Anthony Fauci will step down as director of the National Institute of Allergy and Infectious Diseases (NIAID) this month, leaving behind a government career that spans 54 years, 38 in his current role.
Only a few years ago, his biography would have been dominated by his prominent role in addressing the HIV epidemic. Then came a novel virus that challenged the world like none other in our lifetimes. As director of NIAID and later as chief medical adviser to US President Joe Biden, Fauci became the American public’s leading guide to combating (and now cohabitating with) Covid-19 — a role complicated by extreme partisanship, the outsized influence of social media, and our ever-shifting understanding of a virus that keeps evolving.
As he prepares to depart NIAID, I talked with Fauci about the scientific challenges left on the table, trying to craft public health messaging amid rampant disinformation and the US’s preparedness for the next pandemic. This transcript has been lightly edited for clarity.
Lisa Jarvis (LJ): You’ve taken on a long list of infectious diseases during your career. What are the outstanding scientific questions you still hope to see answered in your lifetime — or, conversely, challenges you’ve come to believe might be too far out of reach?
Anthony Fauci (AF): There aren’t many that are too far out of reach. Because if you take that attitude, you’ll never accomplish some difficult, challenging things. We thought so many things were out of reach that we found out they were within reach.
The most recent example is that we developed safe and highly effective vaccines within 11 months of recognising a brand-new virus. That is entirely unprecedented. A few years ago, something like that would have taken an average of seven to 10 years to accomplish. So you want to assume that anything is possible.
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Some unfinished business that I would like to see [resolved] is getting a safe and effective vaccine for HIV. Even though we’ve done spectacularly well with developing drugs that have transformed the lives of persons with HIV, both from a treatment standpoint and a pre-exposure prophylaxis standpoint, there is that one challenge that we still haven’t met: A safe and effective vaccine. And it’s very difficult because of the nature of HIV, which makes it very different from any other virus that we’ve confronted.
The other challenge is if you look at the real killers in infectious diseases, such as malaria and tuberculosis, again, we still don’t have a highly effective vaccine that can prevent the hundreds of thousands of deaths of malaria each year, particularly among stricken babies.
So there are a lot of things that we can do that we haven’t accomplished yet. But the research being conducted looks quite promising in every one of those areas.
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LJ: Covid-19 felt like the first time that the general public was paying such close attention to the minutiae of the scientific process. Did the advent of preprints and open discussion and debate on social media change your approach to communicating with the public?
AF: It is a very complicated and complex issue. Unfortunately, although social media can be a very positive vehicle for the dissemination of important, factually-based information, the fact is it can also be the source of the dissemination of disinformation and misinformation. And we’ve seen a lot of the latter, where you have wild theories — be it conspiracy theories or outright untruths, [or] distortions of facts — that have made communication regarding Covid-19 very difficult.
LJ: If you could change anything about how you convey health information and messaging during the pandemic, what would it be?
AF: Well, it would be something that I might not have any control over. Getting the public to appreciate that when you’re dealing with a moving target like the evolution of an outbreak, you don’t have all the information you need to make appropriate decisions, recommendations or guidelines. The public, understandably, often doesn’t appreciate the dynamic nature of an outbreak and the fact that you get certain data and evidence at a particular time and make a decision guided by that data at the time. And then, a month or two later, the data changes. And things change because you learn a lot more about the virus.
There are so many examples. Initially, we were not fully appreciative of how quickly the virus spreads from person to person. We were not fully appreciative of the fact that it spread by aerosol. And it’s much more than just staying away from somebody who’s sneezing and coughing because somebody can just breathe next to you and transmit the virus. We were only partially appreciative that 50 to 60% of all transmissions come from someone with no symptoms.
We didn’t know all that in the first month or two or three of Covid-19. When we finally found out, we changed many of our approaches towards the outbreak and many of our recommendations. The general public would interpret that as flip-flopping when it isn’t flip-flopping. It’s modifying your understanding of the outbreak depending on the most recent accurate data. That’s a very difficult thing to have the public understand. That’s been a big source of confusion and even a big source of the mistrust we see in science.
LJ: Do you worry that the value of expertise and experience is being undermined in our hyper-partisan era?
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AF: Yes — oh, it is, of course. When you have social media that’s unchecked and unedited, anybody could pronounce themselves as an expert. And how will the public know whether that person is an expert? That’s a big danger. We have a lot of self-professed experts on things that can be confusing to the general public.
LJ: The statistics on deaths based on vaccination status are a stark reminder of the cost of the polarisation around Covid-19. What does that polarisation mean for the overall health of the American public? And are there areas of public health where you worry we might lose ground?
AF: The push back on Covid-19 vaccines [could] lead to hesitation in people getting vaccines that they have accepted for decades and decades. That would be a disaster.
LJ: Do you feel like we’re coming out of the past three years prepared to address another pathogenic threat?
AF: That’s up to us. There are lessons to be learned. If we heed those lessons, we’ll be much better prepared. If we don’t heed those lessons, we may not be as well prepared as we could be. One of the resounding success stories of this pandemic has been the investment in basic and clinical research, which led to the unprecedented accomplishment of getting a safe and highly effective vaccine available in less than one year from the time the virus was recognised. So that’s a good lesson that we’ve learned to continue to invest in basic and clinical research.
The negative lesson [is] that our public health infrastructure was ill-prepared at the local level to meet the requirements of a good response to an outbreak. So we’ve got to make sure we re-establish the strength of the local public health system and can get meaningful data in real time, not with a delay of weeks to months. But that has a lot to do with the fragmentation of our healthcare delivery system.
LJ: If you were making a list of the biggest priorities for future pandemic preparation, what would be on it?
AF: Well, it’s mostly strengthening the public health infrastructure, which takes many forms. You’ve already heard that the CDC (Centers for Disease Control and Prevention, the national public health agency of the US) is trying to reinvent itself, which they do need to make a more flexible organisation to get data out in real time. But a lot of that is not their fault. The system doesn’t allow them to accumulate the data in real time. But that’s one of the things that need to be improved upon.
LJ: When we last talked, it was about the value of pursuing universal Covid-19 vaccines. Are we running out of time for better vaccines to become a reality?
AF: I don’t think we’ve run out of time. When you’re doing research and public health, you’ve got to keep pushing the envelope and pushing the envelope. One of the important tenets of research, discovery, and implementation is that you can’t get discouraged by failures.
LJ: What’s next for you? Are there scientific problems you hope to still have a hand in?
AF: I’ll be indirectly involved, mainly in an advisory capacity. But I don’t see myself continuing to do my own research programme. I think I can accomplish a lot more in a broader 40,000-foot advisory capacity to get people to benefit from my decades of experience, both as a scientist as well as the director of the Institute for almost 40 years. That’s where I have the most to contribute to society.
LJ: What does waking up on day one after being at NIAID for 54 years feel like?
AF: I don’t know. We’re going to see, aren’t we? — Bloomberg Opinion
