Partnership with the new england journal of massachusetts. Here we are days away from the close of 2020 and we are at an inflection point. While the news around vaccines are promising the daytoday headlines are as grim as they have ever been. An american is dying of covid19 every 90 seconds and we have recorded 4 million new covid19 cases in november and more than 1 million cases in december just nine days into this month. Covid19 has just passed Heart Disease as the number one killer of americans. As of this morning more than 286,000 americans have died due to covid19 and in just one day, just one day yesterday, we lost 2600 of our fellow americans to covid19. To put those numbers into context we are experiencing a tragedy on the scale of pearl harbor every single day, right here at home. From an Economic Security standpoint we are facing the greatest threat to Value Creation since world war ii. If there were ever any doubt about the seriousness of this virus these facts should cast the doubts aside. Simply put, we have been brought to our knees by an invisible enemy. I have to be honest, i have wondered how we gone numb to these numbers . All across the country i see photos and i see film footage of people in malls and at birthday parties congregating in large numbers without masks and without physical distancing. I think hard about the lives behind the numbers of lives lost and i wonder if perhaps being numb, numbness is the way we are coping with this epic Public Health challenge. How could we be acting so recklessly otherwise . At the very same time im astounded by the enormous successes of science, vaccine Genetic Technology has brought forward a whole new class of vaccine and while the development of these vaccines occurred in record time it took years of the search to lay the groundwork for these astonishing rate clues to service. Science was prepared even if we were not. As a lifelong Public Health educator i wont lie to you, i grapple with the fact that so many of us especially some of our leaders appear to be so unwilling to follow the science. I think we must all recognize that this resistance to science, this resistance to evidence is a clear and present danger to all of us. We have already witnessed how reluctant some people are to wear masks and to socially distant. We also know that Vaccine Hesitancy is a challenge that we must confront. According to the november pew survey just 60 of americans said that they would definitely or probably get the covid19 vaccine. We also have to remember that while that number is up from 51 in september it is still down from the 72 who said that they would get the vaccine back in the survey conducted in may. What is even more troubling is that 20 of americans say that they are pretty certain that they will never take the vaccine, no matter what new information they learn about it. Inc. About it, that is one in every five people who wont take into account the safety of their families, their friends, their neighbors, your and my health. Some of the skepticism is understandable, especially among those who have not historically been well served by our medical and Public Health institutions. But Vaccine Hesitancy and skepticism are also what will turn this in flexion point into an even greater tragedy. It is incumbent on all of us, scientists on the public alike to work in tandem with Public Health plane essential role as the spearheading leadership voice in a vaccination campaign. The race to end this pandemic involves each and every one of us. We cannot work in silos, we must Work Together and what we do now our triumphs and our failures will become the very foundation for how we feel the Global Public threats are ahead of us. As a covid19 vaccine begins to be deployed i am reminded quite strangely enough of something a famous military leader, napoleon said to his valet ahead of the battle, he said, dressed me slowly because i am in a hurry. Saving lives is now a race against the clock. So, lets each of us slow down, contemplate the role we can each play to protect our loved ones and strangers alike and do the right thing because we simply cannot afford to go numb. Lets leverage the tools that science and Public Health offers us to save lives and lets do this with a sense of urgency and urgency as though every life depends on what we do now because, quite frankly, every life actually does and so with this introduction i want to say how grateful i am to doctor Anthony Fauci and doctor cooped up for helping us continue this important conversation, doctor group to come over to you. Thank you very much, im so honored to be here so honored to be with you and honestly doctor Anthony Fauci. We get one of these conversations earlier in the summer and i think it would be all but the highest impact conversations we had throughout this pandemic so thank you for inviting us back. I could not agree with you more that science is leading us forward and has done so much in addressing this pandemic. You know, ive been reminded lately that we are this quickfix shortcut sort of society. We are always hoping for the magic cures and potions instead of leaning into the simple effective tools which may require more work. Our human spirits may do so innovative and creative and resourceful and tenacious but it is our Human Behavior that will dictate i think, how deep these wounds ultimately will go. As good as the science is no amount of science [inaudible] that is a theme i like to talk about today. I would like to remind people that were doing this in an academic environment, this conversation today, one that is training the next generation of public leaders and popular to buy hardworking Public Health experts and many of whom are watching and are helping us get through this crisis. We are honored to be joined by doctor Anthony Fauci, director of the niaid and everyone in the world knows him by now. We are also streaming on cnn. Com and showing on cnn in certain markets as well. Please submit your questions to doctor Anthony Fauci at the address at hsp fh. Harvard. Edf you. Or on the Facebook Comments at harvard Public Health. But now onto our distinguished guest, doctor fauci, welcome s sir. Thank you for having me. Appreciate it. These conversations are so important. I would like to cover a variety of topics but let me ask about the news today. You heard about these two people in the uk who received the Pfizer Vaccine yesterday and to health care workers, nurses, i believe, with significance allergic reactions in response to the vaccine, pretty clearly within moments of having received the vaccine. How concerning is this . Well, it obviously is of some concern because there are people who have what is called allergic diathesis or attendant get allergic reactions but both of those individuals, i believe, did in fact have that tendency. What we need to do looking forward and these are the kind of things that happen when you implement large Vaccine Programs. Remember, we had 30000 people in the moderna trial and 44000 people in the pfizer trial but once you start implementing the actual utilization of the vaccine in a clinical setting youre talking about millions of individuals getting vaccinated so you may start seeing effects in some that might not have been picked up when you are dealing with thousands so it likely is an unusual and rare effect but clearly everyone now is aware of that and will be looking at that at a particularly taking care of people who do have underlying allergic phenomenon that they might be cautious about vaccination or at least be prepared to respond with some sort of anecdote to the allergic reaction so if i were a person that had an underlying allergic tendency i might want to be prepared that i might get a reaction and therefore be ready to treat it. The guy, as you probably no, served in the uk is people who had severe reactions to food, to medicines or to previous vaccines should not take this vaccine. If you have a significant percentage of people. It good. You know, that is one of the reasons why it is important to cover the waterfront with different vaccine platforms. You know, you and i have had that discussion that there are many vaccines throughout the world that are being tested and that we in the United States are supporting, developing and facilitating the testing of at least six candidates so, it is in fact if you do find out that there is a consistent issue of certain subset of people like those with allergic reactions will always have other vaccine platforms that you can use and hopefully you will not see that with those other platforms. I want to ask about schools as well, we will take video questions here in a few moments but you know, i was surprised at how well most schools have done in terms of keeping overall infection rates down. I was skeptical thinking that flu viruses transmit easily, respiratory viruses transmit easily but so far positivity rates in schools pretty much have stayed low. What you think that means Going Forward . I know you said keep school open but bars closed but the time we started decided to shut down there were 5000 people infected and now theres 15 Million People who have been confirmed and its spreading significantly and just about every place in the country. Should schools stay open an mid all of that . The answer would you and i have discussed before is our position will always be exceptions and there is never onesizefitsall but in general the position should be we keep the schools open and get children back to schools who are not in school as best as we possibly can. The data that you are saying that imc also is that i agree with you. I was in the same vote as you. When you look at it the number and percentage of children who are getting infected, even when they are in immunity infections to a certain degree, is less than you would have expected. By extrapolating from the General Community which is really good news for keeping the children in school. Obviously, if you want to do that you want to make sure that you take into consideration the safety and health of the children as well as the teacher but in general it looks like we can keep the children in school and get them back to school safely. I believe strongly that as we influence vaccines and get the level of infection in the community lower than it is not which, as you know, is very high it will be even easier to keep children in school and protected. What to say to teachers and faculty members and adults who work in the schools . Ive gotten some emails after the backandforth in new York City Schools from teachers who are basically saying you know, what about us . Are we at greater risk as a result of these schools been open . Apparently not. Obviously, we continued to collect data and continue to modify if necessary policies based on the data as it comes in but right now given the level of infection that we are seen in children and schools it doesnt not appear that the risk for the teacher is any greater then the risk they would face by being in the community in general. I will ask you about testing before we talk about vaccines. Were not talking a lot about testing over the years and i thank you have said we had this conversation a few times that there has not still been adequate testing in terms of overall numbers in this country. I want to frame the question differently. Dr. Fauci, for people who dont have symptoms and just want to get tested to find out if they are, in fact, positive, what exactly should they be looking for . If you have symptoms you should stay home. If you find virus on one of these tests it could be active virus and may not be an active virus but if you are just trying to find out whether or not you are contagious which seems to be the question theyre trying to answer, and no symptoms and i want to get tested to make sure that im not contagious to other people and i dont care if the tests come back positive but i want to know if im contagious. Can we answer that question for the average person was seems to be a fundamental question at this point . In order to answer that question completely accurately i think that our viewers need to understand that there are tests for different purposes. You mentioned one of them. If you been exposed either symptomatic or not and you want to find out if you are infected specifically at this moment in time then you want the most sensitive, most cumbersome, more expensive pcr test that you cant get in ten or 15 minutes but will get, at best, a day or sometimes two, three days. If you are looking to get a feel for what the infection is in a particular group, and a college, in a factory, in a nursing home even though there is no one there that is having symptoms you can get a feel for that by doing a less sensitive test more often. Let me explain what i mean. So, lets take the test which isnt as specific or is accurate as the pcr test. If you get tested two or three times a week the lack of sensitivity of the test will be made up for by the frequency with which you get it. The other point i believe you were referring to is that even though the sensitivity might be lower in the antigen test that is more of a screening test, if you wind up getting a level of virus that is not picked up by the antigen test because it is so low you could be infected but your virus is so low that you are not infective, namely, you are not going to transmit it because it is not picked up by the antigen test and you likely would pick it up by the pcr but what we call the cycle threshold would be at such a level that even though you pick up virus it is not at a level that you would transmit. I think that assuming we are learning more and more about and the more information we get in the more confident we will be asked whether or not these tests will be used on a basis of a screening to tell you at least im not infective to someone else. This is such a fundamental point because ultimately how do you make this sorts of tests actionable in peoples lives, someone that taught me a lot just from reading his work, you know him as well and as it turns out hes joining us right now and has a testing question. Are you there . Testing is one of most crucial Public Health tools inside a pandemic so in the u. S. Review all tests through a single lens which is clinical, medical diagnostics so is it because we have only a single pathway for evaluation of tests throughout the fda . For tackling public of problems we need to have tools tailored for Public Health and test must be accessible and fast and frequent. Is there a role for a new pathway for evaluation of tests focus squarely on Public Health metrics which is distinct from medical diagnostics . Well, he has asked the question after i gave the answer. [laughter] no, his question is totally relevant. I know because i listened to doctor mina make that point about the differences between testing for a medical reason and testing for a Public Health reason and that is an important issue that i think we need to pay it much attention to because we really address the question you asked me about, not necessarily definitively knowing if this symptomatic person is or is not infected versus from a Public Health standpoint what is the level of infections in a college dorm or in a factory or in a prison or in a place of employment . That is what the doctor is talking about and thats a Public Health question as opposed to a specific medical question. Do you think that we would ever get to the point where we would be able to have the type of testing, doctor mina is talking about . Hes describing doing regular at home testing, antigen testing and again low sensitivity and may be or because youre doing so many of them able to give you information of actionable in terms of whether you are contagious but i bring this up not to keep belaboring this point but we heard the three pillars the president elect biden talked about yesterday, masks, vaccines, schools and i feel like testing again has been inadequate all along and still very important especially over the next few months. Could we get to that point where we have tens of millions or hundreds of millions . There is absolutely no reason why we cannot get to that point. We have done things infinitely more, gated with that and we have the technology and we can do it and we can get home tests that are pointofcare, sensitive, specific, cheap without the necessity for a prescription. That is imminently doable and when we get there we can have yet another dimension for being able to control this outbreak by understanding, literally in real time, what the extent and the penetration of infection is in any given segment of the community. But lets talk about the vaccines for a minutes. The subtle questions coming in about this as well. First of all, just to define terms here 95 , 9095 effective or efficacious at preventing covid19 and that is what we know about it and preventing the symptoms of this disease but not necessarily at preventing infection or transmission. Do i have that right . Does that make when you think about the flu shot, does that event infection or present people from getting sick . How will this work if it doesnt necessarily prevent infections . Its very similar to the blue flu. You get a flu shot and it can prevent you from getting infected but as often as not it prevents you from getting symptomatic because the efficacy of the flu vaccine is how it prevents you from getting sick enough to require medical care that is the efficacy of the flu vaccine so that is something i think people dont fully appreciate. Very similar so the primary endpoint of the two vaccines in question the mrna from both phis and madrona are the prevention of symptomatic diseases and the secondary endpoints are the prevention of severe disease and the prevention of infection. Lets take a look. The primary endpoint was met fades, 9495 effective in preventing you from clinically recognizable disease. With regard to severe disease the news is, in some respects, even better and close with the moderna that we saw the data on and close to 100 efficacious in preventing you from getting severe disease. What we dont know right now is the degree to which it prevents you from getting by role infected and we will find that out as we did further and further on and follow up of individuals but today we dont have the answer to that question. One of the things that is conceivable is that it will either prevent you from getting infected or it will if it doesnt prevent you from getting infected the immune response that generated the vaccine may be sufficient to diminish the type of virus in your nasal low enough that you are infected but not infective. Namely, you are infected but you will not transmit it to somebody else. We dont know now the answer to that question but we will find out from following the studies so to be clear until we find that out but again there may have been for people over the next few weeks, if youve been vaccinated you may still need to mass because you could still carry the virus potentially transmitting it even if you are less likely to get sick yourself. Absolutely, no doubt. We should not say that vaccines are a substitution for Public Health measures. It is a compliment to Public Health measures. Protecting yourself from clinical disease, protecting yourself from severe disease, protecting you from infections but if you still have virus in your nasal cavities you still want to wear a mask even though youre not getting sick from infecting someone else and since the vaccine is not 100 effective and we dont know what the durability of the protectionists you also want to wear a mask to protect yourself from getting infected. Wearing a mask and physical distancing, avoiding crowds, that should all stay as we get into the Vaccine Program because there is still a lot of virus out there. And so, just following up on that, for how long do you think we continue then with those basic Public Health measures of masking and taking everything weve now discussed into account, how the vaccine works, what the endpoints are, what is likely to do for the individual so what does that then mean for society as a whole . There is one parameter that you have to factor in if i will and currently answer your question but that is what percentage of people in our society will be willing to be vaccinated . If we have 895 effective vaccine and only 4050 of the people in society get vaccinated it will take a while to get to that blanket of herd immunity that will protect us enough so that you and i are still comfortable and going out into society and saying the level of virus is so low its not a threat to anyone. Lets say we get 75 , 80 of the population vaccinated. If we do that i believe if we do it efficiently enough over the Second Quarter of 2021, by the time we get to the end of the summer i. E. The Third Quarter we may actually have enough herd immunity protecting our society that as we get to the end of 2021 we could approach very much some degree of normality that is close to where we were before. You have seen the trial results of the pfizer data so far is one thing that jumped out at me was that we heard about the 95 or so after two doses but after the first dose the results of of a fair amount of production, 54point to percent, lower but better than what the fda required. Doesnt make sense to you to take the 40 million projected doses by the end of the year and give all those as first doses to the people so you vaccinate more people with some vaccine, manufacture the second dose for them in the following weeks or months . We consider that and we decided that it would be more prudent not to do that, mainly, to get the real total degree of protection, not the 52 but the 95 after the second dose because you will start getting that kind of immunity anywhere from seventen days following the second dose. Even though theoretically you can make an argument for that but the fact is we have enough doses which we anticipate we will that we would like to get everyone vaccinated fully as cookie as possible. You and i have that so many conversations about these topics over time and we talked here and on cnn and things like that and i was reading this piece about you in the Huffington Post any talk for the fact that you spend time trying to get these Public Health messages out and these types of forms. I wonder, have you considered talking to top forums such as lam, newsmax, parler, things like that and audiences that may be not hearing in these forums but need to hear the message the answer is yes, im willing to talk to anyone and any platform that we can effectively get the message across, particularly in the arena of the importance of people getting vaccinated. We do not want that to be the missing link in our success, not having people get vaccinated. Sign me up. Betweeno you balance being a cheerleader for these Public Health practices, providing the evidence and Science Behind them, and also being this sober minded scientist . There are too many people who are still not abiding by these basic Public Health measures 1011 months into this. We have had so many conversations, at what point do you change the message around masks or physical distancing . People who do it have heard the message and are doing it, people who are not doing it have also heard the message and are not doing it, so what do you do in your position . As you well know, that famous saying that Albert Einstein said that the definition of insanity is doing the same thing over and over again and expecting a different result, i do not think we are insane for continuing to try and convince people, i just just think that perhaps we need to get Community People that we engage with two it give a message coming from individuals more trusted by the community. The people need to hear it from a leader that they respect. Maybe that is not necessarily the Public Health officials, but may be some of the political leaders that they respect. That is a possibility that that could help, i will not and should not abandon the scientific basis of the messages that i give because there are some people who are not listening to it. I think you always have to have the evidencebased end the sciencebased fundamental platforms for where you make your policy. It is frustrating that some people no matter how often you say it, they just do not believe it. We have people in certain parts of the country that you are well aware of in which the hospitals are in the danger of being overrun even with lack of staff either with lack of staff or with lack of beds. And in that region people still believe that this is fake news, that it is a hoax. It is incomprehensible to me, but it is true. I have to admit, i do not have an easy answer for how to access those people, i dont. Could stand on i my head, i dont know if it is going to make any difference. Im not so sure if we are going to reach those people. I am curious how frustrating that is for you, i dont want to make this personal, but i know it has been a long year for you. I will say there is a lightness about you now, a little bit of a pressure off your shoulders maybe i dont know, but how do you deal with what you just described . You have been preaching this for so long, have you thrown up your hands . How do you get through the day . I would never do that. I think the enormity of the problem and the responsibility that i have as the director of the Infectious Disease institute s responsibility is the science leading to the advances that have put us in a good position regarding vaccine and therapies, but also as a Public Health official that i have responsibility. It is not an option to throw your hands up and get discouraged and walk away from it because the enormity of the problem and the suffering and the morbidity and mortality is such that it would be unconscionable to walk away from this or to throw up your hands in frustration. And how iabout me feel, it is about what the problem is and the problem is in normas. Enormous. I dont want to get too graphic about it, but you have got to suck it up and keep going about how frustrating a get. When i hear dr. Williams talking about a pearl harbor every day, a 9 11 every day or so, i often grapple with his idea of how much you really expose the audience to . Most people have not really seen the actual suffering that , theyanies covid19 havent unless they have been in the hospital which i have and you have, they probably have not seen what that really looks like. I wonder, when you are talking to your colleagues, your friends or your family, you are trying to describe the actual suffering that goes on with this disease. 286,000 americans have died from it, how do you describe that level of suffering . Is when you get to numbers that are so numbing deaths, 1415 million infections that it almost becomes a meaningless cold statistic to people unless they can make the connection between suffering human beings and those enormous numbers. Not everybody is going to be in that position. Agorally today, a few hours i was across the lawn from the room i am in now over at the Nih Clinical Center making rounds at our patients, a couple of whom had covid19 and when you see a real patient in the room and you see the mri and the ct scan and you look at their pulmonary functions and oxygen saturation, all of the sudden it becomes really real. That one person or two people that we saw on rounds today, multiplied to the 200 plus thousand people who have died, it is the in normandy enormity of the problem, it can actually overwhelm you. You do not want to overwhelm the general public, but you want them to at least understand that you are dealing with real suffering and real disease and real loss in the form of death of loved ones. That is where we are right now. We cannot walk away from that problem. It would seem to me that that has to be motivation enough for at least most of the people to adhere to the Public Health recommendations that we make as well as to seriously consider utilizing a highly efficacious vaccine. Have you had any personal friends or family members who have dealt with covid19 . Yes, if you, is but one in particular, my youngest daughters boyfriends brother is a 32yearold young man, athletic, healthy who got covid19 and had one of the unusual complications of cardiomyopathy within arrhythmia and died, so there you have it, a 32yearold young man otherwise healthy, quite athletic and strong, who died. It made my daughter greatly said. Im really sorry dr. Fauci, i do not know if you shared that before but im sorry to hear that. You do hear the stories of young people getting very sick and dying, it is one of these things, we talked about this back in march or april and at that point you said we have no idea why some people most people find they do well and recover, but some people just dont. Do we have better insights now even among younger people why some people are getting so sick and why others deem to be dramatically less affected by this . The answer to that question sadly is that we do not know. With the the obvious thing is that someone has underlying medical missions that do not letter allow their immune response to respond adequately, but the mystery and i have told you this before that haunts me actually, because i am someone who has studied the diseasessis of viral for my entire multidecade career. The idea that you have a virus that in most people is almost harmless, they dont even get any symptoms, and than in those who get symptoms, most people dont get severe symptoms, and then in another subgroup inexplicably makes them so split sick, that you get 280,000 deaths in the United States. I do not know the answer to that question, and i am sorry to say i just dont. I hope we someday find out. I do, too, i was just reading a story about these twins, 60yearold man who both contracted the disease around the same time. They both recovered ultimately, but one had a much rockier hospitalization course and they are twins, genetically identical, so i hopefully hope we get to the answer that. We have a lot of questions coming in, specifically about how successful we bill at accinating everyone, heres question from mayor keisha lance bottoms. Hi dr. Dr. Fauci fauci, we have seen the racial ethnic disparities as it relates to covid19 in atlanta alone nearly 40 of our cases are attributable to the africanamerican commune, yet 85 of deaths are in the active africanamerican community, my question is how do we better work with the federal government to help address the racial and ethnic disparities making covid19 more deadly in communities of color . Mayor thate madame it is a two step process, one that is immediate and can address the situation as it exists now and one, i believe, has to take the form of a long term commitment on the part of our society. The immediate issue is to have testinge the tasting capabilities and the medical care accessibility to the africanamerican population as best as we possibly can under these somewhat emergency circumstances. Because clearly, African Americans the basis of the jobs that they have to a greater degree than others are putting them out in the community in a situation of exposure with generally essential jobs that give them a greater likelihood of actually getting infected. Once they do get infected, the incidence and prevalence of the underlying comorbidities that they have put them at a much greater danger of a severe consequence of covid19 disease. There is no doubt about that. They have a four times greater chance of getting hospitalized and at least twice as great a chance of dying. The thing we need to do is to try and get them the access to the care that they need by putting resources in those areas that demographically are overrepresented by minority populations, africanamericans and to some extent latinx. What i am seeing having been through a number of outbreaks of different diseases that disproportionately affect particularly the africanamerican population is to address now the decades long problems of the social determinants of health which allow an africanamerican man or woman who have a higher degree of diabetes, obesity, hypertension, liver disease, cable kidney disease, those are the things that lead to severe consequences of covid19. I, thoseow better than things begin almost at birth through the circumstances at which our minority populations grow up in, the diet that they are exposed to, the economic conditions. We, if we want to have some commitment that we can say never again, if we want to get out of this, which we will, where are we going to go in the next few decades to overcome the health thoseities which allow extraordinary depressing numbers of minorities suffering disproportionately from this disease . It is a longrange commitment and we should not forget it. Plus stay on that and for a second, a professor at the Harvard Kennedy school and former president of the naacp has a question, i think an important one. Dr. Fauci, thank you for your service to this country and my question is simply this, with over 2 Million People behind bars in americans americas prisons and more behind bars in americas jails and juvenile lockups, would you and how might you prioritize the distribution of a vaccine to those behind and out across america of the eyesight of Many Americans . That is a great question that certainly any answer is going to be controversial because if you say prioritize, then someone will say you are taking it away from someone who never committed a crime and is out there and needs vaccine. Putting that aside, i would say that we should prioritize vaccines for the most vulnerable and it appears to me that you can make a good case that people who are instant in situations be they in Nursing Homes or prisons or other places where the likelihood of getting infected is very high, that we should at least seriously consider adapting our countermeasure approach to the degree of danger and risk that people are in. I do not make policy, sir for what is going to happen in prisons, but i think you can make a good case that you are dealing with a vulnerable population that have little capability of getting themselves out of that vulnerable situation. So somehow or other, we have got to come and give them some help and help may be in the form of vaccines. The policies made at national level, i know you dont make the policy, but should there be a uniform policy across the country . Right now it seems that each state is determining the triage and distribution of the vaccines question like the one the professor is asking will be decided at the state level, does that make sense to you . Aspect of making things at the state level as you know, i am saying things that you are very well aware of is that each state may be a little bit different in different ways that you want to be able to give them the flexibility of adapting a policy to their particular situation. But there are some things that are common denominators that that across the board deserved a certain action. If you leave it up to the states, if the state one state or the other may decide they do not want to do it, that may be really unfair to the people in that state because there are things that are common across all state. Have it administrate the does not want to do it and the people in that particular environment would suffer more than people in comparable states. It is under those circumstances that you call for a central type of decision. I appreciate these sorts of conversations, i have known you for so long and in the past going back to like anthrax even and other outbreaks, we used this you all the time outfront educating the country and helping people understand what was happening. In the next couple of months after the new administration is sworn in, will you be returning to that role as chief medical advisor . Are we going to see a lot more of you educating people daily or on a regular basis . I cannot say for sure, but i believe so. I have been told by the transition group, by the leaders of the transition that as you said, that the president elect wants me as the chief medical advisor and in that capacity, i cannot imagine that it will not being out there in the public and giving the kinds of messages that i have in the past. I would certainly expect that would be the case, i would be surprised if it were not the case. Alexandria ottavio spencer has a question. I would like to thank you for all you are going to keep this country safe and i would also ake to say i think did wonderful job playing you. What trusted spokesman should we rely on and how do we amplify these voices . Going to Say Something that is the truth and i hope people believe this, the career scientists at our food and Drug Administration, our regulatory authorities are totally committed to the safety and health of the American Public. Deemed tovaccine is be safe and effective by the fda, the American Public needs to appreciate that that process of that decision was both independent of the administration, independent of the drug company, it was independent because the data was looked at it by an independent data and safety monitoring board, analyzed a career scientists, and a decision made in accordance with an Advisory Group that is also independent. You put all those things statesr, if the united food and Drug Administration says that a vaccine is safe and effective, i can promise you that i will take that vaccine myself and i will recommend that my family does that. I think the authority should be the United States food and Drug Administration. You talked a lot about equity when it comes to these vaccines and i want to throw a question to you from the board chair of ae vaccine alliance, has question specifically about the distribution of these vaccines and i will preface by saying something you told me a long time ago. An outbreak anywhere in the world is an outbreak everywhere in the world and we have to remember that, take a listen to this question. Dr. Factory, what are your views about the international equivalent of outbreaks operation warp speed known as the accelerator and its offshoot . This is designed to assure Affordable Access to poor countries for vaccines, therapeutics, and the diagnostics. Will the United States joined the effort . What are your views about vaccine nationalism in the context of this pandemic . Question, i great can firmly answer the second question. I do not think i can give you a firm answer in the first question and that is, i cannot speak for the United States as a whole and what we do with kovacs and what we do with the International Availability of vaccine. I can tell you my own position and that has not changed over iny decades, it originated my position as a Health Authority and a scientist during and continuing to today with hivaids and the United States program and the United States contribution to the global fund sense, as a son jay said, a global problem is a global problem, that means everywhere on the globe and there are countries on our globe that have print resources and different capabilities of responding to epidemics and pandemics that are common to all of us. I feel as an individual, and i cannot speak for my country as it were, but i can tell you how i feel, that we have a moral responsibility as a rich country along with other rich countries to make sure that when we have the facilities and the capabilities be at lifesaving drugs for hiv, lifesaving preventions for hiv, or a accine for covid19, that as Global Community, we do everything we can to make sure that there is the equitable distribution of those countermeasures throughout the world. So that there are not countries because of their economic status or other aspects of their status that they do not have the capability of vaccinating their citizens. I think we all need to pull together as a Global Community to make sure there is equitable distribution. We talked a lot in this conversation about the role of government, the role of personal i get a lotty and of friends from the private sector who talk about ways they might be able to help and we have a question from the head of shaping the future of help and health care at the World Economic forum, take a listen. Under your leadership and thanks to your efforts in the age of getting multiple vaccines to the world, we thank you for that. I you know the Economic Forum am concerned, i see a drop in vaccination and tensions over the past three months. My question is do you see a role for employees to play on the benefits of vaccinations . Thank you very much. Thank you for that question is absolutely yes. In fact, one of the best ways to get to people is through their place of employment. Employers, particularly of Large Organizations that can influence large numbers of people have a unique opportunity to do really good things by educating their employees for example on the benefits of vaccination and even may be being the focal point of how the vaccines are distributed. We have seen that in the past where employers have served whatever that may be, a large organization, a Large Institution as a place for the delivery of Certain Health care commodities. B they vaccines, testing, distribution of drugs, we have seen that, it does work. Thing a lot ofne people ask about this vaccine is the durability. Something you have talked about. Is there any correlation between the strength and efficacy we have seen so far in terms of preventing covid19 and the durability . Is it more likely to last longer if it appears to work this well . Not necessarily, i think those are two separate issues, because if you have a high antibody neutralizing or a powerful t cell response that will give you the 95 efficacy, the fact is, we have no idea how long that lasts. That can be very potent for 56 months a year and then drop off dramatically, the determination of the durability of a response is just going to be a matter of time. We are going to have to see how far out a year or two most of these trials go out for two years of followup, we will know the answer to that question in a year or two. Take one more question, this comes from the former secretary of health. What has surprised you about this pandemic . What did you learn that you did not know before . I learned something that is , i have very disturbing never seen a virus like this that has the capability of of people not getting any symptoms, they are the ones that are responsible in large part for the silent community spread, a substantial proportion of the people who get symptoms have mild symptoms, and yet, that same virus has the capability of devastating other people. Putting them in the hospital and killing them. 280,000 plus deaths that we have experienced so far in this historic outbreak like nothing we have ever seen, that really surprised me. I really i did not realize or think we would get a virus in which most of the people do fine, but has such a high death toll as over a quarter of a Million People thus far and still counting . That is very disturbing and in many respects, very puzzling. I know you have a very important call you have to go put you on thet spot in front of these but thank you for your time. These are such important discussions because we get not only in the specifics but also your way of thinking which i think is critical, with that we will end this amazing discussion. Thank you to dr. Fauci, dean williams, all the experts who shared their questions as well, thanks to the audience. And thank you as well to the school of Public Health and the new england journal of medicine, stay well everybody, be healthy and be kind. With coronavirus cases increasing across the country, use our website cspan. Org coronavirus to follow the trends, track the spread with interactive maps, and watch updates on demand anytime at cspan. Org coronavirus. The food and drug in this ration meets in open session to approve modernas vaccine for covid19, live coverage thursday at 9 00 eastern on cspan3. Stream live and ondemand sp span. Org cspan. Org or listen free on the cspan radio app. Todays rally supporting president trumps legal challenges to the election results, after that, in fda briefing announcing emergency use authorization for the Coronavirus Vaccine and distribution plans. Then, the head of operation warp speed details shipment plans to states nationwide. States electors of the Electoral College cast their votes monday for president of the United States, watch cspans live all day coverage as the results come in. Starting at 10 00 eastern from indianapolis, indiana and the meeting of its 11 electors, at 1130 eastern, delawares three electors meet in dover. In harrisburg, the meeting of pennsylvanias 20 electors, then at 2 00 eastern, michigan 16 electors vote in lansing. And at 3 00 eastern, 38 texas electors meet in austin. Then at 8 00 eastern we are live with john fortier author of after the people vote, a guide to the Electoral College to talk about the results. Watch the Electoral College vote monday live starting at 10 00 eastern on cspan, online at cspan. Org, or listen on the cspan radio app. This is the view of Freedom Plaza in washington, d. C. Where a group called women for America First held a rally supporting president trumps efforts to overturn the president ial election results, the Electoral College is scheduled to formally cast its vote for president on monday