Anthony Fauci, using a baseball analogy for the fight against COVID-19, warns the U.S. may not be halfway through and "certainly we're not winning the game right now." Photo: Al Drago/AFP via Getty Images

The unique characteristics of this pandemic may not allow people to completely eradicate it, but public health measures and good vaccines should bring "very good control," NIAID director Anthony Fauci said Wednesday.

Driving the news: "We are living, right now, through a historic pandemic outbreak. And, we are, right now, in a situation where we do not see any particular end in sight," Fauci told a panel hosted by the not-for-profit TB Alliance.

"It's the perfect storm," Fauci says. "We often talk about outbreaks and pandemics, be they influenza or other pathogens, that have to have a few characteristics that make them particularly formidable. Well, this particular virus has that."

  • For a public health official, this is "almost your worst nightmare," Fauci adds.
  • He points out that SARS-CoV-2 jumps species, is a new pathogen with no known innate human immunity, and is a respiratory-borne virus that is "spectacularly efficient" at spreading from human to human and has a "substantial degree of morbidity and mortality, particularly in certain populations of people."

Plus, "the spectrum of involvement with the same pathogen is very unique," Fauci says.

  • "I've never seen an infection in which you have such a broad range — of literally nothing, namely no symptoms at all, in a substantial proportion of the population; to some who get ill with minor symptoms; to some who get ill enough to be in bed for weeks and have post-viral syndromes; [to] others [who] get hospitalized, require oxygen, intensive care, ventilation and death."
  • From what doctors can tell right now, Fauci says the pathogenesis of the disease indicates "you want to block the virus and keep the immune systems intact early on. But, you want to block inflammation later on, because that assumes a much greater role."

What to watch: Several vaccines are in or will soon be entering phase 3 clinical testing, Fauci says. While the FDA gave a 50% efficacy benchmark for the vaccine, "they're shooting" for a vaccine with 70% or higher effectiveness.

  • One safety concern they're watching for during phase 3 trials are for possible "vaccine-induced immune enhancement" that can sometimes occur if there's suboptimal antibodies in a vaccine that actually enhance the infection once you're exposed later.
  • While there is no "particular reason" to believe this will happen with COVID-19 vaccines, there had been issues before with animals tested with the SARS vaccine, so "we want to pay attention to it."

Fauci says he's "cautiously optimistic" a good vaccine will be available soon.

  • "I don't really see us eradicating it. I think with a combination of good public health measures, a degree of global herd immunity, and a good vaccine ... I think we'll get very good control of this. Whether it's this year or next year, I'm not certain," Fauci says.

Meanwhile, other panel members also expressed concern that the pandemic may cause an uptick in diseases like tuberculosis, HIV and malaria.

  • Soumya Swaminathan, chief scientist for the World Health Organization, pointed out that there's a need to continually address those devastating diseases as well as work on developing new antibiotics.
  • TB Alliance founding board member Ariel Pablos-Mendez, who has worked with both COVID-19 patients and multidrug resistant TB patients, says "I have seen firsthand how deadly diseases are, and the threats they pose to global health and stability."
  • "But I also see signs of hope," Pablos-Mendez added, such as with India's recent approval of TB Alliance’s pretomanid drug, commercialized by Mylan, to be included in a regimen to fight multidrug-resistant TB.

Editor's note: This piece was updated to clarify pretomanid is TB Alliance’s drug that Mylan will commercialize.

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