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Dr. Anthony Fauci On Boosters, Breakthrough Cases And CDC Data

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Following is the unofficial transcript of a CNBC interview with National Institute of Allergy and Infectious Diseases Director & White House Chief Medical Advisor Dr. Anthony Fauci on CNBC's“Closing Bell” (M-F, 3PM-5PM ET) today, Friday, September 17th. Following are links to video on CNBC.com:

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Fauci: I Think The Critical Issue Is The Age Cutoff, If Any, For Boosters

Dr. Fauci On Boosters, Breakthrough Cases And CDC Data

MEG TIRRELL: So, this FDA panel of outside advisors has just voted down, recommending a booster shot from Pfizer's vaccine for people 16 and older. Howeve,r this is not necessarily going to be the final vote today on a booster shot. Right now, this committee of outside experts is discussing whether they would be comfortable voting for perhaps a different age group. We just heard one expert on the panel say she might want to talk about recommending the booster for over age 50 and earlier we heard one person say maybe 60 or 65 and so right now, this is the question the panel was asked to vote on whether they would recommend a booster dose based on the safety and efficacy data they've seen from Pfizer six months out from the primary vaccination for people 16 plus, that has been voted down but it's not the end of this story. We're going to go back to listening to what these experts are saying and we'll let you know if they take another vote on a different age group, Sara, back to you.

SARA EISEN: Keep us posted Meg. Thank you, Meg Tirrell. Well you make your luck, we have the perfect person to respond to that news. White House Chief Medical Adviser, Dr. Anthony Fauci joins us now. Dr. Fauci, it's great to have you. What, what's your reaction to that decision from the FDA advisory panel? Are you surprised?

DR. ANTHONY FAUCI: No, in some respects, I'm not surprised that they didn't vote that it goes all the way down to 16 years old. But as Meg said, what's going on right now which is going to be critical discussion is going to be at what age would they consider making the recommendation for the third boost. Is that going to be 60, 50, 40, we don't know. And that's the reason why we just need to wait and wait for the deliberation and the decision of the advisory board and then what the FDA will do and taking that recommendation or not. So, there's still a lot of ahead even though we have one element of the decision, not the decision but the recommendation, and the vote which as I mentioned it's not totally surprising. I think the critical issue is at what age will be the cut off, if any.

EISEN: And based on the, the research and the studies you've seen from Israel and elsewhere, Dr. Fauci, would you recommend a booster shot for the older cohort which they still might vote on here?

FAUCI: You know I, I have publicly said that looking at the data from Israel that I would be in favor of boosters. I'm not going to give you my age group that I would because I don't want to get ahead of the advisory committee at the time that they're deliberating. I think that would be inappropriate. We have a good group there. I'm very interested to see what their vote is. So, I really would like to respectfully refrain from making an age prediction.

EISEN: But so, didn't you advise President Biden to announce booster shots which he did several weeks ago and actually targeted next week for Americans—


EISEN: To give, to get their boosters?



FAUCI: No, that's incorrect. What we said that we need to plan in case the FDA and the CDC make the recommendation. We said we need to plan and be ready at the week of September the 20th. One of the things that often gets misinterpreted that we made no decision. We said that we feel that there would be a likelihood that we would need boosters and if so, we need to be prepared because you can't just snap your finger when a decision comes and have all the parties that would be involved in implementing the rollout. But in every statement, including the statement that we all signed out on myself, my colleagues, the Surgeon General, the director of NIH, the acting commissioner of FDA, all of them and the people from the various agencies that were involved in the discussion. We always said, provided and under the condition that the FDA give a regulatory decision about what can be done and that's the beauty of the situation because that's what's going on right now. We're in a deliberative mode and we will, I guess by the end of this day, have an answer as to what the advisory committee will recommend so there's no incompatibility with what went on. It was always contingent on what the FDA would be deciding.

MICHAEL SANTOLI: Dr. Fauci, I'm wondering about what goes in all the inputs that would go into a recommendation, whether by the FDA and then by the administration to getting booster shots. Is it purely a matter of does the science suggest that there is effectiveness to adding booster protection that outweighs the risk, if there is an incremental risk or there, is there a messaging consideration here about, you know, will it encourage more people to just in general get vaccinated, will it discourage some people from the idea oh if I need boosters, I'm not going to get my initial vaccination . Is it just about what the numbers tell you or are there other concerns?

FAUCI: Well, it really is mostly a risk benefit ratio. The one thing we do know is that in the clinical studies, some that we've done here, the Israelis have done far more, that when you give a third boost, you dramatically increase the protection and the case that they looked at, they dramatically increased the protection against infection and in some respects against severe disease. So we know that boosters can do that. No doubt there's data. The recommendation of to whom to give it to will always be a risk benefit ratio. We know that the risk of the mRNA, which is the vaccine question now with Pfizer, has a very rare adverse event that did not prevent the recommendation for that vaccine for younger people at two doses. So, the question that the advisory committee is considering and looking at, at what age is that risk of this rare adverse event, which was rare enough as to not preclude at all the recommendation for the two doses, what is the risk of that in a certain age group for the people who might be getting a third dose. And that's what they're going to be talking about right now. How far down in the age group if you make a recommendation for a boost and I'm not going to get ahead of them to anticipate that, but if they make a recommendation for the third boost, at what age cutoff will they do that. I think that's the issue that's being discussed now. It doesn't really have much to do with the messaging if you give a boost will you, will you get people feeling that they shouldn't get the first shot to begin with, I don't think that's the case, to be honest with you. It really is fundamentally a benefit versus risk ratio.

EISEN: What about the million people are so in this country, Dr. Fauci, that have already gotten a booster, whether they were qualified for it or not? I know a lot of people anecdotally who have just already done it because they've looked at the studies themselves and they're, they're looking at Israel and they're talking to other people and they want to protect themselves.

FAUCI: Right, Well, people are doing that and people will do that because a lot of that data has become public. Again, people do that. It is not advised to do that until you get the approval from our regulatory authorities but people, you know, can look at this and make a risk benefit type of decision for themselves individually but we would hope that people would wait until you get the imprimatur from the regulatory agencies but you're absolutely correct. We all know of many people who've done that. There is one group that we want to make sure there's no confusion about, those who are immunocompromised have already been cleared to get the third dose, those are people who are transplant patients, who are receiving immunosuppressive therapy, cancer patients who are on chemotherapy, autoimmunity patients who are receiving an immune compromising doses of immunosuppressive agents, that's already a done deal. Those people can and should be getting the third boost. The others are just what I mentioned with regard to a risk benefit ratio that is always under consideration.

EISEN: I still don't quite understand, Dr. Fauci, and I would think it would play into this decision at some point why US government, why the CDC isn't collecting and publishing data on breakthrough cases, aside from hospitalizations and deaths. Is it because they don't want to alarm people or dissuade people from getting the vaccine because they might see that it doesn't protect you, the vaccines don't protect you from getting the infection? Certainly, the benefit is there with hospitalizations and deaths but there are breakthrough cases all over the place.

FAUCI: Yeah, there are breakthrough cases and again the CDC is not doing something or doing something because of a concern about alarming that's not the case that what they do is based on science, they will be now collecting more data on breakthrough cases that are not symptomatic and that don't go to the hospital. That is now being done in different areas of their cohorts.

EISEN: Do you have any explanation for why the numbers on Israel continue to look worse. They're now at the highest level of cases that they have ever been in any surge for a population that's 80% vaccinated and has administered the most booster shots. How do you explain that and what can we learn from that so we don't follow that path as we have been following in this trajectory of the disease?

FAUCI: Yeah, they are having cases and breakthrough cases. I think people need to understand and it is understandably confusing that when you get a very large proportion of your population that's vaccinated when you have a vaccine that is not 100% protective, as no vaccine is, and particularly when the vaccine was designed and in the clinical trials that proven its efficacy, did not prove its efficacy against infection. It approved its efficacy against clinically apparent disease. So, the Israelis are about a month or more ahead of us in every aspect, temporarily, not necessarily quality but temporarily. And they do very good work, I must say that. And what they have is they have a much, they have a larger proportion of their population fully vaccinated than we do. We're close behind but they have a larger proportion. When you have such a fully vaccinated portion of your population, you will get breakthrough infections because of the reason I just mentioned the vaccines are not 100%, but what they're showing is very clearly in what we show too, that people who are vaccinated when they do get a breakthrough infection, what happens is that it is much more highly likely that that will not be a serious outcome that it will either be an asymptomatic infection or a mildly to moderately symptomatic, usually mildly. The other thing that's important is that Israel has a healthcare delivery system quite different than ours. They have I believe four, maybe five HMOs in which all the data are easily accessible. So they are picking up breakthrough infections that are essentially non symptomatic because when someone comes in for another reason, they'll get a test so they know more about breakthrough effects and so when you see the number of cases that are going up despite booster and despite a primary vaccination regimen that they got with two doses, remember they're following very carefully even asymptomatic individuals so that makes a difference.

EISEN: Dr. Anthony Fauci, very good to have you, especially as this news has been unfolding. Thank you so much for your time.

FAUCI: Good to be with you. Thank you.


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