Dr. Anthony Fauci, chief medical advisor to U.S. President Joe Biden, has been the director of the National Institute of Allergy and Infectious Diseases (NIAID) since 1984. As a member of the White House’s coronavirus task force during the Trump administration, he had to compete with misinformation regarding the virus, including from former President Donald Trump. Fauci has been a key player in the response to multiple pandemics and epidemics, including HIV/AIDS, Ebola, Zika, and MERS. In 2008, then-President George W. Bush awarded him the Presidential Medal of Freedom for his work on the President’s Emergency Plan for AIDS Relief (PEPFAR), a program focused on supporting government responses to the HIV/AIDS crisis around the world.
Fauci spoke to the Nieman Foundation via Zoom in June about communicating with the public about science, the HIV/AIDS crisis, the Covid-19 pandemic, his relationship with the Trump administration, and more. Edited excerpts:
On comparisons between HIV/AIDS and the coronavirus pandemic
Early on in the outbreak with HIV, there was a degree of stigma associated with people who were afflicted with this disease. We didn’t understand the scope of it. It was an evolving situation. We didn’t know what it was. We didn’t know where it came from. We didn’t know what the ultimate impact would be. Any type of an approach, any type of discussion, any type of recommendation, any type of guidelines had to evolve with the evolving knowledge.
The similarity is, now the same thing has occurred. We did not know much about the capability of this virus [SARS-CoV-2] and how effective and efficient it would be in going from person to person.
At first, we thought from the Chinese that it jumped species, from an animal to a human but didn’t have adaptability to go easily from human to human. Then we found out that it did this capability. Then we found out an astounding fact that, uniquely among viruses, a substantial proportion of people transmitting the virus were without symptoms. That was unprecedented in respiratory illnesses.
We had to keep learning and evolving with it. That’s the way science goes. Science is self‑corrective. One of the things we’re facing now is that this is being interpreted as flip‑flopping or misleading of people, which to me is astounding, regarding things like wearing a mask and regarding things like social distancing, etc.
The similarity to HIV/AIDS is that things evolved, and the knowledge and the data evolved. The difference is that one [Covid-19] was met with incredible amounts of conflict and divisiveness, whereas with HIV — since it was restricted, at least demographically, at first — to a relatively restricted population, it didn’t have that countrywide, global-type impact until later on.
On science communication and science journalists
I think classic journalism has not changed. I have always said, and I’ve been on the record going back to the days of HIV, that I think, in general, classic journalism does a really good job. They are an essential part not only of getting correct information to people, but of also making sure that things are transparent in whatever people do.
But what we’re dealing with now is a mix-up of what is social media and social interaction on the internet and on Facebook and in tweets and things. Some people confuse that with media. That’s not media. That’s people communicating in a way often with no data, nobody quality controlling it. The situation is different. I don’t think the classical media that I know of, that I’ve seen over the decades that I’ve been doing this, has changed much.
On his public profile
The celebrity part is something that, despite the opinion of my detractors, I do not embrace. I am fundamentally a scientist, a physician, and a global health individual.
Anyone who knows me and has seen me and what I’ve done over the decades and decades knows that. I try not to make that a distraction. I can say, ‘Fine, great, you want to do all the celebrity stuff. That’s fine,’ but that’s not me.’ Even though people — who are clearly trying to discredit me — say that that’s me, that’s not me. And anybody who knows me knows it’s not.
Sometimes you could use your ‘popularity’ to get a positive message [out] to help the health of the nation and the world. If I utilize that notoriety in any way, it’s always for the positive benefit of the domestic and the global health.
However, that also has been accompanied by an extraordinary amount of attacking, of distortion, of making me a villain. Obviously, that’s not a pleasant thing. That is a major painful distraction because I still have the responsibility of doing what I do, which people who don’t know what’s going on seem to forget. The same institute that they’re throwing slings and arrows at with me as the director is the institute that did the fundamental work that led to the vaccine that is currently saving millions of lives.
On research partnerships with Chinese scientists
We knew — and know — that SARS‑CoV‑1 without a doubt originated in the Guangdong Province of China, jumped species from a bat to a civet cat to a human. MERS, again, was a bat to a camel to a human.
As part of our obligation to study things that would make sure we can be better prepared for them in the future, it was critical to study the bat‑human interface and to determine and study what potential these viruses have for infecting humans. You need to study the bat‑human interface in the setting where it occurs — that’s China.
For those who say, ‘Oh, my goodness, how could you be giving any amount of money out of a grant to China to study?’ — because that’s where the human‑animal interface that’s relevant is. I often say, somewhat tongue-in-cheek, you don’t want to study bats in Fairfax, Virginia, or in Suffolk County, New York. You want to study it where it happens.
We have decades of interaction with Chinese scientists who have been very, very helpful in our understanding influenza and other emerging infections. I’m not talking about the Chinese government. I’m not talking about the Chinese Communist Party. I’m talking about Chinese scientists who have interacted with us, some of whom [were] trained in England, in Oxford, and in the United States. That’s who we’re talking about.
If we had not said we need to study this human‑animal interface, [it] could have been said by some that we were relinquishing our responsibility as health officials. All of that gets distorted in these conspiracy things going on.
Having said that, we cannot account for everything that goes on in Chinese labs. We can only account for what we, in a small way, had a grant [to study], and what the conditions of the grant were. The conditions of the grant had nothing to do with what is currently Covid‑19. In fact, if you look at the viruses that were used in those studies, you could not make them look like Covid‑19 because they’re not.
I am being attacked by some saying, ‘You flip‑flopped! You misled the American people about masks!’ Let’s unpack that.
Back then, there were three things. One, we felt that there was a shortage of masks and, even in the White House Situation Room, it was said, ‘Don’t get people to go out and buy a lot of masks because then you won’t have enough masks for the people who are taking care of patients who need it.’
Number two, we did not have any data that masks outside of the hospital setting were effective in preventing acquisition of infection. All of the data on masks were in the hospital setting.
Number three, we did not know an important fact, that a substantial proportion, in fact at least half of the infections that are transmitted, are transmitted by people with no [symptoms].
What changed? A, it became clear that there was really no shortage of masks at all and cloth masks work. B, meta-analysis showed that, in fact, what we did not know before were that masks were quite effective outside of the hospital setting in preventing transmission and acquisition.
Three, we learned, to our horror, that a substantial proportion of the transmissions occurred from people without symptoms. As soon as that became clear, we said we’d better start wearing masks, and we recommended masks as part of the public health measures.
Even though I keep getting attacked for saying early on we didn’t need to use masks, simultaneously with my saying that, the entire CDC was saying it, as was the Surgeon General of the United States. The people that want to discredit me will say, ‘You were saying it back then.’ So was every other scientific organization. That’s the point.
What would I have done different? Obviously, if I knew then what I know now, I would have said, ‘Wear a mask’. But we didn’t know it.
You’ve got to evolve with the science. Science is a self‑correcting process. If you stick with what you knew at one point and don’t evolve with the data and the evidence, then you’re doing something wrong.
On lessons learned from the Covid-19 pandemic
One of the things that we in the United States have seen is what happens when you let the local public health infrastructure experience attrition, that is, when people leave or retire they don’t get replaced in those slots. Often people, because of this stress, leave. And again, you don’t get replaced. Some departments even cut down — proactively — the size. We saw that in the beginning when we tried to do identification, isolation, and contact tracing.
For a number of reasons, that was not particularly successful, but I think there were inadequacies in the local public health system — not that people were inadequate; there weren’t enough of them — there wasn’t a powerful enough force. When we look ahead at lessons learned, there are going to be a lot of lessons learned from this.
One of them is to please take care of the local public health infrastructure in addition to the international public health security agenda, the communication, the transparency, and all that. But don’t forget about the local public health structure.
On the PEPFAR program
The PEPFAR [President’s Emergency Plan for AIDS Relief] program has been most extraordinary and has saved literally many millions of lives. We felt as a rich nation, and certainly then-President George W. Bush felt that way, that we have a moral obligation to not have people in countries that don’t have our resources die unnecessarily because of where they live, of a disease for which we have successful and adequate countermeasures.
I feel the same way about Covid‑19 vaccines. I believe that one way or the other the rich countries of the world really must address the situation that a global pandemic requires a global response. Whatever that takes. If that takes the investment of billions and billions of dollars to rev up production, to make doses available to people in the developing world, then so be it.
I believe it’s important not only because it’s the right thing to do from the standpoint of moral responsibility, but also I think there’s an element of self-interest. Because if you don’t control the pandemic globally, then you will always have the risk of variants coming in and even negating some of the advances that you make in the developed countries.
On whether he considered resigning during the Trump administration
I never seriously thought about resigning. Even though there are some people, Trump people, who feel that I was deliberately trying to undermine the president, that’s just absolutely not the case. I had nothing against the president. I have a great deal of respect for the office of the presidency, and I merely needed to tell the truth as a scientist.
When something was said that I felt was really not true or accurate, in order to maintain my own personal integrity — but, as important, in order to fulfill my role as a public health official whose responsibility is the health of the American public and by extension of the entire world — I had to, in some respects, be at odds with the president and what he said.
I was not personally against him, but [against] some of the things that he said and some of the people around him. The reason I did not consider resigning: I felt that there would be a vacuum if I did. The vacuum would be of someone who would stand up and say, ‘No, wait a minute, we can’t say that. That would be misleading.’ I was afraid that if I left there would be a bit of a vacuum. I felt that the disadvantage of having to hang around a somewhat hostile atmosphere, to me, that the positive aspect of being able to do some good in that position overrode any kind of instinct of saying, ‘I’ve had enough of this. I want to quit.’
On examining the “lab leak” theory
There’s a possibility that that happened. When you say lab leak, people get maybe a little bit confused. There are some people who say, ‘Well, it was manufactured in the lab.’ You look at people who know how to look at viruses, there’s nothing in that virus that looks like it was manufactured in the lab.
Some people are saying, ‘Well, maybe you were able to have someone who was infected, and you’re studying it, and it leaked out of the lab.’ There’s no way we can prove or disprove that unless there’s information that comes from an examination in the lab. What we as scientists say, and most of the scientists who know a fair amount about virology will say, you must keep an open mind.
The fact that people say, ‘Ah, you’ve changed your mind about the possibility of a lab leak,’ that’s not the case. When you go way back from the very beginning, there was always a discussion. Could this be a lab leak or not?
The overwhelming majority of virologists who looked at it and examined it said, it is their opinion that the most likely reason for this was a natural occurrence and a jumping of species. But, and there’s a big but, if someone was to ask you, ‘Are you absolutely certain of that?’ the answer would have to be no.
You always need to leave open the possibility that there’s another origin. That’s the thing that’s getting very confused and distorted now, when people start talking about who knew what, when, and what they were saying. There was always the realization that something could have happened, but what is the likelihood when you look at the history of how these types of viruses evolve?
On vaccine effectiveness
There are some recent papers looking at people who have been infected [after vaccination], what we call breakthrough infections. In fact, there was a recent CDC report that showed that if you are vaccinated, the chance of your getting infected in an asymptomatic way is much less than if you are not vaccinated.
Also, if you get a breakthrough infection and you’re without symptoms, the level of virus in your nasopharynx, in your body, is [multiples] less than if you’re unvaccinated, get infected, and have no symptoms. That’s an important question.
We’re trying to find out if you’re vaccinated and you get infected with a breakthrough infection, and you have no symptoms at all, what is the likelihood of your transmitting it to someone else? The lower the level of virus in your nasopharynx, the less likelihood you’re going to have of transmitting it to someone else. That’s the thing that the CDC is very carefully looking at right now.