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America's top infectious disease expert predicts the world will have a coronavirus vaccine "in the next few months", but says people are unlikely to be able to go about their normal lives until at least the end of next year.
"I think it will be easily by the end of 2021 and perhaps into the next year before we start having some semblance of normality," Dr Anthony Fauci told a Melbourne audience on Wednesday.
Dr Anthony Fauci speaking at a University of Melbourne webinar on the global response to COVID-19.
"If normal means you can get people in a theatre without worrying about what we call congregate-setting super infections, if we can get restaurants to open almost at full capacity …"
But the director of the United States' National Institute of Allergy and Infectious Diseases said stubborn anti-vaxxer beliefs, political division and the self-interested meddling of politicians would all make the job of immunising the world against COVID-19 tougher.
Masks, for example, had become a political symbol in the US, Dr Fauci said.
"People were ridiculed for wearing masks; it depended on what side of the political spectrum you were at, which was so painful to me as a public health scientist."
Speaking from his US home as part of a University of Melbourne webinar, Dr Fauci – recently called an idiot by President Donald Trump – said scientists must never be afraid to tell politicians what they don't want to hear.
"One of the traps some scientists get into is, they like the idea of having impact at a national and global level and sometimes might hesitate to say something that is not popular to the politicians," he said.
Dr Fauci foreshadowed vaccine hesitancy being a real problem when the vaccine does arrive – fears stoked by the actions of the US government.
"Right now, there is a reluctance to take vaccines," he said.
"Partly fuelled by … mixed signals that are coming out from the government, that is not being very helpful."
Professor Sharon Lewin, director of the Peter Doherty Institute, who also spoke at the webinar, said Australian data showed about 20 to 30 per cent of Australians may be hesitant to have a COVID-19 vaccine.
But current predictions also suggest only 60 to 70 per cent of the population need to be vaccinated for herd immunity to develop, meaning vaccine hesitancy may not be a major hurdle.
However, Professor Lewin cautioned the first vaccines were unlikely to stop people getting infected. Instead, these vaccines would be designed to stop people falling seriously ill with the virus.
It was likely they would go first to those at highest risk of death, she said.
"The first generation vaccines largely protect against disease, not infection.
"So the target population is a little bit different to how we think about, say, the measles vaccine, where we want to vaccine absolutely everyone."
Outside of a vaccine, Dr Fauci said antiviral drugs – currently under development in labs around the world – would fundamentally shift the course of the pandemic.
These drugs could be delivered to patients as soon as they fell ill, helping their body clear the virus in a matter of days and substantially cutting down on mortality.
Dr Fauci applauded Australia's response to the pandemic.
"Australia is one of the countries that has done quite well. New Zealand has done well. I would like to say the same for the US, but the numbers speak for themselves. We've had 8.7 million infections, 225,000 deaths, and we are… getting worse and worse."
Why? In part, Dr Fauci said, it was because Australia was an island nation with strong control of its borders.
Victoria's hard lockdown in the second wave, though bitterly contested, had been driven by scientific modelling, Professor Lewin said.
"The government took a very hard line; we've had a lockdown for 12 weeks," she said. "It’s been driving the business community crazy because they just want to open but the government’s sat really tightly on the science."
Dr Fauci said two scientific mysteries continued to trouble him about the virus: how long natural immunity lasts and what the long-term effects might be.
It remains unclear just how long antibodies the body generates against COVID-19 last for.
While scientists believe it to be at least several months, it could be less than a year – opening the risk of regular reinfections, just like the common cold.
There is also early evidence of long-term health risks from the virus.
Dr Fauci pointed to a study showing a significant proportion of people who have recovered from the virus – and seem otherwise well – have markers for heart inflammation.
"That may be irrelevant," he said. "But I don’t know that right now."
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