Yesterday, I wrote at length about the life and times of reporter and author Randy Shilts during the earliest days of the AIDS epidemic. I was thinking about Randy because it was back then that Americans first learned to appreciate the calming bedside manner of a heretofore unknown clinical immunologist who'd labored with distinction in the field of infectious diseases. His name was Anthony S. Fauci.
Dr. Fauci is back in the news, of course, standing (at least for now) at White House briefings beside the president and vice president, along with the leading health officials in the administration and the federal bureaucracy as they battle the latest contagion sweeping the world.
Although his visibility is unprecedented -- he's all over the airwaves -- the role is nothing new for Fauci. Donald Trump is the sixth U.S. president he has served and although this particular strain of virus that sped out of China to every corner of the globe is new, the fight a familiar one for Tony Fauci.
Pick any March 24 almost at random and he was there on the front lines. Last year on this date, Fauci's byline appeared in STAT, a respected online publication devoted to science, health, and medicine. In the article, co-written with NIH microbiologist Robert W. Eisinger, the authors outlined the roadmap for ridding the world of tuberculosis.
Fifteen years ago, on March 24, Fauci delivered the keynote lecture at the 78th annual meeting of the American Epidemiology Society, held at Johns Hopkins University. One slide he showed to his fellow researchers that day was familiar to various appropriating committees on Capitol Hill. It was a map of the world in which Fauci had superimposed a growing array of infectious diseases over their locations.
"Every year, I add one or two more -- sometimes three," he said that day. "It's gotten to the point where I need to remove a few just to read the slide."
The problem, as those in his audience knew, was (and remains) three-fold. First, the viruses, bacteria, and parasites that cause infectious diseases in humans mutate as fast as scientists develop vaccines and treatments against them. Second, three-fourths of emerging pathogens originate in animals and jump species into humans. This was true of AIDS, avian flu, and SARS. It's true of COVID-19. Third, people don't always observe the hygienic habits known to slow the spread of such diseases. Fauci described the battle lines by quoting Nobel Laureate Joshua Lederberg: "The future of humanity and microbes likely will unfold as episodes of a suspense thriller that could be titled ‘Our Wits Versus Their Genes.'"
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In "And the Band Played On," Randy Shilts highlighted one of the few missteps in Anthony Fauci's distinguished career. It came on May 6, 1983, when Fauci, then AIDS coordinator at the National Institute of Allergy and Infectious Diseases, wrote an article in the Journal of American Medicine based on the faulty research of a New Jersey physician studying AIDS in children.
"If routine close contact can spread the disease, AIDS takes on an entirely new dimension," Fauci warned. This was true, but it was a big "if," and it was wrong. HIV is pass along via semen and blood, not the kind of casual contact through which COVID-19 can spread. But to me the more interesting aspect of this story is how Fauci reacted. Although he noted that journalists with non-scientific backgrounds had ignored his caveat, Fauci never lashed out at anyone. Not the doctor whose research was in error, not Randy Shilts, and not his critics in the AIDS activist movement.
Actually, Fauci's tendency was to win his critics over. Partly this was because, as Shilts noted in his landmark 1987 book, he was an early voice within the government calling for more AIDS research funding. It was also because he was still a practicing physician, one who made heroic efforts to save individual AIDS patients. Shilts had little use for prominent medical researchers who no longer did the actual research themselves, let alone see patients. But Fauci wasn't that kind of doctor.
"Although the federal government's leading AIDS celebrity, Dr. Anthony Fauci of the National Institutes of Health, actually goes into his immunology lab in Bethesda to work with test tubes, a lot of the people you see quoted on TV as major laboratory researchers don't," Shilts wrote. "They have assistants don white coats and do all that tedious work, even though they're the ones Dan Rather chats with once the results are in."
The other thing about this guy was his demeanor. Tony Fauci always managed to be simultaneously clinically precise and exceedingly empathetic. He could be bluntly honest without alienating his audiences -- audiences that ranged from those chairing important congressional committees and incumbent U.S. presidents to angry AIDS activists dismissed by many because of their street-theater antics. Tony Fauci never dismissed anyone. He actually became friends with the latter, such as uncompromising ACT-UP founder Larry Kramer, who in the early days of the AIDS crisis fiercely criticized him publicly. But Fauci never retaliated or responded in kind. He sought Kramer's advice and ultimately befriended him, taking Kramer and other ACT-UP volunteers to Italian restaurants when they were in Washington.
Many years ago, Kramer described one interaction with Fauci to the New York Times. "I was on a C-SPAN program … with Tony, and I attacked him for the entire hour," Kramer recalled. "He called me up afterwards and said he thought the program went very well. I said, ‘How can you say that? I did nothing but yell at you.' He said, ‘You don't realize that you can say things I can't. It doesn't mean I don't agree with you.'"
Today, Dr. Fauci is in close quarters with a man whose temperament isn't any more compromising than Larry Kramer's, the big difference being that Donald Trump can remove him from his job.
"When you go to the White House, always say, in the back of your mind, that this may be the last time I'm going there because I might have to tell this president something he doesn't like," Fauci told the Washington Post recently. "Depending upon the character of the president, if you give bad news, they may say, ‘I don't want this guy around anymore -- he's causing trouble.' So the first thing I decided was I would only speak the truth, based on the evidence I had and my purely clinical scientific judgment."
Fauci wasn't referring solely to Trump. Over the years, he's reported to Ronald Reagan, George H.W. Bush, Bill Clinton, George W. Bush, and Barack Obama. His approach has worked so far. In a 1992 debate between Clinton and the first President Bush, the candidates were asked to name a hero of theirs. Bush mentioned Fauci, saying, "He seems to be a man for all seasons."
This is an especially trying season in American history, however, and the current president is already displaying signs of impatience that the best medical advice is crashing the economy. Will Fauci be a casualty of that exasperation? In their recent profile of Fauci, Washington Post reporters Ellen McCarthy and Ben Terris wrote of Fauci's "political superpower," which they described as an ability to turn everyone he meets into a Fauci convert. The unspoken question it raises is how long it will work on the 45th U.S. president. I don't know the answer, but I would say this. After watching him off and on for 37 years, I think Tony Fauci's political superpower is not his primarily his charm, it's his self-confidence.
This confidence doesn't come from ego, it comes from the data and a lifetime of scholarly success. And it comes from a temperament that insists on being heard, while acknowledging that other voices must be heard as well. It's a lesson that goes beyond science, and beyond politics.