You’ve probably heard the name Anthony Fauci more times than you can count over the past few years. With almost forty years as the director of the National Institute of Allergy and Infectious Diseases at the National Institutes of Health, Fauci emerged as the face of America’s fight against the coronavirus.

Now, taking on the role of a Distinguished University Professor at Georgetown University’s School of Medicine and the McCourt School of Public Policy, Fauci reflects on the COVID-19 pandemic and what it means for the future. For him, January 2020 was the realization of a dreaded scenario: the outbreak of a virus that had the potential to — and did — cause a global pandemic.

But as the dark clouds of COVID-19 begin to disperse, Fauci draws attention to a different challenge — our fading “corporate memory.”

Charting the lessons behind the pandemic

In a recent article in Science Translational Medicine titled “What keeps me up at night”, Fauci dives deep into the lessons we can glean from our experience with COVID-19. These lessons, Fauci hopes, should make us better equipped when the next pandemic strikes. That’s a ‘when’, not an ‘if’.

These lessons, according to him, fall into two distinct categories: the realm of public health and that of science.

The success of science

When you think about the rapid development of vaccines and treatments for COVID-19, it’s hard not to marvel at the achievements of modern science. Fauci believes that if there’s a silver lining to the COVID-19 story, it lies in the “scientific bucket.” This success wasn’t just an overnight miracle. It was the culmination of years of dedicated research.

Take, for instance, the groundbreaking work of Drew Weissman and Katalin Kariko. Their discoveries from more than two decades ago laid the foundation for effective mRNA vaccines against COVID-19, earning them the 2023 Nobel Prize in Medicine or Physiology. Imagine, in just 11 months after identifying the virus’s sequence, safe and effective vaccines were being administered, potentially saving millions of lives. Desperate times called for desperate measures, and science rose to the occasion.

Dr. Fauci highlights a novel approach for future preparedness: the prototype-pathogen strategy.

In simple terms, it’s about focusing on certain virus families known to infect humans and pose pandemic risks. Although SARS-CoV-2, the virus that causes COVID-19, was new to science, it was not completely novel. Scientists had a good understanding of other coronavirus strains, including the original SARS and MERS. It didn’t take long at all before scientists completely sequenced the genome of SARS-CoV-2 and identified the key molecular targets for a vaccine — much of the wait was due to testing for efficacy and safety.

By deeply studying selected viruses within these families, we can design countermeasures for related viruses. It worked extremely well with COVID-19 and the same approach should prove useful when the next pandemic is banging on our doorstep.

The faltering of public health

But it wasn’t all smooth sailing. Despite the leaps in scientific research, there were significant hurdles in the public health response. Fauci, often considered the face of the U.S. public health response during the pandemic, candidly discusses these challenges.

Fractured health care systems, miscommunication, supply chain issues, and misinformation were just a few of the hurdles. The tug-of-war between health guidelines and political divides also didn’t help the situation.

Then, of course, there was the predictable but very poorly handled issue of vaccine hesitancy — largely based on political divides and misinformation as well. And who can forget the maddening inconsistencies regarding masking, distancing, and lockdowns which could change with little notice or could be radically different on a state-by-state basis?

“The negative impact of vaccine hesitancy on the part of certain segments of the U.S. population was manifested in high rates of hospitalization and deaths that became clear after the rollout of highly effective vaccines,” Fauci wrote.

From the disjointed coordination between state governments to supply chain hiccups and the rampant spread of misinformation, our public health infrastructure showed its vulnerabilities.

“The lessons learned in the public health bucket are more complex and nuanced than those in the scientific bucket, but they are as important if we are to successfully address the next challenge of an emerging pathogen of pandemic potential,” says Fauci.

We must learn from our mistakes

The overarching message from Fauci is clear: we must remember. Time has a way of dulling the sharp edges of crises past. As the immediate threat recedes and life returns to a semblance of normalcy, our vigilance often wanes. But, as Fauci warns, this transition from being reactive to being proactively prepared is where we tend to stumble.

Fauci hopes that the unsavory memories of COVID-19 remain etched in our collective consciousness, spurring ongoing support for both scientific research and public health preparedness.

“In my almost 40 years in chasing and preparing for emerging microbes, I have experienced the transient nature of “corporate memory” related to affronts on global health,” Fauci wrote.

“Over and over, after time has passed from the appearance of an acute public health challenge, and after cases, hospitalizations, and deaths fall to an ‘acceptable’ level … the transition from being reactive to the dwindling challenge to being durably and consistently prepared for the next challenge seems to fall flat. Hopefully, corporate memory of COVID-19 will endure and trigger a sustained interest and support of both the scientific and public health buckets.”

“If not, many of us will be spending a lot of time awake in bed or having nightmares when asleep!”