the adverse events, the inconvenience in administering it, you know, you have to scratch it into the skin – those who were felt worth the protection against a deadly disease. So now you have a disease, although there are a lot of painful consequences associated with monkeypox, it is not a deadly disease in general, comparatively speaking.”
• “So whenever you have a disease like that, you've got to balance the benefit and the risk of what the intervention is. So rather than saying, hey, we have 100 million doses of ACAM2000, just give it to everybody. All of a sudden, those who are responsible for the distribution found that they had to really play catch up in getting those doses. There have been over 130,000, which pretty quickly was put out. Another 400,000. And then by the end of next week, we hope we'll have a total of 1.1 million doses.”
• “With regard to the Tpoxx. That was another logistic issue because given the approval of it that in order to get it, the amount of paperwork was very prohibitive and became very difficult for physicians in the community to get it in an expeditious manner to their patients. The CDC has now and the FDA cut down dramatically on the bureaucratic and logistic constraints in getting the drug to the people who need it. And with regard to the diagnostics, again, the CDC had their own, that was about 6000 per week. But now we have at least five commercial companies that are making it. So they'll be 80,000 tests available per week.”
• Dr. Fauci on where he thinks this outbreak is likely to go in the next few weeks/months:
• “I would hope that we get all of these countermeasures distributed in an equitable manner, not just to the people who understand how to get it, because there are a lot of people that are vulnerable throughout the country, and I would hope that this gets distributed in an equitable manner. And by distributed I mean availability of tests. I mean Tpoxx when you need it. And obviously enough vaccines not only to do post-exposure prophylaxis, but also pre-exposure prophylaxis for people who might be at risk.”

 

Listen to “Monkeypox: What's Going On?” and “Fauci on Monkeypox: What Went Wrong” now on Spotify to hear more about the outbreak and Dr. Fauci’s illuminating discussion with host Wendy Zukerman. 

As astronomer Carl Sagan once said, "We live in a society exquisitely dependent on science, in which hardly anyone knows anything about science."