Long Before COVID-19, Dr. Anthony Fauci 'Changed Medicine In America Forever'

President Trump's daily briefings on the COVID-19 pandemic have introduced millions of Americans to Dr. Anthony Fauci, the director of the National Institute of Allergy and Infectious Diseases. At times, the specialist in infectious diseases has differed with the president during the briefings, correcting him on the seriousness of the virus or on the timeline for developing a vaccine. That's fueled speculation that Fauci's tenure might be cut short.

But New Yorker writer Michael Specter doesn't think Fauci needs to worry about job security. "Trump can't fire him," Specter says. "He can kick him off the coronavirus task force ... but he can't fire him from his job."

Specter has known Fauci for decades — covering his work and the way he's handled the role of presidential adviser through six different U.S. presidents and the AIDS epidemic. Specter chronicles those ups and downs in the New Yorker article, "How Anthony Fauci Became America's Doctor."

"He's always taken an open-minded approach to the problems that he's faced," Specter says. "He's never been one, even in the early days, to say, 'This is how we do it and we're never going to do it a different way.' "

Specter notes that in the 1980s, during the height of the AIDS epidemic, Fauci worked with activists to amend the way the government handles clinical drug trials. The policy shift increased the number of patients who had access to experimental HIV/AIDS treatments — and saved countless lives.

"This new system [for AIDS treatment] basically forced people to realize that you can't run drug trials and decide what to do with patients without ever consulting patients," Specter says. "I think it changed medicine in America forever."

Fauci continues to be forward-thinking in his approach to COVID-19, Specter says: "He wants to make a difference. He sees his job as marshaling evidence and presenting it to the people who need to know what he's talking about."

Interview Highlights

On how Fauci's studies in humanities may have influenced the kind of physician he became

Fauci spent a lot of his life studying Latin and Greek and romance languages and philosophy. He was very deeply concerned with the humanities. He wasn't a guy just saying, "What are the English courses I need to take to graduate so I can go to medical school?" It was pretty much the inverse. He was saying, "What are the science courses I need to take to go? Because these other things are also very important." ...

Infectious diseases are diseases that spread among people, and that is a discipline that requires a sort of social interaction. There are some medical disciplines where you can go in and do your job. If you're a surgeon, you'll take things out and maybe you have good bedside manner and maybe you don't, but what we really care about is are you good with your hands? That's not as true with the type of doctor that Fauci is. ... He certainly has said — and said to me — that the combination of the humanities and science seemed to push him towards being a certain type of physician. Because physicians are people who interpret science and deliver it to people — but they need to do it in a human way. They need to do it in a way that people understand, and I think we all know that is sometimes in short supply.

On how Fauci and his colleagues helped develop a cure for vasculitis in the '70s

Vasculitis is a very rare inflammatory disease where your blood cells attack your blood vessels and your organs shut down. And until Fauci and his mentor, Sheldon Wolff, came along, it was almost uniformly fatal. But when Fauci started working on it, he was also called to consult for cancer chemotherapy patients at the National Cancer Institute, just on their treatment — because they get very powerful [toxic drugs], and it suppresses their immune system. So doctors like Fauci were experts on the immune system, and when he saw a bunch of that, a weird thing occurred to him, which is: The vasculitis patients have overactive immune systems. Maybe if we gave them these toxic drugs, but in a much lower dose, it would lower the overreaction without killing them. And in fact, it not only did that, it cured the disease. He and his colleagues, principally Sheldon Wolff, helped cure a disease that, as he has said, it's not a disease that zillions of people have, but people died from it, and they don't die from it now.

On how activists initially blamed Fauci for the slow pace of HIV/AIDS drug trials when he became the head of NIAID in 1984

Basically, drug trials, for a long time, have undergone a particular system where you try a drug over a period of time in a small group of people who are healthy, to see if it's safe, if it has side effects, if it would harm you. Once that's done, and it can take a while, you then move to another level of testing called Phase II, where you test a small group of people to see if it's effective. Does it change the course of your disease? Are there markers in the blood system that show that it's taking effect? That takes a while. And then, if it's safe and seems to be effective, you do a much longer and bigger trial to make sure it works and that there aren't some adverse reactions that people hadn't counted on. This can take years.

Meanwhile, [AIDS patients] had nothing. They had no hope of any treatment or cure. They were dying by the hundreds, the thousands and the tens of thousands. And they were listening to an organizations not only say, "Well, wait a few years," but they had rules like if you were on one experimental drug, you couldn't take another one in a trial. ... These were absurd and outdated rules. And Fauci was the person that they knew who they could attack. It didn't matter whether he was in charge. He was the face of AIDS for the U.S. government.

On how Fauci changed his approach to the HIV/AIDS clinical trials and changed medicine

After a certain number of protests, he looked out at NIH one day as ACT UP and other protesters were storming the gates, and he thought, "These guys, they dress crazy and they say terrible things, but they're mostly from New York like I am. And let me think about this for a minute: If I had a disease in which the result was that I would die no matter what, and the government was telling me, 'You can't try anything that might work under any circumstances,' I'd be ramming down the doors, too."

So at that point, he decided to talk to these leaders more frequently, to go up to New York and meet with them, to go to San Francisco. And he came to realize ... they had a point. And even more importantly, they had some people who understood the system way better than anyone who worked for him. ...

Fauci, once he understood that the activists weren't saying, "Let's get rid of the whole system,' but, [rather], 'Let's open it up a bit so that we can have some relief while we press on to get the ultimate answer.' " He said, "Jesus, that makes perfect sense." And he proposed something called "parallel track," which was these sort of two systems — the old system and the new melded in. And that's what was adopted, and it worked.

On why Fauci doesn't want to be the director of the NIH, despite his popularity and success

Fauci has been offered the head job to be the director of the National Institutes of Health — I've lost track, I think it's three times. He always turns it down. He turns it down for a couple reasons: He has a lab and he cares about keeping his lab. He cares about seeing patients, and, even now, still does. But I think more importantly, he's figured out that you can be more persuasive sometimes without having the top job — you have more room to maneuver. And I think what he values is his ability to get his point across. And sometimes when you run an organization like that, the administration is just very, very burdensome.

On how COVID-19 compares to other recent viruses

It's not as deadly as it could be. In fact, H5N1, which was usually referred to as avian influenza, was truly deadly. And if that virus had spread the way this one spread, we'd be talking millions of people [dead].

In 2009, we had a pandemic of influenza. H1N1 was the designation, and a lot of people called it the swine flu. One quarter of the population of Earth was infected with that virus — 1.47 billion people at the time — before any vaccine got anywhere. So that happened to be way less virulent than is usual for influenza, but had it been super bad, 10 million, 20 million, 30 million people could have easily died. Easily. And yet, we see these things come up every few years and an endless number of reports are issued saying, "We have to do more." Fauci has been screaming this song, since — I don't know, I've talked to him about it at least 10 times in the last 15 or 20 years. And he's not the only one. There are many, many people. There are so many reports and they are constantly ignored. And we've spent hundreds of billions of dollars in missile defenses in the United States. That's something that — it's not even clear it works. And we don't spend pennies on the dollar to do the same thing with viral defenses.

On the structural changes, research and bioengineering that need to happen to be prepared for the next pandemic

I think a lot of things have to happen. ... There has to be someone with authority. Fauci is a guy who is a good spokesman and he can marshal facts; but he doesn't go to his office every day and plan the biological future of this nation. The fact that we are surprised by biology is a tremendous failing, given what we do and what we know.

I'm teaching at Stanford, and in bioengineering that's one of the things we're trying to focus on — to make sure that bioengineers and also people in this country understand that we don't have to be surprised by biology in the future. We can plan for it and we can even create what we want to create. And I'm hoping that maybe this pandemic, which is so ruinous, will at least make people realize that an investment, a few hundred billions of dollars — which sounds like a lot of money, but it's a drop in the bucket of what's happening now — will pay tremendous dividends in terms of the safety of humanity. Because this is going to happen again. There isn't any way that it won't. ...

This does have everyone's attention, but so have other viruses. Not quite as much as this. But I am deeply concerned — and I'm not the only one — that what will happen is we'll get over this, and some money will be appropriated and some commissions will be formed and some words will be said, and over time, people will start to stop thinking about it. And we can't do that. We can't allow ourselves to do that, because, honestly, as bad as this one is, the next one could be worse. And also it would be irresponsible of me not to point out that the next one might not come from a bat. It may come from a crazy person who has the ability to make a virus and it's disseminated — because we are in a world where that is possible. ...

We can use our ability to alter genes and rewrite biology to [cure diseases] and we don't have to wait anymore for bad things to happen to us. We should sit down and say, "What are the things we want to prevent?" and figure out ways to prevent them. It won't be perfect. It won't be 100%. There are lots of questions about how we want to deploy such powerful tools; but we have those tools. We have the ability not to be shocked by biology in the future. We should be using biology — not be afraid of it.

Amy Salit and Seth Kelley produced and edited the audio of this interview. Bridget Bentz, Molly Seavy-Nesper and Deborah Franklin adapted it for the Web.

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