Why Anthony Fauci approaches every trip to the White House as if it's his last

Transcript

DAVE DAVIES, HOST:

This is FRESH AIR. I'm Dave Davies. My guest, Dr. Anthony Fauci, is one of the most recognizable people in America. For much of the past four years, he's been the public face of the government's response to the COVID pandemic, earning admiration and gratitude from millions, and from others, condemnation for masking requirements, business, school, and travel restrictions, and among the most darkly conspiratorial, for somehow causing the catastrophe. Both points of view were on display at a House Committee hearing where he was thanked profusely by Democrats and told he should be in prison by one Republican.

But Fauci's leadership role in protecting the nation's health predates COVID by decades. He headed the National Institute of Allergy and Infectious Diseases at the National Institutes of Health for 38 years before retiring in 2022 to take an academic appointment. He played leading roles in responding to the AIDS crisis, the Ebola outbreak, the SARS epidemic, the threat of anthrax and more.

He became a skilled Washington player, advising seven presidents and constantly briefing Congress in public and private hearings. And he never gave up seeing patients, at one point climbing into protective gear resembling a space suit to treat a hospitalized Ebola patient. Anthony Fauci is now a professor at Georgetown University with a joint appointment at the School of Medicine and the McCourt School of Public Policy. He tells his story in a new memoir titled "On Call: A Doctor's Journey In Public Service."

Well, Dr. Fauci, welcome back to FRESH AIR.

ANTHONY FAUCI: Thank you. It's good to be back with you.

DAVIES: I got to say, congratulations on this book. It is a remarkable journey. And although there is a lot of science, I want to tell readers it is accessible and readable. And having kind of followed you through this long journey and so many battles of public health issues, I have to ask what it is like for you at this point in your life, having done so much in your field - getting the Presidential Medal of Freedom from a Republican president - what does it like now to be known to tens of millions of Americans who associate you really only with this terrible pandemic? And this at a time when our politics are so bitterly partisan, you know, and social media can effectively communicate disinformation.

FAUCI: Yeah, it's a little bit of a distortion of reality. And I think in your introduction, you laid that out pretty well. The story of my commitment to public service, to science, medicine, and public health, dates back more than half a century when I came to the NIH as a fellow in infectious diseases in immunology 54 years ago, and as you mentioned correctly, that I've been the director - I had been director of the National Institute of Allergy and Infectious Diseases, which is responsible for the funding or conduct of most of all the research in the United States and in some respects worldwide, in the field of infectious diseases, that, in fact, because of the nature of - the gripping nature of COVID on the country over the last four-plus years, that I was pretty well known in the scientific community for those decades evolving way back to the early years of HIV.

But to the general public, I'm known predominantly as the person who was communicating with the American public during those terrible years of the peak of COVID. So it's a bit of an unusual feeling where some people only know me for that, whereas the people who really understand my history, understand that it goes back literally, as you mentioned, decades and decades.

DAVIES: You know, I mentioned this House committee hearing that you appeared at. I guess it was a couple of Mondays ago. I watched a lot of it. I gather that, you know, you're no longer a government employee. You appeared voluntarily, is that right?

FAUCI: Yes, I did, of course.

DAVIES: And how do you feel about it? How do you feel about the experience? Should you keep doing this?

FAUCI: Well, I mean, if you look at the hearing itself, it unfortunately is a very compelling reflection of the divisiveness in our country. I mean, the purpose of hearings, or at least the proposed purpose of the hearing, was to figure out how we can do better to help prepare us and respond to the inevitability of another pandemic, which almost certainly will occur. But if you listened into that hearing, as you described just a little bit ago, on the Republican side was a vitriolic ad hominem and a distortion of facts, quite frankly. As opposed to trying to really get down to how we can do better in the future, it was just attacks about things that were not founded in reality.

You know, I've been, as you said, testifying literally at hundreds of congressional hearings over the last almost 40 years during the time that I've been the director. There have been situations that are somewhat politically charged in the sense there's been, you know, a diversity of ideological opinions and how one views a particular issue, which is fine. I think diversity of opinion and diversity of ideology is healthy for the country.

But what we saw at that hearing was not diversity of opinion. It was pure divisiveness and ad hominem attack, which is really unfortunate because it's counterproductive to what we would have hoped a hearing of that type would get us to, namely to be better off from what we learned from it. But there was nothing that was better off at that hearing. You just had to listen to Marjorie Taylor Greene and her rant about dogs and things. I didn't even know what she was talking about.

DAVIES: Yeah. You know, I can remember a day when public hearings were actually opportunities for lawmakers to learn things, actually ask questions they didn't know the answer to, and hear expert witnesses educate them. And this was pretty performative, which seems to be the way things are today. One of the things they focused on so much was the cause of the pandemic and whether or not it came from an animal in the Wuhan wet market or might have leaked from the Wuhan Institute of Virology, this lab there. And you said, you have an open mind about that, but it's clear that the research that your organization funded, NIAID, could not have...

FAUCI: Yes.

DAVIES: ...Spawned this virus...

FAUCI: Yeah.

DAVIES: ...And you're clear about that.

FAUCI: Yeah. Yeah, I have an open mind about whether or not this could have been a lab leak versus a natural occurrence of spillover, which historically is overwhelmingly how new viruses get into the human population. So since we don't know definitively, I keep an open mind. But the thing that I'm pretty certain about and most experienced virologists are, if you look at the viruses that were studied under the NIH grant that went as a sub award to a laboratory in China, the viruses themselves that were studied were so distant - we used the word phylogenetically distant. That means they were so distant in evolution from what turned out to be SARS CoV-2 that it would really be virologically and molecularly impossible for those viruses to be the viruses that were the cause of what turned out to be SARS CoV-2. It just would be virologically impossible.

So that's the thing I was pointing out at the hearing. That still is compatible with my keeping an open mind that somewhere a lab in China or any place else could have been working on a virus that actually slipped out of the lab. And that's what I mean by keeping an open mind. However, if you look at the vast majority of experienced evolutionary virologists, not only from the United States, but throughout the world - from Australia, from Canada, from the European Union, the U.K. and the United States - the very strong evidence is suggestive strongly that it comes from a natural spillover from an animal reservoir.

DAVIES: There was a lengthy piece in the New York Times which sort of aired some of these issues and offered a different point of view. I'm not going to ask you to respond to that. It's really pretty technical. But one question I did want to ask is, how much does it matter whether we discover whether it was a natural occurrence or a lab leak in terms of fighting future infections?

FAUCI: Sure. I mean, if you know definitively what the cause was, then you would put your resources and effort into making sure that that doesn't happen again. But in the context of not knowing whether it was a natural occurrence or a laboratory leak, you can do a lot of productive things, even if you don't definitively know because if it's either one or the other, you should be directing your efforts to preventing either from happening again.

If you look at a lab leak possibility, you should make sure that there are very stringent controls. And if it was, which most virologists think it was, a natural spillover from an animal reservoir, you need to put more controls on the animal-human interface. I mean, bringing animals from the wild that could be infected with viruses that might jump species and bringing them into close contact with humans like in a wet market where people come in to shop for these exotic animals - you've got to put controls on that. And you've got to not encroach on the environment as much, namely pristine places where animals that might have pathogens in them that could spill over. So in some respects, it doesn't really matter what it is, you should be trying to prevent either from ever happening.

DAVIES: We need to take a break here. Let me reintroduce you. We're speaking with Dr. Anthony Fauci. He led the National Institute for Allergy and Infectious Diseases for 38 years, and was the public face of the government's response to the COVID crisis. His new memoir is "On Call: A Doctor's Journey In Public Service." We'll continue our conversation in just a moment. This is FRESH AIR.

(SOUNDBITE OF JOHN COLTRANE QUARTET'S "OUT OF THIS WORLD")

DAVIES: This is FRESH AIR, and we're speaking with Dr. Anthony Fauci, known to most Americans for his role in helping lead the government's response to the COVID-19 pandemic. He has a new memoir called "On Call: A Doctor's Journey In Public Service.".

You grew up in an Italian American family in Brooklyn. Your dad ran a pharmacy. You know, you were a smart kid and a good student. You write that in your neighborhood, most of the kids were either athletes or tough guys - hoods, which is a term we don't hear so much anymore. Which were you?

FAUCI: (Laughter) Well, I was an athlete at, you know. At young age - 8 or 9 years old - I just really became fascinated with both baseball and basketball. And I just loved it. I loved team sports. Then when I went on to high school, I was the captain of my high school basketball team in New York City, which was really a lot of fun, and I think was, you know, formative for me in understanding the importance of teamwork and discipline and things like that. But I was correct. We had a very interesting neighborhood. It was ethnically 90-plus percent Italian Americans in the neighborhood where I grew up in. But it was a warm embracing neighborhood, you know, a high degree of family and neighborhood spirit.

DAVIES: You went to Holy Cross College, and then Cornell Medical School where you graduated first in your class. And it was the Vietnam era, and it was actually the draft, wasn't it, that kind of sent you into public health?

FAUCI: Yeah. I mean, when you reached a certain level, I think it was - not think. It was the fourth year of medical school. We were all drafted, everyone, except the women, and we only had - at that time, way back, we had very few women in the class. We were told by a recruiting officer that at the end of this year, when we went into medical school, we would either be assigned to the Army, the Navy, the Air Force, or the public health service. So put in your priority, and you're going to be serving for at least three years as a service to the country. I was very interested in infectious diseases. So I put down public health service first, the Navy, and then Army and then Air Force, and I was willing to serve in any of them if I got it.

But fortunately for me, the people at the NIH wanted me to come there, so they put in a request for me and I got that, and that was my three-year fellowship in a combination of infectious diseases and immunology that got me interested in research. Because prior to that, my main goal was to be a practicing physician in New York City and just practice medicine, which - I loved taking care of patients, and still do. But at the time, that was my passion. But the turnaround in my direction came when I became fascinated with the concept of doing research to make advances that could have a multiplier effect in having a positive impact on more than just the individual patient that you're taking care of. If it gets accepted by the medical and scientific community, it could have positive impact on large numbers of patients. So I became fascinated with that. And that was my introduction to basic and clinical research.

DAVIES: All right, so you did this research for a lot of years and began to get a national reputation for some fine work you had done on infectious diseases. And in 1981, the first reports of the illness that we would later know as AIDS began to appear in an obscure weekly mortality report from the Centers for Disease Control. You write that when you read about 26 men who died for these unusual forms of pneumonia and cancer, when you read that they were all homosexual, you write that it was the first time a clinical report gave you goosebumps. Why?

FAUCI: Well, because I had been, you know, involved in infectious diseases for the prior nine years. When I came back from my chief residency in medicine in New York City at the New York Hospital, Cornell Medical Center in 1972, for the next nine years, I was very steeped in being an infectious disease consultant at the NIH for patients usually who had cancer and who were immunocompromised and would get secondary opportunistic infections.

And I had never seen anything like this. When I said I got goosebumps, I knew that even though this was brand-new, this 26 - first five young gay men, and then a month later, a report of 26 curiously and amazingly all young, otherwise well - previously well gay men with this devastating disease that was destroying their immune system, I knew I was dealing with a brand-new disease. And up to that point, there were no brand-new diseases. I mean, if you look historically going back, when was the last time an absolutely brand-new disease was recognized?

And even though at the time in the summer of 1981 we didn't have a name for the disease - we were calling it strange names like gay-related immunodeficiency, or gay cancer because of the Kaposi sarcoma. We didn't have an etiology, but the epidemiology of the disease - namely how it was spreading, its pattern of spread - strongly suggested that it was an infectious disease that was sexually transmitted because of the epidemiological patterns.

And the thing that got me goosebumps is that this was totally brand-new, and it was deadly because the young men we were seeing, they were so far advanced in their disease before they came to the attention of the medical care system that the mortality looked like it was approaching 100%. So that, you know, spurred me on to do something that I mentioned in the book, clearly was to totally change the direction of my career, to devote myself to the study of what was at the time almost exclusively young gay men with this devastating, mysterious and deadly disease, which we ultimately, a year or so later, gave the name of AIDS to.

DAVIES: Right. you write that when you'd made that decision to really focus on that, that, you know, it was against the career advice of a lot of folks that you knew. You write that you think of this next period from, you know, roughly 1982 to the late '80s as the dark years of your medical career. You say you might have post-traumatic stress from it. Tell us about that.

FAUCI: You know, Dave, up to that time I had been fortunate enough to have developed therapies for inflammatory diseases of the blood vessels called the vasculitis', which are not rare, but they're unusual diseases that had about 100% mortality. And I developed some therapeutic protocols that really were transformative and led to a 93% to 95% remission rate. So for a period of several years, I was on a high, as it were, with regard to results because people who had a disease that otherwise, a year or two earlier, would have killed them, I had developed the therapies that was essentially saving their lives.

So I was dealing, you know, with a situation where everything I did was almost a positive result. And I felt very good about that. You know, if you're a physician and you're involved in really making people better, that's just a wonderful feeling. Overnight, when I changed the direction of my career, all of a sudden I was taking care of people who were desperately ill, mostly young gay men who I had a great deal of empathy for. And what we were doing was, you know, metaphorically like putting Band-Aids on hemorrhages because we didn't know what the etiology was until three years later. We had no therapy until several, several years later. And, you know, although we were trained to be healers in medicine, we were healing no one. And virtually all of our patients were dying.

So it was such a sharp contrast with what I had been doing for the previous nine years or so to what I was doing now, which was just trying to comfort people and take care of their opportunistic infections, which sooner or later was killing most of them anyway. That's what I meant, you know, by the dark years of my professional career, which spills over into your personal life because it's impossible. And that's what I meant when I said that I and many of my colleagues who were really in the trenches back then before we had therapy really have some degree of post-traumatic stress. I describe in the memoir some very, very devastating experiences that you have with patients that you become attached to, who you try your very, very best to help them, but at the end of the day, it almost always is something that leads to the death of the individual. It was a very painful experience.

DAVIES: We're going to need to take another break here. Let me reintroduce you. We are speaking with Dr. Anthony Fauci. He led the National Institute for Allergy and Infectious Diseases for 38 years. His new memoir is "On Call: A Doctor's Journey In Public Service." He'll be back to talk more after this short break. I'm Dave Davies, and this is FRESH AIR.

(SOUNDBITE OF TED NASH'S "WATER IN CUPPED HANDS")

DAVIES: This is FRESH AIR. I'm Dave Davies. Our guest is Dr. Anthony Fauci, known to most Americans for his role in helping lead the government's response to the COVID-19 pandemic. He has a new memoir about his many decades leading the National Institute of Allergy and Infectious Diseases through a series of public health threats, including the AIDS crisis, the Ebola outbreak, the SARS epidemic, the anthrax threat, and others. His new memoir is "On Call: A Doctor's Journey In Public Service."

You would become a significant advisor to presidents in your career, particularly George H.W. Bush, whom you got to know when he was vice president, when Reagan was the president. And you write that early on, when you were going to meet with - I guess it was the Vice President and others in the West Wing, an old friend gave you some advice on how to handle yourself when you talked to the president. What did he say?

FAUCI: Yeah. It was someone who had experience in the White House. He had worked in the Nixon White House for several years, and I was getting ready to go in for the first time to meet with President Reagan. And he said to me, you know, one of the things you should do is that a good rule of thumb is as you walk into the White House, go under that awning in the West Wing, say to yourself, this might be the last time I'm going to go into this building. And what he meant is you should say to yourself that I might have to say something, either to the president or to the president's advisors that would be an inconvenient truth that they may not like to hear, but it would be the truth.

And then that might lead to your not getting asked back again. But that's OK because you've got to stick with always telling the truth to the best of your capability. If you start going into the White House, saying, wow, this is really a great place to be; I wish I'd get asked back, then you might be afraid to say something that might offend someone or that might essentially shoot the messenger. You never should get yourself into that position. You should always be willing to say, you know, as great as it is and as awesome as it is to go into the White House, a very heady experience, you might not ever get asked back, and that's OK. But if in fact, you keep telling the truth, people will respect you and you likely will get asked back because they respect you.

DAVIES: You write in 1996, Bill Clinton had a meeting. I guess it was at the beginning of his second term, and you were there with Donna Shalala, who was the Secretary of the Health and Human Services. And you were talking about why there was no vaccine for the HIV virus. And this proved to be a very important conversation. You want to explain this?

FAUCI: Yeah. I went to the White House to explain to President Clinton about a brand-new discovery of a fundamental basic science issue, a receptor of the virus, and the president, being somebody who loves that kind of detail, wanted to hear more about it. But at the end of the conversation, he said, you know, by the way, Tony, it's 1996 right now, and you told me that the virus was discovered in 1983. Why don't we have a vaccine? And I explained to him the fundamental difficulties of the unique nature of the virus that to get a vaccine, you'd have to have people in multiple disciplines working together in collaboration as opposed to in a separate siloed-type approach. The best way to do that would be to have a vaccine center of people with multiple disciplines working together. And we could do that at the NIH.

And to his great credit, President Clinton said, well, why don't we just do that? He turned to his chief of staff, who was Leon Panetta at the time, and says, well, why don't we try to make that happen? I thought he was essentially humoring me because he was being nice to me and saying, thank you very much, great suggestion. But as it turned out a few months later, he announced that he was going to get a vaccine research center built on the NIH campus very, very quickly.

And with that, we recruited from all over the country people of multiple disciplines, who would come to work predominantly to work on an HIV vaccine. But as it turned out over the years, the excellence of the individuals who were brought together led to work on other vaccines, including the successful development of an RSV vaccine, and then most recently, they played a major role in the development of a successful COVID C vaccine. So that conversation in 1996 in the Oval Office with President Clinton had enormous implications. Ultimately, I hope we will develop a vaccine for HIV. But little did we know back then that multiple years later, the investigators that we recruited to that vaccine research center would play a major role in the development of a successful COVID vaccine.

DAVIES: You know, you write - right? - at some point in the book that you learned how important it was to develop relationships with people who can make things happen. And this is a case of where, you know, you had trust - and you had the trust of the president, and this really mattered because there was somebody who wanted to make a difference and had the power to do it. It's quite a moment; isn't it?

FAUCI: You know, it is. It's a terrific feeling, and it only can occur related to the issue that I said about always being honest and not being afraid to tell things as they are, even though it might be something that someone might not want to hear that if you do that consistently, over the years, you develop strong trusting relationships, the way I did with President Clinton, with President George H.W. Bush, and then with President George W. Bush and on with Obama and the other presidents, is that you continue to have that feeling of trust that you're going to tell them just what the truth is.

DAVIES: Right. And with George W. Bush, you developed this president's emergency plan for AIDS, which was an effort to share resources with countries, particularly in Africa that had terrible rates of infection, which was an enormously successful effort, wasn't it?

FAUCI: Oh, yeah, I mean, if you look at the track record of the President's Emergency Plan for AIDS Relief, which we call PEPFAR. That is recognized now - it's more than 20 years old - as the most impactful public health endeavor in history, actually. When the president to his great credit, called me into the Oval Office and said, you know, we have a moral obligation to not allow people to die of a preventable and treatable disease merely because of the fact that - where they were born, in a poor country. And that was at a time when we had now developed drugs that were absolutely saving the lives of persons with HIV, having them go on to essentially a normal lifespan here in the United States and the developed world.

So he sent me to Africa to try and figure out the feasibility and accountability and the possibility of getting a program that could prevent and treat and care for people with HIV. And I worked for months and months on it after coming back from Africa 'cause I was convinced it could be done 'cause I felt very strongly that this disparity of accessibility of drugs between the developed and developing world was just unconscionable.

Luckily, the president of the United States in the form of George W. Bush felt that way, and we put together the PEPFAR program, which started off in 14 countries for $15 billion to try and prevent 7 million infections, treat 2 million and care for 10 million people. Twenty years later, we spent a hundred billion dollars in 50 countries, and it has saved 25 million lives, which I think is an amazing example of what presidential leadership can do when a president firmly feels that we want to program and we need a program to get implemented, and that was the PEPFAR program.

DAVIES: You know, there was an Ebola outbreak in 2014 in West Africa, and a number of health care workers were infected. Many died. Some ended up in the United States, and you, in addition to kind of managing the public response, including, you know, dealing with controversial questions like travel restrictions and entrance requirements from affected countries - you personally treated, I guess, two Ebola patients at your own clinical center. Why did you want to do that? Tell us what the experience was like.

FAUCI: Well, the fundamental reason why I wanted to be directly involved in taking care of the two Ebola patients that came to the NIH is that if you look at what was going on in West Africa at the time - and this was during the West African outbreak of Ebola - is that health care providers were the ones at high risk of getting infected. And hundreds of them had already died in the field, taking care of people in Africa - physicians, nurses, and other healthcare providers.

Even though we had, you know, very good conditions here in the intensive care setting of wearing these space suits that would protect you, the highly specialized personal protective equipment, I felt that if I was going to ask my staff to put themselves at risk in taking care of people who, if they get infected by an accident in the care of the patient, they stood a good chance of dying - if I were going to ask them to do that, I wanted to do it myself. I just felt I had to do that. So, you know, we took care of one patient who was mildly ill, who we did well with. But then the second patient was desperately ill. And that was the patient that I spent a fair amount of time measured in several weeks because the patient was in the hospital for over three weeks and literally taking care of them, you know, as a regular shift with the other physicians and nurses and healthcare providers that were doing that.

DAVIES: And this patient was excreting all kinds of bodily fluids, which would have been deadly had you had contact with.

FAUCI: Yeah. I mean, we did have contact with him, and we did get these virus-containing bodily fluids - you know, everything from urine to feces to blood to respiratory secretions. We got it all over our personal protective equipment, and that was one of the reasons why you had to very meticulously take off your personal protective equipment so as not to get any of this virus on any part of your body. So the protocols for taking care of persons with Ebola in that intensive care setting were very, very strict protocols, which we adhere to very, very carefully. But it was a very tense experience trying to save someone's life who is desperately ill at the same time as making sure that you and your colleagues don't get infected in the process.

DAVIES: We need to take another break here. We are speaking with doctor Anthony Fauci. He led the National Institute for Allergy and Infectious diseases for 38 years. He has a new memoir. It's called "On Call: A Doctor's Journey In Public Service." We'll continue our conversation after this short break. This is FRESH AIR.

(SOUNDBITE OF SLOWBERN'S "WHEN WAR WAS KING")

DAVIES: This is FRESH AIR, and we're speaking with Dr. Anthony Fauci, who is best-known to most Americans for his role in helping lead the government's response to the COVID-19 pandemic. He spent 38 years leading the National Institute for Allergy and Infectious Diseases. He has a new memoir. It's called "On Call: A Doctor's Journey In Public Service."

So let's talk about your experience with COVID. I mean, you'd had great relationships with the many presidents that you had served. You were known. I gather you didn't have a lot to do with Trump until this issue arose. And yet you became kind of the public face of this. There came a point when you were working with the task force which Vice President Mike Pence headed that you were going to have to contradict the president. You were going to have to publicly refute his message - for example, his embrace of hydroxychloroquine. So how did you decide to handle that?

FAUCI: Well, it was not an easy decision because I have a great deal of respect for the office of the presidency of the United States that I had served on the multiple presidents. But I felt I had, you know, a responsibility to preserve my own professional and personal integrity as well as importantly to fulfill my responsibility to whom I really serve, namely the people of the United States of America. And when the President started to say things, I mean, he wanted so badly for this to end because the fact that we were - you know, it was January and February and March, and then people started thinking about - pretty soon we were going to get into election mode, and he really wanted, understandably, the outbreak to essentially go away. So he started to say things that were just not true. Like it's going to disappear like magic. It's going to go away. Don't worry about it. We have everything under control. And when it became clear that that was not the case, then he started to say things that were just scientifically untrue, like hydroxychloroquine is essentially the end-all. It's going to take care of us. So I just felt that I had to when asked, get up and just tell the truth and say when a reporter asked me, the president says this is going to go away like magic. Is that true? And I would have to say no.

According to my estimate, it's not going to go away like magic. And they would ask me about hydroxychloroquine, and I'd say no. There's no scientific evidence that hydroxychloroquine works. And in fact, there is evidence that it might be harmful. And that was the beginning of a situation that put me at odds not only with the president, but more intensively with his staff. But I felt I had to do it. There was no turning back. I could not give false information or sanction false information for the American public. I just could not do that.

DAVIES: Right. It was interesting, as you described this relationship with Donald Trump, that, you know, you're both New Yorkers, and he kind of liked you for that. You kind of had this background. And you write that after you would be in these COVID briefings when you were both there, that he would sometimes pull you into a side room afterwards - to talk about what?

FAUCI: You know, there were a couple of things. I mean, he - you know, a very complicated figure. We had a very interesting relationship, was very correct. I don't know whether it was the fact that he recognized me as kind of a fellow New Yorker, but he always felt that he wanted to maintain a good relationship with me. And even you know, when he would come in and start saying, why are you saying these things? You got to be more positive. You've got to be more positive, and he would get angry with me. But then at the end of it, he would always say, we're OK, aren't we? I mean, we're good? Things are OK? - because he didn't want to leave the conversation thinking that we were at odds with each other. Even though many on his staff at the time were overtly at odds with me, particularly the communication people and people like Peter Navarro and others.

So it was a complicated issue. There were times when you'd think he was very favorably disposed and then he would get angry at some of the things that I was saying, even though they were absolutely the truth.

DAVIES: Yeah. Well, I think readers will enjoy a lot of the direct quotes that you have here, because they are pretty salty. In particular, at one point in the spring of 2020 when - remember when Easter was approaching, and Trump had agreed to some restrictions on activity and mitigation measures, but he really wanted to get this over with and get the country back open. And you were giving a different message. You were saying, no, we've still got a lot of deaths and a lot of infections in hospitals. We have to stay with this. He says to you, and this is a quote from Trump to you. Anthony, you are losing me trillions of F-ing dollars. Anthony, you and I are OK. There is no problem between us. I know you better than you think, and I respect and I like you. You need to do your thing, and I need to do mine.

What did you take that to mean? Like, like, I know you're a doc and you have to tell the truth. I'm a politician, and I'm going to use you as a punching bag later?

FAUCI: You know, I think, actually, that's what he was saying. He was saying, you know, I know - I understand you. And I know you feel you got to do that. You know, I don't like what you're doing, but you're going to do your thing and I'm going to do mine. And he was essentially say, I'm going to keep saying what I'm saying regardless of what you say. When he was saying, you know, you're losing me $1 trillion. He was referring to the fact that, when I would say something like that, that there would be difficulty, that we're still in the middle of it, obviously, the stock market didn't like that. And that's what he meant by I'm losing him trillions of dollars. But it happened to be the truth. It wasn't like I was trying to get the economy in trouble. It was the truth.

DAVIES: Yeah. You know, I'm wondering how you got these direct quotes. Did you keep a diary?

FAUCI: No. It's very difficult to forget when the president speaks to you like that. It gets embedded in your mind - very difficult to forget that.

DAVIES: We need to take a break here. Let me reintroduce you. We're speaking with Dr. Anthony Fauci. He led the National Institute for Allergy and Infectious Diseases for 38 years, and was the public face of the government's response to the COVID crisis. His new memoir is "On Call: A Doctor's Journey In Public Service." We'll continue our conversation in just a moment. This is FRESH AIR.

(SOUNDBITE OF DANIEL FREEDMAN'S "LOVE TAKES TIME")

DAVIES: This is FRESH AIR, and we're speaking with Dr. Anthony Fauci, known to most Americans for his role in helping lead the government's response to the COVID-19 pandemic. He has a new memoir called "On Call: A Doctor's Journey In Public Service."

You know, it's hard to imagine a more difficult situation where there's this terrible pandemic, which is, you know, highly infectious, highly deadly, and you're operating, you know, at best, even in good faith, with incomplete information. Like, what should the social distancing number be? And, you know, how effective are masks, depending on what we know about how it spreads? And you say in the book that, you know, there were certainly things that you would have done differently if, you know, if you'd had more information. And yet, did you ever get the feeling that the president really cared to listen to the science, that when you would explain things, he was taking it in?

FAUCI: You know, it's tough to get into someone's mind about what they were thinking, how much attention they were paying. But I can tell you that he did not get into the details of understanding the science. It was more the broad big picture. He wanted the outbreak over, and he wanted to get down to the business of, you know, running the country and getting the reelection going. That was the main thing on his mind. That was always the main thing on his mind.

DAVIES: Again, I'll tell listeners there are plenty more salty quotes from the president in there. We're not going to dwell on all of them, but there's a lot of detail here about what you went through. What I'm interested in - and I don't know if you've reflected on this. But how might the experience of the United States have been different if there was a president, you know, who had the patience to listen to the scientists and develop consistent policies and messaging and, you know, worked collaboratively on this?

FAUCI: Yeah.

DAVIES: Have you thought about that?

FAUCI: You know, I think it's not a good idea to try and quantitate that because then that gets taken out of context. But, you know, the one thing that I felt was a lost opportunity, that whenever you have a situation when the bully pulpit of the presidency can be used in a positive way to get the country to move in one direction or another in response to whatever crisis or whatever issue is at hand, it has a lot of impact, you know?

And for example, one of the things, when it became clear that we were telling people to wear masks, the president sort of said, well, I'll go along with that, but personally, I don't really think I want to wear a mask. It really could have been such a great boost to mask-wearing if he had been very proactive in saying, hey, everybody out there, you know, the CDC is saying you should wear a mask. And I'm going to wear a mask just to show that I'm doing it, too. He never did that. He always gave a negative connotation to wearing masks.

DAVIES: Right, so there was plenty of room for his followers to think it was useless and the people who were suggesting it were dupes. You're no longer in the government now. What's your life like?

FAUCI: Well, you know, for the greater part of a year - I stepped down in the end of December of 2022 and I spent a lot of time since then working on, you know, writing this, finishing it and finally editing it, which as you might imagine takes a while to get it to what I really like and I felt good about it, which I do. But I also am on the faculty as a distinguished university professor in a dual appointment at the department of medicine in the school of medicine...

DAVIES: At Georgetown. Yeah, yeah.

FAUCI: ...At Georgetown University and in the McCourt School of Public Policy. And I just love Georgetown. I mean, it's just such a great place to be. I love being around students. I love, you know, the kind of interactions you have, with fireside chats and seminars and lectures that I give. And I just like being on campus. You know, I had been at the NIH, as I mentioned, for 54 years. And my interaction was exclusively with people at the doctoral and post-doctoral level. The idea and the reality of being surrounded by students, I mean, really young students - undergraduate students, medical students, students who are going for master's degrees or Ph.D.s, to have exposure to them is just a very invigorating experience. And I'm really enjoying it an awful lot.

DAVIES: Good luck. Thanks for your efforts. And thanks for speaking with us, Dr. Fauci.

FAUCI: My pleasure. I appreciate you having me on the show.

DAVIES: Dr. Anthony Fauci led the National Institute for Allergy and Infectious Diseases for 38 years. His new memoir is "On Call: A Doctor's Journey In Public Service." On tomorrow show, as Juneteenth approaches, actor David Oyelowo reflects on what he's learned about the history and resilience of Black Americans by portraying notable figures. He played Martin Luther King Jr. in the film "Selma" and now stars in a series about Bass Reeves, one of the first Black deputy U.S. marshals. I hope you can join us. To keep up with what's on the show and get highlights of our interviews, follow us on Instagram at @NPRFreshAir.

(SOUNDBITE OF REGGIE QUINERLY'S "REFLECTIONS ON THE HUDSON")

DAVIES: FRESH AIR's executive producer is Danny Miller. Our technical director and engineer is Audrey Bentham. Our interviews and reviews are produced and edited by Amy Salit, Phyllis Myers, Ann Marie Baldonado, Sam Briger, Lauren Krenzel, Therese Madden, Thea Chaloner, Susan Nyakundi and Joel Wolfram. Our digital media producer is Molly Seavy-Nesper. Roberta Shorrock directs the show. For Terry Gross and Tonya Mosley, I'm Dave Davies.

(SOUNDBITE OF REGGIE QUINERLY'S "REFLECTIONS ON THE HUDSON") Transcript provided by NPR, Copyright NPR.