As Yogi Berra once said, “It ain’t over till it’s over,” says the Chief Medical Advisor to the President in an article in NEJM

Anthony S. Fauci, President Biden’s chief medical adviser has said there is no reason to believe that the threat of emerging infections will diminish, since their underlying causes are present and most likely increasing.

“In addition to the obvious need to continue to improve on our capabilities for dealing with established infectious diseases such as malaria and tuberculosis, among others, it is now clear that emerging infectious diseases are truly a perpetual challenge,” Fauci, who has led the National Institute of Allergy and Infectious Diseases since 1984, said in an article published by the New England Journal of Medicine.

“As one of my favorite pundits, Yogi Berra, once said, “It ain’t over till it’s over.” Clearly, we can now extend that axiom: when it comes to emerging infectious diseases, it’s never over. As infectious-disease specialists, we must be perpetually prepared and able to respond to the perpetual challenge.”

He recalled his days after completing residency training in internal medicine in 1968 and undertake a 3-year combined fellowship in infectious diseases and clinical immunology at the National Institute of Allergy and Infectious Diseases (NIAID).

“Unbeknownst to me as a young physician, certain scholars and pundits in the 1960s were opining that with the advent of highly effective vaccines for many childhood diseases and a growing array of antibiotics, the threat of infectious diseases — and perhaps, with it, the need for infectious-disease specialists — was fast disappearing,” Fauci wrote adding that despite his passion for the field he was entering, he might have reconsidered his choice of a subspecialty had he known of this skepticism about the discipline’s future. “Of course, at the time, malaria, tuberculosis, and other diseases of low- and middle-income countries were killing millions of people per year.”

He said in the 1960s and 1970s, most physicians were aware of the possibility of pandemics, in light of the familiar precedent of the historic influenza pandemic of 1918, as well as the more recent influenza pandemics of 1957 and 1968.

“However, the emergence of a truly new infectious disease that could dramatically affect society was still a purely hypothetical concept,” he added.

“That all changed in the summer of 1981 with the recognition of the first cases of what would become known as AIDS. The global impact of this disease is staggering: since the start of the pandemic, more than 84 million people have been infected with HIV, the virus that causes AIDS, of whom 40 million have died,” the article read.

“In 2021 alone, 650,000 people died from AIDS-related conditions, and 1.5 million were newly infected. Today, more than 38 million people are living with HIV,”

Given the lack of global equity in the accessibility of these lifesaving drugs, HIV/AIDS continues, exacting a terrible toll in morbidity and mortality, 41 years after it was first recognized, he added.

During his tenure as NIAID director, Fauci said they were challenged with the emergence or reemergence of numerous infectious diseases with varying degrees of regional or global impact.

“Included among these were the first known human cases of H5N1 and H7N9 influenza; the first pandemic of the 21st century (in 2009) caused by H1N1 influenza; multiple outbreaks of Ebola in Africa; Zika in the Americas; severe acute respiratory syndrome (SARS) caused by a novel coronavirus; Middle East respiratory syndrome (MERS) caused by another emergent coronavirus; and of course Covid-19, the loudest wake-up call in more than a century to our vulnerability to outbreaks of emerging infectious diseases,” Fauci wrote.

“The devastation that Covid-19 has inflicted globally is truly historic and highlights the world’s overall lack of public health preparedness for an outbreak of this magnitude,” he wrote.

However, he added, one highly successful element of the response to Covid-19, was the rapid development-enabled by years of investment in basic and applied research-of highly adaptable vaccine platforms such as mRNA and the use of structural biology tools to design vaccine immunogens.

“The unprecedented speed with which safe and highly effective Covid-19 vaccines were developed, proven effective, and distributed resulted in millions of lives saved.”