Fauci Hails Early COVID-19 Vaccine Results With ‘Cautious Optimism’

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As part of its ever-expanding inventory of digital resources, APA’s SMI Adviser has released a new mobile app that will enable individuals with serious mental illness (SMI) to plan out and share their treatment desires in advance of a mental health crisis. Known as My Mental Health Crisis Plan, this is SMI Adviser’s first patient-focused mobile application.

“Cautious optimism” is how Anthony Fauci, M.D., director of the National Institute of Allergy and Infectious Diseases (NIAID), described the prospects for an imminent COVID-19 vaccine during a virtual address to the 2020 annual meeting of the Academy of Consultation-Liaison Psychiatry (ACLP).

Speaking just days after Pfizer Pharmaceuticals announced positive results of its phase 3 trial of a vaccine, Fauci said that “by the end of the calendar year and into 2021, we hope to begin to administer the first doses of an effective vaccine, first to those at highest priority and then to everyone else.”

(For further reporting from the ACLP meeting, see future issues of Psychiatric News.)

Fauci outlined the public-private effort led by the National Institutes of Health (NIH) involving six pharmaceutical companies pursuing several different strategies but with common primary and secondary endpoints, shared databases, and common safety monitoring protocols overseen by NIH. The six companies are Novavax, AstraZeneca, Johnson and Johnson, Sanofi/GlaxoSmithKline, Moderna, and Pfizer/BioNTech.

The coordinated strategy is described in full in an article co-written by Fauci and NIH Director Francis Collins, M.D., and published in the May issue of Science Magazine. Co-authors also included Lawrence Corey, M.D., a professor in the Department of Laboratory Medicine and Pathology at the University of Washington, and John Mascola, M.D., director of the Vaccine Research Center at NIAID.

“[S]everal major vaccine platforms are moving toward clinical evaluation,” they wrote. “These include traditional recombinant protein, replicating and nonreplicating viral vectors, and nucleic acid DNA and [messenger RNA] approaches. … No single vaccine or vaccine platform alone is likely to meet the global need, and so a strategic approach to the multipronged endeavor is absolutely critical.”

In his address to the ACLP, Fauci—who has been the most public face on the White House Task Force on Coronavirus—referenced results announced by Pfizer from its trial of a messenger RNA vaccine in more than 44,000 subjects that demonstrated greater than 90% efficacy.

Three days after Fauci spoke, Moderna reported similar early success in its phase 3 COVE study (Coronavirus Efficacy and Safety study). Both vaccines require two doses—the Pfizer vaccine doses are spaced three weeks apart; the Moderna vaccine, a month.

Fauci spoke to ACLP as the number of cases, hospitalizations, and deaths was rising precipitously. He said that following the initial spike in cases in March and April (principally in New York), nationwide case numbers fell but did not return to a baseline, and they began to rise again in the summer in other parts of the country.

Fauci said that after June 19, there was a resurgence of cases due to reopening the economy, which occurred—in some areas of the country—without sufficient adherence to social distancing and other prevention guidelines.

He reiterated the five fundamental measures to prevent infection with COVID-19: wearing masks, physical distancing, avoiding indoor crowds, confining group activities to outdoors, and hand washing. “If those five were adhered to universally, it is clear we would not be having the resurgence of cases we are currently seeing,” he said.

Fauci outlined the history of the virus from its discovery in Wuhan, China, in December 2019, its relationship with other coronaviruses, and its more lethal effects on the elderly and those with preexisting conditions.

“For people of any age with certain conditions, there is an increased risk for severe COVID illness,” Fauci said. “Paramount among these are obesity, chronic obstructive pulmonary disease, hypertension, and chronic heart conditions.”

Severe COVID-19 illness can involve acute respiratory syndrome and/or kidney injury or failure. Among children there has been evidence of a “curious multisystemic disease resembling Kawasaki’s disease.” Fauci also noted the emergence of a “post-COVID-19 syndrome” that may affect as many as a third of those who have been infected, involving lingering symptoms of fatigue, muscle aches, and inability to concentrate.

He said the “profound disparities” in illness among African Americans and Latinos are due in part to the higher prevalence of comorbidities and to the fact that jobs commonly held by individuals in those groups are likely to require them to be exposed to more people.

Finally, Fauci referenced the spike in mental illness, including substance use and suicidal ideation, “associated with extreme restrictions during lockdowns.”

“Medical workers themselves are experiencing a mental health crisis because of the strain of taking care of so many desperately ill individuals,” Fauci said. ■