Dr. Anthony Fauci is reflecting on his decades of work at the National Institutes of Health, and everything he’s learned through his time spearheading the defense against the COVID-19 pandemic—including regarding mistakes that were made. Dr. Fauci appeared on the Science Friday podcast and spoke with host Ira Flatow about his experience dealing with the most deadly virus outbreak since 1918, and his concern about how science and medicine will be approached in the future.
“We have a pandemic, the likes of which we have not experienced on this planet since the iconic Influenza pandemic of 1918,” Dr. Fauci says. “Simultaneously with a degree of divisiveness in this country in which political ideologies, missing misinformation, disinformation, conspiracy theories, have all conflated together to make what you would hope have been a unified, concerted, pulling-together effort to fight this pandemic. Instead, we have such differences in approaches that are not just honest differences of opinion, but that are manifested by attacks, attacks on science, conceptually, verbal, and sometimes physical attacks on public health officials.”
Dr. Fauci is deeply disturbed about what some of the backlash against health officials means for future health emergencies. “It is most extraordinary and most disturbing because I think it not only inhibits what we would hope have been a better response to this deadly outbreak, but I think it’s linked into what we’re seeing in the country, which is really in a front and an attack on our democratic institutions and our democratic process. That’s one of the more scary aspects of it. One is a public health issue, but one is a manifestation of how profound differences and divisiveness can impact important efforts like fighting a pandemic.” Here is what Dr. Fauci has to say about what might come next. Read on—and to ensure your health and the health of others, don’t miss these Sure Signs You’ve Already Had COVID.
Dr. Fauci says in order to do his job properly, he has to focus on his job and do what he thinks is best. “I focus like a laser beam on what my job and what my purpose is, which it has been ever since I became a physician more than 60 years ago,” he says. “Ever since I’ve come to the NIH 54 years ago, and ever since I become the director of the NIAID, which is 38 years ago, is to focus on what your purpose and job is in mind is to do whatever I can within the realm of science, evidence, data, and public health to preserve and protect the health and the safety of the American public. And if you get distracted by all the bobs and the arrows in all of the disinformation and conspiracy theories, that distracts you from what you should be doing. So as much as I don’t pay attention to the praise, I mean it’s nice that people like what I’m doing and there are a lot of people who do. You don’t want to get taken up by that, but you also don’t want to get taken up by the bobs and the arrows and the discouraging remarks.”
Dr. Fauci is worried about what all the controversy will mean for the future of public health. “It is a question of compartmentalization. If you get too deeply immersed in the adulation and the praise, that’s unrealistic and that’s distracting. If you get too deeply immersed in the other aspects of it, that is also distracting. So I don’t want it to interfere with my job, but what it has done, and I’ve got to be perfectly honest with you, it has very much disrupted my life in the sense that my job stays steady and I keep doing what I’m doing. I’m doing what I did the first time you interviewed me decades ago, working 16 hours a day, all the weekends and stuff, because I like it. I’m an unapologetic workaholic and I really love what I do, but when you get the venom introduced into it, it impacts—for example—it’s not comfortable having to go around with armed federal agents around you all the time. That’s not a good model for encouraging people to go into public health.”
Dr. Fauci says his upbringing and family life have prepared and protected him against some of the more negative aspects of his job, especially during the COVID-19 pandemic. “I don’t like the idea that my wife and my three daughters get harassed and threatened all the time, but I’m not alone. I’m a very visible person. So you know about it, but there are many public health officials who are also being threatened and harassed because they stick up for good public health principles. That should never happen in a country like ours, but it is.
“I grew up in a tough neighborhood in Brooklyn. I had great parents who kept me on the right track of education and doing things for public service. That has been a part of my family tradition for my father and my mother and my schooling. Jesuit training and high school and college, about making sure that honesty and integrity is absolutely critical to everything you do, and don’t back down under any circumstances from that. The other important thing is the relationships we developed. I’ve been very, very fortunate. I have a wife who is just the most extraordinary. She’s brilliant intellectually. She is the anchor in my life, in the sense that she has a bit of a different personality than I. She takes things very calmly and in a very measured way. She’s very analytic, and whenever I need a reality check, I have one at home every day when I go home. That’s really important.”
According to Dr. Fauci, he appreciated that people who felt ignored by the government made their voices heard during the HIV/AIDS crisis in America. “The idea that the activists who pushed back and picked me out because I was a visible figure (one of the few people who was out there talking about HIV in the 1980s) there were not a lot of us there, and I was a federal employee, so I became the face of the federal government. The activist had some very valid concerns and the authorities were not paying attention to them. So they acted in a very theatrical iconoclastic and disruptive way to gain attention. They used exaggerated language like, you’re killing us, you’re a murder, that kind of thing, hang you in effigy… But they were doing it for the purpose of getting our attention, and in some respects that was a good thing because they got my attention, and when I started listening to what they were saying, they were making perfect sense.
“They had really important considerations that needed to be looked at and taken seriously, including them in the discussions of the scientific agenda, the clinical trial design, the rigidity of the regulatory process. And I sat down with them and we talked about it, and we went from gradually there being adversarial, to being cooperative, to being colleagues, to now, many of them are literally my closest friends. They were right all along. They were disruptive, but they made a point that was a valid point. What you’re seeing now is attacks and slings and arrows that are based on misinformation, disinformation and very strong political considerations.”
There’s some things that really worked and some things that didn’t. So the thing that was the clear success story of all of this was the scientific approach, namely the fact that we had invested for decades on basic and fundamental and clinical science in platform technology for vaccines, in structure based immunogen design, in delineating the replication cycle of viruses in order to pinpoint vulnerable targets. That investment paid off to save millions of lives by getting us a vaccine in 11 months. That was beyond anyone’s wildest expectations that we’d be able to do that, and it was a combination of investment in science, and investment in implementation. What didn’t go so well was what we thought was a good public health response when you had a moving target like a virus—the likes of which we had never seen before—that the information that rolled out early on was not correct information.
“We didn’t fully appreciate how efficient it was in spreading. We didn’t get the right early information from China. We didn’t think or know that it would be aerosol spread. We approached it as a syndromic disease where you knew who was sick by their symptoms, when in fact you had 50 to 60% of the transmissions were of people who had no symptoms at all. That was a total game changer. So, certainly had we known all of those things early on, we could have done much, much better, but we didn’t. Sometimes we responded quickly enough and sometimes we didn’t. So there was no perfection in this from a public health standpoint. That’s for sure. Let’s hope we learn the lessons of what has happened for the future preparedness and response, particularly the idea of getting data in real time so that we could move as quickly as our moving target was moving.”
Dr. Fauci says he is incredibly proud of contributions he has made to fighting dangerous diseases and helping protect vulnerable communities. “So when I think of the things I feel good about, one is as a scientist, when I came to the NIH very early on, well before HIV—when certainly nobody outside of the inner group of scientists in that field even had any idea who I was—I had the luck and the privilege of working in a field of autoinflammatory and autoimmune diseases and developed highly effective therapies for inflammatory diseases of the vessels called vasculitis,” he says. “They’re rather unusual, but it was a major advance in people who had almost a 95% mortality rate and had a 93% remission rate. So that was as a scientist. Then when HIV came along, I—and I still do that to this day—have a laboratory that is delineating the pathogenic mechanisms of HIV.
“Then the hat as director of the National Institute of Allergy and Infectious Diseases, where one of the things I did right off, was develop an AIDS program and put an enormous amount of resources into understanding HIV, but importantly, partnering with pharmaceutical companies to develop the multiple combination drugs that we have now, that have resulted, literally, in transforming the lives of persons with HIV to make them lead almost a normal lifespan. That, I feel very good about, because that’s a program that I started from scratch, again, with the help from a lot of very talented people, but I was the one that started that program.”
Dr. Fauci says more money is needed to be prepared for the future as right now, he doesn’t believe that’s the case. “The answer is right now, no, and that’s unfortunate. We have a plan. There’s a pandemic preparedness plan that was put together involving an all of government response that came out a while ago from OSTP, the Office of Science and Technology Policy. The toll of that, from the standpoint of resources, the amount that would be needed, was tens and tens and tens of billions of dollars. We must say, to be perfectly fair, that Congress has given an enormous amount of money for us to respond to the current outbreak. However, that funding has now dried up, and that’s a real problem because if we want to continue to respond to the ongoing outbreak and be prepared for the inevitability, even though we don’t know when it will occur of the next outbreak, we are going to need a continual consistent investment in resources and for a variety of reasons, we don’t have that right now.”
Follow the public health fundamentals and help end this pandemic, no matter where you live—get vaccinated or boosted ASAP; if you live in an area with low vaccination rates, wear an N95 face mask, don’t travel, social distance, avoid large crowds, don’t go indoors with people you’re not sheltering with (especially in bars), practice good hand hygiene, and to protect your life and the lives of others, don’t visit any of these 35 Places You’re Most Likely to Catch COVID.