Fauci’s New Memoir Obscures His COVID and HIV Missteps

On Call: A Doctor’s Journey in Public Service, by Anthony Fauci, Viking, 480 pages, $36

As a young medical student, I admired Tony Fauci. I bought and read Harrison’s Principles of Internal Medicine, a vital textbook that Fauci co-edited. In reading his new memoir, On Call, I remembered why I admired him. His concern about his patients’ plights, especially HIV patients, comes through clearly.

Unfortunately, Fauci’s memoir omits vital details about his failures as an administrator, an adviser to politicians, and a key figure in America’s public health response to infectious disease threats over the past 40 years. His life story is a Greek tragedy. Fauci’s evident intelligence and diligence are why the country and the world expected so much of him, but his hubris caused his failure as a public servant.

It is impossible to read Fauci’s memoir and not believe he was genuinely moved by the plight of AIDS patients. Since the first time he learned of the illness from a puzzling and alarming case report, his laudable ambition has been to conquer the disease with drugs and vaccines, cure every patient, and wipe the syndrome from the face of the earth. He is both sincere and correct when he writes that “history will judge us harshly if we don’t end HIV.”

When an aide in 1985 offered to quit when he contracted AIDS for fear of scandal at Fauci’s beloved National Institute of Allergy and Infectious Diseases (NIAID), Fauci hugged him, declaring “Jim, you crazy son of a bitch, there is no way in the world I would ever let you go.” This was Fauci at his best.

But Fauci paints an incomplete picture of his attitude toward AIDS patients in its early days. In 1983, in response to a case report of an infant with AIDS published in The Journal of the American Medical Association, Fauci told the press that AIDS might be spread by routine household contact. There was no good evidence then and is none now to suggest that HIV is transmitted that way. But Fauci’s statement, prominently echoed in the media, panicked the American people, almost certainly leading many to physically shun AIDS patients out of an unfounded fear of catching the disease.

Fauci does not address this incident, so one is left to speculate about why he was attracted to this theory. One possibility is that there was little political support for government spending on AIDS when the public thought it only affected gay men. As the public came to understand AIDS impacted broader populations, such as hemophiliacs and IV drug users, public support for funding HIV research expanded.

Fauci was tremendously successful in eventually building public support for government spending on treating and trying to prevent the spread of AIDS. Likely no other scientist in history moved more money and resources to accomplish a scientific and medical goal than Fauci, and his memoir proves he was highly skilled in managing bureaucracy and getting his way both from politicians and from an activist movement that was at first highly skeptical about him. (One prominent AIDS activist, playwright Larry Kramer, once called Fauci a murderer.)

Fauci’s response to activist criticism was to build relationships and use them as a tool to push for more government funding. Fauci’s activist allies seemed to understand the game, staging attacks on Fauci, both playing their part to gain more money for HIV research.

By contrast, his treatment of scientific critics is harsh, crossing lines that federal science bureaucrats should not cross. In 1991, when University of California, Berkeley, professor and wunderkind cancer biologist Peter Duesberg put forward a (false) hypothesis that the virus, HIV, is not the cause of AIDS, Fauci did everything in his power to destroy him. In his memoir, Fauci writes about debating Duesberg, writing papers, and giving talks to counter his ideas. But Fauci did more, isolating Duesberg, destroying his reputation in the press, and making him a pariah in the scientific community. Though Fauci was right and Duesberg wrong about the scientific question, the scientific community learned it was dangerous to cross Fauci.

Fauci’s HIV record is mixed. The great news is that, because of tremendous advances in treatment, a diagnosis of HIV is no longer the death sentence it was in the 1980s or 1990s. Fauci claims credit in his memoir, pointing out that the NIAID developed a clinical trial network that made it easier for researchers at pharmaceutical companies to conduct randomized studies of the effectiveness of HIV medications. But any competent National Institutes of Health (NIH) director would have directed NIAID resources this way. Furthermore, many in the HIV community have criticized Fauci for not using this network to test treatment ideas developed within the community—especially off-patent medications. Fauci is more reasonable when he takes credit for the 2003 creation of the President’s Emergency Plan for AIDS Relief program (PEPFAR), through which the U.S. sent effective HIV medications to several African nations.

Despite billions of dollars spent on the task, no one to date has produced an effective HIV vaccine or a definitive cure, and the virus remains a threat to the health and well-being of the world population. By Fauci’s own high standard, there is still a long way to go.

In the early days of the war on terror, Fauci became head of civilian biodefense, with the mandate to develop and stockpile countermeasures to biowarfare agents. This appointment made Fauci one of the most well-paid and powerful figures in the U.S. government. Fauci leveraged his deep knowledge of the federal bureaucracy, streamlining federal contracting rules to issue “sole source contracts” and “rapid research grants” to create constituencies of companies and scientists who depended on Fauci for their success.

In 2005, avian flu emerged and spread among birds, chickens, and livestock. Also spreading were worries that the virus could evolve to become more transmissible among human beings.