NIAID Director Discusses Readying for Next Infectious Disease Threat

Anthony Fauci, MD

In a presentation at the Internal Medicine Meeting in San Diego in March, Anthony Fauci, MD, Director of the National Institute of Allergy and Infectious Diseases (NIAID) since 1984, explained how experiences responding to infectious disease outbreaks have helped to prepare for future threats.

That presentation is the basis for a recent publication co-authored with NIAID colleagues, which he discussed with MD Magazine.

Fauci and colleagues described the critical role that the NIAID played in the research response to SARS (Severe Acute Respiratory Syndrome), for example, helping to develop preclinical vaccine candidates in less than a year by using several novel technologies.

Although the SARS pandemic resolved before a vaccine became available, the candidate products served as templates for the DNA vaccine platform used in approaches to other coronaviruses.

"Moreover, this rapid response set the pace for our research response to future infectious disease threats," Fauci and colleagues wrote.

Fauci told MD Magazine that it took about 20 months from the time the NIAID sequenced the SARS virus, to the time it was placed into a phase 1 trial.

“Then, if you go down the line, to the different challenges since then, it became less and less,” Fauci said. “Going from SARS to H5N1 to H7N9, then you get to Zika, which took about 3 to 4 months to go from the time we sequenced it to the time we had a DNA vaccine."

Fauci advocated for a strong scientific response in the midst of outbreaks.

“You have to anticipate in certain ways, that you can be flexible in responding, such as the building up of platform technologies where, when you see a new pathogen, you don't have to go through all the rigorous issues of identifying it, growing it,” Fauci said. “Each time you get challenged with a different pathogen, you take less and less time to come out with an intervention like a vaccine."

The H1N1 influenza pandemic began just months after the inauguration of President Barak Obama in April 2009, followed in quick succession by outbreaks of chikungunya in the Caribbean in 2013, Ebola in West Africa in 2014, and by Zika virus in the southern regions of the Americas in 2015 — with 373 symptomatic cases now in the US, recorded by the Centers for Disease Control and Prevention (CDC).

"In response to this (Zika) outbreak, the NIH rapidly launched a comprehensive research program to better understand the natural history and pathogenesis of Zika and develop effective countermeasures, such as vaccines," Fauci and colleagues wrote.

The Zika candidate vaccine went relatively quickly into phase 1 study, and is currently in phase 2 trials, Fauci said.

In addition to the pursuit and perfection of adaptable new platform technologies, Fauci emphasized the importance of ensuring public health measures such as global surveillance to detect outbreaks early; transparency, collaboration and open communications in response to outbreaks; and building and incorporating health care infrastructure domestically and internationally.

Fauci also spoke to the importance of having flexible funding mechanisms.

"What we were talking about, particularly during Zika, was the need for a public health emergency fund, similar to the fund that one has with FEMA (Federal Emergency Management Agency)," Fauci said.

Fauci is also looking toward a considerable, concerted effort to develop a universal influenza vaccine.

"Influenza is always a threat — at the seasonal level and at the potential for a pandemic level," he said. "For that reason, we need to get a vaccine that we can stockpile and have ready for an emergency, instead of chasing it when it occurs."

The article based on Fauci's presentation on applying lessons from past outbreaks to emerging infectious disease threats was published in the December issue of Annals of Internal Medicine.