Kim Hjelmgaard, a London-based world-affairs correspondent for USA TODAY, interviewed Francis Collins, the director of the National Institutes of Health, as part of ongoing coverage of the coronavirus pandemic.
This is a lightly edited transcript of that interview.
When will there be a vaccine?
We are flat out on this. But everyone needs to recognize that even flat out for a vaccine means we're a year to a year-and-a-half away. And that would be breaking the record by a factor of three or so given how long it usually takes to get something fully ready to be distributed to the public. Two days ago (March 16), the first volunteers were injected with a vaccine that is a collaboration between the NIH research center and a company called Moderna. There are 45 volunteers in Washington state and this will be our opportunity to find out whether it generates any good and safe responses. Depending on how that goes, and if it's remarkably positive also provides efficacy, it will move on to a phase 2 trial with larger numbers. Following that, but not until the fall, you'd expect to see a phase 3 trial, and possibly an opportunity to scale this up because if it works we may need hundreds of millions of doses. But it would need at least a year for wide deployment, which is why people should not be waiting to take actions that will help minimize the impact of this growing pandemic. (Editor's note: Scientists, companies and governments around the world are racing to develop and test other vaccines.)
Can the U.S. 'flatten its curve' – slow down the spread of coronavirus – as places in Asia have?
China, South Korea, Singapore, Taiwan – we can take very significant lessons from these places. Anyone who looks at the experiences in Asia will see highly activated systems to avoid further transmission by having people shelter in place, avoid interactions, hand washing and all the other things that we know make a difference (easy access to testing and tracing). That lesson should apply to any circumstance where this virus is spreading. It may be that a country like China has a more top-down ability to insist on certain sets of behavior changes. But we ought to be able to do it in our way, in a bottom-up fashion. Americans are smart. They now have some data they can look at it to know how important this is. We just have to get together and say, as a people, this is so important for saving what may otherwise be a million lives lost.
Can the U.S. avoid the dire Italy-like situation?
We should be able to blunt it. But let's be clear: There's going to be a very rough road in the weeks and months ahead of us. They are trying to manage the situation and make awful decisions about who gets a ventilator and who doesn't. God help us if this happens more broadly across the world and we certainly hope that it doesn't happen here. When you make a decision about one of these measures, such as social distancing, and it's front of mind for everybody, don't expect that you can see an immediate consequence. Right now, in the U.S., we supposedly have 6,500 cases (as of March 16). That's got to be a vast underestimate because we have not been able to sample all the people who may be infected or who have no symptoms at all. Some of these people are already destined to become very sick. If we did everything right today, you would still see the numbers going up over the next two weeks because of what's out there already. We can't change that. But, what we might be able to do is change what's going to happen three or four weeks from now. That's our challenge. When you're on an exponential curve every moment is dangerous. This is a particularly critical moment for us to try to bring all the resources and determination of government and the American people to try to get off of it.
How concerned are you about a second wave of infections when restrictions are lifted?
The risk of a second wave when much of the population is still not immune because they didn't get it in the first place is always there. China will be watching this closely (now that it has started to ease restrictions in some areas and reported no new cases). Until we have a vaccine, and we get herd immunity with 90%-95% of the population immunized, this risk of another wave is not going away. We have to think about that, too. If we're organized enough, if we're smart enough, if we're motivated enough, to flatten our curve this year, and, say, only 10% of the U.S. population gets it this year, then when the next wave comes along we'll be better off. But only if we have the vaccine.
Should the U.S. impose a total lockdown now?
It's so hard to answer that but what I would say is what Anthony Fauci (director of the National Institute of Allergy and Infectious Diseases) has said a few times in recent days and that is that the approach we should be taking right now is one that most people would find to be too drastic because otherwise it is not drastic enough.
Does the U.S. have enough medical staff for this?
We're getting there. Hospital ships are being placed on the West and East coasts. The next few months will determine whether we are outstripping our capabilities or not. I don't know any hospital that isn't running around trying to maximize what it can do. Here at NIH we run a hospital and we stopped elective admissions ten days ago to make sure we have all the resources we may need for extremely ill patients. I imagine most hospitals have done the same. But when it comes down to it, will we have enough physicians, nurses, respiratory therapists, laboratory technicians, ventilators? We don't know what the need is going to look like and we should be doing everything we can to spread this need out over a few months instead of having it hit in one terrible crisis, which is what we are seeing happening in Italy. It would be almost impossible to look at the situation in Asia and just say they were lucky their curves flattened. We are at a point in the U.S where we are doubling the number of new cases about every two to three days. That's called an exponential curve. If you map that up next to Italy you might say we're about eight to 10 days behind them in terms of infections. We better get busy.
Is testing improving?
It got off to a rocky start. We can't fix that now. What we can do now is to make sure it's available much more broadly for people with symptoms. Drive-thru testing should help. But it may also freak everyone out when these facilities are widely set up because the number of known cases will take a sudden leap up. Although nobody should assume that means that a lot more people just got infected all of a sudden.