Fauci: 'COVID-19 Is Here to Stay, but We Can Control It'

 Though it would be next to impossible to eradicate SARS-CoV-2, it is fully feasible to control it, said Anthony Fauci, MD, director of the National Institute of Allergy and Infectious Diseases (NIAID), during a virtual event held Friday morning by the National Press Club.

A variety of factors make COVID-19 different from polio and measles, viruses that were previously eliminated in the U.S., including the number of genotypically and phenotypically diverse variants of SARS-CoV-2, and that SARS-CoV-2 has animal reservoirs for the virus, Fauci noted.

There has also been a lack of widespread acceptance when it comes to COVID vaccines, and immunity through vaccination or infection wanes over several months.

"We're hoping for control," Fauci said, which would involve a combination of common-sense hygiene and mitigation measures, intermittent vaccination, and treatment with effective antivirals and monoclonal antibodies.

As for the next generation of COVID shots, and how regularly they would be needed, Fauci was both optimistic and realistic.

"I would hope that we get to the point where immunity lasts long enough where we only intermittently need to be boosted," he said, adding that he doesn't think a schedule of receiving shots as often as once every 4 months is feasible.

However, waning immunity is not surprising, he noted.

"The protection that follows infection is not particularly durable, and you would expect, that being the case, that the protection following [vaccination is] not going to be durable," Fauci said. "We are trying very hard to develop vaccines that give a greater degree of durability of immunity."

The mRNA vaccines have a "phenomenally" high degree of efficacy and safety, but the durability of protection isn't life-long or even years long. "We've got to do better," he added, pointing out that improvements in durability may involve adjuvants.

In response to a question from MedPage Today about the potential significance of variant-specific vaccines, Fauci noted that NIAID is currently testing them. The ongoing COVID-19 Variant Immunologic Landscape (COVAIL) trial is administering a fourth ancestral strain-specific dose, a variant strain-specific dose, or both to people who have received a third dose of mRNA vaccine; initial findings could be available this summer.

Fauci stressed that it will be essential to continue to monitor for variants. There are currently subvariants of Omicron that are 25% to 30% more transmissible, though they are not necessarily more severe.

"But we always have to be on the lookout and vigilant," he said. Of particular concern is a variant that may be so different from prior strains that it evades immune protection.

Also important, Fauci noted, is ensuring that the American public and healthcare providers know about the oral antiviral Paxlovid.

Ultimately, to attain control, case counts need to be low enough that they are not disrupting society, overwhelming hospitals, or creating fear, Fauci said, putting SARS-CoV-2 in a similar place as other respiratory viruses like RSV and influenza.

But he made it clear that the U.S. is still dealing with a pandemic, and that individual risk assessments and choices about health remain necessary. It's important not to question others' personal decisions because they may be made due to personal factors that are not outwardly obvious, he said.

https://www.medpagetoday.com/infectiousdisease/covid19/98486