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Anthony Fauci,
The Symbol and The Scientist

 

Author: Madeline Roberts, PhD, MPH

Anthony Fauci’s face has become something of a post-pandemic Rorschach test, an image offering insight into the observer's pandemic experience, views on science, and political leanings. Fauci recognizes his position as a "political lightning rod," writing, "Beyond my control, I became a symbol of the profound divisiveness in our country."

Fauci’s memoir, On Call: A Doctor’s Journey in Public Service, reads like a medical time travelogue from the 1970s to the present day, guided by a poised physician-scientist navigating the major disease landmarks that have shaped the past several decades. During his nearly six-decade tenure as a public health official, he has been in the service of seven U.S. presidents and at the helm of disease response for AIDS, bioterrorism threats, anthrax, SARS, MERS, Ebola, and Zika. And, of course, COVID.

To read On Call is to look over Fauci’s shoulder as he reads a June 1981 MMWR article about a cluster of unusual pneumonia in Los Angeles, one of the first U.S. indicators of what would come to be known as AIDS. As additional clusters of Pneumocystis pneumonia and Kaposi's sarcoma are reported in New York and San Francisco, Fauci breaks with his successful immune-mediated disease research to dedicate himself to studying this novel disease. Before much was known about AIDS treatment, the book gives a point-blank look at the devastating progression of the disease and the humanity of a physician in its wake when Fauci steps out of sight and “bursts into tears” upon realizing that one of his AIDS patients has gone completely blind in a matter of hours from cytomegalovirus. There was nothing he could do.

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There is something to be said for engaging rather than avoiding even the most combative opponents, and Fauci developed a reputation for not only engaging with AIDS activists but also involving them in the scientific agenda. He ignored conventional wisdom and advice from colleagues to avoid Larry Kramer, an activist with a volatile reputation. Fauci believed it was critical to interact with activists, which he credits with improving the design of some clinical trials. Fauci’s approach led to a Parallel Track initiative, an “optimal design of clinical trials that were user-friendly and still yielded valuable scientific results.”

The parallels between HIV/AIDS and COVID-19 are as uncanny as they are potentially instructive, perhaps especially for those who did not live through the beginning of the AIDS epidemic, when it was truly novel and people were dying, while nearly nothing was known about the virus or treatments. There were pathological similarities such as asymptomatic infection and spread, and also scientific communication challenges and personal opposition. The problem of false equivalency, for example, which can arise from the otherwise advisable practice of engaging in debates with opponents or directly addressing erroneous theories; AIDS activists storming the NIH campus, some carrying “fake caskets bearing the words ‘Fuck you, Fauci’”; some writing articles calling Fauci a murderer. Maybe this is just our democratic process as it relates to epidemics. Except the proliferation of credible death threats against scientists during and after COVID have now altered the tone.

Though in the public eye, Fauci's face may be essentially equated with the COVID-19 pandemic, it comprises a relative fraction of his public health career and only one of five sections of his memoir. The book’s title stems from Fauci’s description of being on call during medical residency—the grueling pattern of every other day, every other night, and every other weekend with nearly no sleep, which was at times compounded if a fellow resident fell ill: “the solution was that you just continued to be on call without relief.” This came to characterize substantial portions of his career and is at least part of what it means to be in public service or medicine.

Public health is inherently political, and perhaps nowhere is this more evident than Fauci’s career. He had one foot in the sphere of science and one in political advisory and advocacy for most of his tenure, advancing basic and clinical research while pushing for more funding at the highest levels.

Fauci self-identifies as a “cautious optimist by nature.” A man of great precision—graded to the tenth of a percentage point by Dominican nuns in primary school—the influence of his Jesuit education is evident throughout his life, best captured by the phrases “precision of thought and economy of expression,” and “Men for Others.” His parents were first-generation Italian Americans who both in word and by example instilled in him diligence and devotion to serving others.

Fauci is troubled by what he calls a “crisis of truth” in American culture. He writes, “We have seen complete fabrications become some people’s accepted reality.” This erosion of truth has been happening for some time but perhaps became more conspicuous several years ago with the admission of the phrase “alternative facts” into the general lexicon. Steven Johnson writes in his book The Ghost Map on the 1854 London cholera epidemic, “Of course, for meaningful lessons to be learned from a tragedy…you have to begin by acknowledging the facts of the event itself.” Of all the plagues Fauci faced, misinformation and disinformation are among the most formidable—he calls these the “true enemies of public health.” As an antidote, Fauci now seeks out the younger generation in hopes of encouraging them to pursue a life serving others. This, he says, was his chief purpose in writing his book.    

 

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