Even as the first doses of the Pfizer-BioNTech COVID-19 vaccine are being distributed and medical professionals are being vaccinated across the U.S. and Canada, there are still fears of even higher surges of caseloads related to holiday gatherings.

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In early December, just days before the Food and Drug Administration granted an emergency use authorization (EUA) for the Pfizer COVID-19 vaccine, the winter surge of COVID-19 cases continued to be alarming. More than 100,000 individuals were hospitalized each day and more than 3,000 died each day in the post-Thanksgiving period, with total deaths at the time approaching 300,000.

Anthony S. Fauci MD ,director of the National Institute of Allergy and Infectious Diseases and a member of the White House coronavirus task force, discussed the latest statistics and the impact of the EUAs for COVID-19 vaccines with JAMA Editor-in-Chief Howard Bauchner, MD, in a recent episode of “Conversations  with Dr. Bauchner,” a JAMA Network™ livestream and podcast.

In December, Dr. Fauci also agreed to serve as President-elect Joe Biden’s chief medical adviser. Biden will be the seventh president that Dr. Fauci has advised during his career.


Dr. Fauci described the post-Thanksgiving statistics as “record-breaking,” and noted that public health officials have not yet seen that full effect of travel and group celebrations over the Thanksgiving holiday.

He said he believed those reported cases were just the beginning, because usually cases surge about two to three weeks following a particular event when people congregate. And that would mean the surging cases would continue right into the Christmas travel season, he explained.

“And then we are going to do the whole thing over again. We are going to have more people traveling and instead of just having a weekend of the holiday, it’s well over a week. It’s Christmas and the week between Christmas and New Year’s and then New Year’s,” Dr. Fauci said.

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Public health officials should advise people to limit their travel and group gatherings as much as they possibly can, he added. While everyone anticipates some pandemic relief from the introduction of new vaccines, that cannot be expected for several months.

Until then, he said, the public must continue mitigation activity such as physical distancing, wearing masks and avoiding group activities.

“It’s particularly challenging given the terribly historic numbers that we are seeing,” he said. The rapid development of vaccines is good news, he said, but as doses are rolled out, first to at-risk medical professionals and then eventually individuals, “now it is our challenge to convince people that it [the process] wasn’t rushed in any reckless way.”

Dr. Fauci explained how vaccine efficacy was analyzed and reviewed. For example, the Pfizer-BioNTech clinical trial found about 95% efficacy in prevention of clinically recognizable disease, but did not measure whether the vaccine would lower the presence of virus to such a level that it would prevent actual infection and transmission to others, he said.

Efficacy levels also vary somewhat by age groups. While efficacy never dropped below 90% for any age group studied, the rates did fall to 91% for the elderly, but Dr. Fauci said that analysis of the phase 1 trials of the Pfizer vaccine indicated that the development of the neutralizing antibodies was as good in the elderly as it was in other test groups.

Two recipients in the United Kingdom also reported significant allergic reaction, but Dr. Fauci noted that the trial pool excluded subjects with a history of very strong allergic reaction. Both recipients who experienced a reaction carried EpiPens because of their history of allergic reactions.

“Now that we have this heads up, what you do is what you would do with anything in clinical medicine. You stay alert for it and—if it happens again—people are in a facility that can take care of them,” he said.

Dr. Fauci anticipated a timely EUA for the Moderna vaccine, and between Pfizer and Moderna sources, millions of doses of vaccine to be available by early 2021. Operation Warp Speed, the government vaccine project, is predicting about 100 million each from Pfizer and Moderna and about 40 million between them in December and 50 million between them in January. Other vaccine providers may start to contribute doses in March or April.

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That may seem like a lot of doses, but Dr. Fauci said he does not expect vaccination of the next group recommended for vaccination—those outside health care, long-term care or high-risk patients with underlying conditions—until late March or early April. Read more about who’s first in line for coronavirus immunization.

Subscribe to the “Conversations with Dr. Bauchner” podcast. Each week, he interviews leading researchers and thinkers in health care about their recent JAMA articles. Go beyond an article recap, and delve into the background, context and implications of the study or editorial.

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